You might have heard before that our gut microbiome impacts our overall health. But you may be surprised to hear that our gut health may also be connected to
your reproductive system, especially for those with polycystic ovary syndrome, or PCOS. Before we explore what information I found about the potential connection between the two, let’s have a quick look at each condition…
What is PCOS?
Polycystic ovary syndrome is a hormonal disorder which can present as a combination of the following symptoms: irregular or infrequent menstruation, lack of ovulation, skin and hair changes, weight gain, increased anxiety and depression, multiple cysts on the ovaries, infertility, and sleep apnoea.1
It affects around 1 in 10 women, with around 70% of women with the condition estimated to be undiagnosed.1
What is IBS? Irritable Bowel Syndrome is one of the most common conditions affecting the digestive system. Symptoms of IBS include abdominal pain or cramps, passing wind, diarrhoea, constipation, bloating and nausea.2 There are actually a few different types of IBS2: - IBS-C – constipation dominant
- IBS-D – diarrhoea dominant - IBS-M – mixture of constipation and diarrhoea
It is approximated that 1 in 5 Australians have IBS.2 Unfortunately, it is a condition that affects more women than men and sadly we aren’t quite sure about what exactly causes it.2 There are a few known triggers such as stress and anxiety, food intolerances, hormonal changes, and medications.2
So, what is the link? Both conditions are common on their own which means there is bound to be some overlap. What is interesting is that it is approximated that 30-40% of people with PCOS also have IBS.3,4 The link between the two conditions is pretty unclear; however, both conditions often affect young women, meaning it is highly likely that a person with one condition may also have the other. They do also have fairly similar symptoms like bloating, constipation, diarrhoea, pelvic and abdominal pain. I will say this connection hasn’t been heavily researched, so a definite reason why so many women have both conditions has not been found yet. This being said let’s have a look at the potential reasons behind this link… Being a female So, it has been reported that IBS is more commonly found in females. Females are thought to be 2-2.5 times more likely to have this condition.5 These numbers may not be the most accurate as they are dependent on the amount of people who have sought out medical care for their IBS. We all know that seeking medical care for anything can be affected by a variety of reasons such as the severity of the symptoms, accessibility of care and how we think we are going to be perceived for doing so. Interestingly, women and men tend to experience different IBS symptoms.5 Women have been found to be more likely to report abdominal pain and constipation related discomfort, while men were more likely to report diarrhea related symptoms.5 Women are also more likely to report frequent and severe IBS symptoms during menstruation such as loose stools, bloating and worsening abdominal pain, which are likely related to changes in the menstrual cycle.5 The reason behind why women are more likely to have IBS is unclear as to whether it is differences in our biology or differences between the sexes in seeking medical help for their IBS. A growing body of evidence shows that sex hormones, like estrogen and progesterone, may be the reason behind the gender differences. These hormones can trigger IBS symptoms, which may explain why people tend to have more flare ups at different points of their menstrual cycle. Estrogen and progesterone affect IBS symptoms in a few ways, from how our intestines work to how much pain we feel. The following is the main ways that our hormones may affect IBS: - Digestion: They are known to inhibit the contraction of the smooth muscle in our intestines, which impacts on how quickly food travels through your system.5 - Pain level: Estrogen boosts the production of serotonin, which is a feel-good chemical in your brain. A dip in your estrogen levels can lower your pain threshold, while an increase can reduce the amount that your bellyaches or cramps are hurting you.6 - Inflammation: Some sex hormones can raise the levels of inflammation throughout your body which can makes your IBS symptoms worse.7 Scientists have found that androgens, such as testosterone, may protect against the development of IBS.8 This research is really interesting seeing as people with PCOS have elevated levels of these hormones, which would make you think that there shouldn’t be as much overlap between the two conditions as what is reported. This being said, PCOS is also marked by a higher ratio of luteinizing hormone and follicle stimulating hormone, which are involved in ovulation.9 A study found that high levels of these hormones can delay the movement of food in the digestive tract which results in constipation.9 Inflammation So, PCOS and IBS may also be linked through inflammation. Many studies have shown a strong association between PCOS and chronic, low-grade inflammation. 10 Inflammation levels can be measured by looking at certain biomarkers in your bloodstream, including C-reactive protein (CRP). People with PCOS are believed to have higher than normal CRP levels.11,12 A common (but not all) root cause to PCOS, can be its associated with insulin resistance – this is when cells start resisting or ignoring signals from a hormone called insulin which controls how our body handles blood sugar – and inflammation, which can manifest in the bacteria that live in the small intestine. 13,14 A condition called small intestinal bacterial overgrowth (SIBO) can occur, when there is an abnormal increase in that group of bacteria. SIBO has symptoms that are very similar to that of IBS including abdominal bloating, pain, diarrhoea, and constipation.14 An imbalance of the bacteria in the gut can cause inflammation and make PCOS symptoms worse.
Stress and Anxiety Stress and anxiety are supposed to be our body’s reaction towards danger. But, with everything that is going on in the world at the moment, and so many other valid reasons, these emotions are becoming increasingly more common in our day to day lives. Stress, anxiety, and major life traumas are known to worsen the symptoms of IBS.15 In some it can sometimes trigger the overactivity of the gut, causing diarrhoea and stomach churning. In others, the brain signals may be underactive, causing the gut to slow down, which can cause constipation, gas, and abdominal discomfort. So, how does this relate to PCOS? Well, even though we don’t really know what causes PCOS, it is thought that genetics and environmental factors, like stress, play a role. It is also not unusual for people with PCOS to also experience anxiety or depression.16.17 Just like, it is also not unusual for people to experience their first symptoms of PCOS during a time of extreme stress or anxiety. Research has found that anxiety is more common among people with PCOS, with people with PCOS being almost three times as likely to report symptoms.16 Many people with PCOS experience anxiety and panic attacks due to the symptoms of PCOS. Some people also struggle with infertility, which can lead to anxiety and depression surrounding what their future might hold, whether they planned on having children or not. The news of this diagnosis can be really confronting for some people. Being told you have a condition, no matter what it is, that can only be managed and not cured is confronting and any feeling you might have had when receiving the diagnosis is completely valid and normal, and you’re definitely not alone.
The Bottom Line There isn’t an overwhelming amount of evidence out there that provides a clear reason why so many people that have PCOS also have IBS. What we do know is that both conditions are common and often affect young women, which means that there is bound to be some overlap. The conditions are closely linked in terms of the way that they affect the body. Although the exact cause of IBS in women with PCOS is unclear, it may be linked with chronic inflammation, elevated luteinizing hormone and follicle stimulating hormone, and stress and anxiety. Sadly, there is no cure for PCOS or IBS at this point in time. This means we the focus is on reducing and managing symptoms. This can include:
- Prioritising self-care – finding out what works for you can take time – it may look like making sure you set aside time to exercise, practicing meditation, creating and following a skin care routine, getting massages, eating food that you enjoy, going for walks in beautiful places, finding someone you trust to open up to or even joining a support group. - Eating a nutrient-rich balanced diet as often as possible - Staying as physically active as possible - Work out what triggers your IBS and try to limit these foods if you can
I work with clients everyday to find solutions for them, in their world. No two ladies are the same; so no two meal plans will be the same. Everyone has their own triggers; stressors; food requirements and needs; and even within this, needs can change on a weekly, even daily basis. By working one-one with me; together we can help find your food that’s right for you and your PCOS health journey.
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