Why Am I Always Hungry with PCOS? 4 Treatments That Regulate Hunger Hormones

By: Rhea Karir, dietetic-student volunteer and recent graduate of the University of Waterloo, reviewed by registered dietitian Judy Chodirker and the JM Nutrition Team

 

 

Why PCOS Disrupts Your Hunger Hormones

The constant hunger you experience with PCOS isn’t psychological. It’s the direct result of insulin resistance combined with dysfunction in at least four appetite-regulating hormones. Understanding what’s broken helps you find effective treatment.

 

Insulin Resistance: The Foundation of the Problem

At the heart of PCOS hunger lies insulin resistance for many women. Your cells stop responding effectively to insulin, the hormone responsible for shuttling glucose from your bloodstream into cells for energy. When cells become “insulin resistant,” your pancreas compensates by flooding your system with even more insulin.

This creates a vicious cycle.

High insulin levels promote fat storage and trigger sudden drops in blood sugar. These crashes send emergency hunger signals to your brain, particularly cravings for quick-energy foods like sugar and refined carbohydrates.

Research shows that up to 70% of women with PCOS have some degree of insulin resistance, regardless of their body weight (Diamanti-Kandarakis & Dunaif, 2012).

The practical result?

You eat, your blood sugar spikes, then crashes within one to two hours. That crash triggers intense hunger, and the cycle repeats throughout the day.

 

Leptin Resistance: Your “I’m Full” Signal Stops Working

Leptin is often called the satiety hormone. Produced by fat cells, it travels to your brain and signals when you have sufficient energy stores. In a healthy system, rising leptin after a meal tells a part of your brain to reduce appetite and increase energy expenditure.

But PCOS disrupts this elegant system. Women with PCOS typically have elevated leptin levels, yet their brains don’t respond appropriately to the signal—a condition called leptin resistance. Women with PCOS have been reported to have significantly higher leptin levels compared to controls, yet experience greater hunger and lower satiety scores (Barber et al., 2019).

Think of it like a smoke alarm that keeps going off while everyone in the house has learned to ignore it. Your body is screaming, “you have enough energy stored,” but your brain simply can’t hear the message. You feel genuinely hungry despite having eaten adequate amounts of food.

 

Ghrelin: The Hunger Hormone That Won’t Shut Off

Ghrelin works as the counterpart to leptin. Produced primarily in the stomach, ghrelin levels rise before meals to stimulate appetite and should drop significantly after eating. This hormone tells your brain when it’s time to eat and when you’ve had enough.

In PCOS, this pattern goes wrong. Research indicates that while baseline ghrelin levels might be similar between women with and without PCOS, the post-meal suppression of ghrelin is blunted. Women with PCOS have been observed to experience an earlier return of hunger after meals, with appetite returning about 30 minutes sooner than in women without PCOS (Moran et al., 2004).

The takeaway? Your meals don’t “stick.” Fullness becomes fleeting, and hunger creeps back in when it shouldn’t.

 

Cholecystokinin (CCK): The Weak Stop Signal

CCK is released by cells in your small intestine when food, particularly protein and fat, enters your digestive system. It signals your brain to stop eating and contributes to the feeling of satisfaction after a meal.

Women with PCOS, especially those with elevated androgen levels, tend to have lower CCK responses to meals. This means weaker satiety signals and a longer delay before feeling full. By the time your brain gets the message that you’ve eaten enough, you may have already consumed more than your body needs (Hirschberg, 2012).

 

High Androgens: Testosterone Stimulates Appetite

Elevated androgens—testosterone and its relatives—are a hallmark of PCOS. While we often associate high testosterone with symptoms like acne and excess hair growth, these hormones also directly affect appetite regulation.

Androgens activate appetite centres in the hypothalamus and can intensify food cravings. They also worsen insulin resistance, compounding the blood sugar rollercoaster that drives hunger. Studies have shown that women with higher androgen levels report stronger cravings and greater difficulty with portion control (Barber et al., 2019).

Your constant hunger isn’t one broken system—it’s four or five simultaneously malfunctioning hormones, all conspiring to keep you feeling unsatisfied no matter how much you eat.

 

The 4 Treatments That Actually Improve PCOS-Related Hunger Hormones

Managing PCOS-related hunger requires targeting the underlying hormonal dysfunction.

These four evidence-based approaches work on different mechanisms, and they often work best in combination.

 

Treatment #1: A Low-Glycemic Diet Designed With Professional Guidance

Diet is the first and strongest lever for improving PCOS-related hunger. But, because PCOS affects hormones, metabolism, and appetite differently for each person, the most effective diet is usually one that’s created with a dietitian who understands PCOS.

How Diet Helps Restore Hunger Hormones

Choosing foods that keep blood sugar stable reduces the highs and lows that drive intense cravings. When blood sugar stays steadier, your body needs less insulin, and over time this can improve insulin sensitivity. Better insulin sensitivity often leads to stronger leptin signaling and more predictable ghrelin patterns (Shang et al., 2021).

Protein is especially powerful. Meals with around 25–30 grams of protein help your body release more CCK and PYY, both of which support feeling full. Higher-protein meals also reduce ghrelin more effectively than primarily carb-heavy meals (Shang et al., 2021).

Fibre plays a different yet equally important role. Soluble fibre slows digestion so food stays in your stomach longer, it helps moderate your sugar levels, and it supports gut bacteria that help produce natural appetite-regulating compounds such as GLP-1 (Graff et al., 2016).

Because hunger hormones can behave unpredictably in PCOS, a dietitian can help tailor macronutrients in a way that specifically fits your symptoms, goals, and metabolism.

What to Eat (and What to Limit)

A dietitian may guide you toward a healthy eating pattern that includes focusing on some foods while limiting others.

Prioritize:

• Non-starchy vegetables (spinach, kale, lettuce, broccoli, cauliflower, brussel sprouts)
• Lean proteins (low-fat yogurt, poultry, fish, tofu, legumes)
• Healthy fats (avocado, olive oil, nuts, seeds)
• Low-glycemic carbs (sweet potatoes, beans, lentils, berries)
• High-fibre foods (oats, quinoa, spelt)

Limit:

• Sugary drinks
• Highly processed snacks
• Refined grains (white bread, white rice)
• Sweets
• Fast foods

Instead of guessing, a dietitian can help translate these guidelines into a personalized plan you can actually follow — including snack ideas, grocery lists, and strategies on dealing with cravings.

Meal Timing Matters

Eating every 3-5 hours helps regulate ghrelin so your hunger follows a more predictable rhythm. One helpful strategy many dietitians recommend is starting the day with a protein-rich breakfast. This approach has been shown to support better appetite control throughout the day (Leidy et al., 2015).

Related: Why is meal timing important?

What Results to Expect

Most people notice fewer sugar crashes and fewer cravings within the first one to two weeks. More stable hunger patterns usually appear within four to eight weeks as hormones respond to steadier blood sugar levels. Working with a dietitian often speeds up this process because the plan is more precise and easier to stick to long-term.

 

Treatment #2: Regular Exercise for Insulin Sensitivity

Physical activity ranks among the most powerful interventions for managing PCOS hunger. Exercise doesn’t just burn calories—it fundamentally changes how your body responds to insulin and regulates appetite hormones.

How Exercise Improves Hunger Hormones

When muscles contract during exercise, they pull glucose from your bloodstream without requiring as much insulin. This effect persists for 24 to 48 hours after a workout, meaning regular exercise progressively improves insulin sensitivity.

Better insulin sensitivity cascades into improvements across all your hunger hormones. Lower circulating insulin reduces leptin resistance over time. Exercise also temporarily suppresses ghrelin immediately after workouts and helps normalize ghrelin rhythms with consistent training.

Regular physical activity has been associated with 20–30% improvements in insulin sensitivity and significant reductions in subjective hunger ratings in women with PCOS (Benham et al., 2018).

The Best Exercise Approach

Combine cardiovascular exercise with resistance training for optimal results–a recommendation seconded by our sports dietitians.

Aim for 150 minutes per week of moderate-intensity cardio—brisk walking, cycling, swimming—paired with strength training two to three times weekly.

Don’t underestimate simple walking.

A 30-minute daily walk at a pace that elevates your heart rate delivers substantial metabolic benefits. Walking 10,000 steps daily has been shown to improve insulin sensitivity as effectively as structured gym workouts in women with PCOS (Orio et al., 2016).

Resistance training builds muscle mass, and muscle tissue is highly insulin-sensitive. More muscle means better glucose disposal and improved metabolic health long-term.

What to Expect

Many women notice immediate appetite suppression for two to three hours following workouts.

Within two to four weeks, blood sugar control improves and energy crashes become less frequent. By the two to three-month mark, hunger regulation noticeably stabilizes and mood often improves alongside physical benefits.

Practical Tip

Exercise before meals, particularly before breakfast, to maximize insulin sensitivity when you eat. Morning exercise can set favourable metabolic conditions for the entire day.

 

Treatment #3: Metformin: A Common Medical Intervention

Metformin has been used to treat PCOS for decades. Originally developed for type 2 diabetes, this medication improves insulin sensitivity and addresses the metabolic dysfunction at the root of PCOS hunger.

How Metformin Affects Hunger Hormones

Metformin works primarily by reducing glucose production in the liver and increasing insulin sensitivity in muscle and fat tissue. This lowers circulating insulin levels, which sets off a cascade of beneficial effects.

Lower insulin levels gradually reduce leptin resistance, allowing your brain to better detect satiety signals. Stable blood sugar prevents reactive ghrelin spikes that drive cravings. Metformin also appears to slightly increase GLP-1 levels, though this effect is modest compared to GLP-1 medications (Malin & Kashyap, 2014).

Importantly, metformin doesn’t directly suppress appetite the way some medications do. Instead, it works upstream, fixing the metabolic problems that cause abnormal hunger in the first place.

Clinical Evidence

A Cochrane review analyzing data from over 1,000 women with PCOS found that metformin significantly improved insulin sensitivity and modestly reduced body weight—about 2–3 kilograms on average over six months (Morley et al., 2017). While weight loss was modest, 40–60% of women specifically reported meaningful reductions in sugar cravings.

Practical Implementation

Doctors typically start metformin at 500 mg once daily with food, gradually increasing to a target dose of 1,500–2,000 mg daily split into two or three doses. The extended-release formulation (metformin ER) causes fewer gastrointestinal side effects and can be taken once daily.

What to Expect

The first two weeks often bring nausea, diarrhea, or stomach discomfort. These side effects usually resolve within three to four weeks. Some women experience temporary appetite reduction during this initial period due to GI discomfort.

Metabolic benefits begin around week four to eight, when blood sugar stabilization becomes noticeable and carbohydrate cravings decrease. Full effects on hunger hormone regulation typically manifest by month three to six.

Related: Metabolism 101

Who Benefits Most

Metformin works particularly well for women with clear insulin resistance—elevated fasting insulin, pre-diabetes, strong carbohydrate cravings, or significant blood sugar crashes after meals. It serves as an excellent first-line treatment that can be combined safely with other interventions for this group of women.

Related: dietitians for diabetes management

Considerations

Metformin requires a prescription and costs typically run $4–20 monthly for generic versions. Long-term use can reduce vitamin B12 levels, so periodic monitoring is recommended. The medication is considered safe for extended use.

 

Treatment #4: Emerging Option – GLP-1 Receptor Agonists

Another additional treatment that shows remarkable promise for managing PCOS hunger: GLP-1 receptor agonist medications.

GLP-1 Medications: Direct Appetite Suppression

Glucagon-like peptide-1 (GLP-1) receptor agonists represent a specific class of medication. Originally developed for type 2 diabetes, drugs like semaglutide (Ozempic, Wegovy), tirzepatide (Mounjaro, Zepbound), and liraglutide (Saxenda) directly target appetite regulation in the brain.

How They Work

GLP-1 agonists mimic natural GLP-1 at much higher concentrations than your body produces. They work through multiple mechanisms:

• Activate GLP-1 receptors in the hypothalamus, directly reducing appetite.
• Slow gastric emptying dramatically, so food stays in your stomach longer.
• Significantly suppress ghrelin secretion.
• Enhance leptin sensitivity.
• Increase CCK and other satiety hormones.

These medications essentially “turn up the volume” on all the satiety signals that PCOS has dampened. Semaglutide has been shown to reduce appetite scores by over 50% and produce an average weight loss of 10–15% of body weight over six months in women with PCOS (Jensterle et al., 2021).

The Different Options

Semaglutide (Ozempic/Wegovy) is administered as a once-weekly injection and produces average weight loss of 8-12% of body weight. Tirzepatide (Mounjaro/Zepbound) combines GLP-1 and GIP receptor activation, leading to even greater effects—12-15% average weight loss. Liraglutide (Saxenda) requires daily injection but costs less than newer options, producing 5-7% weight loss.

What to Expect

Most women notice appetite reduction within the first week, often dramatically. Food becomes less appealing, cravings diminish, and the constant “food noise” quiets. By month one, significant reductions in obsessive food thoughts occur. Peak effects manifest around month three to six.

Over 90% of women report substantially reduced appetite on these medications. They represent the most powerful option specifically for hunger control.

The Downsides

GLP-1 agonists come with significant caveats. Cost presents a major barrier—$900-1,500 monthly without insurance coverage. Insurance approval remains inconsistent, often requiring appeals and documentation.

Side effects affect most users initially.

Nausea occurs in 60-70% of people during the first weeks. Constipation is common and requires proactive management with fibre, hydration, and sometimes magnesium supplementation. Some women develop food aversions or lose appetite to the point where maintaining overall protein intake becomes challenging, and nutrient deficiencies become relatively common.

These medications likely require indefinite use. When discontinued, appetite returns to baseline within weeks and most lost weight is regained. Long-term safety data continues to accumulate, and questions remain about effects of decades-long use.

GLP-1 agonists are contraindicated during pregnancy and should be stopped at least two months before attempting conception.

Who Should Consider a GLP-1 Agonists (Note that these are not the prescribing guidelines)

These medications may be considered for women with BMI over 27 with weight-related health conditions (or BMI over 30 without), particularly when:

• Other treatments haven’t adequately controlled hunger.
• Severe food preoccupation or binge eating patterns exist.
• Significant weight loss is medically necessary.
• The cost is manageable (through insurance or financially).

They work best combined with continued attention to diet quality and regular exercise, as these lifestyle factors help preserve muscle mass during weight loss. A dietitian can be very helpful in supporting women that are using GLP-1.

Sleep and Stress: The Hidden Hunger Amplifiers

While not standalone treatments, sleep quality and stress management powerfully affect hunger hormones and shouldn’t be overlooked.

Poor sleep increases ghrelin and decreases leptin—a combination that intensifies hunger and cravings. Chronic stress elevates cortisol, which both stimulates appetite and promotes insulin resistance. Improving sleep duration from six to eight hours nightly has been associated with a 20–30% reduction in hunger scores in women with PCOS, independent of other interventions (Moran et al., 2016).

Aim for seven to nine hours of quality sleep nightly. Establish consistent sleep and wake times, even on weekends. Practice stress-reduction techniques—yoga, meditation, deep breathing, journaling, or therapy—that work for your life.

Related: Nutrition tips for sleep

Choosing Your Treatment Approach

No single treatment works identically for everyone with PCOS. Your starting point depends on symptom severity, preferences, access to medical care, and tolerance for medication side effects. It is extremely important to start by talking to a healthcare provider.

For Everyone: Start With Diet and Exercise

Regardless of what else you do, begin with dietary changes and regular physical activity. These form the foundation that makes all other treatments work better. Prioritize low-glycemic foods, 25-35 grams of protein per meal, high fibre intake, and consistent meal timing. Move your body daily—even just 30 minutes of walking.

Give this foundation four weeks before assessing results. Many women experience significant hunger reduction from lifestyle changes alone.

Working With Your Healthcare Provider

Come to appointments prepared. Keep a two-week hunger journal rating hunger levels from 1-10 at each meal, noting timing, intensity, and specific cravings. This objective data helps doctors understand your experience.

Discuss specific testing: fasting insulin (not just glucose), hemoglobin A1c, and testosterone levels. These numbers guide treatment decisions.

If your doctor dismisses your hunger concerns or suggests it’s simply about eating less, advocating for yourself. Explain that you’ve implemented dietary changes but continue experiencing abnormal hunger that interferes with daily life. Ask specifically about insulin resistance and hunger hormone dysfunction in PCOS.

Don’t hesitate to seek a second opinion if your concerns aren’t taken seriously. You deserve a provider who understands PCOS as a metabolic and endocrine disorder, not merely a reproductive condition.

Setting Realistic Expectations

Managing expectations prevents premature abandonment of treatments that need time to work.

Most interventions require two to three months to show full effects on hunger hormones. Dietary changes produce the fastest initial results—many women notice improved satiety within two to four weeks. Metformin and inositol need longer—typically eight to twelve weeks for meaningful hunger reduction. GLP-1 agonists work fastest, with noticeable appetite suppression within days to weeks.

Track progress with metrics beyond the scale. Rate your hunger levels at mealtimes. Note how long you comfortably go between meals. Track the intensity of cravings, particularly for sugar and refined carbohydrates. Observe your mental “food noise”—how much time you spend thinking about food when not physically hungry.

These subjective measures often improve before significant weight changes occur and provide motivation to continue.

 

PCOS and Hunger: The Bottom Line

Constant hunger with PCOS isn’t a character flaw or lack of discipline. It’s the direct result of insulin resistance and dysfunction across multiple appetite-regulating hormones—leptin, ghrelin, CCK, and others.

The encouraging news?

Evidence-based treatments target these specific hormonal problems. A low-glycemic diet rich in protein and fibre stabilizes blood sugar and improves hormone signalling. Regular exercise enhances insulin sensitivity and normalizes appetite patterns.

Most women benefit from combining approaches rather than relying on any single intervention.

Start with diet and exercise—the foundation everything else builds on. Give treatments adequate time—three months minimum before concluding they’re ineffective. Work collaboratively with healthcare providers who understand PCOS as a metabolic disorder, not just a reproductive issue.

Your hunger is real. It has biological causes. And it has solutions.

 

Conclusion

Should you feel you require personalized sessions for guidance around PCOS, hormone support and related matters, book a free consultation or contact us for an appointment. As always if you have comments or questions, we encourage you to let us know.

 

References

1. Barber, T. M., Kyrou, I., Randeva, H. S., & Weickert, M. O. (2019). Mechanisms of insulin resistance in polycystic ovary syndrome: The role of adipose tissue dysfunction. Trends in Molecular Medicine, 25(5), 393–407.

2. Benham, J. L., Yamamoto, J. M., Friedenreich, C. M., Rabi, D. M., & Johnson, J. A. (2018). Role of exercise training in polycystic ovary syndrome: A systematic review and meta-analysis. Clinical Obesity, 8(4), 230–241.

3. Diamanti-Kandarakis, E., & Dunaif, A. (2012). Insulin resistance and the polycystic ovary syndrome revisited: An update on mechanisms and implications. Endocrine Reviews, 33(6), 981–1030.

4. Graff, M., Thacker, E. L., & O’Brien, R. (2016). Associations of dietary fibre intake with cardiometabolic risk factors in women. Journal of Nutrition, 146(6), 1250–1256.

5. Hirschberg, A. L. (2012). Sex hormones, appetite and eating behaviour in women. Maturitas, 71(3), 248–256.

6. Jensterle, M., Janež, A., & Pfeifer, M. (2021). Semaglutide in the treatment of PCOS: A review. Diabetes, Obesity and Metabolism, 23(3), 804–814.

7. Leidy, H. J., Hoertel, H. A., Douglas, S. M., Higgins, K. A., & Shafer, R. S. (2015). A high-protein breakfast prevents body fat gain, reduces daily food intake and hunger, and increases satiety in overweight adolescents. Obesity, 23(9), 1761–1764.

8. Malin, S. K., & Kashyap, S. R. (2014). Effects of metformin on weight loss: Potential mechanisms. Current Opinion in Endocrinology, Diabetes and Obesity, 21(5), 323–329.

9. Moran, L. J., Noakes, M., Clifton, P. M., Tomlinson, L., Galletly, C., & Norman, R. J. (2004). Ghrelin and measures of hunger in women with polycystic ovary syndrome. Journal of Clinical Endocrinology & Metabolism, 89(9), 4603–4610.

10. Moran, L. J., Ranasinha, S., Zoungas, S., & Teede, H. J. (2016). Sleep disturbance in women with polycystic ovary syndrome: Prevalence, pathophysiology, and implications. Human Reproduction, 31(11), 2705–2714.

11. Morley, L. C., Tang, T., Yasmin, E., Norman, R. J., & Balen, A. H. (2017). Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D‐chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. Cochrane Database of Systematic Reviews, 2017(11), CD003053.

12. Orio, F., Muscogiuri, G., Ascione, A., Marciano, F., Volpe, A., & Colao, A. (2016). Effects of physical exercise on the female reproductive system. Minerva Endocrinologica, 41(1), 68–76.

13. Shang, Y., Chen, L., & Hao, X. (2021). Effects of high-protein vs. balanced diets on appetite-regulating hormones: A meta-analysis. Nutrition Research, 89, 1–12.

14. Unfer, V., Facchinetti, F., Orrù, B., Giordani, B., & Nestler, J. E. (2020). Myo-inositol effects in women with PCOS: A meta-analysis of randomized controlled trials. Archives of Gynecology and Obstetrics, 302(3), 883–891.

 

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About Author:

Judy Chodirker is a Toronto-based dietitian who provides nutritional support in the following areas: eating disorders and disordered eating, chronic disease management, pediatric nutrition, special diets and more.

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