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Is there a hormonal reason for not being able to lose weight? Learn about PCOS as a common cause.

I am constantly surprised by how many women come into my practice to help with weight but have undiagnosed polycystic ovarian syndrome (PCOS). 

This condition is usually first seen in the teenage years but not always.  It can take decades for a diagnosis.  It’s really easy for us (doctors) to miss. And, because of the difficulties talking to us (doctors) about weight, the whole picture gets missed often enough that I am routinely diagnosing women in their 30s, 40s and 50s with PCOS. 

What is PCOS?

The cause of the condition isn’t totally known but it’s fundamentally a syndrome of male hormone excess (hyperandrogenism).  This excess has many downstream effects on the whole body.  

People with PCOS can have:

  • Acne that is hard to treat
  • Hair growth in areas typically seen on males (i.e. chin) or loss of hair in the front or crown of head
  • Insulin resistance or impaired tolerance of sugar
  • Excess weight, especially around the central belly
  • Periods that are irregular and very heavy
  • Cancer in the lining of the uterus (endometrium)
  • No or irregular ovulation and infertility
  • Breathing during sleep that isn’t effective (sleep disordered breathing)
  • Metabolic issues, such as low HDL (good cholesterol), high triglycerides, high blood pressure and weight around the belly
  • Fatty liver, or liver disease

The most common reason for someone to bring themselves to a doctor to talk about what could be happening are acne, weight and period issues. 

Because this is a whole body condition, it’s important to step back and try to see the whole picture.  We struggle to find the time to capture all of this but PCOS is the most common hormone disorder causing weight issues among women.  

That’s why I think most women should have a basic understanding of what it is so that they can present as much of the picture as possible to their doctors. 

How is PCOS connected to weight?

This is definitely a chicken-egg situation. 

There is debate about whether weight and its causes lead to PCOS or the other way around.  It probably doesn’t matter as long as we are offering people the help they need. Usually, this is medical intervention and a lot of support. 

Somewhere between four and twenty percent of women of reproductive age around the world have PCOS.  Of those, about 50 percent are in larger bodies. 

These women are more likely to have insulin resistance (higher sugars in blood because insulin receptors aren’t responding as well) and metabolic issues, like high blood pressure.  Even more likely than women with PCOS who are not in larger bodies. 

PCOS is a very, very common reason for people to enter the diet roller coaster which results in persistent, progressive weight gain.  

What do we do about it?

At this time, each component of the syndrome is treated with its own approach.  These aren’t that different from how we treat these issues in people without PCOS. 

We first start with the basics of a healthy life: drink enough water, sleep enough, move enough, spend time with people you like and eat satisfying foods regularly. 

Then, we can get medical about it:

  • Infertility: medications to trigger ovulation, including metformin (an old diabetes standby medication that is still first line treatment for diabetes)
  • Irregular and/or heavy periods: birth control pills with estrogen and progesterone, IUDs and metformin (again).  These also help prevent uterine cancer. 
  • Acne: birth control pills, topical prescriptions and medications to reduce testosterone and (maybe) metformin
  • Hair: same as for acne, but also laser hair removal works wonders and (maybe) metformin
  • Metabolic syndrome: medications for blood pressure, cholesterol and diabetes. 

And for weight? Helping with behaviours, medications and sometimes surgery. 

Not diets. Never diets. 

You’ll notice that metformin shows up a lot in this list.  It is not used in every patient with PCOS and it isn’t even the first line for people with PCOS.  But it has so many benefits, little downside, and is so cheap that I often prescribe it anyway.  

Medical causes of weight aren’t the most common

I see a lot of people who firmly believe they have an underlying medical reason for their weight.  Usually, they’re confident that their thyroid is messed up.  This is rarely the case. 

But for PCOS, this is actually pretty common and needs to be considered with every female. 

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