This post was updated on March 30th, 2023
By Kym Campbell, BSc. | Updated March 30th, 2023
Excess belly fat is a common problem for most women with PCOS. Even lean women with PCOS often struggle with this symptom.
To tackle PCOS belly fat, you need to understand the underlying causes. This article explains these mechanisms. From there, it’s a short hop to evidence-based solutions. As you might expect, eating the right kind of diet is key. Other evidence-based lifestyle interventions make a big difference too.
As a companion to this article, I’ve created a free 3-Day Meal Plan. The meal plan, recipes, and shopping list included in this pdf can help you follow a PCOS-friendly diet.
You can also sign-up for my next free 30-Day PCOS Diet Challenge. During this live event, you’ll receive weekly meal plans and video lessons within a supportive online community. This program has helped hundreds of thousands of women beat PCOS.
What is a PCOS Belly?
There are three reasons why your stomach can look big. Bloating, subcutaneous fat, and visceral fat.
Bloating occurs when you have excess gas within your GI tract. This can be caused by irritable bowel syndrome or food sensitivities. Constipation or microbial overgrowths also cause bloating.
Subcutaneous fat is the fat you can see under your skin. It’s the soft stuff that you can pinch (or grab). Visceral fat, by contrast, is fat that sits around your organs. You can’t see visceral fat but it pushes your abdominal wall outwards. This creates the classic beer-belly look. The abdominal wall is made of muscle and tough fibrous tissue which is why visceral fat makes your abdomen hard.
For women with PCOS, all three of these factors are usually at play. This can create confusion. But it’s also an opportunity for an easy win.
A lot of women join my free 30-Day PCOS Diet Challenge because they want to lose belly fat. Doing this in a healthy way is a slow and steady process. But bloating can often be addressed quickly. If you’re dealing with bacterial or fungal overgrowth things can take longer. But in most cases, dietary change can ease bloating within weeks, if not, days.
Relieving bloating reduces your waist circumference. Racking up some easy wins like this makes it easier to stick with the dietary changes that help with belly fat over the longer term.
The Root Causes of PCOS Belly Fat
Women with PCOS have higher central abdominal fat deposits independent of body mass index .
This is why normal-weight women get a PCOS tummy too [2-4]. It’s also why, from a treatment perspective, I don’t differentiate between different types of PCOS. Lean women tend to have a milder form of PCOS, but all PCOS phenotypes exist on the same spectrum. This means that the solution is the same too.
The root causes of PCOS are well understood. PCOS is driven by poor insulin regulation, elevated androgens, and chronic inflammation [5-10]. Diet is also a key factor in PCOS pathology .
Other factors contribute to PCOS belly fat too. Stress and cortisol responsiveness is strongly associated with abdominal obesity . PCOS women may be particularly at risk here as studies show we have a “disturbed stress response” .
Thyroid dysfunction is another common underlying cause of PCOS belly fat. Autoimmune thyroiditis affects more than one in four women with PCOS [14, 15]. Many of these cases are undiagnosed.
Understanding these mechanisms points us toward the solutions to PCOS belly fat.
1. Regulate Insulin with Diet
Insulin resistance and body fat are intricately linked [16, 17]. Focusing on lifestyle changes that improve insulin sensitivity can solve both of these issues.
Following a PCOS diet is key. PCOS women with insulin resistance experience elevated insulin levels after consuming carbohydrate-rich foods. This is because one of insulin’s many roles is to transport glucose from the blood into the body’s tissue where it’s either used or stored.
Research has shown that a typical Western diet is not appropriate for women with PCOS . Most people eat too much sugar and carbs. What women with PCOS need instead is to eat fewer carbs sourced from low-GI whole foods. This usually also means dramatically cutting sugar intake.
Fats and proteins have minimal impact on blood glucose levels. Consuming fat and protein with carbs actually slows the rate at which blood glucose levels rise. Dietary fiber also has this effect.
This is why it’s recommended that women with PCOS eat a low-carb, high-fat, adequate protein diet. I explain this further in my article on the best macros for PCOS. If you want to lose PCOS belly fat, then getting your macros right is essential.
For examples of what a macro-balanced PCOS diet looks like, download this free 3-Day Meal Plan. Or sign-up for my next free 30-Day PCOS Diet Challenge.
2. Regulate Insulin with Supplements
Metformin is the most widely used pharmaceutical for improving insulin regulation in women with PCOS. But experts now warn against its use for this purpose. As I explain in my article on Metformin for PCOS, this drug doesn’t help much with weight loss either.
Fortunately, other natural medicines may be better.
Inositol is one of the best supplements for PCOS. This class of vitamin-like compounds has insulin-regulating effects. But like metformin, the impact on weight loss is small.
Berberine and Vitamin D are possibly the best PCOS belly supplements. Berberine redistributes fat in the absence of weight loss . It also improves insulin regulation and is well-demonstrated as an effective PCOS natural treatment [19, 20]. As I explain in my article on Vitamin D for PCOS, women with PCOS need to ensure they have adequate levels of this essential nutrient. Given its health-wide impact, insufficient vitamin D is a significant barrier to PCOS weight loss. Supplementation is required for most women.
Magnesium also appears to be important. Studies show that having normal magnesium levels is essential for optimal insulin regulation . A recent review of the literature supported the importance of this mineral for women with PCOS. Magnesium combined with vitamin E or zinc-calcium-vitamin D improved metabolic biomarkers . Women with PCOS have increased risks for mineral deficiencies . Given this hazard, nutrient supplementation can be another easy win in your battle with a PCOS belly.
3. Regulate Insulin with Lifestyle
Other lifestyle changes also improve insulin sensitivity.
Studies show that strength training and aerobic activity improve insulin sensitivity in women with PCOS [24-26].
Intermittent fasting has also been demonstrated in PCOS populations. Limiting eating to within eight hours each day can improve body composition and insulin resistance. Menstruation, chronic inflammation, and androgen regulation can also be improved by fasting .
Insufficient sleep is another risk factor for insulin resistance [28-30]. Better rest at night has many other benefits that can help you reduce belly fat. Inadequate sleep makes you less active and impacts your eating habits [31, 32]. For example, getting more sleep reduces sugar cravings [33, 34].
4. Lower Androgen Levels
Elevated androgens like testosterone are one of the hallmarks of a PCOS diagnosis. Elevated androgen levels are closely associated with insulin resistance. Some researchers believe these two factors are the main causes of PCOS .
With this in mind, anything that lowers androgens can help with belly fat due to PCOS.
The best way to lower androgens is to improve insulin sensitivity (see above). Reducing inflammation also helps.
5. Reduce Inflammation
Chronic inflammation is one of the underlying mechanisms that cause PCOS [6-11]. That’s why reducing inflammation helps with PCOS belly on several fronts.
Inflammation occurs when the body’s immune system is triggered. There are many ways that our everyday environment creates an inflammatory burden. Endocrine disruptors found throughout the household can exacerbate pre-existing PCOS inflammation. Other factors like poor air and water quality, or chronic infections also drive an inflammatory response.
The biggest source of inflammation for women with PCOS though occurs through the gut.
Inflammation occurs whenever intestinal permeability is compromised . There are several common causes of increased gut permeability:
- Imbalances in the gut microbiome 
- Sugary foods 
- “Vegetable oils” 
- Gluten-containing foods [39, 40]
- Dairy products (for people with dairy intolerances) 
- Other food allergies or intolerances
The impact of these foods to avoid with PCOS guides the creation of my PCOS recipes. The meal plans I provide during my free 30-Day PCOS Diet Challenge are all gluten and dairy-free. Same with those in my free 3-Day Meal Plan. I don’t use vegetable oils and sugar is kept as low as practical. A healthy gut microbiome is also promoted through the consumption of prebiotic vegetables. The results speak for themselves.
6. Relieve Stress
Stress and obesity are trapped in a vicious cycle. Obesity causes stress and stress causes obesity .
Stress causes abdominal fat accumulation by increasing cortisol secretion [43, 44]. It also alters our behavior making weight loss more difficult .
Researchers have tried to break this cycle with evidence-based interventions. For example, a mindfulness program for stress eating showed some promise. Improvements in mindfulness, stress and cortisol were associated with reductions in abdominal fat .
But there are many other practical ways to help relieve stress. Slow down, cut yourself some slack, and connect with people you love. Getting more sleep and making time for exercise can also help.
Many women want to know is coffee bad for PCOS. Your sensitivity to stress plays a large role in answering this question. From what I’ve seen in the laboratory of real life, among other things, quitting caffeine helps get rid of stomach fat.
7. Get Your Thyroid Sorted
As I mentioned already, thyroid dysfunction is a common comorbidity of PCOS . It’s also closely associated with obesity .
Because PCOS and thyroid dysfunction shares so many similarities, a PCOS diet also helps with an underactive thyroid. But sometimes diet alone isn’t enough.
Depending on your circumstances, you may need medical assistance. This can further enhance your efforts to get rid of excess stomach fat. To understand your unique requirements, it’s important to get a full thyroid panel. You don’t want to rely on the standard tests for TSH and T4. These thyroid biomarkers can be normal in women with PCOS despite an underlying thyroid disorder. A proper diagnosis can only be made with a thyroid panel that includes TBG, T3, and reverse T3 biomarkers.
Speak with your doctor about getting these tests.
The Bottom Line
Bloating and excess stomach fat are common issues within the PCOS community. Bloating can often be resolved quickly. But a slow and steady approach is best for reducing belly fat.
Many interventions target the underlying causes of PCOS belly. Dietary change is the most important place to start. For help putting a PCOS diet into practice, sign-up now for my free 30-Day PCOS Diet Challenge. Or begin today with this free 3-Day Meal Plan.
Other lifestyle factors also play a role in reducing excess stomach fat. These include fasting, exercise, sleep, and stress reduction. If you need more help than what you can achieve on your own, speak with your doctor about a full thyroid function test. Nutritional supplements that can improve insulin sensitivity are also worth considering.
Ready To Take Action?
Combining rigorous science and clinical advice with a pragmatic approach to habit change, Kym is on a mission to show other women how to take back control of their health and fertility. Read more about Kym and her team here.
Quick Disclosure: Some of the links on this page may be affiliate links. This means that when you use them to purchase something, it won't cost you more but I may get paid a commission for referring you. In order to avoid any prejudice, I only recommend products that I personally use or would have recommended anyways.
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