PCOS and Weight Lifting

PCOS is one of the most common and complex endocrine disorders that comprises irregular periods and ovulatory problems, higher than normal testosterone (which can present as acne, unwanted hair on the body and hair loss on the scalp), and infertility. In 80% of women with PCOS, weight loss can be especially difficult and insulin resistance is commonly seen. Long-term, there is a higher risk for developing cardiovascular disease, diabetes and endometrial cancer without proper treatment and lifestyle changes. Unfortunately, there are a number of other mental health and eating disorders in women suffering PCOS. A common problem regarding body image is likely perpetuated by being constantly reminded to lose weight and eat healthy, however are rarely prescribed a specific meal plan or exercise regiment.

To date, we don't really understand what causes PCOS, but what we do know is that in PCOS there is often insulin resistance which leads to higher insulin levels. This increased insulin can lead to higher fat storage, induces higher production of testosterone in the ovaries (which is what gives it its unique appearance on ultrasound) which leads to irregular periods and infertility. In turn, high testosterone levels further increases insulin resulting in a vicious cycle of worsening insulin resistance, glucose intolerance, hyperandrogegism and potentially further weight gain. 

The diagnostic criteria of PCOS is still a matter of debate, but if you have been diagnosed with PCOS and are overweight/obese, implementing resistance training and improved nutritional habits can significantly improve certain hormonal parameters. This is because central (aka abdominal) fat is hormonally active causing worsening insulin resistance, higher estrogen and testosterone levels and can further worsen symptoms. Even small reductions in weight can be a big difference! Studies have shown that even 12 weeks of consistent exercise can significantly improve metabolic and hormonal parameters in women with PCOS (Tedee et al. 2018, P.B. Miller, 2005). Now, these lifestyle changes are not designed to focus on aesthetics, but rather your internal physical, mental and reproductive health. That being said, body recomposition is an inevitable side effective to weight training and proper nutrition and will results in reduced abdominal fat storage. 

 

So why specifically do weight lifting??

Progressive weight lifting results in muscle hypertrophy and promotes development of lean muscle mass, and with increased lean muscle mass, comes a higher basal metabolic rate. That means you burn more calories when resting compared to someone with less muscle mass. Though favorable changes can be seen after only 12 weeks, continued weight training can result in a leaner body habitus and improved health long-term. Even lean women with PCOS should really focus on proper nutrition and exercise since despite their lean bodies due to long term higher risk of cardiovascular disease, diabetes, and cancer. This is again a result of insulin resistance and abnormal lipid profiles seen. In fact, lean women with PCOS still have a higher waist circumference and body fat percentage when compared to weight matched women without PCOS. 

 

Though other forms of resistance and strength training are great (such as calisthenics), many movements are a lot more difficult to perform and progress with. Progressing in the amount of weight being lifted is one of the most effective ways to see results! 

Now, although lifestyle modification is the first line treatment for PCOS, this does not always replace pharmacotherapy. You may still need to be medicated (such as in the case of not having periods or persistently elevated blood sugar levels) and this should always be discussed with your doctor. But the primary goal of lifestyle optimization is to minimize your drug requirement and positively impact your overall health.