PCOS and gut health: what’s the link?

In the ever-evolving world of health and wellbeing, two areas are drawing increasing attention: PCOS and gut health. And, the potential link between them is even more compelling. But what exactly are PCOS and gut health? And how might they be intertwined? Let’s dive in.

What is PCOS?

Polycystic Ovary Syndrome (PCOS) is a hormonal disorder common among people assigned female at birth. People with PCOS may have infrequent or prolonged menstrual periods and excess male hormone (androgen) levels. Symptoms of PCOS range from acne, oily skin, alopecia, and hirsutism to irregular periods and challenges getting pregnant.

What is gut health?

Gut health refers to the balance and function of microorganisms in the gastrointestinal tract. A balanced gut promotes overall health, absorption of nutrients and immune function.

The gut microbiome is a community of diverse bacteria within the intestines. In fact, our bodies contain ten times more microbes than human cells, with the majority working to maintain our health. This community plays an important role in immunity, gut health, digestion and production of macro and micronutrients, metabolism and neurological functions – pretty important stuff! Therefore, it’s not surprising that alterations in the gut microbiome have been associated with certain disorders and diseases.

What contributes to a healthy gut?

A healthy gut is often characterised by a diverse array of beneficial bacteria, known as the gut microbiome. This diversity is nurtured by a balanced diet and regular physical activity.

What are the signs of an unhealthy gut?

An unhealthy gut can manifest in various ways, from bloating and gas to irregular bowel movements, chronic bad breath, food allergies or sensitivities, and constant fatigue.

What impacts gut health?

Factors that impact gut health range from diet and medications to stress levels, sleep patterns, and hydration. Additionally, underlying medical conditions and genetic factors may also influence gut health.

What’s the link between PCOS and gut health?

Recent research has begun to suggest that gut health might play a role in the exacerbation or potentially even the onset of PCOS. Studies have found that individuals with PCOS have less diverse gut bacteria than those without the condition. People with PCOS are more likely to have a damaged intestinal mucosal barrier compared to those without PCOS.

A rodent study in 2016 treated rats with PCOS with “good” bacteria. They found that the rats saw improvements in their menstrual cycles, androgen levels and ovary health. We need more research in humans with PCOS but this evidence suggests that there may be a link between PCOS and gut health – and PCOS symptoms may improve by boosting gut health.

It is hypothesised that inflammation, hormonal changes and stress seen in people with PCOS may impact gut health, and vice versa.


Chronic inflammation, which can be influenced by gut health, has been associated with PCOS. Some inflammation in the body is a good thing, but persistently elevated levels of inflammatory mediators might result in various chronic disorders.

Certain types of microbes may reduce inflammation. Therefore a balanced gut can potentially reduce inflammation and, consequently, may help in managing PCOS symptoms.

Hormonal changes

New research has indicated that sex hormones can impact the makeup of the microbiome, including the gut and vagina microbiome. In people with PCOS, when sex hormones like LH, FSH, oestrogen and progesterone are imbalanced, this may contribute to an imbalanced gut microbiome.


Stress, depression and other mood disorders can contribute to increased gut barrier permeability, impacting gut health. People with PCOS tend to have higher levels of stress and are more impacted by the effects of stress.

6 ways to improve gut health for PCOS

6 ways to improve gut health for PCOS

Improving your gut health may improve your overall health, and even improve symptoms of PCOS. There are several ways you can improve your gut health, but if you believe you have a gut health condition such as IBS, speak to your healthcare professional as soon as you can.

Reduce stress levels

Stress can negatively impact your gut balance. Engaging in relaxation techniques like meditation, deep breathing exercises, and yoga can help alleviate stress and improve gut health. The gut and brain are closely connected, which is why emotional disturbances can wreak havoc on the digestive system. Practices like meditation, journaling, and leisurely walks can help manage stress.

Improve sleep quality and quantity

Sleeping well can work wonders for your gut. Aim for 7-9 hours of uninterrupted sleep each night. Sleep deprivation can impair the gut lining and disrupt the balance of gut microbes. A 2023 study found that just a 90-minute difference in the timing of the midpoint of sleep (halfway between sleep and wake time) can change gut health composition.

Establishing a consistent sleep routine, avoiding screens before bed, and creating a conducive sleep environment can make a significant difference. Read more about sleep and PCOS in our dedicated article.

Eat more mindfully

Paying attention to what and how you eat can promote better digestion. Chew your food thoroughly and listen to your body’s hunger and fullness cues. Rushing through meals or eating while distracted can lead to poor digestion. Taking time to savour every bite and listening to body cues can promote better gut function.

>> Read more | PCOS and intuitive eating: the ultimate guide

Include prebiotics and probiotics in your diet

Prebiotics and probiotics are both beneficial to health – particularly gut health.

Probiotics in food

Probiotics are live microorganisms, such as bacteria and yeast, which can promote health benefits by changing the balance of the gut microbiota when the right amounts are consumed. They have been found to increase the amount of good bacteria while decreasing harmful bacteria. As a result, this aids in the reduction of infection risk as the production of short-chain fatty acids via the protective bacteria can reduce inflammation.

Typical fermented foods that either naturally possess probiotics or have them incorporated include yoghurt, kefir, kombucha, sauerkraut, pickles, miso, tempeh, kimchi, sourdough bread, and certain cheeses.

Prebiotics in food

Prebiotics are non-digestible food ingredients, and a type of dietary fibre, although not all fibres are considered prebiotics. To be categorised as a prebiotic they must: resist acidic stomach conditions, remain undigested until reaching the colon, be fermented by the intestinal microbiota, and change the activity of the microbiota.

To put it simply, they act as a source of energy for the intestinal microbiota, permitting “good bacteria” to thrive. The most beneficial prebiotics include galactooligosaccharides, fructooligosaccharides and inulin.

They can be found in plant foods such as oats, garlic, artichokes, onions, chicory and banana. While they can be found in supplements, in most cases they are not necessary, as they are readily available in many food sources offering additional health benefits.

Take probiotic supplements if required

Consult with a healthcare professional to understand if a probiotic supplement might benefit you. Probiotics are living entities, including bacteria and yeast, that can provide health advantages when taken in appropriate quantities. With numerous probiotic strains available, there’s a wide range of products to choose from. Probiotics are often recommended if you are taking antibiotics, in an effort to rebalance your gut microbiome.

In terms of PCOS, probiotics may improve testosterone levels, measures of hirsutism, fertility outcomes and blood lipid levels. Read more about probiotics for PCOS in our dedicated article.

Stay hydrated

Keeping adequately hydrated is essential for many aspects of gut health, ranging from digestion and the removal of waste to preserving a balanced gut microbiome and protective barrier. Keep hydrated to ensure the gastrointestinal system functions at its best.

FAQs: PCOS and gut health

We know you may have questions about PCOS and gut health so we’ve answered some of the most commonly asked questions.

Is there a link between SIBO (Small Intestinal Bacterial Overgrowth) and PCOS?

While research is ongoing, some studies suggest a potential link between SIBO and PCOS. Women with PCOS may have a higher risk of developing SIBO due to hormonal imbalances.

Is there a link between leaky gut and PCOS?

Again, while research is in its early stages, there’s a growing interest in understanding if there’s a link between a leaky gut (increased intestinal permeability) and PCOS.

Are PCOS and IBS linked?

Although more evidence is needed, people with PCOS report a higher prevalence of IBS. Learn more about PCOS and IBS in our dedicated article.

Key takeaways: PCOS and gut health

We need more evidence of the link between PCOS and gut health, but we can’t deny the emerging research is interesting. It’s clear that a balanced gut plays a vital role in overall health, and its connection with PCOS is a promising area of study.

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Annabel Sparrow ANutr Author at The PCOS Collective

Author | Registered Associate Nutritionist

Annabel is a Registered Associate Nutritionist and pilates teacher with an interest in gut health and pre-and post-natal nutrition. She has a BSc degree in Psychology and is passionate about building healthy relationships with food and understanding the connection between food and mood.

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