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Women’s health

PCOS, menopause and weight: what changes and what helps?

Hormones shape where the body stores fat and how it responds to treatment. Here’s what changes with PCOS and menopause, and what the evidence supports.

Written by Dr. Richard Kowalsky, MD, board-certified in obesity medicine Last updated Sources cited Editorial policy

6 min readPublished Updated

Weight isn’t only about calories in and out. For many women, hormones play a large part in when weight changes, where it settles, and how hard it is to shift. Two common examples are polycystic ovary syndrome (PCOS) and the menopause transition.

PCOS and weight

PCOS is one of the most common hormonal conditions in women of reproductive age. It often involves insulin resistance, which makes weight gain more likely and weight loss harder, and it raises the risk of type 2 diabetes. The 2023 international PCOS guideline recommends healthy lifestyle care for all women with PCOS. It notes that in women with excess weight, even modest weight loss can improve metabolic and reproductive features.[1]

The guideline also supports anti-obesity medications as an option for adults with PCOS alongside lifestyle care. Because some of these medicines must be avoided in pregnancy, their use is planned together with contraception and any pregnancy plans.[1][3]

The menopause transition

Many women notice their body changing in their 40s and 50s, even with the same habits. The Study of Women’s Health Across the Nation (SWAN) followed women through this transition. Fat gain roughly doubled and lean (muscle) mass began to decline as the transition started, and both trends continued until about two years after the final menstrual period before leveling off.[2]

The same habits can give different results at 52 than at 32. That’s a reason to adjust the plan, not to give up.

What helps

  • Strength training helps protect muscle, which naturally declines around menopause.
  • Protein at each meal supports muscle and fullness.
  • Sleep care. Night sweats and insomnia affect appetite and energy, so treating them helps weight care too.
  • Screening for weight-related conditions, including blood sugar, blood pressure and cholesterol.
  • Medication, when appropriate, chosen with your full health history in mind.

A coordinated approach

Severe obesity is more common in US women than in men: 12.1% compared with 6.7% in the latest national data.[4] Women’s weight care works best when it’s coordinated with gynecologic care, so that contraception, pregnancy plans, menopause symptoms and medications all fit together.

Sources and references

  1. Teede HJ, Tay CT, Laven JSE, Dokras A, Moran LJ, Piltonen TT, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023;108(10):2447-2469. View source
  2. Greendale GA, Sternfeld B, Huang M, Han W, Karvonen-Gutierrez C, Ruppert K, et al. Changes in body composition and weight during the menopause transition. JCI Insight. 2019;4(5):e124865. View source
  3. Grunvald E, Shah R, Hernaez R, Chandar AK, Pickett-Blakely O, Teigen LM, et al.; AGA Clinical Guidelines Committee. AGA clinical practice guideline on pharmacological interventions for adults with obesity. Gastroenterology. 2022;163(5):1198-1225. View source
  4. Emmerich SD, Fryar CD, Stierman B, Ogden CL. Obesity and severe obesity prevalence in adults: United States, August 2021–August 2023. NCHS Data Brief, no. 508. Hyattsville, MD: National Center for Health Statistics; 2024. View source

This answer is general education for adults and isn’t a substitute for a personal medical evaluation. Individual results vary. In an emergency, call 911.

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