What treatments help PCOS & weight loss?

Key Points

• Weight loss is often an important step in PCOS treatment to restore ovulation and improve overall symptoms.
• There are many different PCOS medications that aid in weight loss, insulin resistance, and hyperandrogenism.
• Your care team, including a registered dietitian, will help find the right medication for your symptoms.   

Polycystic ovary syndrome can be a difficult endocrine disorder, leading to weight gain, insulin resistance, excess androgen that causes hair and skin issues, and difficulties with ovulation and pregnancy. PCOS weight loss can be challenging but it's not impossible!

There are many treatments and medications used to help women with PCOS. These drugs can help improve your symptoms of PCOS, normalize insulin resistance, and restore ovulation – as well as promote weight loss.

There are many different kinds of PCOS treatments, so let's dive into all the options.

How Is PCOS Diagnosed?

Polycystic ovarian syndrome is diagnosed by a few different exams and tests administered by a doctor. These tests include:

• Ultrasound: This exam can look at the appearance of your ovaries and uterine lining. This can show any abnormalities, including cysts, which are common in PCOS patients.
• Pelvic exams: Pelvic exams are another way to check for masses, growths, cysts, and any potential changes in your ovarieis and uterus.
• Blood tests: You can measure hormone levels through a blood test, which can indicate potential causes of excess androgen, menstruation issues, and other PCOS symptoms. You can also test your fasting cholesterol or glucose tolerance to see if you have insulin resistance or high cholesterol.

Additional tests include blood pressure, sleep apnea, and depression or anxiety screenings. All of these are common symptoms in PCOS patients and don't indicate the condition on their own but can be contributing factors.

Symptoms of PCOS

Women with PCOS often experience the following symptoms:

• Enlarged ovaries or ovarian cysts
• Irregular periods or amenorrhea (lack of menstruation)
• Hirsutism, or excess body hair
• Issues with fertility
• Weight gain and obesity
• Acne or oily skin
• Skin abnormalities, like skin tags in the neck or armpits, or dark/thick skin patches on the neck, armpits, or under breasts

Most women with PCOS experience a combination of these symptoms. Experiencing just one of these symptoms doesn't necessarily mean you have PCOS. If you think you have symptoms of PCOS, go to your primary care provider or OBGYN to discuss testing options.

Medications for Polycystic Ovary Syndrome

There are several different medical options for PCOS. Each medication has a different focus and targets different PCOS symptoms. Which medication is right for you depends on your particular symptoms, personal goals, and overall health. You will work with your doctor to find the right PCOS medication.

Insulin Resistance Treatments

Metformin is the most popular insulin resistance medication, used for both symptoms of PCOS and diabetes. It is associated with improved menstruation, improved ovulation, and reduced androgen levels. It can also have metabolic benefits, with many patients losing weight. Weight loss improves your endocrine profile and makes ovulation and pregnancy more likely. Many PCOS patients see a lot of success using metformin.

“Metformin is a proven insulin resistance treatment, but there are other options too,” says Rita Faycurry, RD. “Myo-inositol and D-Chiro are well tolerated and are just as impactful. They are great in helping not just with insulin resistance, but also hyperandrogenism and re-establishing a menstrual cycle.”

Weight Loss Treatments

Obesity is a prevalent issue with PCOS – as many as 35-60% of women with PCOS are obese. Obesity is associated with ovulatory issues, miscarriage, and late pregnancy complications, including gestational diabetes. It can also cause poor response to some PCOS treatments like clomiphene citrate (CC).

As such, weight loss can play an important role in healing PCOS. Even losing just 5% of body weight can improve ovulation and menstrual cycles. The first line of treatment for weight loss is, of course, lifestyle changes – diet and exercise.

You should work with your care team to design a diet and exercise approach that is right for you. A registered dietitian will be able to provide professional guidance in order to lose weight sustainably. Find a PCOS dietitian covered by your insurance here.

Weight loss drugs can also aid in weight loss for PCOS. One small study found that treatment with semaglutide, at low doses, significantly reduces body weight in almost 80% of obese PCOS patients who were unresponsive to a previous lifestyle plan. These results are often associated with a normalized menstrual cycle, and many participants had positive improvements in their fasting glucose and insulin as well. This indicates that that semaglutide might be a good alternative to metformin for improving insulin resistance and presenting type 2 diabetes. The study noted, however, that severely obese patients might need a higher dose to achieve the same results.

Ovulation Treatments

In addition to metformin, clomiphene is often used to improve ovulation in PCOS patients. Clomiphene citrate, also referred to as CC, is taken during the first part of your menstrual cycle to reduce estrogen levels. It is well-established as an effective treatment to normalize ovulation and help women with PCOS get pregnant. However, patients with a high BMI (>30) or advanced age might not have the same results.

Hyperandrogenism Treatments

Many women with PCOS deal with hyperandrogenism, an excess of androgen hormone, which leads to hirsutism (excess body hair), acne, and/or alopecia. For those who aren't trying to conceive, hormonal birth control is a common form of treatment. Oral contraceptives help decrease androgens and can improve these symptoms. There are many different types of contraceptives with different levels of hormones, so your doctor will help determine the right combination for your needs.

Another common PCOS medication is spironolactone, which can have anti-androgenic effects in larger doses. It can also be used alongside oral contraceptives, though women pursuing pregnancy can also use spironolactone.

There are several other hyperandrogenism medications available if these don't work for you. Your medical provider will help find the right PCOS treatment for you.

How to Achieve PCOS Weight Loss

While losing weight with polycystic ovary syndrome can be difficult, it's not impossible. With the right care team, dedication, and a little patience, achieving a healthy weight is possible.

That's why it's so important to work with a PCOS dietitian. An RD can work with the rest of your medical providers to design a PCOS diet that will work alongside your other treatments, including metformin. The right dietitian will know how to work with insulin resistance and can help focus on ovulation and improving irregular periods through diet and lifestyle changes.

When it comes to losing weight with PCOS, it's often not as simple as just reducing calories. You have to manage insulin resistance by eating the right foods, watching your carbohydrate intake, and timing your meals appropriately. An RD will guide you every step of the way, keeping you educated and informed while cheering you on.

Find a board-certified PCOS dietitian covered by your health insurance with Fay Nutrition. When you work with Fay, you can pay as little as $0 per session, and Fay bills directly to your insurance so you don't have to worry.

Click here to get started.

The views expressed by authors and contributors of such content are not endorsed or approved by Fay and are intended for informational purposes only. The content is reviewed by Fay only to confirm educational value and audience interest. You are encouraged to discuss any questions that you may have about your health with a healthcare provider.