PCOS and weight loss at menopause

Polycystic ovary syndrome (PCOS) is a hormonal condition that affects metabolism, insulin sensitivity, weight and fertility (1,2). Similarly, as women enter the menopause transition, they also often experience shifts in weight and metabolism.

For many women with PCOS and/or going through the menopause transition, weight gain and difficulties managing weight can cause many frustrations. In this blog, you’ll explore the effects of PCOS and menopause on weight, and strategies to help with weight management.

Menopause and the affects on weight

What is menopause?

The menopause transition is a natural part of ageing, with menopause officially marking the end of menstrual cycles. It typically occurs between 45-55 years old (7). 

Perimenopause marks the start of this transition, and can begin in your early 40s. During this phase, hormone levels fluctuate, including oestrogen and progesterone, before declining at menopause. The fluctuations in hormone levels can lead to the physical and emotional symptoms experienced during menopause. 

Weight changes during menopause

During the menopause transition, reduced levels of oestrogen and progesterone, lead to changes in fat distribution. Fat is more likely to build up around the tummy. There’s also a decrease in metabolic rate, which occurs naturally with ageing as well as due to hormonal changes linked to menopause, which means the body burns fewer calories at rest. This can lead to weight gain over time.

Abdominal (tummy) fat is associated with a higher risk of insulin resistance, which makes blood sugar regulation more difficult (3). Insulin resistance can also make managing weight more difficult, as explored later on in this blog.

Some menopause symptoms may also affect weight indirectly:

• Sleep disturbance can disrupt metabolism and increase cravings. During menopause, hormonal changes, particularly the reduction in oestrogen, can lead to night sweats, hot flushes and mood swings, all interfering with sleep. Poor sleep can increase hunger during the day, leading to stronger cravings of sugary and high fat foods.

• Fatigue can lead to reduced motivation for exercise. The persistent tiredness caused by poor sleep and mood swings can lead to lower energy levels and less motivation to stay active. A drop in physical activity can reduce overall calories burnt, making weight management and weight loss more difficult. 

• Increased appetite and cravings. Hormonal changes may lead to changes in mood, which can lead to stronger cravings for high calorie ‘comfort’ foods, making it more difficult to stick to a nutritious and balanced diet. 

PCOS and the affects on weight

What is PCOS?

PCOS is a hormonal disorder that affects how the ovaries work. This can impact metabolism, insulin sensitivity, weight and fertility.

According to the Rotterdam Criteria, PCOS is diagnosed when two of the three of the following are present 

• Irregular or absent periods 

• Excess androgen levels - either physical characteristics like acne or excess facial hair, or biochemical characteristics identified via blood tests.

• Polycystic ovaries (The presence of polycystic ovaries alone is not enough to diagnose PCOS!)

Insulin resistance and weight gain in PCOS

Insulin is the hormone that helps the body move glucose (sugar) from the bloodstream into the cells, where it's used for energy or stored for later use.

Insulin resistance is common in PCOS. Insulin resistance occurs when body cells become less responsive to insulin. As a result, blood sugar levels can stay higher for longer. To compensate, the pancreas (which produces insulin) produces even more insulin to get the same response it used to be able to achieve prior to insulin resistance. High insulin levels increase fat storage, especially around the tummy, and insulin resistance can increase the risk of developing type 2 diabetes (2, 4).

Insulin resistance can also cause increased hunger and cravings towards sugary and high calorie foods, and may lead to overeating. This can make weight gain easier.

PCOS symptoms and weight gain 

Common PCOS symptoms that can indirectly affect weight are:

• Fatigue: low energy levels can reduce motivation to exercise

• Mood swings: emotional fluctuations may lead to emotional eating of high-calorie foods and overeating

• Sleep disturbances: This can disrupt metabolism and increase cravings (5)

Can PCOS affect weight loss during the menopause transition? 

Overall, PCOS can make weight loss during menopause more challenging, this is because of the overlapping hormonal factors.

This includes insulin resistance that is already linked to PCOS, and then during menopause, there is a further reduction in insulin sensitivity, making it harder to manage weight. 

The lower oestrogen levels experienced during the menopause transition can change the body's fat distribution and metabolism, causing fat to build up around the tummy. Women with PCOS already naturally struggle with a slower metabolism, and during menopause, it further reduces, making weight loss feel even more difficult (6). 

Tips for weight loss with PCOS during menopause 

Balanced diet

Balancing meals with wholegrains, lean proteins, fruits and vegetables, and healthy fats can help you to eat smaller portions that fill you up for a longer amount of time. This can help stabilise blood sugar levels, reduce cravings and reduce the amount of snacking throughout the day (4).

Regular exercise

Aim to increase physical activity and decrease sedentary time. The NHS guidelines recommend around 150 minutes of moderate intensity activity per week, such as brisk walking. Movement is important for managing weight and can also boost mood. It's important to participate in a range of movements like cardio, strength training and restorative exercise. 

Stress management

Stress can increase cortisol levels (the stress hormone), which can increase belly fat and cravings for high-calorie foods (comfort foods). Habits like meditation, yoga, journaling and breathwork can help to ease stress. It’s important to take care of your mental wellbeing.

Conclusion

Weight management and weight loss can be challenging for women dealing with PCOS or navigating the menopause transition, as both conditions impact hormones, metabolism, and insulin sensitivity. However, understanding these changes is the first step toward making positive shifts. With a combination of nutritious, balanced meals and snacks, regular physical activity, stress management, and medical support when needed, it is possible to improve overall health and better manage weight during these life stages.

This blog was written by Mia Watkins, a second year Nutrition student at Oxford Brookes University with a strong interest in individual health, particularly how the diet can support long term wellbeing.

Lutrition is founded by Registered Nutritionist Lucy Jones, who provides 1-1 support for those going through perimenopause and menopause who want to lose their stubborn unwanted fat for good, so they can fit comfortably and confidently into their clothes. Consultations are available virtually and in person across Brackley, Towcester, Northampton, Milton Keynes, Bicester and Banbury.

References 

1. Mahajan, N. and Sharma, S. (2021). Polycystic ovarian syndrome and menopause in forty-plus women. Journal of Mid-life Health, 12(1), p.3. doi:https://doi.org/10.4103/jmh.jmh_8_21. 

2. NHS (2022). Polycystic Ovary Syndrome. [online] NHS. Available at: https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/.

3. Cleveland Clinic (2024). Menopause: Age, Stages, Signs, Symptoms & Treatment. [online] Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/21841-menopause. 

4. Verywell Health. (n.d.). The Dual Challenge of PCOS and Insulin Resistance. [online] Available at: https://www.verywellhealth.com/how-do-i-know-if-i-have-insulin-resistance-2616646. 

5. Mayo Clinic Staff (2022). Polycystic Ovary Syndrome (PCOS) - Symptoms and Causes. [online] Mayo Clinic. Available at: https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439. 

6. Verywell Health. (n.d.). Does PCOS Go Away After Menopause? [online] Available at: https://www.verywellhealth.com/pcos-and-menopause-5211322. 

7. BRITISH MENOPAUSE SOCIETY Tool for clinicians Information for GPs and other health professionals What is the menopause? (n.d.). Available at: https://thebms.org.uk/wp-content/uploads/2023/08/17-BMS-TfC-What-is-the-menopause-AUGUST2023-A.pdf.. 

8. Bouy (2023). How Does Insulin Resistance Affect Weight Gain? | Buoy. [online] www.buoyhealth.com. Available at: https://www.buoyhealth.com/weight-management/insulin-resistance-and-weight-gain.