Hormonal
Obesity, particularly abdominal obesity, exacerbates hyperandrogenism and insulin resistance in women with PCOS, leading to poorer reproductive outcomes (anovulation, infertility) compared to normal-weight women with PCOS.
If you have PCOS and are overweight, your excess body fat (especially around the abdomen) is actively making your hormonal imbalance worse. It lowers SHBG and raises insulin, which drives up androgens and stops ovulation. Losing weight reverses this hormonal drive, improving your chances of pregnancy and reducing metabolic risks like diabetes.
Compared with normal weight women with PCOS, those with obesity are characterised by a worsened hyperandrogenic and metabolic state, poorer menses and ovulatory performance and, ultimately, poorer pregnancy rates.
Why this rating
This is a review article summarizing multiple studies; no primary data is presented, but the consensus is strong.
Source
Review article: The impact of obesity on reproduction in women with polycystic ovary syndrome
R. Pasquali et al. · BJOG An International Journal of Obstetrics & Gynaecology · 2006
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