PCOS bloating

PCOS bloating

We know how frustrating PCOS bloating can be. It can not only feel uncomfortable, but it can impact your self image too. 

This article will guide you through what PCOS bloating is exactly, what drives it and how to manage it naturally so you can feel your best.

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What is PCOS bloating?

PCOS bloating is when the stomach distends more than usual for women with PCOS (PCOS stands for polycystic ovary syndrome). The stomach can feel tight, uncomfortable and sometimes even painful. 

PCOS bloating is often accompanied by other frustrating stomach symptoms such as gas, constipation or diarrhoea. 

PCOS bloating is different from PCOS belly which is the buildup of visceral fat around the stomach due to factors including high androgens, insulin resistance and stress. PCOS belly doesn’t fluctuate and isn’t usually uncomfortable or painful. Whereas PCOS bloating can change from day to day and even moment to moment and can be uncomfortable and painful.  

PCOS bloating can be a very frustrating symptom for those with PCOS. But don’t worry, we are here to help and by addressing the root cause, we can help prevent and reduce PCOS bloating!

What is PCOS really?

The 5 main causes of PCOS bloating

At FUTURE WOMAN, we passionately believe that addressing the root cause through testing and expert advice from a functional medicine practitioner is key to bring about lasting change.

So let’s look at the 5 most common causes of PCOS bloating.

1. Low progesterone

Low progesterone is a hallmark feature of PCOS. 

What is progesterone? Well, in a healthy ovulatory cycle, when an egg is released from the follicle during ovulation, the empty follicle will then break down and produce a hormone called progesterone. This hormone helps to prepare the uterus and menstrual lining for pregnancy. 

However, women with PCOS often do not ovulate, as a result of raised androgen levels. This then results in irregular or absent menstrual cycles, leading to low levels of progesterone. 

So how does low progesterone cause bloating?

Progesterone is a natural hormonal diuretic which helps the body release excess fluids. So low progesterone may lead to water retention, which is a common cause of bloating. Water retention can fluctuate day to day and also can have symptoms like swollen ankles. We test your progesterone levels in our Advanced Hormone Test.

Read more about low progesterone.

PCOS bloating and low progesterone

2. Gut dysbiosis

You cannot look at PCOS without looking at the gut! 

Our gut is home to roughly 100 trillion bacteria which make up the gut microbiome. This is made up of beneficial ‘good’ bacteria and more pathogenic ‘bad’ bacteria. 

In a healthy person the good and bad bacteria are balanced and live harmoniously together. However, if there is a lack of diversity of bacteria in the gut, or more of the bad bacteria than the good, the gut microbiome becomes imbalanced. This can lead to gastrointestinal issues such as PCOS bloating, flatulence, constipation or diarrhoea. It can also result in inflammation which is a root driver of PCOS. 

Interestingly, women with PCOS have been shown to have higher rates of gut dysbiosis than women without. Women with PCOS have especially been shown to be low in good bacteria that produce short chain fatty acids (SCFAs) which play an essential role in regulating metabolic activities and are helpful in reducing insulin resistance. Insulin resistance is a common root driver of PCOS, affecting up to 70% of women with the condition.

We test for gut dysbiosis in our Advanced Hormone Test.

3. Irritable Bowel Syndrome (IBS)

Many studies have suggested a link between PCOS and IBS, especially the IBS-constipation type (IBS-C). One study found that as many as 42% of PCOS individuals may suffer from IBS, compared to 10% of controls. 

In PCOS, women can have high luteinizing hormone (LH) which prevents ovulation and also can lead to constipation. Excess LH can cause constipation by delaying the movement of food in the digestive system and this results in PCOS bloating.

PCOS and IBS

4. Eating patterns

If you have PCOS then you may already know that it is common to have increased cravings for highly palatable foods. This is particularly true for carbohydrates and starches. 

It can be a really hard part of PCOS to manage these food cravings. Complex carbs and starches are broken down into sugars which can feed bad bacteria in the gut which can contribute to bloating or make existing bloating worse. 

Emotional, disordered and addictive eating can also be higher in patients with PCOS because of the self-esteem issues that come with many of the symptoms of PCOS. But don’t worry, by addressing your root cause of PCOS, food cravings can come under control and even disappear.

Food cravings, binge eating and PCOS bloating

5. Stress

Stress causes cortisol (our stress hormone) to be released from the adrenal glands, which raises blood sugar levels and can result in cravings for unhealthy food choices which can contribute to bloating, as seen above in part 4. 

Feelings of stress can also cause gastrointestinal problems like bloating through the gut:brain axis. In times of stress the body goes into a flight or fight response where resources are directed into processes needed for survival, such as focus and strength, and away from systems such as digestion.  This can cause a sluggish digestive system, constipation and resulting flatulence and bloating.

Other causes of bloating

Other causes of bloating, that aren’t specifically related to PCOS, can include leaky gut, food intolerances (including lactose, gluten or FODMAP intolerances), premenstrual syndrome (PMS), fizzy drinks, artificial sweeteners or swallowing lots of air when eating. Not eating enough fibre can also cause constipation and resulting bloating. 

At FUTURE WOMAN, we assess your sex hormones, stress hormones and gut dysbiosis in our Advanced Hormone test to understand what is driving your PCOS bloating. 

Check your PCOS symptoms now

How we approach treatment of PCOS bloating at FUTURE WOMAN

First of all, it’s important with PCOS bloating to determine that you definitely have the condition. Many women with PCOS have received a PCOS diagnosis based on ultrasound alone, without a test to confirm elevated testosterone or other androgens. This leads to a lot of overdiagnosis of PCOS. 

Testing with our easy at home urine-based Advanced Hormone Test will help to determine if your androgens or androgen metabolites are raised, and if not, whether something else is driving your symptoms. We assess all androgens in the Advanced Hormone Test, including the androgen metabolite 5a DHT, which can be three times more potent than testosterone, and is only detectable in urine testing.

Read more about the benefits of testing hormone metabolism.

What type of PCOS do I have?

Secondly, it is important in PCOS to determine which type of PCOS you have so that your practitioner can address the underlying root causes of your PCOS facial hair. 

For example, insulin resistance is the most common PCOS type, and we would treat this differently to Inflammatory PCOS (driven by inflammation) or adrenal PCOS (driven by stress). 

The Advanced Hormone Test assesses the full range of adrenal hormones, like cortisol, as well as many markers for inflammation to help us determine your PCOS type.

4 types of PCOS

What factors are contributing to my PCOS bloating?

As we’ve seen above, there are many other factors that could be driving your PCOS symptoms, like bloating. 

In the Advanced Hormone Test, in addition to androgen levels, we assess both free and metabolised cortisol and cortisone for a comprehensive assessment of your stress response and HPA (hypothalamus pituitary adrenal) axis functioning. This is especially important in PCOS as increased cortisol can increase overall inflammation in the body, which in turn increases androgen production resulting in the worsening of symptoms. 

Estrogen and progesterone are also measured as these impact PCOS bloating too. 

Other possible root causes of PCOS bloating that would show up in our testing include gut dysbiosis and inflammation.

PCOS bloating and supplementation

Once we establish the drivers of your PCOS bloating through testing, one of our expert nutritionists will create a personalised healthplan for you. This will include evidence based supplement, diet and lifestyle recommendations to address your unique drivers and symptoms.

 Supplements  can be helpful for PCOS in general but only if they are right for you. For example the supplement myo-inositol has been shown to be hugely beneficial for insulin resistant PCOS but may worsen hormonal symptoms for people who do not need it. That is why it is so important to test first and determine which supplements and dietary changes are right for you.

3 tips to help banish PCOS bloating for good

To bring about lasting change with PCOS bloating, here are our top 3 recommendations.

  1. Confirm if you really have PCOS by testing. We see many women who have been misdiagnosed with PCOS based on ultrasound alone. You need irregular or non ovulatory cycles AND raised androgens to confirm if you have PCOS.
  2. Test ALL androgens and androgen metabolites. It’s not just about testosterone! PCOS can be present if ANY of your androgens or androgen metabolites are raised. Metabolites can only be tested in urine, not blood serum.
  3. Check other hormonal drivers of your PCOS bloating. Every woman with PCOS is different. As we’ve covered in this article, there are many possible hormonal drivers of PCOS bloating. Testing with the Advanced Hormone Test can help you understand your unique hormone picture and we can then address those drivers in your free personalised plan.

References

Bazarganipour, F., Taghavi, S. A., Asemi, Z., Allan, H., Khashavi, Z., Safarzadeh, T., Pourchangiz, S., Zare, F., Ghasemi, S., Karimi, Z., & Azizi Kutenaee, M. (2020). The impact of irritable bowel syndrome on health-related quality of life in women with polycystic ovary syndrome. Health and quality of life outcomes, 18(1), 226. 

Duan, L., An, X., Zhang, Y., Jin, D., Zhao, S., Zhou, R., Duan, Y., Zhang, Y., Liu, X., & Lian, F. (2021). Gut microbiota as the critical correlation of polycystic ovary syndrome and type 2 diabetes mellitus. Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie, 142, 112094.

Kałużna, M., Kompf, P., Wachowiak-Ochmańska, K., Moczko, J., Królczyk, A., Janicki, A., Szapel, K., Grzymisławski, M., Ruchała, M., & Ziemnicka, K. (2022). Are patients with polycystic ovary syndrome more prone to irritable bowel syndrome?. Endocrine connections, 11(4), e210309. 

Li, P., Shuai, P., Shen, S., Zheng, H., Sun, P., Zhang, R., Lan, S., Lan, Z., Jayawardana, T., Yang, Y., Zhao, J., Liu, Y., Chen, X., El-Omar, E. M., & Wan, Z. (2023). Perturbations in gut microbiota composition in patients with polycystic ovary syndrome: a systematic review and meta-analysis. BMC medicine, 21(1), 302. 

Mathur, R., Ko, A., Hwang, L. J., Low, K., Azziz, R., & Pimentel, M. (2010). Polycystic ovary syndrome is associated with an increased prevalence of irritable bowel syndrome. Digestive diseases and sciences, 55(4), 1085–1089. 

Salehi, S., Allahverdy, J., Pourjafar, H. et al. Gut Microbiota and Polycystic Ovary Syndrome (PCOS): Understanding the Pathogenesis and the Role of Probiotics as a Therapeutic Strategy. Probiotics & Antimicro. Prot. (2024). 

Sun, Y., Gao, S., Ye, C., & Zhao, W. (2023). Gut microbiota dysbiosis in polycystic ovary syndrome: Mechanisms of progression and clinical applications. Frontiers in cellular and infection microbiology, 13, 1142041. 

Wei, Z., Chen, Z., Xiao, W., & Wu, G. (2023). A systematic review and meta-analysis of the correlation between polycystic ovary syndrome and irritable bowel syndrome. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, 39(1), 2239933. 

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