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What Is PCOS Belly? Causes and Treatment

Polycystic ovary syndrome (PCOS) is a common hormonal imbalance. In PCOS, there are too many androgens (male sex hormones) that can lead to excess hair growth (hirsutism), weight gain, excessive accumulation of fat in the abdomen ('PCOS belly'), and acne. PCOS is associated with irregular periods, infertility, and a higher incidence of pregnancy complications, and some people have fluid-filled sacks in their ovaries seen by ultrasound. Fortunately, several lifestyle interventions and some drugs can help control PCOS symptoms.

Let us take a deeper look into what PCOS belly is, why it happens, and, most importantly, how to manage it.

PCOS belly: what is it?

The term 'PCOS belly' refers to the excessive accumulation of fat in the belly area in some people affected by polycystic ovary syndrome.

All individuals have a genetic and hormonal predisposition to store fat in determined places of their bodies (hips, thighs, arms, belly, glutes), which is why different body shapes exist. However, people designated female at birth who are affected by PCOS tend to store more fat in the belly area than they would under normal conditions.

What causes PCOS belly?

PCOS belly is associated with polycystic ovary syndrome (PCOS), a common endocrine disorder characterized by hormonal imbalances that can lead to irregular or absent periods, weight gain, fertility issues, and other health problems.

Specifically, PCOS belly may be a result of:

  • An excessive amount of male sex hormones, like testosterone, which can contribute to an increased storage of fat in the abdomen.
  • Insulin resistance, a state frequently associated with PCOS, which can affect your glucose metabolism (how your body metabolizes the sugar from your diet).
  • Increased low-grade inflammation

The factors mentioned above may contribute to excessive accumulation of fat, especially in the belly area, which can appear as a 'PCOS belly.' Nevertheless, abdominal obesity may also happen due to other health problems, such as hypothyroidism (underactive thyroid gland) and cardiovascular disease.

Additionally, factors like having a poor diet, lack of exercise, and unhealthy lifestyle habits (e.g., smoking and lack of sleep) can contribute to the appearance of a more prominent belly as well.

What does a PCOS belly look like?

Some people with a PCOS belly have an apple-shaped body, meaning that most of their fat is localized in the middle area of their body (abdominal fat). However, despite common misconceptions, apple-shaped bodies do not happen exclusively in people who are overweight or obese.

An apple-shaped body can also happen in a lean or even athletic person. It all comes down to the distribution of fat around their bodies.

In this case, people with PCOS belly will have a large waistline, which will look disproportionate when compared to the rest of their body, resulting in a rounder, more pronounced belly.

It is also important to differentiate abdominal fat from bloating. In bloating, the belly can look round due to the accumulation of gases or liquids in the intestines. It can come and go during the day, and it’s usually related to the ingestion of certain foods or drinks.

In the case of a round belly due to abdominal fat, the belly stays the same throughout the day.

Risks of PCOS belly

PCOS belly happens as a result of central obesity, which is defined as excessive visceral adipose tissue (fat that surrounds your organs).

Central obesity has been related to a higher risk of developing several diseases and conditions, such as:

  • Insulin resistance
  • Type 2 diabetes
  • Hypertension
  • Heart disease
  • High levels of cholesterol and triglycerides
  • Stroke
  • Infertility
  • Cancer

Furthermore, acne, hirsutism, and obesity in PCOS are associated with high stress levels. People with PCOS have an increased risk of suffering from mental health issues, including anxiety and depression.

How to manage PCOS belly

PCOS causes weight gain, insulin resistance, and other metabolic problems that affect how the body distributes fat and metabolizes (breaks down) food.

This creates a cycle where hormonal imbalances lead to weight gain and central obesity, which worsens insulin resistance, making it even more challenging for individuals with PCOS to keep their weight under control.

Unfortunately, there is no cure for PCOS. However, its symptoms can be controlled with proper treatment and weight management interventions, and there are many approaches to reducing the characteristic 'PCOS belly.'

Dietary changes

Eating a healthy, balanced diet can significantly help you get your glucose (sugar) metabolism and overall metabolic health back on track.

Increasing your intake of fresh fruits and vegetables, along with lean meats, fish, whole grains, and healthy fats (e.g., olive oil and avocados), can help you lose weight, which in turn will help your body regulate its endocrine (hormone) system.

Avoid eating and drinking ultra-processed and sugary foods and beverages, like fast-food meals, pre-made meals, pastries, candies, and regular soft drinks.


Any type of physical activity is better than none. If you are not used to exercising, you can start by walking, cycling, or swimming 30 minutes per day, at least five days a week.

Once you feel ready, add weight lifting and vigorous-intensity exercises, such as high-intensity interval training (HIIT), for at least 90 minutes per week.

Exercising has been proven to positively impact glucose metabolism and decrease insulin resistance, which can further help you lose weight.

Stress management

Stress impairs your body’s ability to regulate your hormone and glucose metabolism. When you experience stress, your body activates the hypothalamic-pituitary-adrenal (HPA) axis (a stress-response system), which releases several hormones, including cortisol.

Cortisol, also known as the stress hormone, raises glucose levels in your blood and makes your cells less sensitive to insulin (insulin resistance). Insulin resistance causes cells to be less efficient in taking up glucose from the bloodstream, which leads to even higher blood glucose levels and can eventually lead to type 2 diabetes.

Additionally, cortisol also affects the metabolism of fats, proteins, and carbohydrates, and potentially encourages the storage of fat in the abdomen. Therefore, controlling your stress levels can help you lose weight and improve your body fat composition.

Some effective stress reduction techniques include meditation, mindfulness, and breathing exercises.

Lifestyle modifications

Consistency in your diet and exercise routine is the most important lifestyle habit you need to incorporate into your daily life.

However, other healthy lifestyle habits that can help you regulate your metabolic health include sleeping for at least eight hours each night, avoiding smoking, abstaining from excessive caffeine and alcohol intake, and staying well hydrated.


Certain supplements, like inositol and omega-3, may potentially help you control your PCOS symptoms and have a positive impact on the appearance of PCOS belly. However, every person and body is different. So, remember to always consult with your healthcare provider before taking any supplements.

Although PCOS is a common disorder that affects nearly 10% of people assigned female at birth in the world, other conditions and diseases can also cause some of the symptoms of PCOS, including thyroid disease and tumors of the ovaries, adrenal glands, and pituitary gland.

Diagnosis of PCOS is made based on blood tests and pelvic ultrasound, and treatment often involves weight management, dietary changes, exercise, and stress reduction. Certain drugs like birth control pills can also help in some cases.

When all the previous alternatives fail, invasive procedures like laparoscopic ovarian drilling or bariatric surgery may be recommended by your doctor.

Thus, seeking early medical attention is imperative to get PCOS symptoms under control and prevent or treat possible health complications, like type 2 diabetes, heart disease, and infertility.


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