In recent years, scientists have made groundbreaking discoveries about the role of the trillions of microorganisms residing in our digestive tract. As regulators of vital bodily functions, including the immune system, they take part in the prevention and development of many diseases, including endocrine and urogenital conditions.

This article explores the possible link between PCOS (polycystic ovary syndrome) and gut health, how they affect one another, and possible treatments focusing on improving the gut microbiome.

How Does Gut Health Affect PCOS?

Polycystic ovary syndrome, or PCOS, is a gynecological condition that affects many women in their reproductive period. One of its hallmark features is the presence of polycystic ovaries—enlarged ovaries containing multiple small, fluid-filled follicles that often fail to release eggs regularly.

PCOS also causes irregular or absent menstrual cycles, excess androgen levels (which can lead to hormonal hair loss or hirsutism), and fertility challenges. It’s frequently associated with insulin resistance, weight gain, acne, and increased long-term risks such as type 2 diabetes and cardiovascular disease.

Doctors don’t know what causes PCOS, but they recognize insulin resistance as the primary reason behind its reproductive dysfunction. Recent research has found that gut health is a significant factor in this process. An imbalance in the gut microbiota—known as dysbiosis—can contribute to insulin resistance, systemic inflammation, and hormonal disruption, all of which are closely linked to PCOS. This growing body of evidence suggests that improving gut health may play a meaningful role in managing PCOS symptoms and supporting overall metabolic and hormonal balance.

Here is a breakdown of the key drivers of PCOS.

Gut Dysbiosis

Gut dysbiosis refers to an imbalance in the composition and function of microorganisms in our digestive tract and is often marked by the overgrowth of pathogenic bacteria, fungi, or viruses. This microbial imbalance damages the intestinal barrier, interferes with key signaling pathways, and disrupts hormonal and neurotransmitter function. These effects may contribute to systemic inflammation, insulin resistance, and chronic ovarian dysfunction, which lead to the development of PCOS.

Insulin Resistance

Insulin resistance is one of the most common characteristics of PCOS, affecting approximately 70% of patients. A diet high in sugar and unhealthy fats can cause gut dysbiosis, reducing the production of beneficial short-chain fatty acids (SCFAs) normally synthesized by certain gut bacteria. SCFAs regulate glucose and lipid metabolism, and a decrease in these metabolites can reduce sensitivity to insulin.

Gut dysbiosis also damages the intestinal epithelial barrier and increases intestinal permeability, allowing pathogens to enter the bloodstream. The leakage of certain bacterial components, such as lipopolysaccharides (LPS) and branch-chain amino acids (BCAA), is linked to immune system activation. These inflammatory mediators interfere with insulin receptors and may be responsible for insulin resistance in PCOS patients.

Note: Learn how insulin resistance hinders weight loss and what treatments can help.

Chronic Inflammation

Chronic low-grade inflammation is a common feature of PCOS. Increased intestinal permeability, or leaky gut, allows harmful substances like lipopolysaccharides (LPS) – components of the outer walls of certain bacteria (e.g., Escherichia coli) – to enter the bloodstream. Once in circulation, LPS can activate the immune system and stimulate the release of pro-inflammatory cytokines, leading to systemic inflammation.

High Testosterone Levels

Gut dysbiosis may trigger systemic inflammation and excess insulin production, both of which disrupt hormone regulation. Elevated insulin levels can cause ovaries to produce more androgens and prompt the pituitary gland to release more luteinizing hormone (LH), further increasing testosterone levels. This excess of androgens interferes with the normal development of ovarian follicles, leading to irregular periods and other common PCOS symptoms.

Excess Hair Growth and Acne

Excess free testosterone in the blood may cause excess hair growth on the face and other body parts, scalp hair loss (alopecia), and hormonal acne. These symptoms are common in PCOS patients.

Obesity

Obesity in PCOS patients is closely associated with a disbalance in intestinal flora. The gut microbiome plays a crucial role in digestion, energy balance, and the regulation of appetite-related hormones, such as ghrelin and leptin. A disbalance in gut microbiota levels and diversity can contribute to overeating, increased fat accumulation, and obesity. In a vicious circle, obesity perpetuates insulin resistance and excess testosterone production, exacerbating PCOS.

Infertility

Gut dysbiosis can contribute to insulin resistance and chronic inflammation, which may cause ovarian dysfunction. These metabolic and immune disorders can also disrupt the growth and development of endometrial cells, interfering with the successful implantation of a fertilized egg and contributing to infertility commonly seen in PCOS patients.

Mood Disorders

The gut-brain axis refers to the communication network between the gut and the brain, involving neural, hormonal and immune signaling pathways - including neurotransmitters like serotonin and dopamine.

These neurotransmitters play a critical role in regulating mood, and a significant portion of their production is influenced by the gut. In fact, about 90% of serotonin is produced in the gastrointestinal tract. Gut bacteria help synthesize and modulate these neurotransmitters, making a balanced microbiome essential for emotional wellbeing.

Gut dysbiosis can reduce neurotransmitter production and signaling, contributing to mood disorders such as hormonal depression and anxiety. This link is especially important in conditions like PCOS, where hormonal imbalances and gut health issues often overlap, amplifying emotional symptoms.

Does PCOS Affect Your Gut Health?

Research shows that women with PCOS often have lower gut microbiota diversity and different microbial composition. Thus, PCOS and gut health have a bidirectional relationship.

How Does PCOS Affect Gut Health?

High androgens and insulin resistance in PCOS can affect gut motility, gut barrier function, digestion, and the environment in which gut bacteria live. This creates a vicious cycle where PCOS exacerbates hormonal imbalances and gut dysbiosis, aggravating PCOS symptoms.

Gut health issues that often occur in PCOS patients include:

• Constipation
• Bloating
• Gas
• Abdominal pain

How Are PCOS and Gut Health Issues Diagnosed?

Polycystic ovarian syndrome is diagnosed using the Rotterdam criteria, which include a physical examination, symptom evaluation, and lab tests that help determine if the patient’s symptoms fit the different phenotypes of the condition. According to these guidelines, a PCOS diagnosis can be made if a patient has two of the following three features: elevated androgen levels, irregular or absent ovulation, and polycystic ovaries that are not the result of another disorder.

Since the discovery of the gut microbiome’s role in metabolic and endocrine disorders, scientists are exploring new diagnostic options for PCOS. These include using the patient’s stool sample to identify bacteria as potential biomarkers of the disease. The approach is still in the experimental phase.

How to Improve Gut Health and PCOS?

Current treatments for polycystic ovary syndrome include insulin-sensitizing and lipid-lowering medications, such as metformin and atorvastatin. However, medications are not always effective. Researchers are exploring therapies that target the gut microbiome, and the results are promising.

Probiotics and Prebiotics

PCOS patients often have reduced levels of beneficial gut bacteria like Lactobacillus and Bifidobacteria and increased levels of pathogenic microorganisms like Escherichia and Shigella.

Probiotics are foods and supplements that contain beneficial bacteria, which can help restore microbial diversity, reduce inflammation, improve insulin sensitivity, and balance hormones. Foods that contain probiotics include fermented products, such as yogurt, kefir, sauerkraut, and kimchi.

Prebiotics are foods and supplements that feed beneficial microorganisms and help them outnumber pathogens. By supporting gut microbiota, they may help reduce insulin resistance, androgen levels, and menstrual irregularities.

Our medical professionals have created Vibrant supplements with probiotics, prebiotics, and other microbiome-supporting ingredients that aid in improving gut health, metabolic functions, and hormonal imbalances.

Diet Modification

PCOS patients may benefit from dietary changes that can help diversify intestinal flora and decrease uncomfortable symptoms. Recommendations include:

• Increase intake of fiber-rich fruits and vegetables. Dietary fiber nourishes beneficial gut bacteria, promoting the production of anti-inflammatory short-chain fatty acids (SCFAs) that support overall metabolic and gut health.
• Add more polyphenols. Found in berries, green tea, apples, carrots, broccoli, etc., polyphenols balance the gut microbiome, reduce inflammation, and may improve insulin sensitivity and ovarian function.
• Eliminate processed foods and those high in sugar and unhealthy fats. These foods disrupt the gut microbiome by feeding pathogenic bacteria, contributing to inflammation, insulin resistance, and hormonal imbalance.

Note: Learn more about anti-inflammatory diets and how they can help improve gut health.

Other Lifestyle Changes

Sleep quality and stress levels can significantly impact the composition of our gut microbiota. Health experts recommend seven to nine hours of uninterrupted sleep at night and relaxing activities to support both microbial balance and healthy hormone levels.

Moderate-intensity exercise, including long walks, light cardio, and Pilates, can improve sleep patterns and lower stress. Research shows regular exercise is one of the best ways to improve overall health.

Fecal Microbiota Transplantation (FMT)

FMT is a procedure involving stool transplantation from a donor with healthy intestinal flora to a recipient with gut dysbiosis. Medical professionals currently perform the procedure only for patients with an antibiotic-resistant Clostridiodes difficile infection.

However, the medical community considers FMT a promising solution for other metabolic conditions, including obesity, insulin resistance, and polycystic ovary syndrome. Preliminary research suggests restoring microbial diversity through FMT may help improve hormonal balance and metabolic function in people with PCOS.

Conclusion

The gut microbiome is an emerging area of interest in medical research. Scientists have established a link between gut microbiota diversity and function and the occurrence of polycystic ovary syndrome, but more research is needed to develop adequate diagnostics and treatments.

In the meantime, adopting healthier lifestyle habits – such as more fiber intake, adding probiotic supplements, engaging in regular exercise, and improving sleep – may help support gut health and manage symptoms associated with PCOS.