The reason why likely has to do with certain processes in the body that can both increase your weight and toss your hormones off-kilter, and how GLP-1s can affect them. Read on to learn why weight and PCOS can be so intricately intertwined, and how GLP-1 drugs might snap the feedback loop between the two and resolve symptoms along the way.
Weight gain and PCOS can have a tricky bidirectional relationship in some people.
As noted, PCOS symptoms generally happen when your ovaries produce an excess of androgens, or stereotypically “male” hormones like testosterone. The resulting hormonal imbalance can screw with your reproductive cycle, specifically the normal development of egg follicles, and leave you with a bunch of tiny fluid sacs (hence, “polycystic”). It can also make your periods irregular and trigger the hormonal fallout of acne, excess facial hair, scalp hair loss, and mood changes commonly associated with the disorder. Though doctors don’t know what initially causes PCOS, they have pinpointed a few processes that can drive the overproduction of androgens in the condition, one of which can have a simultaneous (and related) effect on weight in certain folks.
In particular, up to 70% of people with PCOS have insulin resistance; that means your cells don’t respond well to insulin, the hormone that tells them to use glucose (a.k.a sugar) from food as energy, Christina Boots, MD, a reproductive endocrinologist at Northwestern Medical Group, in Chicago, tells SELF. When insulin is ineffective, more glucose winds up floating around in your blood, which prompts your pancreas to overcompensate and produce even more insulin, Dr. Boots explains, as it tries to get your cells to pick up and use the excess sugar. All that insulin triggers your ovaries to pump out extra androgens, leading to PCOS symptoms. (High blood sugar levels can also cause prediabetes and up your risk for type 2 diabetes, both of which commonly co-occur with PCOS.) At the same time, your body stores the unused glucose as fat, which can prompt weight gain, Dr. Boots says.
A vicious cycle unfolds from there: Carrying more weight may pump up the size of your fat cells and trigger inflammation, both of which can make it even tougher for your cells to respond to insulin. Which again, spurs the production of excess insulin, and in turn, the surge of androgens that can trigger the full slate of PCOS symptoms. Those extra androgens can also “predispose you to weight gain, particularly the accumulation of fat around your middle,” for reasons we don’t quite understand, Basma Faris, MD, a board-certified ob-gyn at Mount Sinai West, tells SELF. Plus, all these metabolic shifts can screw with the hormones that regulate appetite, she adds, which can keep you from feeling full…and prompt you to eat more, further contributing to weight gain.
That said, it’s important to point out that just because weight gain may exacerbate PCOS doesn’t mean that it is the cause, Dr. Faris notes. Attributing someone’s PCOS solely to their weight creates unfair blame and shame, she says. In reality, there are likely genetic factors that may set you up for both weight gain and PCOS. There are also women with PCOS who do not have a high weight or the above metabolic dysfunction that can worsen the condition, Dr. Boots notes. But again, for those who do have PCOS and a higher weight, plenty of data suggests that the two can fuel and feed into each other.
GLP-1s may help break the vicious cycle of weight gain and PCOS symptoms in people who experience both.
The reason GLP-1s are “really exciting [for people with PCOS]” is because they can remove the barriers to weight loss that can keep people with the condition stuck in the above cycle, Kerry Krauss, MD, a board-certified ob-gyn in Philadelphia and medical director at Natural Cycles, tells SELF. In particular, the drugs can boost insulin sensitivity (in part by slowing the passage of food in the GI tract) and act on parts of the brain that influence appetite and cravings, all of which can reduce that never-quite-full feeling common in folks with PCOS.
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