The hormonal weight gain of PCOS, menopause, and some types of birth control is caused by a combination of insulin resistance and androgen excess.
Here’s what you need to know.
Insulin resistance causes abdominal weight gain
Insulin resistance is the condition of having chronically elevated levels of insulin. It’s also called hyperinsulinemia, metabolic syndrome, or pre-diabetes.
There’s growing evidence that high insulin causes abdominal weight gain by increasing appetite, preventing fat-burning, and promoting fat storage.
Do you have insulin resistance? Are you sure? A test for blood glucose is not a test for insulin resistance. To assess insulin, you have to test insulin either as fasting insulin or a glucose tolerance test with insulin (also called an insulin assay or Kraft test). You then look at your insulin reading, not your glucose reading. A healthy fasting insulin should be less than 60 pmol/L (8 mIU/L). One hour after the sugar challenge, insulin should be less than 410 pmol/L (60 mIU/L).
High insulin can cause abdominal weight gain; so can high testosterone.
The link between testosterone and insulin resistance
In women, a higher level of testosterone increases the risk of insulin resistance and abdominal obesity. (In men, it has the opposite effect.)
The link between testosterone and insulin resistance is most clear with the hormonal condition PCOS, in which high androgens cause insulin resistance and delay ovulation. Delayed ovulation causes low progesterone and therefore robs the system of progesterone’s beneficial anti-androgen effect. Which in turn, causes more high androgens and more insulin resistance, creating a vicious cycle.
Other situations of relatively high androgens include menopause and progestins (birth control) with a “high androgen index” such as levonorgestrel, norethindrone, etonogestrel, and medroxyprogesterone, found in many pills, Nuvaring, Mirena IUD, Nexplanon implant, and Depo-Provera shot. In fact, the depo shot has been observed to cause “unstoppable weight gain.”
Progesterone, on the other hand, promotes weight loss (see below).
So, there’s a bi-directional relationship between high testosterone and insulin resistance.
In one direction, insulin resistance or high insulin can stimulate ovarian cells to make more testosterone. That happens with PCOS and menopause.
In the other direction, testosterone can cause or worsen insulin resistance. That happens with PCOS, menopause, and androgenic progestins.
👉🏽 Tip: Non-androgenic progestins such as drospirenone and cyproterone promote weight loss and but can cause rebound weight gain when you try to stop them.
Estrogen and progesterone are good for weight loss
Both estrogen and progesterone have a beneficial anti-androgen effect to break the vicious cycle of testosterone and insulin resistance. For example, estrogen directly improves insulin sensitivity and lowers testosterone by increasing sex hormone-binding globulin (SHBG), the protein that binds and inactivates testosterone. Progesterone promotes weight loss by stimulating metabolic rate and lowering testosterone. See Professor Jerilynn Prior’s protocol of cyclic progesterone therapy for PCOS. It also improves insulin sensitivity (but only in the presence of estrogen).
👉 Tip: There’s no progesterone in hormonal birth control. Contraceptive drugs are progestins, many of which are androgenic or testosterone-like.
How to treat the hormonal weight gain of PCOS, menopause, and hormonal birth control
The strategy is two-fold: 1) reverse insulin resistance and 2) lower androgens, which been shown to improve insulin resistance in women.
- To reverse insulin resistance, follow the recommendations in my updated blog post Reverse insulin resistance in 4 easy steps.
- To lower androgens, try to establish regular ovulation to make estrogen and progesterone. You can also consider using cyclic progesterone therapy or other natural anti-androgen supplements.
👉🏽 Tip: If you are in menopause, you can no longer ovulate to make estrogen and progesterone and may need to consider body-identical estrogen and progesterone.
Ask me in the comments!