Page last updated February 2021
Can overexercising impact PCOS?
There’s evidence that moderate weight loss can help with symptoms of polycystic ovary syndrome (PCOS),1 but is there a point where these efforts can become unhealthy, and do more harm than good?
The short answer, according to three gynaecologists that The Femedic spoke with, is yes. But as with many questions about our health, the short answer isn’t the complete answer.
Overexercising can broadly be defined as exercising to excess without giving your body enough time to recover, and can have negative effects whether you have PCOS or not. If you do have PCOS, the stress overexercising can cause — including from the sense of pressure to lose weight — can have effects that are felt on top of existing symptoms.
When weight loss is recommended as a way to manage symptoms, the motivation to improve our condition can make it difficult to realise when diet and exercise habits are becoming unhealthy. This point becomes especially tricky to identify when you consider that separately, both PCOS and overexercise can cause periods to stop.
How does overexercising affect the body?
“When you overexercise, you lose your body fat, and your body fat is an endocrine organ in its own right,” says consultant gynaecologist at King Edward VII’s Hospital, Mr Michael Dooley.
The body’s fat cells produce oestrogen, and the drop in oestrogen when you lose weight can cause periods to stop. For some people with PCOS, the follicles within their ovaries do not develop or mature properly, which prevents ovulation from happening and therefore also causes periods to stop.
“You have the same outcome, no periods, but one is due to lack of oestrogen and one is due to lack of ovulation,” says Mr Dooley.
“Everything that becomes stressful will have an impact on PCOS symptoms, whether it is overexercising, overindulging in food, or depriving yourself of food”
Overexercise can also impact hormone health, says consultant gynaecologist and resident gynae for period care brand Callaly, Dr Tania Adib: “If you’re overexercising, then that will cause an imbalance in the hormones and potentially have a negative effect on the already imbalanced hormones due to PCOS. And it often also increases stress.”
Whether the physical stress caused by overexercise can impact PCOS directly is something that still needs investigation, but any mental stress caused can definitely have an effect, explains consultant obstetrician and gynaecologist and member of Plant Based Health Professionals, Dr Nitu Bajekal: “Stress on its own is definitely associated with hormonal health and hormonal balance, but exercise on its own should not increase your stress. If anything, exercising at a steady pace is something that should bring joy.
“Everything that becomes [mentally] stressful will have an impact on PCOS symptoms, whether it is overexercising, overindulging in food, or depriving yourself of food.”
Stress has been identified as a contributing factor to the development of PCOS and in influencing how symptoms present.2 This makes sense when you consider that the body’s stress response involves the release of hormones, including cortisol and androgens. Excess androgen production can contribute to hyperandrogenism, which is considered the “hallmark feature” of PCOS and can cause symptoms such as acne, hair loss, and body hair growth (hirsutism).3
A sense of pressure to lose weight can intensify feelings of stress, creating a vicious circle where mental stress increases as a person feels that they need to exercise more and more.
What does healthy weight loss look like?
All three gynaes advocate for a person-first approach in treating patients with PCOS who may benefit from moderate weight loss. “The most important thing to understand is why they want to lose weight,” says Dr Bajekal. “Because just telling someone to lose weight has never worked in any field, including PCOS. It just doesn’t help.”
Dr Bajekal works with her patients to reframe exercise as something to be enjoyed as part of a healthy lifestyle, whether that means going for a walk in the morning or dancing around in your bedroom. She focuses on why that person might want to lose weight, for example to get their periods back or to get pregnant, rather than the fact of the weight itself, when creating guidance for them to follow.
“A lot of people have a feeling where they want control, and they treat exercise as a way of working off their calories rather than to get healthy.”
“They might want to have a baby, they may want clearer skin — whatever it is, if you don’t actually address that and just talk about weight loss, [you’re not] guiding the patient,” she says. “These are very difficult situations that have to be handled without judgement. A lot of people have a feeling where they want control, and they treat exercise as a way of working off their calories rather than to get healthy.”
For Dr Adib, a thorough understanding of a person’s lifestyle habits are essential in determining whether they are pushing their body too far. Telltale signs that this is happening are if someone stops enjoying exercise and is motivated by the amount of weight lost rather than optimising their health, she explains: “They’ll tell you how much they’re exercising, and it often becomes almost addictive, that they have to be exercising. And they begin not to enjoy it.
“It’s not just about giving them a prescription, it’s about guiding them, helping them, and advising them on lifestyle issues, which is the first measure that we should really be recommending.”
Exercise is still important
Whether you have PCOS or not, regular exercise is an essential part of a healthy lifestyle and can have specific benefits for people with PCOS. “Exercising several times a week can improve insulin sensitivity, reduce levels of excessive androgen hormones and improve menstrual frequency,” says obstetrician and gynaecologist Dr Ellie Rayner.
Dr Rayner recommends at least 150 minutes of moderate intensity activity or 75 minutes of vigorous intensity activity per week, and advises those with PCOS to monitor how their body is responding:
“You should always ensure that after exercise you get enough rest to recover and you aren’t pushing yourself so hard you become injured. You should build up your exercise regime over time to allow your body to adapt.”
If you find exercise stressful or painful, speak with your doctor who will be able to work through this with you, and best advise on a treatment plan going forward
Featured image is of a person sitting on a bench in the gym, as if they are tired and taking a break. Their hands are on their knees and you can see gym equipment around them. They are visible in the frame from the torso downwards
Page last updated February 2021
- Kiddy, D.S., et al., Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome, Clinical Endocrinology, January 1992, vol 36, issue 1, pp 105-111
- Basu, B.R., Possible link between stress-related factors and altered body composition in women with polycystic ovarian syndrome, Journal of Human Reproductive Sciences, Jan-March 2018, vol 11, no 1, pp 10-18
- Ashraf, S., et al., Hyperandrogenism in polycystic ovarian syndrome and role of CYP gene variants: a review, Egyptian Journal of Medical Human Genetics, November 2019, vol 20, no 5 [online] (accessed 24 February 2021)