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You eat well, exercise regularly, and still your body seems to be changing in ways that are hard to explain. The scale barely moves or even goes up, despite your efforts. At the same time, your cycle becomes irregular or your period stops altogether. Many women first assume stress or diet is to blame. But often, there is an underlying hormonal cause, such as PCOS.
You pay attention to your nutrition. You exercise regularly. Maybe you even track your calories. And yet something is happening that you cannot quite explain.
The scale barely moves – or even shows weight gain despite a calorie deficit.
At the same time, your cycle begins to change. Your period becomes irregular, or in some cases disappears completely.
You may have already searched for questions like:
Many women initially assume stress or diet is the reason. But often there is something else behind these symptoms: a hormonal cause.
One of the most common is:
PCOS – Polycystic Ovary Syndrome.
Many women with PCOS describe a similar pattern.
First their cycle changes. Then their skin. Their weight increases more easily than before. Over time, additional symptoms may appear, including:
Many of these symptoms are linked to elevated androgen levels, meaning higher levels of male hormones.
These hormonal changes can affect both the menstrual cycle and metabolism.
Yet instead of investigating the underlying cause, treatment often focuses only on the symptoms:
But the fundamental question often remains unanswered:
Why is this happening to me?
Polycystic ovary syndrome affects approximately 5–10% of women of reproductive age worldwide¹. Many women remain unaware that they have the condition.
Estimates suggest that up to 70% of cases remain undiagnosed², and it can take up to ten years before a clear diagnosis is made³.
A key factor in PCOS is metabolism. Research shows that up to 70% of women with PCOS have insulin resistance, even when fasting glucose levels appear normal⁴.
This has long-term consequences for health:
One of the most common questions women ask is:
“Why am I not losing weight despite a calorie deficit?” Or: “Why am I not losing weight despite exercising?”
If you visit a gynecologist and receive a diagnosis of PCOS, you are often prescribed hormonal contraception to “regulate” your cycle – and little else. What is frequently overlooked, however, is that for many women with PCOS the underlying issue lies in metabolic dysfunction.
Insulin is the hormone that regulates how the body stores and uses energy. When cells become less sensitive to insulin, a state known as insulin resistance- , the body compensates by producing more of it.
Chronically elevated insulin levels can:
This is why PCOS weight gain is often not a matter of discipline, but part of a hormonal imbalance.
Insulin resistance is now considered one of the central mechanisms in the development of PCOS⁷.
This is also why some women experience hormonal belly fat, even when maintaining a healthy lifestyle.
Another reason PCOS is often diagnosed late is that the condition does not look the same in everyone.
Some women primarily experience metabolic PCOS, which involves strong insulin resistance and weight gain.
Others may experience inflammatory PCOS, or adrenal PCOS, where stress hormones play a larger role.
Recent research suggests that PCOS may consist of different metabolic and reproductive subtypes⁸, which may explain why treatment responses vary between patients.
Some women also experience PCOS without insulin resistance, highlighting the biological complexity of the condition.
Common signs of hormonal imbalance or dysregulation in women associated with PCOS include:
Many women only seek help once fertility becomes a concern. It is not uncommon to hear: "You have PCOS. Come back when you want to get pregnant."
However, PCOS affects overall health long before fertility becomes an issue.
If you want to understand how hormone balance and cycle regulation can be addressed, read our next article:
→ How to Regulate Your Cycle Naturally: A Medical Approach to PCOS & Hormone Balance
1 Teede H. et al.
International Evidence-Based Guideline for PCOS
https://www.monash.edu/__data/assets/pdf_file/0003/3379521/Evidence-Based-Guidelines-2023.pdf
2 https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome
WHO PCOS Fact Sheet
3 Gibson-Helm M, Teede H, Dunaif A, Dokras A. Delayed Diagnosis and a Lack of Information Associated With Dissatisfaction in Women With Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2017
https://pmc.ncbi.nlm.nih.gov/articles/PMC6283441/
4 Amisi CA. Markers of insulin resistance in Polycystic ovary syndrome women: An update. World J Diabetes. 2022
https://pmc.ncbi.nlm.nih.gov/articles/PMC8984569/
5 Anagnostis P, Paparodis RD, Bosdou JK, Bothou C, Macut D, Goulis DG, Livadas S. Risk of type 2 diabetes mellitus in polycystic ovary syndrome is associated with obesity: a meta-analysis of observational studies. Endocrine. 2021
https://pubmed.ncbi.nlm.nih.gov/34176074/
6 Legro R. et al.
Journal of Clinical Endocrinology & Metabolism
https://pubmed.ncbi.nlm.nih.gov/9920077/
7 Zhao H, Zhang J, Cheng X, Nie X, He B. Insulin resistance in polycystic ovary syndrome across various tissues: an updated review of pathogenesis, evaluation, and treatment. J Ovarian Res. 2023
https://pmc.ncbi.nlm.nih.gov/articles/PMC9832677/
8 Dapas M. et al.
PLOS Medicine
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003132
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You are 44 years old. Sharp, organised, high-functioning. But lately you cannot find the word you are looking for mid-sentence. You wake at 3am and lie there for an hour. You are eating the same way you always have, but your waist is changing. Your hair is coming out in the shower. You feel like yourself but not quite yourself. Your GP ran blood work and said everything looks normal.What you may be experiencing are the early signs of perimenopause and they are some of the most commonly searched and least explained symptoms in women’s health. Brain fog, hormonal hair loss, night sweats, weight gain that does not respond to diet: these are not random. They are biological signals, each one pointing to a specific process that is shifting in your body. Understanding what is behind each symptom changes everything about what you can do about it.
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You eat well, stay active, and still your body begins to change. Your cycle becomes irregular, your period may disappear, or your weight increases despite doing everything “right.” Many women experience this combination without a clear explanation for a long time. Often, the cause is not lifestyle alone, but a deeper hormonal imbalance, such as PCOS.
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Many women experience cramps when their period begins. A pulling sensation in the lower abdomen, pressure in the pelvis, or pain that radiates into the lower back can occur during menstruation.For some women this discomfort lasts only a few hours. For others it can continue for several days and may even interfere with work, exercise, or sleep.This raises an important question many women ask themselves:Are painful periods normal?
