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PCOS and Obesity: Breaking the Cycle

In Conversation with Dr. Andrew Viljoen, The Weight Loss Clinic

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Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal conditions affecting women of reproductive age, estimated to impact between 5–10% worldwide. While we often speak about it in relation to irregular periods and infertility, PCOS is far more complex. It is deeply intertwined with metabolism, weight, and long-term health.

What is PCOS?

PCOS is a hormonal disorder where the ovaries produce excess androgens (‘male’ hormones that are normally present in small amounts in women). This hormonal imbalance disrupts ovulation, often causing irregular menstrual cycles, infertility, and symptoms such as acne, excessive hair growth, and hair thinning. On Pelvic ultrasound, many women with PCOS show multiple small follicles, though not every woman fits this pattern.

What Causes It?

The exact cause of PCOS is still not fully understood, but several factors play a role:

– Insulin resistance: Many women with PCOS struggle with insulin resistance, meaning their bodies produce more insulin to keep blood sugar under control. This high insulin level drives the ovaries to produce more androgens, which worsens symptoms. These high levels of insulin also cause more fat storage and limit the bodies natural mechanism to break down fat.

– Genetics: PCOS often runs in families, suggesting a strong hereditary component.

– Hormonal imbalance: Excess androgens and disrupted signals between the brain and ovaries both fuel the condition.

The Link to Obesity

Obesity and PCOS are closely connected in a vicious cycle. About 40–80% of women with PCOS are overweight or obese. Excess body fat—particularly around the abdomen—worsens insulin resistance, causing the body to make more insulin which in turn worsens hormonal imbalance. The result? More irregular cycles, more androgen-related symptoms, and higher risks of developing diabetes and heart disease.

At the same time, PCOS itself makes weight management more difficult. Hormonal changes can increase hunger, slow down metabolism, and make fat storage more efficient. This means women with PCOS often find themselves battling against biology when trying to lose weight. Think of your body functioning like someone who has type 2 Diabetes.

Fertility and PCOS

One of the most emotionally challenging aspects of PCOS is its impact on fertility. Because ovulation is irregular or absent, conceiving naturally can be difficult. Obesity compounds this challenge by further disrupting hormone levels and lowering the success rates of fertility treatments such as IVF.

However, there is hope. Even modest weight loss—just 5–10% of body weight—has been shown to restore ovulation in many women, improve chances of conception, and reduce pregnancy complications.

Managing PCOS and Obesity

Although PCOS cannot be “cured,” it can be effectively managed. The cornerstones of management include:

– Lifestyle changes: A balanced diet rich in whole foods and cutting out processed foods and sugars, regular exercise, and maintaining a healthy weight can significantly reduce symptoms.

– Medical treatments: Options include hormonal contraceptives to regulate cycles, medications like metformin to improve insulin sensitivity, and fertility treatments when needed. Assisted tools for weight loss like GLP1 injections, and weight loss procedures.

– Support and awareness: Because PCOS impacts both physical and emotional health, mental health support and community resources are vital.

Breaking the Cycle

PCOS and obesity feed into each other, but with the right strategies, the cycle can be broken. Early diagnosis, lifestyle management, and medical support not only improve fertility but also protect long-term health. For women navigating PCOS, knowledge and proactive care are powerful tools—turning a challenging diagnosis into a manageable journey.

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