What is PCOS?
PCOS (Polycystic ovary syndrome), as any suffer will attest, is a complicated endocrine disorder that is estimated to affect as many as 10% of women of childbearing age in Ireland. It is one of the most common causes of infertility because it interferes with a woman’s ability to ovulate, or release an egg for fertilisation.
In addition to infertility, other complications of PCOS include:
- Irregular or absent menstrual cycles
- High levels of androgens or “male” hormones, which may cause symptoms like acne, facial hair growth and head hair loss
- Insulin resistance (thought to be a primary driver or “root cause” in PCOS)
- Vitamin and mineral deficiencies
- Chronic low-grade inflammation
- Pregnancy complications such as gestational diabetes or high blood pressure
- Sleep apnoea
- Elevated cholesterol levels and heart disease
What causes PCOS?
What causes PCOS, however, is less clear cut, with scientific research yet to settle on one — or several— explanations.
There are many theories to what triggers PCOS, including genetic and environmental factors. One such theory — and one that is relatively new but is currently being explored by scientist and researchers across the globe —is the theory that an imbalance of microbes in the gut can trigger the development of PCOS.
While some microbes are pathogenic (capable of causing a disease) to us, there are a host of microorganisms (MOs) that help us carry out many of our bodily functions and protect us from the “bad” MOs.
Believe it or not but there are actually approximately as many bacterial cell in the human body as there are human cells. A recent study found that there are approximately 38 trillion bacterial cells, with a resulting mass of roughly 0.2kg, and 30 trillion human cells in the average 70kg man aged between 20-30, with minor quantitative variations for women.
Most of these bacterial cells can be found in the gastrointestinal (GI) tract where they function to protect us against bad bacteria, aid in biochemical signalling, and help us by increasing the nutrition value in much of the food we eat. The imbalance, or maladaptation, of microorganisms in the gut— which is referred to as dysbiosis of the gut — is certainly a ‘hot topic’ in the medical world right now.
What is Dysbiosis of the gut?
We have a symbiotic relationship with our normal flora, or “good bacteria”, where we act as their host and they facilitate many of our bodily processes.
What constitutes as our gut microbia is largely determined at birth and during the first three years of life, where exposure to the mother’s normal flora and the environment determine the phylogenic contents of our adult gut microbiota.
“Good” bacteria helps us in a number of different ways including displacing “bad bacteria”, assisting us in the breaking down of larger molecules so that they may be safely absorbed into our blood stream, and producing certain chemicals, such as serotonin, that we may use for various processes throughout our bodies.
In order for these bacterial to thrive me must produce a favourable environment for them; otherwise “bad’ bacteria may over populate, causing a microbia imbalance, or dysbiosis of the gut.
It should be acknowledged that dysbiosis is a catch-all term since there is no “perfect” microbiome. Every human is unique, and that means that every microbiome is unique, too. However, researchers have identified three broad signs of dysbiosis that are related to the quantity of certain microbes in relation to others:
- Overgrowth of some bacteria or yeasts
- Absence or insufficiency of beneficial bacteria
- Low diversity of species in the microbiome
What happens when there is Dysbiosis of the gut?
When we consume a poor diet (low in fibre) and excessive amounts of alcohol, our good bacteria become “uncomfortable”, which results in the pH in the GI tract increased, creating a more favourable environment for “bad bacteria”.
If a poor diet is consumed over a sustained period, the ratio of “good” to “bad” bacteria will likely decrease to a point where the by-products of the “bad” bacteria will reduce the integrity of the GI tract wall.
When the wall of the GI tract is compromised, its permeability increases and, subsequently, large molecules, which are not meant to pass between the epithelial cells of the GI wall, are able to enter the blood stream, creating a number of unfavourable responses.
Studies have shown that women with PCOS have dysbiosis and less diverse gut bacteria than woman without PCOS, which may contribute to symptoms and disease progression. Researchers have also found that the higher the androgens, the lower the gut bacterial diversity is in PCOS. In addition, the complications associated with PCOS (obesity, insulin resistance, etc) may lead to worsening dysbiosis, further complicating things.
How does dysbiosis of the gut relate to PCOS?
Two biochemical factors have always been in agreement
and observed in the majority of women with PCOS: the presence of chronic inflammation and insulin resistance (metabolic dysfunction). Many studies have found a correction between gut microbiota and metabolic dysfunction, where it is said that mediators of the brain-gut axis — by which messages are sent between the central nervous system and the GI tract — may be regulated by “good” bacteria.
One study found that women with PCOS had higher levels of certain “bad” bacterial strains in their stool sample than non-PCOS women; this demonstrated a positive correlation with BMI and testosterone in women with PCOS.
In recent years a new concept, referred to as microgenderome (or sexual dimorphism in microbiome), reveals a potential relationship between sex hormones and gut microbiota. At this time, the studies encompassing the microgenderome concept are largely animal-based; nonetheless, these studies are significant stepping stones in discovering connections between hormone concentrations and gut microbiota in humans.
The imbalance between “good” and “bad” bacteria within the gut can potentially affect the exacerbation, and possibly the development, of PCOS in a number of different ways.
“Bad” bacteria contain what is known as lipopolysaccharide (LPS), a known stimulant of inflammation, on their cell wall. Inflammation in the GI (gastrointestinal) tract can increase the permeability of the GI tract walls as it compromises the integrity of the ‘tight junction’ proteins that keep the wall cells tightly bound. Inflammatory promoting factors are then released in the blood stream; these factors have been associated with the inactivation of insulin receptors on our cells, preventing insulin from binding its respective receptor; thereby preventing glucose from entering a cell to be used as fuel.
An increase in blood insulin levels, as well as the increase in certain inflammatory factors, trigger a rise in androgen production from the theca cells of the ovaries. High levels of blood insulin also reduces the Sex Hormone Binding Globilin (SHBG) released from the liver which allows more free, bioavailable, testosterone to exist throughout the body.
Prolonged inflammation further weakens tight junctions creating a positive feed-back loop. Therefore, the evidence indicates that dysbiosis of the gut has the potential to make serious contributions to the development and aggravation of PCOS.
 Guo Y, Qi Y, Yang X, Zhao L, Wen S, Liu Y,et al. (2016) Association between Polycystic Ovary Syndrome and Gut Microbiota. PLoS ONE 11(4):e0153196. doi:10.1371/journal.pone.015319
What can women with PCOS do?
While there is no cure for PCOS, overweight and obese women can help balance their hormone levels by losing weight. Otherwise, treatment is aimed at managing symptoms.
The most common way to control the condition is through diet and exercise. The former is especially important if the aim is to bring balance to the gut microbiota. A healthy diet of unprocessed foods, limited alcohol, and high fibre (women of childbearing age need at least 25 grams of fibre per day) will help to produce an environment for good bacteria to thrive.
A good probiotic supplement, such as Nua Fertility, will help to jumpstart gut microbial replenishment and should be taken regularly. The “friendly bacteria” they contain can help restore balance and composition in the gut microbiome and help to address or prevent dysbiosis. Furthermore, probiotics support the proper digestion and absorption of nutrients, support the immune system, and may reduce inflammation in the digestive tract.
Additional ways to alleviate the effects of PCOS include stress-management, reducing the intake of sugar and ensuring sufficient sleep is achieved.
 Rowland I, Gibson G, Heinke A, Scott K, Swann J, Thiele I, Tuohy K (2017) Gut Microbiota functions: metabolism of nutrients and other food components. Eur J Nutr. doi:10.1007/s00394-017-1445-8
PCOS is closely linked to an imbalanced gut microbiome, so supporting gut health is an incredibly important component in managing PCOS and boosting fertility.
For Women thinking, planning or trying for a baby with PCOS, Nua for Women supports gut health.