PCOS & Gut Health

Written by Jonene Ford

As we know, the gut microbiome impacts every single organ, tissue, and system in the human body. This includes the endocrine system.  I’ve recently had an influx of patients diagnosed with polycystic ovarian syndrome (PCOS), and have been studying this endocrinopathy fervently over the last year or so. I’ve since developed a strong interest in the role of the gut microbiome in the treatment of PCOS.

PCOS is the most common endocrine disorder in women of child-bearing age.  It is commonly associated with several conditions and outcomes, including infertility, miscarriage, hirsutism, obesity, type 2 diabetes, hypercholesterolemia, and cardiovascular disease.  Women with PCOS also tend to have lower gut microbiome diversity than those without the condition.

Obesity may play a role in the onset of PCOS. In one study of fecal transplantation, fecal matter transferred from obese humans into germ-free lab mice produced an obese phenotype in the mice.  This result may suggest that altered gut microbiome could be a potential cause of obesity and/or PCOS (Torres, et.al., 2018). Of course, more research would be needed to prove this, but still, the idea is thought-provoking.

One characteristic of PCOS is hyperandrogenism. This is evidenced by increased levels of total testosterone in blood chemistry results.  Women with hyperandrogenism also tend to experience unwanted facial and body hair (hirsutism).  Women with hypoandrogenism also were shown to have an abnormal gut microbiome. This correlation may be indicative of a connection between diminished gut microbiome diversity and imbalanced sex hormones.  It also suggests that androgens have an impact on microbiome diversity and that microbiome diversity plays a direct role in the development of PCOS in women.

In order to make a clearer assessment, other potential causes of microbiome imbalance would need to be addressed.  Other factors, such as lifestyle, diet, age, and drug, alcohol, or cigarette use can also impede the diversity of a woman’s gut microbiome.  However, the connections made in the research between PCOS and an imbalanced gut microbiome cannot be denied.


Lindheim, L., Bashir, M., Münzker, J., Trummer, C., Zachhuber, V., Leber, B., Horvath, A., Pieber, T. R., Gorkiewicz, G., Stadlbauer, V., & Obermayer-Pietsch, B. (2017). Alterations in Gut Microbiome Composition and Barrier Function Are Associated with Reproductive and Metabolic Defects in Women with Polycystic Ovary Syndrome (PCOS): A Pilot Study. PloS one12(1), e0168390. https://doi.org/10.1371/journal.pone.0168390

Lipski, E. (2019).  Digestive Wellness, 5th ed. NY, NY: McGraw-Hill.

Thackray V. G. (2019). Sex, Microbes, and Polycystic Ovary Syndrome. Trends in endocrinology and metabolism: TEM30(1), 54–65. https://doi.org/10.1016/j.tem.2018.11.001

Torres, P. J., Siakowska, M., Banaszewska, B., Pawelczyk, L., Duleba, A. J., Kelley, S. T., & Thackray, V. G. (2018). Gut Microbial Diversity in Women With Polycystic Ovary Syndrome Correlates With Hyperandrogenism. The Journal of clinical endocrinology and metabolism103(4), 1502–1511. https://doi.org/10.1210/jc.2017-02153