Pilates guide
Pilates can be part of the exercise that helps polycystic ovary syndrome (PCOS), now called polyendocrine metabolic ovarian syndrome (PMOS). The international guideline recommends exercise for everyone with PCOS, whatever your weight, and finds no type better than another, so Pilates counts if you enjoy it. It works best as your 2 strength days a week, with brisk walking, cycling or other cardio on most other days.
The Pilates evidence in PCOS is very thin: one small study without a comparison group, and a first proper trial only just registered. Pilates sits beside care from your GP, never in place of it, and it isn't a treatment for periods, fertility, hair or skin.
This guide covers what exercise does and doesn't change for insulin, weight, periods and mood, what the Pilates study found, the reformer and hot Pilates, how to build your week, moves with 3D demos, and the signs that mean you should see a GP.
The 2023 international guideline recommends exercise for everyone with PCOS, whatever their weight, and says there's no evidence that any one type or intensity is better than another. Pilates is a reasonable choice if it's what you'll keep doing.
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The guideline asks for 150 to 300 minutes of moderate activity (or 75 to 150 of vigorous activity) a week, plus muscle strengthening on 2 days that aren't next to each other. Most mat Pilates is light to moderate, so add brisk walking, cycling or intervals; springs, bands or weights make Pilates count as strength training.
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The only Pilates study in PCOS we could check had 26 women and no comparison group, and measured period pain and cycle length, not hormones or ovulation. A first randomised trial of Pilates in PCOS was registered in October 2026 and hasn't started.
Across exercise trials in PCOS, fitness and waist size improve, insulin resistance probably falls a little, weight changes only a little, and periods haven't reliably become more regular.
The guideline says "There are benefits to a healthy lifestyle even in the absence of weight loss", and asks health professionals to recognise weight stigma and offer care that doesn't have to focus on weight.
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The warning signs below list when to see a GP, word for word from our exercise for PCOS guide, including signs of diabetes, missed periods and very heavy periods.
In 2026 a global consensus of 56 organisations, with 14,360 responses, renamed polycystic ovary syndrome polyendocrine metabolic ovarian syndrome (PMOS), because the old name wrongly suggested cysts. The "cysts" are follicles that stopped developing, earlier diagnoses still stand, and the way it's diagnosed hasn't changed. The NHS and Verity, the UK charity, now use PMOS. Most people still search for PCOS, so we use both names.
A lifelong hormone condition that "can affect hair growth, periods, fertility and mood", the NHS says, affecting 10% to 13% of women of reproductive age. The NHS lists irregular periods or long gaps between them, extra hair growth or hair loss, weight gain or difficulty losing weight, difficulty getting pregnant, depression or anxiety, oily skin and acne, feeling very tired, and thick, dark patches of skin on the neck or armpits. There is no cure, but treatments and lifestyle changes help.
In 28 studies using the most accurate test, the body responded to insulin 27% less well in women with PCOS than in women without it, whatever their weight. The guideline calls insulin resistance part of how PCOS works, but says insulin blood tests aren't accurate enough for routine care.
The NHS lists type 2 diabetes, high blood pressure, heart and circulation disease, fatty liver and womb cancer among the risks, and says regular check-ups help reduce them. These are the main reasons exercise matters in PCOS.
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The guideline's muscle strengthening includes "resistance/flexibility" work, and a Pilates class with springs, bands or weights fits there. A typical mat class is light to moderate effort, about like a slow walk (our Pilates for weight loss guide has the numbers), so it rarely counts towards the guideline's aerobic minutes. Pilates isn't named in the guideline.
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Most of this comes from trials of exercise in general in PCOS, not Pilates. The trials are small, so most of the evidence is low or very low certainty.
The guideline strongly recommends exercise, alone or with healthy eating, for all women with PCOS, to improve metabolic health, but rates the evidence very low certainty. It finds no type or intensity of exercise better than another and advises activity that suits your own preferences and goals. Exercise and Sports Science Australia's 2024 statement gives the same weekly amounts.
In 18 trials, exercise raised fitness by about 4 mL of oxygen per kg a minute and trimmed the waist by 2.6 cm; another review of 18 studies (593 women) found 4.0 mL and 1.5 cm. The gains were consistent but small, at low certainty.
In 25 studies (1,107 women), exercise lowered insulin resistance by a moderate amount, and in 23 trials (1,192 women) steady moderate exercise lowered it a little, at low to moderate certainty. One review of 18 studies found no change, so the reviews don't fully agree.
Lifestyle programmes took off about 1.7 kg on average (9 trials, 353 women, low quality). In 20 trials of aerobic exercise to July 2026, the effect on weight was trivial, and in a network of 19 trials only moderate aerobic exercise lowered body mass index (BMI).
Testosterone fell a little with exercise in some 2026 reviews but not overall in another. No trial in the Cochrane review reported how regular periods were, and in the largest trial, 64 women, interval training didn't change how often periods came over a year: periods became more frequent in every group, including the women who didn't exercise. A 2026 review of 10 small studies in women at a higher weight reported more regular cycles, without pooling the results.
Across 7 trials, exercise eased symptoms of depression, and quality of life improved in all 11 trials of another review. The trials were few and small, and none was of Pilates.
In 10 trials (382 women), strength training increased lean mass and cut body fat, with little effect on hormones. In smaller studies, strength training lowered testosterone and waist size, and body fat fell without weight changing.
The guideline's own review of interval training against steady exercise (5 studies, 216 women) found no clear difference, and nor did a 2025 review of 6 trials. A 2020 analysis that included some non-randomised studies found vigorous exercise brought the biggest gains, so harder effort is worth adding if you enjoy it.
In India, 26 women did classical mat Pilates 3 times a week (the paper gives both 8 weeks and 3 months). Period pain fell from about 7.7 to 6.0 out of 10, and cycles shortened. There was no comparison group, ovulation, hormones and weight afterwards weren't measured, and its conclusions go beyond its data. It can't tell us whether Pilates helps PCOS.
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A randomised trial in Pakistan plans to compare mat Pilates, interval training and a control group in 60 women with PCOS for 8 weeks, measuring body size, quality of life and fitness. It was registered in October 2026 and isn't recruiting yet.
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In 11 trials of adults with overweight or obesity (393 people), Pilates took off about 2.4 kg against no exercise. Pilates lowered blood sugar after meals and cholesterol in people with type 2 diabetes, but had "no significant effect" in people without diabetes, and none of those trials was in PCOS.
These are the 2023 guideline's amounts, which match the general adult guidelines. Treat them as targets to build towards.
150 to 300 minutes of moderate activity, or 75 to 150 minutes of vigorous activity, or a mix, spread through the week. Moderate means you can talk but not sing. For modest weight loss, the guideline suggests at least 250 minutes of moderate activity or 150 minutes of vigorous activity.
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Muscle strengthening on 2 days that aren't next to each other. A Pilates class counts, especially with springs, a band or weights. Our editorial starting point for the loaded moves: 2 to 3 sets of 8 to 12, stopping with 2 to 3 reps to spare, the dose our exercise for PCOS guide gives.
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In one large review, exercise programmes in PCOS ran from 6 to 26 weeks, and in another, the programmes linked with more regular periods usually lasted 3 months or more. Give a new routine about 12 weeks before you judge it.
No study has tested any of them in PCOS. The reformer's springs make it closer to strength training, and wall Pilates is a gentler way in. If you enjoy hot Pilates and aren't pregnant or trying to conceive, our hot yoga guide covers keeping safe in the heat; if you could be pregnant, skip heated classes (our suggestion, as our yoga for PCOS guide advises for hot yoga).
A little: about 2.4 kg against no exercise in trials in other adults, and about 1.7 kg with lifestyle programmes in PCOS. No exercise burns fat from one spot, so Pilates won't target a "PCOS belly". Walking, cycling and eating changes do more for weight; our Pilates for weight loss guide has the detail.
The guideline found no consistent difference in eating or activity between women with and without PCOS, but says many women with PCOS have underlying reasons for gaining more weight over time.
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The guideline says many women with PCOS face weight stigma in healthcare, and asks professionals to offer care aimed at weight loss or care aimed at healthy habits without a weight-loss goal, as you prefer. In a 2026 survey of 151 women, exercise advice for PMOS was mostly about weight, and women with PMOS were less satisfied with it. Fitness, strength, energy, mood and blood sugar are just as good reasons to exercise.
The guideline says metformin and an active lifestyle work about equally well. Talk any medicines through with your doctor; Pilates doesn't replace them.
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No exercise has been shown to make periods regular in a well-controlled trial, and the one Pilates study had no comparison group. Protecting the womb lining is a reason to see your GP, not a job for exercise.
The Royal College of Obstetricians and Gynaecologists explains that with "fewer than three periods a year" the womb lining can thicken, and that treatment can protect it, so tell your GP if your periods are very far apart.
A review linked very heavy exercise, over an hour a day, with not ovulating, while 30 to 60 minutes a day of vigorous exercise was linked with less infertility from not ovulating. Pilates a few times a week is nowhere near that.
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The guideline recommends a healthy lifestyle, including exercise, before pregnancy. Gentle and moderate Pilates is fine while you're trying; our Pilates for fertility guide covers IVF and the two-week wait.
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The NHS lists pregnancy first among the common causes of a missed period, so if you've missed a period and could be pregnant, do a test (our suggestion). Once you're pregnant, keep time flat on your back to a few minutes after the first trimester, as our Pilates moves advise, and use our Pilates in pregnancy guide.
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Lateral breathing, 5 to 8 breaths at the start of every session (the move's page); a standing march for 2 minutes to warm up (our editorial starting point); slow breathing to finish, at least 5 minutes, done regularly as part of your daily routine (the move's page).
From the moves' pages: the hundred, 50 beats to start, building to 100; single-leg stretch, 6 to 10 each side; side kick, 8 to 10 each side; swimming, 2 to 3 sets of 20 to 30 seconds; knee hover, 3 holds of 15 to 30 seconds; leg pull front, 3 to 5 each side, once the knee hover is easy. Glute bridge, 2 sets of 10 to 12 (our editorial starting point). Rest your head down if your neck aches.
3D demoHundred (Pilates)Intermediate · No equipment
3D demoSingle-leg stretch (Pilates one leg stretch)Intermediate · No equipment
3D demoSide kick (Pilates side kick series)Beginner · No equipment
3D demoSwimming (Pilates)Intermediate · No equipment
3D demoKnee hover (Pilates tabletop hover)Beginner · No equipment
3D demoLeg pull front (Pilates leg pull down)Advanced · No equipment
3D demoGlute bridgeBeginner · No equipmentOn 2 days that aren't next to each other: 2 to 3 sets of 8 to 12 of each, stopping with 2 to 3 reps to spare (our exercise for PCOS guide's dose, our suggestion). These are the loaded moves in our Pilates strength class.
Most days, at a pace where you can talk but not sing, building towards the guideline's 150 to 300 minutes a week; add bursts of 20 to 30 seconds on the air bike once that feels comfortable (our exercise for PCOS guide).
Nothing is off limits because of PCOS itself. The moves' own cautions still apply.
Start with the wall and chair versions in our wall Pilates and chair Pilates guides, and our Pilates for plus-size bodies guide, then add mat work as it gets easier (our suggestion).
Skip hot classes, and after the first trimester keep time flat on your back to a few minutes: prop yourself up, or use a side-lying or all-fours version, as our Pilates moves' cautions say.
If you take insulin or a sulfonylurea, follow the blood sugar advice in our Pilates for diabetes guide before, during and after class.
Do the Pilates strength class twice a week on days that aren't next to each other, and walk, cycle or use the cardio classes on most other days. New to Pilates? Start with the beginner or wall class for a few weeks.
A 30-minute Pilates strength class with dumbbells or a band: Pilates trunk work plus squats, lunges, rows and push-ups, each set taken until it is hard.
30 minIntermediate15 movesA dumbbell, A bandA 45-minute session for weight loss and health: a 20-minute brisk walk, which does more for the scales, then a short-rest Pilates circuit for strength.
45 minBeginner11 movesCardio machineA 30-minute Pilates class for type 2 diabetes: standing strength in your shoes, then mat work for hips, back and trunk, head up throughout and finishing seated.
30 minBeginner16 movesA bench or box, A wallA 20-minute mat Pilates workout for complete beginners. It covers breathing, spine position and the foundation moves, each with an easier option.
20 minBeginner13 movesNo equipmentA 20-minute beginner wall Pilates workout: standing and floor moves that use a wall for support and feedback. No equipment.
20 minBeginner9 movesA wallA steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallA 25-minute walk with short faster bouts: notice your heart and breathing speed up, then settle. A gentle way to get used to the feelings of effort.
25 minBeginner5 movesCardio machine, A wallA 25-minute interval session on a bike or rower: one-minute hard efforts with two minutes easy, building from 4 to 8 rounds.
25 minIntermediate1 movesCardio machineStrength and cardio across the week. The beginner Pilates plan builds the habit; add the walking plan for the aerobic minutes.
A weekly workout plan for women: three strength days, cardio and pelvic floor training, with the evidence on periods, pregnancy and menopause.
3 training days45 minBeginner3 days a weekA free 4-week, 3-day Pilates plan for complete beginners. Two mat days and one wall day, with clear rules for when to move each exercise to its harder version.
3 training days25 minBeginner6 days a weekA free 8-week walking plan for beginners: build to 150 minutes of brisk walking a week, with intervals, hills and two short strength sessions.
6 training days40 minBeginnerThese are the same warning signs as our exercise for PCOS guide, word for word. This is general information, not a diagnosis. A&E means accident and emergency; in the US, call 911 for 999, and use your doctor's urgent line or urgent care for NHS 111.
Call 999 if:
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Call 999 or go to A&E (accident and emergency) straight away for severe difficulty breathing (gasping, choking or not able to get words out), a chest that feels tight or heavy, pain that spreads to your arms, back, neck and jaw, lips or skin turning very pale, blue or grey, or sudden confusion. If you're more short of breath than usual, or your heart is racing, fluttering or skipping beats, contact NHS 111.
Heavy periods that affect your life: changing a pad or tampon every 1 to 2 hours, passing clots larger than about 2.5 cm, or bleeding through to your clothes.
See a GP if heavy periods are affecting your life.
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The NHS says to contact your GP or call NHS 111 if you think you might be pregnant, even without a positive pregnancy test, and you have a combination of symptoms such as a missed period, tummy pain low down on one side, vaginal bleeding that's different from your usual period, pain in the tip of your shoulder, or discomfort when peeing or pooing. These can be signs of an ectopic pregnancy.
If you have seriously harmed yourself or feel you may be about to, call 999 or go to A&E. For support now, call Samaritans free on 116 123, call NHS 111, or text SHOUT to 85258. In the US, call or text 988.
You feel any pain or become unwell, as the NHS advises for its Pilates videos, and especially for chest pain or pressure, unusual breathlessness, dizziness or fainting. If you have a health problem, an injury or any symptoms, get advice from a healthcare professional, such as a GP, before you start.
The NHS advises getting advice from a healthcare professional first if you have a health problem, an injury or symptoms, or have recently had a heart attack or an operation.
There's no cure, the NHS says, and Verity says there is "no cure for PMOS, nor is there one treatment". There's one small Pilates study in PCOS, and across exercise trials, effects on hormones are small and inconsistent, with no proven effect on periods.
The guideline found no type or intensity of exercise better than another, and no review has compared Pilates with other exercise in PCOS. The best exercise is the one you'll keep doing, plus some aerobic activity.
No trial shows this. Interval training did about as well as steady exercise, and vigorous exercise brought the biggest fitness and insulin gains in one analysis. Our exercise for PCOS guide covers the cortisol claim in full.
In trials, strength training lowered testosterone or barely changed hormones, while building lean muscle and cutting body fat.
Exercise trims the waist a little, about 1.5 to 2.6 cm across PCOS trials, and Pilates alone took off about 2.4 kg in trials in other adults. No exercise burns fat from one spot.
The guideline says there are benefits even without weight loss, and fitness, body fat, insulin resistance and mood can all improve while weight stays the same.
Joseph Pilates developed his "signature mat exercises" alongside his equipment, the Pilates Method Alliance says, and the reformer is one of several pieces of equipment. The one Pilates study in PCOS used mat work.
Yes, as part of your week: the international guideline recommends exercise for everyone with PCOS and says no type is better than another, so Pilates counts if you enjoy it. Its main job is your 2 strength days a week; add brisk walking or cycling on most other days. The Pilates evidence in PCOS is very thin, so it isn't a treatment on its own.
Yes. In 2026 a global consensus renamed polycystic ovary syndrome polyendocrine metabolic ovarian syndrome (PMOS), because the "cysts" are follicles that stopped developing, not cysts. The NHS now uses PMOS, the diagnosis is made the same way, and the exercise advice hasn't changed.
A little. Lifestyle programmes took off about 1.7 kg on average in PCOS, and Pilates alone about 2.4 kg in trials in other adults. For modest weight loss the guideline suggests at least 250 minutes a week of moderate activity plus strength on 2 days, so pair Pilates with brisk activity and eating changes.
No exercise burns fat from one spot. Exercise trims the waist a little in PCOS and helps fitness and insulin resistance even when weight doesn't change. Pilates strengthens the muscles underneath; walking, cycling and eating changes do more for belly fat.
It hasn't been tested in PCOS. Exercise in general probably lowers insulin resistance a little in PCOS, and the Pilates trials that lowered blood sugar were in people with type 2 diabetes. Count Pilates as strength work and add steady or interval cardio, which has the most evidence.
No study has tested it. The springs add resistance, so a reformer class can count as strength training, which builds muscle and reduces body fat in PCOS. It isn't better than mat Pilates or a gym: choose what you'll keep doing.
Neither has been shown to be better: the guideline finds no exercise type better than another. Yoga has a few more small trials, at low certainty, and Pilates has one small study. Choose the one you enjoy, and add aerobic activity.
We can't say it does. The one Pilates study, in 26 women with no comparison group, reported shorter cycles, but in the largest exercise trial periods became more frequent in every group, including women who didn't exercise. See a GP if: "You haven't had a period for more than 4 months: you may need treatment to protect your womb lining."
Twice a week on days that aren't next to each other, as your strength sessions, with 150 to 300 minutes of moderate activity spread across the week. Any amount is better than none, and the benefits come even without weight loss. Give it about 12 weeks.
No study has tested it. If you enjoy it and aren't pregnant or trying to conceive, our hot yoga guide covers keeping safe in the heat; if you could be pregnant, skip heated classes.
Yes: gentle and moderate exercise is fine, and the guideline recommends a healthy lifestyle before pregnancy. Very heavy exercise, over an hour a day, has been linked with not ovulating. Our Pilates for fertility guide covers IVF and the two-week wait.
Exercise eased depression and improved quality of life in small PCOS trials, none of them of Pilates. If Pilates gets you moving and feeling calmer, it counts. See a GP if: "You feel low or anxious most of the time, or you worry a lot about food, weight or exercise."
Exercise education, not a personal prescription, and clinical review of these guides is pending. If you are pregnant, have a health condition or have had recent surgery, check with a doctor, midwife or physiotherapist before starting, and stop for sharp or increasing pain. Health disclaimer.
