Weight loss can be especially challenging for women with PCOS (Pratama et al., 2025) because of hormonal imbalances. Hormones are your body’s chemical messengers that regulate blood sugar, fat storage, appetite, inflammation, sleep, and stress response. When disrupted, they cause the body to hold onto fat and burn calories less efficiently, even with healthy eating and exercise. Let’s look at these factors in detail. 1. Insulin Resistance and Metabolism Insulin is a hormone responsible for moving sugar (glucose) from your blood into your body’s cells, to be used as energy. Upto 70% of women with PCOS have insulin resistance (Marshall & Dunaif, 2012), which means their cells don’t respond well to insulin’s signals. When your cells resist insulin, sugar builds up in the bloodstream, so: Body produces more insulin to bring blood sugar down and provide energy to cells High insulin signals your body to store more fat, especially around the belly, for extra energy reserves This slows down metabolism because the body senses excess energy, and burns fewer calories to conserve resources Common signs: Feeling tired after meals, craving sugar or carbohydrates, and struggling to lose weight despite controlling calories. 2. Elevated Androgen Levels Androgens, often called “male hormones,” are naturally produced in small amounts in women too. These hormones, like testosterone, play a key role in maintaining bone strength, muscle health, mood regulation, and sex drive (Ye et al., 2021) In women with PCOS, the hormonal signals that control the ovaries get disrupted. High insulin levels directly stimulates the cells in the ovaries to produce more androgens (Baptiste et al., 2010) These excess hormones then: Trigger a stress like response, signalling fat cells to store more energy as a backup Disrupt appetite by interfering with brain signals that control hunger, leading to increased cravings Causes more muscle breakdown, further lowering metabolism since muscle burns more calories than fat 3. Chronic Inflammation Inflammation is your body’s natural response to injury or infection, usually helping to heal and protect you. PCOS is often linked to low-grade chronic inflammation (Gonzalez et al., 2022), a low level, ongoing immune response that stays active over time, even when there is no obvious injury or infection. This happens because of hormonal imbalances, insulin resistance, and lifestyle factors like stress, poor sleep, and diet. This constant immune activity can: Releases molecules that interfere with how your cells produce energy (Dey et al., 2023) Slows down your metabolism, so you burn fewer calories at rest Makes it harder for the body to burn fat efficiently 4. High Cortisol Levels & Poor Sleep Cortisol is your body’s main stress hormone. It naturally peaks in the morning to wake you up and drops at night to help you sleep. In women with PCOS (Zhou et al., 2023), hormonal imbalances like high insulin and androgen levels increase sensitivity to stress. But chronic stress and hormonal imbalances keep cortisol levels elevated even at night, disrupting the natural sleep-wake cycle. This keeps the brain alert and lowers melatonin, making it harder to fall and stay asleep. High cortisol signals the body to hold onto extra fat Cortisol signals the liver to release glucose for energy for “fight or flight”, increasing blood sugar levels Poor sleep quality raises ghrelin (the hunger hormone) and lowers leptin (hormone that makes you feel full), increasing appetite and cravings. Together, these effects create a cycle that makes losing weight more challenging for women with PCOS. 5. Gut Microbiome Changes Your gut is home to trillions of bacteria that help digest food, regulate your immune system, and even influence hormones. Emerging research shows that people with PCOS often have altered gut bacteria (Sun et al., 2023), which can: Affect insulin sensitivity Certain bacteria trigger ongoing low-grade inflammation, slowing metabolism and disrupting hormone signals Affecting energy balance by changing how the body processes nutrients Why it matters: Supporting gut health with fiber-rich foods, probiotics, and less processed food can improve hormone balance and help with weight management in PCOS.