How to manage your PCOS with exercise

23/07/2024 / Esther Wainwright

Medically Reviewed by Hertility on July 23, 2024

PCOS is one of the most common reproductive health conditions. Some of the most common symptoms people struggle with are physical symptoms such as issues with weight; skin and hair related issues such as acne or excessive hair growth and irregular periods. These are mainly driven through disrupted hormones. Androgens are a group of hormones, including testosterone, that are made in the ovaries and are often found at much higher levels in women with PCOS, called “hyperandrogenism”. Insulin is also found to be at much higher levels, due to insulin resistance. Normally, Insulin helps manage blood sugar levels, helping cells absorb glucose. Insulin resistance is when the body no longer responds to normal levels of insulin. This can result in excess amounts of insulin being produced, misregulated blood sugar levels and metabolism issues like weight gain and type 2 diabetes.

Women are also 3 times more likely to experience mental health related symptoms like anxiety, depression or body image issues. Unfortunately there is currently no cure for PCOS, however, there are treatment options aimed to manage symptoms.

Think you might have PCOS? Check your hormones

Benefits of regular exercise

Regular exercise can be an extremely effective way to help manage PCOS symptoms. Some experts suggest exercise as a first port of call for PCOS management but can also work alongside medications like metformin for increased effects, particularly for improving cycle related issues (1). Exercise can have positive effects on physical, hormonal and mental health related issues including:

Improves fitness
Reduces the risk of diabetes, hypertension and heart disease
Improves menstrual cycle regularity
Assists with weight management
Improves insulin resistance
Helps manage androgen levels
Improves self-confidence
Improves energy levels and positivity

How much exercise is recommended?

For a healthy lifestyle, preventing weight gain and maintaining health:

Adults should do a minimum of 150 minutes a week of moderate-intensity physical activity or 75 minutes per week of vigorous activity or a combination of both and include muscle-strengthening activities

Young women should do 60 minutes or more of moderate to vigorous activity per day including those that strengthen muscle at least three times a week

Activity can be done in 10-minute bursts or around 1000 steps, aiming to do at least 30 minutes on most days.

For those who have a goal to lose weight, prevent weight regain or achieve greater health benefits more exercise is needed:

A minimum of 250 minutes a week of moderate-intensity activity or 150 minutes a week of vigorous activity or a combination of both

Muscle-strengthening activity on 2 non-consecutive days of the week.

Overall, aim for around 30 minutes per day. Of this, 90 minutes per week should be more active or aerobic activities (running, biking, fast pace walking etc.) at a moderate to high intensity to optimise clinical outcomes (see table below for suggested activities).

Remember physical activity includes walking, activity at work, household chores, sports and planned exercise. Choose an exercise you like and if possible exercise with friends or others to increase your motivation. Mixing up exercise will also help with motivation.

Benefits for your body

What are the benefits of exercise on PCOS?

PCOS can affect the body’s metabolism making it harder to lose weight and also affect where fat is stored. Visceral fat (fat in the abdomen and around your organs) tends to be increased in those with PCOS. Alongside this, there is an increased risk of long-term health issues including obesity, cardiovascular disease and high blood pressure. Regular physical activity can help improve body composition and is extremely beneficial for reducing these risks.

In general aerobic exercise (or cardio), like running, swimming or cycling, is great for reducing blood pressure and improving heart health. Increasing your daily energy expenditure (the amount of energy you burn in a day) can help with losing weight by creating a calorie deficit (burning more calories than you consume). Women with PCOS who had greater vigorous activity levels were found to have less visceral fat (2). A 6 month study introducing an exercise regime of 30 mins aerobic exercise 3 times a week saw a reduction in waist circumference (as a measure of visceral fat), and improvements in menstrual cycle patterns (3).

What type of exercise is best?

There is a lack of evidence supporting any one type and intensity of exercise being better than another for metabolic, hormonal, reproductive or psychological outcomes.

The International guidelines and majority of studies have focused on aerobic exercise routines, however, resistance training (exercise designed to improve muscle strength or endurance) such as weight lifting, has big benefits too. Resistance training has a positive effect on body composition by increasing muscle mass, which can contribute to increasing your energy expenditure. In studies focusing on resistance training for women with PCOS, a reduction in visceral fat and an increase in lean muscle mass was seen (4).

It is also important to know that exercise without weight loss or only moderate weight loss can still lead to a reduction in visceral fat and improve insulin sensitivity. Think of being active as often as you can through the day, for example take stairs instead of lifts, park further away from shops etc.

Can exercise improve chances of conceiving?

Improvements in reproduction have been seen in women with minimal weight loss – so the scales are not the be all and end all! The NHS states as little as 5% reduction bodyweight can help improve symptoms (5). Other important lifestyle factors to consider, particularly for managing weight, are issues with appetite regulation – if this is something you are struggling with you can speak to one of our Fertility Nutrition Consultation.

Benefits for your hormones

Insulin resistance is common among those with PCOS and can contribute to many of the symptoms like dark skin patches, fatigue and weight issues. This goes hand in hand with visceral fat and general inflammation throughout the body.

This is believed to be associated with greater levels of visceral fat and amount of visceral fat Women who had greater levels of physical activity, had better chances of normal insulin responses (6) and reduced chances of inflammation (7).

Excess insulin can increase the production of androgens in the ovaries, contributing to hyperandrogenism. Resistance training and building muscle tissue has been shown to manage testosterone levels. Many studies have found resistance training to reduce circulating testosterone in women with PCOS (3). Aerobic exercises also showed reduced testosterone levels and hyperandrogenism related symptoms (1).

Benefits for your mental health

Body image issues have been found to play a major role in negatively affecting mental health for those with PCOS, which can also affect relationships and social lives. Studies have found a decrease in stress levels surrounding body image with exercise, even without changes in body composition itself (8).

Exercise generally can have positive effects on mood through increasing blood flow to the brain, release of endorphins and other neurotransmitters (chemicals released by the brain). Specifically in women with PCOS an increase in motivation and optimism was found with increased exercise and reduced levels of anxiety and depression (9) . Those who were less active generally experienced more anxiety and depression symptoms than those who were regularly active. Movement such as yoga and pilates can increase mindfulness which are also very beneficial for mental health (10). Stress can also exacerbate symptoms so movement and mindfulness can help manage this.

Introducing more physical activity into your daily life can have a whole host of benefits and is particularly useful for managing physical and mental symptoms whilst improving hormonal issues.

Barriers to exercise

Research shows that some women with PCOS may experience barriers to exercising due to a number of issues such as; body image, weight and negative experiences in the past. If you think this is the case, it is important to seek support to get started. Try joining a group session or work with a trainer who can assist to build your confidence to do regular exercise.