Understanding PCOS Belly: Causes, Symptoms, and Proven Ways to Manage Hormonal Belly Changes

PCOS belly refers to abdominal fat common in women with polycystic ovary syndrome, caused by hormonal imbalances, insulin resistance, and lifestyle factors. Learn how to recognize it, understand its causes, and explore effective strategies to reduce and manage PCOS belly for better health.

What is PCOS Belly?

Out of all the visible Polycystic Ovary Syndrome (PCOS) symptoms, PCOS belly might be the one you notice most. While stomachs come in all shapes and sizes, many women with PCOS notice that their abdominal fat tends to accumulate in specific areas around the midsection and waist, creating a characteristic belly shape that we know as "PCOS belly." 

A PCOS belly is typically apple-shaped and projects outward around the midsection and waist. You might notice that your stomach takes on this shape even when you are at a lower weight. It can seem like your body is programmed to store fat in this area, and as you'll discover in this comprehensive guide, that's partially true. 

What is PCOS?

Polycystic Ovary Syndrome is a set of symptoms women of reproductive age can experience related to an imbalance of hormones and neurotransmitters. It's estimated that around 13% of women have PCOS, but a large number of women go undiagnosed [1].

PCOS can have far-reaching effects on your body and mind, including physical and mental health symptoms like these:

• Weight gain and PCOS belly

• Hirsutism (excessive hair growth on the face and body)

• Thinning hair or male-pattern baldness

• Acne

• Irregular periods

• Fertility issues or infertility

• Mood swings

• Anxiety, depression, and other mental health conditions
  

These symptoms can present daily challenges when you're living with PCOS. Still, you can implement a range of effective treatments, therapies, and lifestyle adjustments to mitigate your symptoms and take control of your health. 

Defining PCOS Belly

Polycystic Ovary Syndrome belly refers to the unique characteristics of your stomach and abdominal fat accumulation if you have PCOS. Typically, this stomach shape features a pronounced apple shape that's widest at the center. Fat tends to accumulate around the waist and midsection in women with PCOS, creating a rounder appearance.

A PCOS-related belly usually indicates the presence of dangerous visceral fat, which is fat that accumulates around your organs. It may also be a clue that you're dealing with insulin resistance—a defining trait of PCOS.

Doctors believe underlying hormonal imbalances and metabolic problems in PCOS may be the root cause of developing this type of belly. The risk of developing this trait increases with obesity, and not every woman with PCOS will experience it. 

PCOS Belly vs. Hormonal Belly

While PCOS is one potential cause of hormonal-related abdominal weight gain, several other hormonal conditions can lead to similar patterns of fat accumulation. Understanding the distinctive characteristics of each can help guide proper diagnosis and treatment.

The way fat accumulates in the abdominal area often provides clues about the underlying hormonal cause. For instance, PCOS typically results in an apple-shaped distribution around the midsection, while thyroid-related weight gain tends to be more diffuse. Cortisol-related belly fat often appears as central obesity with thin limbs, and menopause-related changes frequently present as increased visceral fat in the middle and upper abdomen.

Common hormonal causes and their characteristic patterns include:

• PCOS-related belly: Presents as a rounded, apple shape concentrated around the midsection and waist, creating a larger waist-to-hip ratio that may appear disproportionate to the rest of the body. This pattern is often accompanied by insulin resistance.

• Thyroid-related belly: An underactive thyroid typically leads to overall weight gain including the abdominal area, often accompanied by fluid retention and bloating. The weight distribution tends to be more generalized rather than strictly concentrated in the belly.

• Cortisol-related belly: High cortisol levels from chronic stress can create what's known as "cushingoid" appearance, with central obesity particularly in the trunk and face while the limbs remain relatively thin. The abdomen may also develop stretch marks.

• Menopausal belly: The hormonal shifts during menopause often lead to increased visceral fat in the middle and upper abdomen, even in women who maintain the same weight. This can be accompanied by changes in fat distribution throughout the body.

• Leptin resistance belly: Can present as overall weight gain with particular difficulty losing abdominal fat, often accompanied by strong cravings and difficulty feeling satisfied after meals.

Given the complexity of hormonal interactions and the overlap in symptoms, professional medical evaluation is essential for proper diagnosis. This typically includes comprehensive blood work to examine various hormone levels, including:

• Reproductive hormones (testosterone, estrogen, progesterone)

• Thyroid function tests

• Cortisol levels

• Insulin and glucose levels

• Leptin levels when indicated

The results of these tests, combined with a thorough medical history and physical examination, can help determine which hormonal factors are contributing to abdominal weight gain and guide appropriate treatment strategies.

What Does PCOS Belly Look Like?

If you think you have a PCOS belly, looking at its physical characteristics can help determine whether your stomach's general shape, feel, and size meet the criteria.

These are the traits of a typical abdominal area seen in women with PCOS:

• Rounded, apple-like shape

• Protrudes most around the waist and midsection

• Large waist-to-hip ratio (waist measuring larger than hips in some cases)

• Abdominal area that seems out of proportion to the rest of the body
  

If your stomach meets these criteria, you may be gaining weight in your abdominal region due to symptoms of PCOS. 

Common Symptoms of PCOS Belly

With a PCOS belly, you might notice that you are more prone to bloating and abdominal discomfort or find it difficult to lose weight when following diet and exercise recommendations. When losing weight, you may see weight loss in other areas of your body but struggle to lose in your abdominal area. 

If you have this symptom, you might notice a tendency to gain the most weight around your midsection while your limbs or face accumulate fat at a slower rate. You may also notice a firm or distended feeling in your belly. 

PCOS Belly Shape: Differences from Other Types of Belly Fat

Regular belly fat, or subcutaneous fat just under the skin, tends to accumulate evenly around the abdomen and body, with the stomach's size in proportion to the rest of the body. With PCOS, your belly may appear much larger than other parts of your body and feature a notably round, apple-like shape.

Another key difference between PCOS and regular belly fat is the association with visceral fat that accumulates around the organs. Larger waist circumferences indicate larger amounts of visceral fat, which crowds around organs like your heart, intestines, and liver. Visceral fat is correlated with higher risks of heart problems, diabetes, certain cancers, and metabolic problems like high blood pressure and high cholesterol. 

PCOS Belly vs. Pregnant Belly

While both a PCOS and pregnant belly feature notable protrusions that may seem out of proportion with the rest of the body, can feel firm to the touch, and have a round appearance, there are some key differences between the two.

• PCOS belly: Apple-like shape that protrudes the most around the waist or midsection; may feel firm to the touch
  

• Pregnant belly: Rounded, firm shape that protrudes the most around the lower abdominal region as the uterus grows to accommodate the fetus
  

If you believe you may be pregnant, it is recommended to take an at-home pregnancy test of schedule a visit with your doctor/

Before and After Images: PCOS Belly Transformation

Below, you can see the marked difference between a typical PCOS belly before and after treatment to target the underlying hormonal and metabolic imbalances caused by this syndrome. Note how the "before" image shows the PCOS belly appearing more apple-like with a pronounced protrusion around the midsection, while the rest of the body appears much smaller in proportion to the abdominal area.

In the "after" photo, you can see how the belly looks more proportional to the rest of the body, does not have an apple shape that is as pronounced, and has less subcutaneous and visceral fat.

Causes of PCOS Belly

What causes a PCOS belly? Research shows that many factors influence how your body stores and accumulates fat when you have PCOS, including your insulin production, hormone and stress levels, and lifestyle factors. 

Insulin Resistance and Abdominal Fat

Women with PCOS have a higher risk of insulin resistance [2]. Insulin is a hormone that acts like a street sweeper, taking glucose (sugar) out of your blood and into your body's cells to manage your blood sugar levels. With PCOS, your body may be resistant to insulin, which prevents the hormone from ushering glucose into your cells. As a result, your blood sugar levels can be higher and increase your risk of developing type 2 diabetes.

Insulin resistance is closely linked to higher levels of abdominal fat and intra-abdominal fat, leading women with PCOS to gain weight predominantly around the midsection and waist. This is one cause of PCOS belly fat accumulation. 

Hormonal Imbalances (Androgens, Cortisol, and Estrogen)

Other hormones, including androgens (male hormones like testosterone), cortisol (the "stress hormone"), and estrogen, are common culprits behind the typical apple belly shape seen in women with PCOS.

If you have PCOS, you may have higher levels of androgens like testosterone circulating in your blood. Androgens can lead fat to accumulate primarily around your waist in what doctors call an “androgenic distribution pattern”. While women typically gain weight in a pear-shaped way (primarily the hips, legs, and bottom), men are predisposed to gain weight around the abdomen. 

Higher circulating levels of cortisol and estrogen in women with PCOS can also be pinned as possible causes of developing the characteristic apple-shaped belly. Elevated cortisol and estrogen levels are associated with increased fat accumulation around the belly and organs, and both can contribute to insulin resistance.

Body fat produces estrogen, so as you gain weight with PCOS, these hormonal imbalances can become even more pronounced. 

Stress and Cortisol Belly Fat

PCOS mental health symptoms often include stress and anxiety, both of which can influence your body to produce more cortisol. This hormone is produced by the adrenal glands and circulates in the bloodstream to help your body respond to stress effectively, manage blood sugar, and metabolize food to give you energy.

When cortisol levels get too high, or if your body produces too much cortisol in response to ongoing stress or anxiety, adverse effects like these can occur:

• Increased fat accumulation in the face and belly

• Increased blood pressure and blood sugar

• Thin, acne-prone skin

• Mood swings, anxiety, and irritability

• Trouble sleeping

Lifestyle Factors: Diet, Sleep, and Activity

Other causes of PCOS belly fat accumulation involve lifestyle: the way you eat, sleep, and move. If you eat a lot of processed foods with high amounts of sugar, simple carbohydrates, and saturated fats while providing lower amounts of protein, you may see effects on the size and shape of your belly and the amount of abdominal fat—especially if you have PCOS.

Another abdominal-influencing lifestyle factor to be mindful of is sleep. Getting less than nine hours of sleep each night, taking long daytime naps, or waking up frequently through the night are all associated with higher levels of abdominal fat. Poor sleep also leads to hormonal imbalances, increased cortisol levels, and reduced activity—all of which can encourage excess fat accumulation around the belly.

Your activity level can influence your likelihood of developing a PCOS belly. A sedentary lifestyle, which involves spending most of your day sitting with little to no exercise or physical activity, increases your risk of accumulating dangerous visceral fat around your organs and increasing abdominal and subcutaneous fat.

If you have PCOS and don't work 30 minutes or more of physical activity into your life a few times each week, you could experience PCOS belly fat accumulation. Avoid over-exercising, as this can also disrupt your hormone balance.

Risks Associated with PCOS Belly

The risks associated with a PCOS belly stem far beyond cosmetics and appearance—developing this trait can elevate some of the underlying concerns and risk factors that many women already have with PCOS. These are the health complications and long-term risks to be aware of if you think you have a PCOS belly. 

Health Complications from Abdominal Obesity

Abdominal obesity increases your risk of developing serious conditions and health complications [3]. These are some of the health concerns that are associated with higher amounts of abdominal and visceral fat:

• Insulin resistance and increased type 2 diabetes risk

• High blood pressure and elevated cholesterol levels 

• Increased risk of heart attack and stroke

• Elevated risk of atherosclerosis and heart disease

• Chronic inflammation

• Metabolic syndrome

• Increased risk of some cancers, like breast and colon cancer

Long-Term Risks of Hormonal Weight Gain

Because PCOS essentially "programs" your body to store and accumulate fat around your abdomen due to hormonal imbalances, it's important to understand the long-term risks of hormonal weight gain and what effects it can have on your body over time.

When an imbalance of hormones is partially to blame for excessive fat around the belly, your risk of developing chronic or life-threatening conditions goes up. This includes health problems like:

• Infertility and pregnancy complications

• Type 2 diabetes

• High blood pressure

• Some cancers

• Mood disorders

• Cardiovascular disease

• Stroke 

• Heart attack
  

Excess weight can directly cause these health concerns, as it makes the body work harder to pump blood, regulate blood sugar, and manage processes like ovulation and mood regulation. Other problems, like cancers and heart attacks or strokes, may occur as part of a cascade of issues stemming from hormonal imbalances. 

How to Get Rid of PCOS Belly

Just like other PCOS symptoms, including acne, unwanted hair growth, anxiety, and mood swings, there are ways to treat and manage excess abdominal fat while prioritizing whole-body health and wellness. To get rid of a PCOS belly, you can change your diet and nutrition goals, create an exercise plan to increase your activity level and make a few lifestyle changes to help burn off belly fat while keeping other symptoms at bay. 

Dietary Approaches

The old adage, "You are what you eat," holds true, especially for those with PCOS. The typical American diet consists of highly processed foods with high amounts of sugar, fat, and salt and are low in essential vitamins, minerals, and critical micro- and macronutrients. Parting ways with this typical way of eating is an effective way to target your PCOS belly and jump-start your body's ability to burn off abdominal fat.

Choosing healthier, nutrient-rich foods will also help you stay full longer, reduce your urge to snack or binge on unhealthy foods, and may help clear up skin conditions like acne, oily skin, or dandruff—other potential symptoms of PCOS.

What dietary approaches can you take to get rid of a PCOS belly? Try implementing simple swaps and changes like these:

• Minimize processed foods, choosing whole foods when possible

• Eliminate added sugar from your diet, opting for natural sugars instead

• Limit saturated fats in favor of healthy poly- and monounsaturated fats [4]

• Eat plenty of lean protein, like chicken, fish, and lean pork

• Swap white grains for whole grains (oats, rice, wheat, etc.)
  

In addition to choosing smarter foods that are nutrient-rich, you can take it a step further by making these adjustments to your diet:

• Choose foods with a low glycemic index to avoid blood sugar spikes and control insulin levels. Examples include Lentils, chickpeas, legumes, whole grains, and non-starchy vegetables.
  

• Use anti-inflammatory ingredients like garlic, turmeric, ginger, nuts, and green veggies.
  

• Try the DASH (Dietary Approaches to Stop Hypertension) diet—lots of veggies, fruit, whole grains, lean protein, healthy fats, and reduced-fat dairy.
  

• Add daily PCOS-friendly natural supplements to target hormonal belly fat, increase lean body composition, and support blood sugar levels.

Exercise Plans for Hormonal Belly Fat Reduction

Diet changes can have a lasting, significant impact on a hormonal belly related to PCOS, but adding exercise to your lifestyle can amplify those effects. Not only is exercise a proven way to burn calories (essential in any form of weight loss), but it's also an effective way to manage other PCOS symptoms, like mood swings, anxiety, and depression.

Some of the best types of exercise to get rid of a PCOS belly are strength training, cardio, and low-impact full-body workouts. Here are a few you can try:

• Strength training: Planks, lunges, squats, lifting small hand weights, and deadlifting weights will increase your strength, balance, and lean muscle mass to burn more abdominal fat.
  

• Cardio: Dancing, walking, jogging, aerobics, jumping jacks, and stationary biking are great ways to give your heart a workout and burn calories to shed fat.
  

• Low-impact full-body workouts: Rowing, swimming, cycling, and water aerobics are low-impact while working muscles throughout your body, helping you burn more calories and get your heart rate up to encourage abdominal fat loss.
  

Becoming more active can seem like a major undertaking if you've been sedentary for a while, but making exercise fun lowers the barrier to entry and can help reduce anxiety associated with starting your fitness journey. Pop on your favorite upbeat playlist, exercise outdoors, or take a group class to maximize your experience. Starting slow and working at your own pace is the best way to build a lasting fitness routine. 

Lifestyle Changes

Small, consistent changes to your daily routine can make a significant impact when addressing PCOS-related weight gain. By optimizing everything from sleep patterns to stress management, you can create an environment where your body functions more efficiently. These fundamental lifestyle adjustments help regulate metabolism, balance hormones, and support neurotransmitter function—all crucial elements in managing PCOS symptoms effectively.

• Better manage stress: Practice mindfulness and meditation to lower stress levels and ground yourself in the present moment. Adopt new, relaxing hobbies you enjoy and spend more time with your favorite people to help reduce cortisol levels.
  

• Improve sleep quality: Try to get at least nine hours of sleep each night, avoid taking long naps during the day, and practice good sleep hygiene before bed to limit waking up in the middle of the night (no electronics, food, caffeine, alcohol, etc. before bed). 

Medical Treatments and Interventions

Making changes to your lifestyle and habits can be incredibly empowering as you work to manage or get rid of a PCOS belly. Still, sometimes, medical treatments and interventions might be necessary in combination with the changes you've made. Hormonal treatments and medications that target insulin resistance are both possible options if you decide to seek medical help to reduce PCOS-related abdominal fat.

• Hormonal treatments: Hormonal birth control, including combined contraceptives and progestin-only pills, can help make periods more regular while curtailing other PCOS symptoms, like acne and unwanted hair growth.
  

• Insulin resistance treatments: Anti-diabetic medications metformin and pioglitazone are potential options to treat insulin resistance with PCOS. These drugs may help regulate ovarian function and reduce androgen levels to target other PCOS symptoms.
  

Side effects are important to consider when taking either of these routes. Birth control can effectively control some PCOS symptoms, but some women report gaining weight when using oral contraceptives. In some cases, progestin-only pills can increase androgen production and make symptoms worse [5].

While treatments for insulin resistance, like metformin, can be very effective, they may have side effects like indigestion, nausea, constipation, or headaches. 

Supplements for Treating PCOS Belly

Managing PCOS-related abdominal weight can be particularly challenging due to the condition's impact on insulin sensitivity and hormone balance. While lifestyle modifications like diet and exercise are essential, certain supplements have been shown to help target this specific type of weight gain by addressing the underlying hormonal and metabolic factors that contribute to PCOS belly. Here are the key supplements that research suggests may help manage PCOS-related abdominal weight:

• Inositol: Helps improve insulin sensitivity and can help reduce abdominal fat accumulation.

• Chromium: Helps regulate blood sugar and insulin levels, which can help reduce belly fat.

• Magnesium: Helps improve insulin sensitivity and may help with weight management.

• Vitamin D: Low vitamin D levels are associated with increased abdominal obesity in PCOS; supplementation may help with weight management.

• Acetyl-L-Carnitine: Helps with fat metabolism and may help reduce abdominal fat.

• Alpha Lipoic Acid: Supports metabolism and may help reduce insulin resistance

• Cinnamon: Helps regulate blood sugar levels and may help reduce abdominal fat.

Preventing PCOS Belly

If you haven't developed PCOS and belly fat around your waist, there are preventative steps you can take. Not every woman with PCOS will accumulate fat around the abdomen in this way. By initiating healthy lifestyle practices, promoting natural hormonal balance, and watching for early signs of hormonal weight gain, you can halt or slow the accumulation of visceral fat around your midsection, effectively preventing PCOS belly.

Healthy Lifestyle Practices

A healthy, intentional lifestyle offers an array of benefits—whether you have PCOS or worry that your hormones are out of balance. Think of your current habits and where there may be room for improvement. These are some of the basic tenants to leading a healthier life that helps prevent the accumulation of PCOS belly fat:

• Take nutrition seriously: You get out what you put in, and being more intentional with your food and supplement choices can help you maintain a healthy weight while supplying your body with what it needs to support hormonal production, neurotransmitter function, and homeostasis.
  

• Get plenty of sleep: Try to rest for nine hours each night and make bedtime a cozy routine you look forward to. Avoid alcohol, TV, scrolling on your phone, snacking, and drinking water for an hour or so before bed to signal your body that it's time to sleep.
  

• Make movement a priority: Desk jobs, working from home, and endless entertainment on our phones and TVs make it tempting to skip workouts or avoid going outside. Make exercise a priority at least three days each week. Do strength training, cardio, and low-impact, full-body workouts to boost your metabolism, get stronger, and burn calories.
  

• Kick stress to the curb: Stress is part of daily life, but with more effective stress management techniques, you can avoid spikes in cortisol and anxiety from everyday stressors. Meditation, mindfulness, quiet hobbies, and quality time with people you love can be great stress relievers. 

Balancing Hormones Naturally

If medical treatments don't seem the right choice for you, there are many ways to naturally balance your hormone levels. Since increased levels of androgens, estrogen, and insulin are hallmarks of PCOS, finding ways to naturally regulate your hormones can offer effective relief for issues like PCOS belly, depression, mood swings, and high blood sugar. Look for natural PCOS supplements to support your body's ability to self-regulate and manage PCOS symptoms.

Women with PCOS often show deficiencies in several key nutrients, including vitamin D, B-complex vitamins (especially B12), magnesium, zinc, and chromium. When choosing a PCOS supplement, look for ingredients that target hormonal balance and metabolic health, such as inositol (particularly myo-inositol and D-chiro-inositol in a 40:1 ratio), berberine, N-Acetylcysteine (NAC), and spearmint. Additionally, omega-3 fatty acids, selenium, and evening primrose oil have shown promise in supporting overall hormonal health and reducing inflammation. The most effective supplements often combine these ingredients with adaptogenic herbs like ashwagandha that can help manage stress and support endocrine function.

Recognizing Early Signs of Hormonal Weight Gain

If preventing PCOS belly is your goal, learning how to recognize the early signs of hormonal weight gain is crucial. Here are some signs to look out for:

• Sudden, unexplained weight gain

• Frequent urination

• Irregular, missed, heavy, or light periods

• Weight gain concentrated in the abdomen or face.

• New sugar or carbohydrate cravings, even when full

• Mood swings or bouts of irritability and sadness

• Digestive problems or constipation
  

Consulting a healthcare professional is the best way to determine if you're experiencing early signs of hormonal weight gain. This weight gain may be due to normal hormone fluctuations around your period or it could be linked to PCOS, hypothyroidism, disorders of the hypothalamus, or Cushing's syndrome. 

Taking Control of Your PCOS Journey

Understanding and managing PCOS-related weight gain, particularly around the abdomen, requires a comprehensive approach that combines medical insight with personal advocacy. While the presence of a "PCOS belly" can be frustrating, it's important to remember that it's a manageable aspect of the condition. By working with healthcare providers to determine the right combination of treatments, incorporating targeted supplements like inositol, maintaining consistent healthy lifestyle habits, and addressing nutritional needs, you can make significant progress in managing your symptoms.

Remember that every person with PCOS has a unique experience, and what works best for one individual may not be the optimal solution for another. If you're concerned about PCOS-related weight gain or other symptoms, start by taking our PCOS Symptoms Quiz.

Be patient with your body as you implement changes, and don't hesitate to adjust your approach based on your body's response. Join a PCOS support group to connect with others who understand your journey and share experiences about what has worked for them.[6] With the right support system, proper medical care, and dedication to healthy lifestyle modifications, you can take meaningful steps toward managing PCOS-related weight gain and improving your overall well-being.