Losing weight with PCOS can be challenging: Understanding the role of insulin resistance, hormones and lifestyle

PCOS-related weight gain isn't simply about lifestyle. Here’s what women need to know about the role of hormones and metabolism.

For many women with PCOS, weight loss can feel like an uphill battle. They may be watching what they eat, exercising regularly and doing everything they have been advised to do, yet the results may be slower than expected. This can be frustrating and is often reduced to a simple message: ‘eat less and exercise more.’ But PCOS is much more complex than that. In an interview with HT Lifestyle, Dr Seema Daksh, MBBS, MD, DM, consultant endocrinologist, Yatharth Super Speciality Hospital, Noida, explained what works in PCOS.

Understanding PCOS

According to Dr Daksh, PCOS is a hormonal and metabolic condition, and before labelling someone as having PCOS, it is important to make sure there isn’t another underlying hormonal disorder causing similar symptoms. Not every irregular period or excess facial hair is PCOS. Several endocrine conditions can look very similar.

Not every irregular period or excess facial hair is PCOS. Several endocrine conditions can look very similar.

“Hypothyroidism, high prolactin levels and non-classic congenital adrenal hyperplasia can cause menstrual disturbances or features of androgen excess,” said Dr Daksh. Cushing syndrome may be associated with weight gain and irregular periods, while, rarely, ovarian or adrenal tumours can produce excess androgens.

Dr Daksh highlighted that one important piece of the puzzle is insulin resistance, which is common in PCOS, though not every woman with PCOS has it. When the body does not respond efficiently to insulin, it produces more insulin to compensate. Higher insulin levels can favour fat storage and can also stimulate the ovaries to produce more androgens, contributing to acne, unwanted facial hair and irregular periods. Weight gain, particularly around the abdomen, can in turn worsen insulin resistance. This creates a cycle that can make losing weight more difficult.

“At the same time, it is important to remember that sometimes, difficulty losing weight may have another hormonal explanation: the secondary causes of PCOS,” said Dr Daksh. If an underlying hormonal disorder remains unrecognised and untreated, a woman may struggle to lose weight despite genuine efforts with diet and exercise. This is why looking beyond the weighing scale and identifying—and treating—any underlying endocrine disorder is an important part of PCOS evaluation and weight management.

What actually helps?

Diet and exercise remain extremely important, but the approach needs to be realistic rather than restrictive. Instead of chasing crash diets, the emphasis should be on habits that can be sustained and balanced meals with adequate protein and fibre, good-quality carbohydrates, regular physical activity, resistance training, adequate sleep and better stress management.

Diet and exercise remain extremely important, but the approach needs to be realistic rather than restrictive.

For women who are overweight, even a 5–10% reduction in body weight can bring meaningful improvements in metabolic health and may improve menstrual regularity and ovulation. Progress does not have to mean dramatic weight loss.

Lifestyle changes are the foundation, but they may not always be enough. Depending on the individual symptoms , medications such as metformin or evidence-based weight-management therapies, and hormonal pills may be considered under medical supervision.

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.