If you have polycystic ovary syndrome, losing weight can feel kind of like trying to pry yourself away from an episode of Real Housewives – impossible, to say the least. The one bright spot of reassurance? It's not just your imagination—it really is harder to lose weight with PCOS.
According to the National Institutes of Health, up to 20 percent of women have PCOS, a condition characterised by an imbalance of reproductive hormones – too many androgens, or "male hormones" in particular.
In addition to creating problems in a woman's ovaries (like issues with egg development and release), the higher levels of androgens also up the odds of weight gain around the waist – launching a vicious cycle. Abdominal fat decreases responsiveness to insulin, a hormone that helps your body process sugar, making you likely to gain even more weight.
“Some people with PCOS complain they have a hard time losing weight no matter what they do,” says Doctor Daniel Dumesic, expert in reproductive endocrinology and infertility, who also specialises in PCOS.
Oh, and it gets worse: When the average woman wakes up in the morning, she immediately starts burning fat for energy until she eats again. Women with PCOS, however, don't burn fat first thing because they're programmed to save it instead, says Dumesic. (Those pesky androgens are linked to insulin resistance, which can cause you to store more fat instead of burning it.)
So, yes, shedding any extra kilos is especially tricky when you have PCOS, but it isn’t impossible—as long as you arm yourself with the right info. Here are a few ways to make weight loss with PCOS a little less soul-crushing.
Try a low-carb diet on for size
It should be said that no one diet is the magic fix for women with PCOS – and that the type of diet you choose is less important than whether you're able to stick with it long-term. “There’s no evidence that one diet is better than another, so compliance is critical,” says Dumesic.
That said low-carb diets tend to work well for women with PCOS, because they tend to be insulin-resistant. “Lowering carb content lowers insulin levels, which can help with weight loss,” says Doctor Caroline Apovian, an endocrinologist and weight-loss researcher.
That means you'll have to up your protein; Apovian suggests a diet with 1.5 grams of protein per kilogram of your ideal body weight – about 90 grams of protein a day if your goal is 60 kilograms. Feel free to eat as many non-starchy veggies as you want (leafy greens, green beans, and carrots are all on the menu) and two to four servings of fresh fruit, but make sure to skip the juice.
At the beginning, Apovian suggests eliminating grains entirely. If you need carbs to keep up your diet, you can add back up to two servings a day (one slice of whole grain bread, one cup of oats, one cup of brown rice, one cup of whole-wheat pasta, etc.).
"Women with PCOS need an average of 400 fewer calories a day than women who don't have PCOS."
If you still have trouble losing or at least maintaining weight following a low-carb diet, you may need to work with a doctor to adjust your calorie intake, says Doctor Lori B. Sweeney, an endocrinologist and associate professor of medicine.
"Women with PCOS need an average of 400 fewer calories a day than women who don't have PCOS—and any excess calories go to fat storage," she previously told Women's Health. But that's not free range to start slashing cals—a doctor can help you figure out how to cut back in a healthy way.
Exercise first, eat later
Exercising right before a meal can help rev your metabolism so you end up storing more carbs as energy than fat, according to Sweeney. And exercising on the regular trains your body to use up extra glucose stores in your body, which can help keep your insulin levels down, says Maria Horstmann, a certified trainer who specialises in working with women who have PCOS.
Horstmann previously told Women's Health that women with PCOS should focus on high-intensity interval training, which utilises short, intense bursts of energy, while Apovian and Dumesic both recommend any type of cardio that gets your heart rate up.
While you're at it, add in more strength training to your workouts too. Because muscles use glucose for energy, building more muscle can only improve insulin sensitivity and metabolic health, says Dumesic.
If you've got sleep issues, don't ignore them
One common side effect of PCOS is sleep apnea, which disrupts sleep. Lack of sleep causes weight to go up because it messes with hormones controlling hunger and fullness, says Apovian. Try to get at least seven hours of shuteye per night, and talk to your doctor if you think you might be suffering from sleep apnea.
Your doctor might sign you up for a sleep study to confirm that you have sleep apnea and, if you do, prescribe a continuous positive airway pressure device (CPAP), a mask you’ll wear while you sleep that gently blows air into your airway to keep it open.
Try to find an A+ support system
Women with PCOS are more likely to have depression and anxiety, says Dumesic, which can make it even harder to lose weight. (It's tough to work up the motivation to prepare healthy meals and work out if you're feeling happy, let alone if you're depressed.) If you think you might have symptoms of either, check in with a mental health professional. “It’s important to have a good support system. You have to get your mindset aligned with your goals to accomplish weight loss,” he says
If you're still struggling, ask your doctor about other medication options.
Metformin, a medication used to regulate glucose levels and insulin sensitivity, can be prescribed if you're still having trouble keeping your weight in check or are prediabetic. “By better regulating sugar, it subtly affects your appetite and can help with weight loss, although not everyone loses weight,” says Dumesic. Metformin decreases the amount of sugar you absorb from foods and increases your sensitivity to insulin, to help keep your appetite in check.
Other, more powerful drugs made specifically for weight loss may help too, if diet and exercise aren't working. Many of these weight-loss drugs, like a medication called Saxenda, are particularly well-suited for women with PCOS, since they're prescribed to people with higher levels of abdominal fat, says Dumesic.
But keep in mind, these drugs are typically a last resort. "“They’re very strong medications. They have to be given under doctor supervision and are recommended for only six months at a time,” says Dumesic. They also come with a whole slew of side effects like nausea and diarrhea, and can be very dangerous for an unborn baby if you accidentally conceive while taking it.
This article originally appeared in Women's Health US.