How to Identify PCOS Belly: Signs & Causes You Must Know

Learn to identify - and shrink - a PCOS belly.

This article was medically reviewed by Mónica Faut, Ph.D., Fertility Specialist & Medical Writer

Most women with PCOS carry extra belly fat, and it’s an alarm signal that the body’s hormones are off balance. 

Often overlooked, the classic PCOS belly shape is a surprisingly PCOS common symptom. 

According to the 2020 Current Opinion in Endocrine and Metabolic Research, abdominal weight gain frequently appears alongside irregular periods and excess body hair as key signs of polycystic ovary syndrome. 

The good news is you can slim down your midsection while improving your hormonal health.‍ 

Identifying  typical PCOS belly

I’ve had extra weight around my midsection for years, and I know firsthand how frustrating it can be. A real PCOS belly won’t respond to conventional ab workouts. And even if you lose weight, stubborn stomach fat could last longer if you don’t address the underlying hormonal imbalance. For many of us, these proportions cause massive distress and frustration.

When people speak about the classic PCOS belly shape, they mean storing excess fat around the midsection instead of the hips, butt, or thighs. 

But, of course, extra belly weight isn’t connected solely with PCOS. 

Your doctor will calculate your waist-to-hip ratio to determine whether your belly fat is linked to PCOS. A waist-to-hip ratio above 0.85 indicates central obesity. Excess belly fat linked to PCOS will also appear in conjunction with other symptoms. For example:

  1. Irregular periods: PCOS can cause irregular periods or even the absence of periods altogether.
  2. Excess hair growth: Hormonal imbalances can lead to excess hair growth on the face, chest, and stomach. This hair growth excess is called hirsutism.
  3. Acne: If you have PCOS, you may experience acne, especially on the face, chest, and back.

In reproductive medicine, central obesity is a defining feature of PCOS, where visceral, rather than subcutaneous, fat is the main characteristic of PCOS condition. You should know that visceral fat is a type of fat that wraps around our organs, specifically the liver and intestines. Too much of this fat poses serious health risks… But we’ll get into that detail later. 

You’ll also want to rule out bloating and gut issues. There’s an established link between PCOS and health conditions that cause bloating. Specifically, studies show a connection between PCOS and gut health problems, reports the Journal of the Endocrine Society. Increased androgens may contribute to an imbalance in the gut microbiota, write researchers. Moreover, another study demonstrated that PCOS is highly related to Irritable Bowel Syndrome, mainly the type where constipation is predominant.

‍‍Even lean women can develop a PCOS belly, writes Nadia Brito Pateguana in the PCOS Plan. Dr. Nadia Brito Pateguana, a naturopathic doctor who aims to help people with metabolic dysfunctions, explained their book “The PCOS Plan” that whenever weight gain, extra pounds went straight to the bally:

“An estimated 50 to 60 percent of women with PCOS have central obesity, regardless of their BMI. This fat distribution is often noticeable as an increased waist circumference, and it is also ‘masculinized body fat distribution, which is associated with lower conception rates and ovulatory frequency.” 

Potential causes of the PCOS belly shape

You can’t talk about any PCOS symptom without factoring in hormones. ‍So while it’s tricky to pinpoint the exact cause of the PCOS belly shape, it’s likely related to a hormonal imbalance.

Fundamentally, PCOS makes you more prone to weight gain. In a longitudinal study published in Human Reproduction, researchers showed that women with PCOS gained more weight each year and throughout the 19 years of study. However, the limitation of this study is the use self-reported survey from the participants 

Half of women with PCOS are overweight, a fertility specialist, Julie Tantibhedhyangkul, MD, cites:


“PCOS itself might make women gain weight more easily than others. And, the more weight they gain, the more additional symptoms they’ll have.”

PCOS makes your body resistant to insulin -the hormone that regulates glucose metabolism- and is one of the reasons we gain weight easily. Insulin resistance causes your pancreas to make more insulin, which promotes fat storage and increases hunger.

In addition to insulin problems, PCOS is also associated with high levels of androgens, which are male hormones, called hyperandrogenism. Elevated androgens can change your body shape. Fat distribution is different between men and women. While men tend to have more abdominal fat (visceral fat), women carry more fat in the thighs and butt (subcutaneous fat). However, this pattern of fat accumulation is altered in women with hyperandrogenism.

In “The PCOS Plan”, Brito Pateguana explains how this hormone imbalance contributes to the PCOS belly.

“Women without PCOS have more subcutaneous (under the skin) fat on their arms and legs than concentrated in the abdominal area. High testosterone, which is associated with hyperandrogenism, promotes central, or visceral, obesity, where the fat is distributed primarily around the abdominal organs.

Several clinical trials confirm higher abdominal fat is linked with hyperandrogenism.‍ A 2023 Fertility and Sterility journal published a report that showed the use of an anti-androgen called flutamide reduces abdominal fat deposition and normal-weight women with PCOS.

Women with PCOS also have higher levels of cortisol, which contributes to metabolic stress. Metabolic stress can lead to the development of several PCOS symptoms, such as weight gain and abdominal fat accumulation.

That’s to say, changing your PCOS belly firstly means balancing your hormones. 

Treating a PCOS belly: 3 researched backed strategies

Managing insulin levels and stress can help reduce the risk of developing this type of belly fat. I lost 13 kilograms, a lot of that belly fat, through diet, exercise, and hormone balance supplements. I wish I could say it was easy. Even though I was steadily dropping the weight, my daily progress felt minimal. Documenting my weight each day helped. It was concrete evidence that the number on the scale was going the right way even if it didn’t feel like it.

‍We all know any body shape that deviates from the idealized - unrealistic -  female form is enough to cause distress. Superficial concerns aside, a PCOS belly is a health risk. Carrying too much weight opens you up to serious health problems.

A ‍2020 paper published in the Human Reproduction Open, evaluated the health implications of extra belly weight in women with milder forms of PCOS. Beyond the small sample, researchers found a significant connection between abdominal fat and type 2 diabetes. 

Here are some tips to help you lose a PCOS stomach.

1. Maintain a healthy diet

Eating a balanced diet that is low in carbohydrates and high in protein, fiber, and healthy fats can help you lose weight and reduce insulin resistance. You'll also need to cut out sugary and processed foods.

Study after study shows dietary changes have a major effect on abdominal fat. A 2019 study found the Mediterranean Diet improved PCOS symptoms. Researchers suggest the diet reduces insulin resistance, excess androgens, and inflammation.  Another study published in the Metabolism journal suggests a low-carb diet -maintaining the calorie intake- is linked with a reduction in belly fat. 

Sticking to a new eating pattern is hard. But making smaller swaps helps make the change feel more manageable. For example, replace potatoes with sweet potatoes. ‍Substitute rice with cauliflower rice in curries. Clearing out the pantry makes a huge difference, too. We only have water and cold-pressed juice in the house. This meant chucking out the Coca-Cola, formerly a staple in my fridge.

2. Start exercising

While diet is a great place to start, certain types of physical activity can also speed up your progress. 

CDC guidelines propose at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous-intensity aerobic exercise per week, plus strength-training exercises at least twice per week. These recommendations are backed by research, but I try to do what I can. Committing to 150 minutes of exercise each is daunting, especially if you haven’t been doing any exercise at all. It’s OK to start with a more moderate cadence  - whatever works for you.

Specific belly fat exercises for PCOS include workouts that balance hormones. Cardio, resistance training, and yoga have all been shown to lower belly fat.

3. Pay attention to possible PCOS bloating

I know firsthand managing PCOS bloating can be challenging, but some steps can relieve your discomfort.

In addition to diet and exercise, eating smaller, more frequent meals throughout the day and drinking plenty of water can also help prevent bloating. Supplementing with probiotics, magnesium, and ginger can provide relief from bloating symptoms.

Consult with a healthcare professional for personalised advice. I worked with my medical health practitioner to start a gut health program. During this process, I identified trigger foods and made changes to my diet as a result.

4. Use hormone balance supplements

Certain supplements have been studied for their ability to improve PCOS and reduce symptoms.

Although still requires more studies, Inositol has been shown to lower insulin resistance and androgen excess in PCOS women. Moreover, according to a 2019 research review, these types of drugs are well tolerated and safe, this means they get to the root of the hormone imbalance without any health risk. 

There is a link between PCOS and vitamin D deficiency. Researchers proved that low levels of vitamin D are associated with hyperandrogenism, considering this deficiency a new risk factor for PCOS development. The research team suggests vitamin D supplementation as a treatment to reduce this risk. I notice a huge positive shift in my mood when I’m taking vitamin D regularly. 

Get rid of your PCOS belly 

Left untreated, PCOS sends your hormones out of balance. This imbalance leads to a PCOS belly and other serious health issues. While these tips can improve your PCOS belly and your overall health, you’ll want to talk to your doctor about your concerns. Have them run a few tests to confirm a PCOS diagnosis before making any changes.

Remember that making any type of health-related change takes time and consistency. Be patient and stick with your healthy habits. With time and effort, you can lose a PCOS stomach and improve your overall health.