PCOS Body Type: What Your Shape Says About Your Hormones

Learn the hormones that influence the PCOS body shape.

If you have polycystic ovary syndrome (PCOS), your body shape might signal a serious hormone imbalance.

Living with PCOS is often challenging; hormonal fluctuations can lead to unpleasant physical changes: acne, increased hair growth, and weight gain. Women with PCOS may also struggle with an "apple shape” - excess weight around the waist.

At times, it can feel like you have no control over your body. One of the most frustrating PCOS symptoms for me has been the effect on my body.  Truth is I’ve been critical, harsh, and unforgiving of my body’s flaws. I know I’m not alone here. Often when we look in the mirror, we zoom in on all the ways we don’t conform to society’s unrealistic beauty standards.

 Almost everyone experiences body insecurity at some point, but if you have PCOS you may be especially vulnerable. A review of the research published in the 2021 BMC Endocrine Disorders journal shows a “high prevalence” of “body image distress” among women with PCOS.

And while body positivity is absolutely important, having extra fat around the middle or regular acne flare-ups could signal a more serious problem.


Does PCOS affect body shape?


PCOS can affect how easily you gain weight and where you tend to build up fat. That’s because shifts in your hormone levels may contribute to weight gain, slow metabolism, and increased appetite. What this might look like is excess abdominal fat and a tendency to store fat in the upper body. This type of fat distribution can also lead to a “PCOS belly”.

Here’s a couple of hormones to note when we’re talking about the PCOS body shape: testosterone, insulin, and cortisol. 

Even women with lean PCOS can carry extra body fat. One older study, published in the Human Reproduction journal, found:

"Although matched for age, weight and BMI, lean PCOS patients showed a significantly higher amount of body fat and lower amount of lean body mass than the controls."

Insulin resistance, in particular, is at the heart of multiple PCOS symptoms. Insulin resistance occurs when your body doesn't react appropriately to insulin, resulting in elevated insulin levels, which may lead to an "apple-shaped" body.

What’s more, research suggests excess androgens, male hormones, can lead to women with PCOS carrying more weight around the midsection. If you have too many male hormones, you might also notice acne along the lower parts of your face and excess hair growth on your upper lip or chest. (Raise your hand if you’ve ever tweezed a nipple hair or two).

All that said, there’s no set body shape that’s exclusively associated with PCOS. Every woman's body is different, and the symptoms and effects of PCOS can vary widely from person to person. For example, there are different types of PCOS. 

What hormonal imbalances are linked to the PCOS body shape

Hormonal imbalances, including excess androgens, insulin resistance, estrogen dominance, and leptin resistance, can contribute to PCOS body shape. 

As Aviva Cohn, MD and assistant professor of medicine at Rutgers Robert Wood Johnson Medical School, tells Women’s Health Mag, hormones play a role in weight gain

“We have hormones that function to maintain all aspects of our health, including our appetite and satiety, general metabolism, reproduction, and more. When certain hormones are in excess or deficient, there can be effects which can lead to belly fat gain.” 

Below, we’ll look at the connection between hormones and PCOS body type.


Your thyroid hormones may be out of balance


If you have PCOS, your weight gain could be linked to a problem with your thyroid hormones.


Some research suggests women with PCOS may have a risk for thyroid disorders. One study, published in the 2020 Obesity Facts journal, revealed a connection between a thyroid hormone imbalance and increased abdominal fat storage.


Hypothyroidism, or an underactive thyroid, is when your thyroid doesn’t produce sufficient thyroid hormones. According to the National Institute of Diabetes and Digestive and Kidney Diseases, hypothyroidism is also linked with irregular menstrual cycles and fertility issues.


Have your health care professional run tests to check thyroid function if you’re concerned. I’ve had my thyroid checked twice. Both times involved blood tests, and in one case my doctor physically examined my thyroid.


You may be resistant to insulin 


Insulin resistance is common among women with PCOS and is tied to high blood sugar levels and weight gain.


Research published in the 2022 Reproductive Biology and Endocrinology journal finds:


“(PCOS) is linked with insulin resistance through preferential abdominal fat accumulation that is worsened by obesity.” 


There’s evidence that abdominal fat is a “driving factor” behind insulin resistance, Margaret Eckert-Norton, PhD, a registered nurse and certified diabetes educator, tells Everyday Health


Insulin resistance is at the heart of many PCOS symptoms  - elevated insulin can trigger the ovaries to make more androgens, stalling ovulation.


You may have too many male hormones


Excess male hormones, androgens, can influence the PCOS body type. 

Although men and women produce androgens, like testosterone, they’re typically considered male hormones. When women have high levels of these male dominant hormones, we have a condition known as hyperandrogenism.

Researchers call hyperandrogenism one of the “cardinal manifestations” of PCOS.  

These hormones affect the way men and women store their body fat. Men typically carry more fat around the middle, while women typically store more fat around the hips and thighs. Women with androgen excess tend to carry weight in the abdomen. 

If you’re experiencing acne, increased body hair, and extra abdominal fat, it’s worth flagging with your doctor.

You have elevated cortisol levels 


Research shows women with PCOS often have increased cortisol levels, and cortisol influences how our bodies store fat.

The stress hormone cortisol is associated with increased belly fat, according to this research review. Not only that, but cortisol increases sugar cravings and slows down your metabolism, reports Very Well Mind.

As Fiona McCulloch, a naturopathic doctor who has PCOS notes in the 8 Steps to Reverse PCOS:

“Over time, if a woman with PCOS ensures a great deal of stress, her adrenals will produce more cortisol than average, and this is a continuous strain on the adrenal glands themselves.” 

What’s more, cortisol has a knock-on effect on all of your hormones, throwing them all out of sync:

“Your hormones are less effective when cortisol levels are high. This is because high levels of cortisol cause abnormalities in the way that many of the sex hormones and thyroid hormones work in the body. Raised cortisol levels make the cells in your body less able to use estrogen, progesterone, and thyroid hormones…”

In sum, stress is a major culprit, creating chaos in the PCOS body.

You may be resistant to leptin

Weight gain in PCOS may be related to leptin resistance. 

The hormone leptin plays a role in regulating body weight and energy balance. It is produced primarily mainly by fat cells. Leptin is secreted in proportion to the amount of body fat: as levels of leptin rise, body fat stores increase. 

One 2022 study published in the Frontiers in Endocrinology journal links PCOS and leptin resistance. 

When you have leptin resistance, your brain doesn’t get the message to decrease hunger, leading to overeating, writes McCulloch.

“..women with PCOS, whether they are lean or carry extra weight, secrete more leptin than women without PCOS. All of that excessive leptin we have floating around in our bodies desensitizes our brain, totally overriding the body’s natural hunger mechanisms. To make it simple, when you are leptin resistant, your brain thinks you are starving and tells your body to store more fat.” 

High leptin levels are also related to ovulation problems. 

Weight loss tips for the PCOS body


You can manage PCOS weight loss through diet, supplements, exercise, and stress control.


During the COVID lockdown, I gained 13 kilograms and suffered frequent acne outbreaks. Using a combination of diet, exercise, and supplements, I dropped the weight and cleared up my acne. My periods were regular for the first time in my life. 


I consulted with a doctor before starting this weight loss programme, and she worked with me to find the best supplements to help me lose weight and balance my hormones.


Please know this: I’m not discounting the role of medication to deal with PCOS weight loss or any other symptoms. But my personal experience was that diet and other lifestyle changes provided relief from my worst PCOS symptoms and came with zero nasty side effects. In fact, one meta-analysis published in 2020 suggests lifestyle changes can be as effective for managing PCOS as medication.

Below, we'll review some of the best ways to manage weight loss.

Manage stress

Finding healthy ways to cope with stress can improve your weight loss efforts and overall quality of life.

As we’ve seen, increased stress stimulates cortisol production, leading to weight gain and other hormonal imbalances. In a perfect world, you'd stamp our stress permanently. And while you should definitely look for ways to reduce stress, you can also find healthy ways to handle life's stressors.

Luckily, managing stress through techniques such as meditation, yoga, and deep breathing can help to lower cortisol levels and promote weight loss.

During periods of stress, I’ve tried different coping strategies. For a long time, my first line of treatment was prescription medication. Here’s the thing: the pills provided short-term relief but I struggled to function without them - this is especially true for sleeping medication. I’ve lost count of the number of times in my life I’ve been completely dependent on sleeping pills.

COVID lockdown prompted me to find professional help to deal with stress. I started going to therapy regularly and prioritised self-care. Taking a warm Epsom salt bath, reading a book, and starting my day with a few minutes of mindfulness went a long way to help me manage stress.

Additionally, I practiced better sleep hygiene, supplemented with magnesium, and cut out coffee. Eventually, I fixed my sleep. 

Choose a balanced diet

Be mindful of what you put in your body. Eating a balanced diet rich in nutrient-dense foods is important for managing weight with PCOS.

Study after study backs this up. A meta-analysis published in 2022 in The Journal of Clinical Endocrinology & Metabolism found diet regulated insulin and increased weight loss among women with PCOS.

The best foods for PCOS are whole foods, lean protein, healthy fats, and complex carbohydrates. These foods can help to regulate blood sugar levels, reduce inflammation, and promote weight loss. Great diets for PCOS include the Mediterranean diet, anti-inflammatory diet, and insulin resistance diet.

Restricting simple carbs and fast foods made the biggest difference in my weight loss. I'll admit I don't always stick to healthy eating. But whenever I deviate, I feel it immediately. The energy slump after a hamburger and coke is just not worth it. 

Exercise regularly

Regular physical activity is essential for managing weight with PCOS. 

Through exercise, you can improve insulin sensitivity, increase metabolism, and promote weight loss. Aim for at least 30 minutes of moderate exercise, such as brisk walking or cycling, most days of the week.

Above all, the best exercise for PCOS is one you can stick with. Walking and regular yoga sessions work for me.


Medication and supplements  


Prescription medication and hormone balance supplements may help you lose weight.


One well-known PCOS medication is metformin. According to a systematic review published in the 2020 International Journal of Endocrinology, metformin lowered body mass index, waist circumference, and testosterone levels in overweight women with PCOS. One thing to note is researchers found no improvement in fasting insulin levels. 


You might also be prescribed birth control pills. I tried a number of different birth control pills, and I didn’t have a positive experience. They made me moody. Even worse? Every single one of my symptoms reappeared right as soon as I stopped using them. Your experience might be different.

Apart from medication,  there are many natural remedies available that can help you manage your symptoms. For example, supplementing with inositol can aid weight loss with polycystic ovary syndrome.

Listen to your body

Managing PCOS symptoms can be a challenging journey, but it's important to remember that you are not alone. With the right strategies and support, you can take control of your health.

Seek professional medical advice and share your specific concerns. Make the right lifestyle changes to maintain your health. Over time, you'll find you have more energy and self-confidence. You'll have faith in your ability to manage your symptoms.


 Featured image credit: Photo by SHVETS production