Living with PCOS? These weight-management medications may help

Most women are well-acquainted with the hormonal shifts that occur throughout their menstrual cycle, and their life stages. Think acne breakouts before your period or hot flashes during perimenopause. But for the 8%-13% of women in the world with polycystic ovary syndrome (PCOS), these symptoms go far beyond what’s standard.

In addition to potentially causing acne, impacting periods, and potentially affecting fertility, PCOS can also lead to weight gain or difficulty losing weight. In fact, research suggests 38%-88% of women with PCOS are also living with obesity. Here’s what you need to know about the endocrine disorder — including why managing it with willpower alone might not be enough.

What is PCOS?

PCOS is an endocrine disorder that affects hormones during a woman's reproductive age, which spans ages 15-49 on average. More specifically, in people living with PCOS, the ovaries produce abnormal amounts of androgens, which is a type of male sex hormone. In the past, PCOS was viewed primarily as a reproductive disorder, but we now know it as an endocrine (aka hormone) disorder that can lead to wide-ranging symptoms, including (in no particular order:

• Infertility
• Irregular or stopped periods
• Stubborn hormonal acne
• Increase in facial hair
• Skin darkening (particularly on the back of the neck, armpits, and under breasts)
• Thinning hair or hair loss
• Skin tags
• Ovarian cysts

How PCOS is diagnosed

There is no one test that can determine if you have PCOS. Most doctors will review your medical history, ask you about your symptoms, run lab work, and do a physical exam. They may also order a vaginal ultrasound in order to get better imaging of your ovaries and uterus.

PCOS is sometimes hard to diagnose because different women experience a different combination of symptoms, some of which (like ovarian cysts) are hidden unless using special imaging tools.

More research is still being done to help discover what other symptoms polycystic ovary syndrome might cause.

PCOS and weight gain

Another classic symptom of PCOS is difficulty managing weight. Studies have explored the relationship between PCOS and obesity, a chronic condition marked by excess adipose (fat) tissue. But it is still unclear whether PCOS causes obesity or obesity leads to PCOS.

Currently, research supports that both conditions can exacerbate one another. For example, obesity can worsen reproductive abnormalities. And the hyperandrogenism (excess male hormones) that goes along with PCOS may lead to overweight and obesity. Same with PCOS-related insulin resistance, which happens when the body stops responding to the insulin, a hormone that converts glucose into energy.

Why it’s important to treat PCOS-related obesity

Regardless of which condition came first, if you’re living with obesity and have PCOS, losing weight can improve your symptoms. A 2010 study published in BMC Medicine found that even a “modest weight loss of 5% to 10% of initial body weight has been demonstrated to improve many of the features of PCOS.”

Notably, weight loss can improve insulin levels, reduce androgen levels, and lead to improvements in ovulation and fertility. It can also reduce your risk of developing another obesity-related condition — including type 2 diabetes, high blood pressure, heart disease, stroke, liver disease, and more.

The problem? Though weight loss can improve PCOS symptoms, PCOS itself can make that weight loss harder. This is because PCOS often leads to insulin resistance — which can increase appetite and make weight loss more of an uphill battle.

How to lose weight with PCOS

If you’re having a hard time losing weight because of PCOS-related weight gain, it’s likely not related to your willpower. Your biology is impacting your ability to lose weight. But it’s still possible to improve your weight loss even after a PCOS diagnosis. Here are three complementary ways to treat PCOS-related obesity:

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1) Prescription weight-loss medications

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Metformin

PCOS patients are at a higher risk of developing prediabetes, which can lead to type 2 diabetes or metabolic syndrome if left untreated.

To assist with insulin resistance — and, subsequently, make weight loss easier — your clinician may prescribe Metformin.

Metformin works by improving the sensitivity of peripheral tissues to insulin, which reduces circulating insulin levels. This helps counteract insulin resistance. In addition to its effects on insulin and glucose levels, which benefit PCOS patients with insulin resistance, Metformin may also have a benefit on appetite levels.

As a treatment for type 2 diabetes and weight loss, Metformin addresses both symptoms of PCOS and the common comorbidity of obesity. Safe for patients who are pregnant or looking to become pregnant, it has even been seen to positively support ovulation in those with PCOS-caused anovulation, which occurs when the ovaries stop releasing eggs.

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GLP-1 Medications

Another good option for those looking to lose a significant amount of their body weight is a GLP-1 medication.

GLP-1 stands for “glucagon-like peptide-1.” This class of medications works by mimicking a hormone in your gut, which reduces appetite and cravings. Originally a class of prescription drugs used for type 2 diabetes, there are now multiple GLP-1 medications available for weight loss.

Three medications that are FDA-approved for weight loss are Zepbound (tirzepatide), Wegovy (semaglutide), and Saxenda (liraglutide).

With their success in supporting sustainable and safe weight loss, GLP-1 medications are a great option for PCOS patients, particularly those primarily looking to treat obesity. By combating insulin resistance, they make it easier for those with PCOS to treat their weight. For example, in clinical trials of Zepbound (tirzepatide), participants lost 15%-20% of their body weight over 72 weeks.

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2) Exercise

In addition to incorporating a prescription weight-loss medication into your treatment, it is also important to incorporate lifestyle changes. Proper exercise can help reduce BMI, regulate insulin, and promote well-being. When trying to lose weight, focus on creating a workout routine that’s consistent. Every little bit counts, and it's going to take time to see positive results. You could start by walking for just 15 minutes a day.

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3) Nutrition

Food is an important part of the treatment equation too. Although there is no specific PCOS diet, changing up how you eat can also help regulate insulin and support mental and physical health. To avoid elevated blood sugar levels, eat smaller portions of carbohydrates throughout the day, prioritizing complex carbohydrates and whole grains. It’s also key to include a source of lean protein (such as chicken and turkey) with snacks and meals and choose healthy fat sources (i.e. salmon and other fatty fish, olive and avocado oils, nuts and seeds, and avocado). WeightWatchers can help guide to make the most nutritious food choices for you and your body — whether through GLP-1 Program for people taking GLP-1 medications or our science-backed program for weight loss for those who are not.

Other treatments for PCOS

While medication and lifestyle changes can help treat PCOS-related obesity, it is important to view your PCOS care holistically — including treatments that address non-weight aspects of the condition.

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Birth Control

If you are not actively trying to get pregnant, birth control can be a great option for women with PCOS. It can help regulate your menstrual cycle, lower the production of androgens (decreasing acne and body hair), and reduce your risk of ovarian or endometrial cancer (which those with PCOS are 2.7 times more likely to develop).

In those with ovarian cysts, hormonal birth control also helps prevent cysts from forming. Birth control pills, patches, vaginal rings, shots, or a hormonal IUD are great options.

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Spironolactone (aldactone)

Spironolactone is a blood-pressure medication with anti-androgen properties, meaning it blocks androgen receptors and decreases the production of androgen from the ovaries and adrenal glands.

It is a useful medication for the treatment of PCOS for those who experience hyperandrogenism, or abnormally high levels of male sex hormones, including testosterone.

Spironolactone is primarily helpful as an addition to birth control. For patients with PCOS, spironolactone can help treat excessive body hair (“hirsutism”) or unwanted hair loss. In addition, it is useful against hormonal acne that derives from hyperandrogenism.

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Acne Medication

Not every PCOS patient develops acne, but it is a very common symptom that develops as a result of the excess androgens.

Cystic and pustular acne are the most common acne types seen in PCOS patients. Acne in those with PCOS is often difficult to get rid of because you must treat not just the skin but also the hormonal imbalance.

In addition to birth control and spironolactone, prescription acne medication, such as Accutane (isotretinoin) can help reduce acne for those with PCOS.

Where to get treatment

Treating PCOS often requires a multidisciplinary team. Seeing your primary care physician is a good place to start. They will evaluate you for your condition, or refer you to someone who can.

OBGYNs are the go-to for issues like irregular periods. They can prescribe birth control and check to see if you’ve developed ovarian cysts. They can also help if you're actively trying to get pregnant and having trouble.

Visiting a dermatologist is highly encouraged for PCOS patients dealing with stubborn acne, discoloration of the skin, and excess facial hair. Dermatologists can prescribe acne medications if over-the-counter treatments are ineffective.

Bottom line

Polycystic ovary syndrome (PCOS) is an endocrine disorder that can lead to a wide range of symptoms, including weight gain and difficulty losing weight, and it’s also connected with overweight and obesity. There are treatments that can help, however, including diet, exercise, and medication. With more and more research being published about PCOS, there's hope that even more care options will become available in the near future.

If you’re looking to learn more about weight-loss medications, the healthcare providers at WeightWatchers Clinic can help. These obesity-trained clinicians make it easy by providing virtual appointments every day of the week, across US time zones, so there’s bound to be an appointment that’s convenient for you. Find out if you qualify.