If you’ve recently been diagnosed with PCOS, it’s completely normal to feel overwhelmed — especially when conversations around weight feel confusing, loaded, or even quietly blaming. Many women I speak to describe feeling as though their body has changed without their consent, despite eating well, moving regularly, and “doing everything right.”

One phrase that often comes up in this space is PCOS Belly. It’s talked about frequently online, but rarely explained with enough nuance, compassion, or science. So let’s slow this down and talk about what it really means — and, just as importantly, what it doesn’t.

PCOS Belly is a non-medical term used to describe fat stored around the abdomen that sometimes occurs in women with polycystic ovary syndrome. It’s not a clinical diagnosis, and it’s not a reflection of your health, effort, or worth.

Research suggests that around 40–85% of women with PCOS are classified as overweight in medical literature, although this range is very broad and far from perfect¹. One of the main reasons abdominal weight gain can occur in PCOS is insulin resistance, which affects how the body handles blood sugar.

When insulin levels remain elevated, the body is more likely to store energy as fat — particularly around the midsection. Elevated insulin can also stimulate higher levels of androgens such as testosterone, which may further influence fat distribution around the abdomen³.

This creates a feedback loop: insulin resistance influences hormones, hormones influence fat storage, and fat storage can worsen insulin resistance. None of this is about discipline or willpower — it’s about physiology.

It’s also crucial to say this clearly:

• Not all women with PCOS have insulin resistance

• Not all women with PCOS gain weight

• PCOS exists across all body sizes

For women who do carry excess weight, studies show that a modest reduction of around 5–10% of body weight may improve insulin sensitivity, menstrual regularity, and fertility outcomes²³. This is not a requirement for health — it’s simply one possible therapeutic tool among many.

One of the most distressing things about PCOS Belly is how resistant it can feel. Many women tell me they’re eating balanced meals, exercising regularly, and still seeing no change — or even continued weight gain.

There are a few reasons this can happen:

• Metabolic adaptation: Chronic dieting or restriction can slow metabolism, making weight loss harder over time

• Hormonal prioritisation: When insulin, cortisol, or androgens are elevated, the body prioritises fat storage for protection

• Stress physiology: High stress signals the body that it’s not safe to let go of energy reserves

This isn’t a failure — it’s your body trying to keep you safe in the only way it knows how.

PCOS looks different for everyone, and so does PCOS Belly. Some women notice clear changes in their midsection, while others don’t experience abdominal changes at all.

This is one of the most common areas of confusion.

• PCOS Belly refers to longer-term fat distribution linked with insulin and hormones

• Bloating is often temporary and related to digestion, food sensitivities, or gut motility

• Inflammation can cause both bloating and fluid retention and is commonly elevated in PCOS⁴

You can experience one, two, or all three — and each requires a slightly different kind of support.

PCOS Belly isn’t a cosmetic issue — it reflects underlying metabolic and hormonal activity.

Chronic stress raises cortisol, which can worsen insulin resistance and encourage fat storage around the abdomen⁸. Stress management is not optional in PCOS care — it’s foundational.

Low-grade inflammation is common in PCOS and can worsen hormone signalling and insulin sensitivity⁴.

Emerging research suggests gut health may influence insulin resistance and androgen levels. Regular meals, fibre, and gentle consistency can be supportive.

PCOS Belly is not caused by laziness, lack of discipline, or “not trying hard enough.” Hormones drive metabolism — not the other way around.

You don’t need extreme diets to support PCOS. Research supports:

• Low glycaemic index eating, which stabilises blood sugar⁴

• Mediterranean-style patterns, rich in fibre, fats, and antioxidants

Anti-inflammatory foods that may help include:

• Leafy greens, berries, nuts, and seeds

• Beans, lentils, and whole grains

• Olive oil and omega-3 fats

Many women with PCOS are also lower in magnesium, zinc, and iron, so personalised guidance is always recommended.

Exercise helps PCOS because it improves insulin sensitivity — not because it burns calories.

• Resistance training has been shown to reduce abdominal fat and improve lean mass⁵

• Moderate, consistent movement is linked with improved ovulation, regardless of exercise type⁶

The best exercise for PCOS is the one you can return to without fear or burnout.

Poor sleep worsens insulin resistance and cortisol regulation⁷. Aim for:

• Consistent bed and wake times

• Reduced screens before bed

• A calming evening routine

• Around 7–9 hours of sleep, where possible

Chronic stress worsens insulin resistance and symptom severity⁸.

Helpful supports include:

• Gentle movement

• Mindfulness or breathing exercises

• Creative outlets

• Clear boundaries

• Emotional support

Professional mental health support is a valid and powerful tool.

Yes. Many women with PCOS never experience abdominal weight gain. PCOS Belly is not universal.

Hormonal imbalances, insulin resistance, and stress hormones can all influence how easily the body stores fat.

Some supplements may support insulin sensitivity or inflammation, but these should always be personalised and guided by a professional.

PCOS may increase the risk of metabolic, reproductive, and endometrial concerns over time. Early, supportive care matters.

PCOS cannot be cured, but symptoms may improve when hormones and insulin are supported. Weight loss is not a requirement for care.

Managing a PCOS Belly isn’t about fixing your body — it’s about understanding it.

Your body isn’t broken. It’s responding to hormones, stress, and metabolism in ways that deserve compassion and evidence-based support. Small, consistent changes — made gently and sustainably — can make a meaningful difference over time.

You are not to blame. And you don’t have to navigate this alone.

1. Alvarez-Blasco F et al. Arch Intern Med. 2006;166(19):2081–6.

2. Magkos F et al. Cell Metab. 2016;23(4):591–601.

3. Legro RS et al. J Clin Endocrinol Metab. 2016;101(7):2658–66.

4. Manta A et al. Nutrients. 2023;15(15):3483.

5. Kogure GS et al. Med Sci Sports Exerc. 2016;48(4):589–98.

6. Harrison CL et al. Hum Reprod Update. 2011;17(2):171–183.

7. Beccuti G, Pannain S. Curr Opin Clin Nutr Metab Care. 2011;14(4):402–12.

8. Yan YX et al. J Epidemiol. 2016;26(7):355–60.