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PCOS and IBS (irritable bowel syndrome): what’s the link?

Polycystic ovary syndrome (PCOS) and irritable bowel syndrome (IBS) are distinct conditions that each present a range of challenging symptoms for those affected. PCOS is a hormonal disorder, marked by irregular menstrual cycles, and is often associated with an array of metabolic issues. IBS, on the other hand, is a gastrointestinal disorder characterised by symptoms such as abdominal pain, bloating, and altered bowel habits.

Emerging evidence has begun to shed light on a potential link between PCOS and IBS, suggesting that individuals with PCOS may be more susceptible to developing IBS. A deeper understanding of the relationship between these two conditions is critical to improve diagnostic experience and tailor more effective management strategies. Lifestyle interventions, support systems, and comprehensive healthcare are key in helping those affected to manage the symptom’s impact on daily life and enhancing overall health and wellbeing.

Key Takeaways

  • PCOS and IBS are separate conditions with some similar symptoms which have overlapping management strategies.
  • There is a growing body of evidence suggesting a link between PCOS and IBS.
  • Comprehensive support and management can improve the quality of life for individuals with PCOS and IBS.

Understanding PCOS and IBS

Polycystic ovary syndrome (PCOS) is a hormonal disorder characterised by the development of multiple small cysts on the ovaries and a range of other symptoms such as irregular menstrual cycles, elevated levels of androgens, and insulin resistance. It’s a complex condition that affects various aspects of a person’s health and quality of life and impacts approximately 1 in 10 people with ovaries in the UK.

Irritable bowel syndrome (IBS) is a gastrointestinal disorder that leads to abdominal discomfort, bloating, and altered bowel habits such as constipation or diarrhoea. While the direct cause of IBS is unknown, it’s often associated with a combination of gut-brain axis disruptions, gut motility issues, and chronic inflammation. It is thought to impact around 11% of the global population.

The prevalence of IBS in individuals with PCOS has been noted to be higher than in those without PCOS. Research suggests a link between PCOS and IBS, potentially due to shared pathways of chronic inflammation and hormonal imbalances. Though people with PCOS are more prone to IBS, the symptoms of IBS can vary widely among individuals.

Several factors may explain the connection between these two conditions:

  • Hormonal fluctuations affecting gut motility
  • Shared inflammatory pathways possibly exacerbate both conditions
  • Insulin resistance, a common factor in PCOS, may influence gut health

Understanding the co-occurrence of polycystic ovarian syndrome and irritable bowel syndrome (IBS) is crucial for the effective management and treatment of patients. This involves considering the symptom overlap and the potential for each condition to complicate the other.

The symptoms and management of both conditions may overlap, necessitating a comprehensive approach to treatment and care.

Symptoms and diagnosis

In exploring the relationship between Polycystic Ovary Syndrome (PCOS) and Irritable Bowel Syndrome (IBS), it’s crucial to understand the distinct symptoms that may be experienced, alongside the diagnostic criteria used to identify them.

PCOS symptoms

People with PCOS may encounter a range of symptoms due to hormonal imbalances. These often include irregular menstrual cycles, which can lead to infrequent ovulation or anovulation. They might also experience elevated levels of testosterone, resulting in symptoms like excess body or facial hair (hirsutism). The hormonal fluctuations may contribute to mood changes, such as anxiety or depression.

IBS symptoms

IBS tends to manifest with a combination of abdominal painbloating, and altered bowel habits such as diarrhoea or constipation. People with IBS often report excess gas and stomach pain that may be relieved following bowel movements. The condition can significantly fluctuate, with symptoms showing marked variation over time.

Diagnostic Criteria for PCOS

To diagnose PCOS, healthcare professionals primarily look for at least two of the following criteria: irregular ovulation or anovulation, clinical or biochemical signs of hyperandrogenism (elevated testosterone levels), and the presence of polycystic ovaries visible through an ultrasound scan. Blood tests are regularly used to measure hormone levels, such as luteinising hormone (LH) and follicle-stimulating hormone (FSH).

Diagnostic Criteria for IBS

The diagnosis of IBS is made based on symptoms and by ruling out other conditions. The most commonly used criteria are known as the Rome IV criteria, which include recurrent abdominal pain, on average, at least one day per week in the last three months, associated with two or more of the following: related to defaecation, associated with a change in the frequency of stool, or associated with a change in the form (appearance) of stool. The symptoms should have started at least six months before diagnosis, and all other serious conditions need to be excluded before IBS can be diagnosed.

A table describing symptoms of IBS and symptoms of PCOS

What’s the connection between PCOS and IBS?

Polycystic ovary syndrome (PCOS) and irritable bowel syndrome (IBS) are conditions that affect the endocrine and digestive systems, respectively. Investigations into the precise mechanisms suggest a multifaceted link influenced by hormonal disbalance, digestive irregularities, and immune responses.

Hormonal influences

Individuals with PCOS often experience hormonal imbalances such as elevated levels of androgens, which can disrupt the regular functioning of the ovaries. This hormonal disruption is also associated with insulin resistance, a common feature of PCOS that contributes to metabolic dysfunction. Studies have revealed that these hormonal irregularities may play a role in the gastrointestinal symptoms prevalent in people with IBS, indicating a possible endocrine connection between the two conditions.

Digestive system dynamics

The digestive system in those with IBS can exhibit abnormalities such as altered gut bacteria composition and increased intestinal permeability, which may contribute to symptoms like bloating, constipation, and diarrhoea. These symptoms are also observed in individuals with PCOS, suggesting that shared gastrointestinal dynamics could underlie the increased prevalence of IBS within the PCOS population. While further research is needed, the presence of IBS in people with PCOS could partially result from these shared digestive disturbances.

Inflammation and immune responses

Both PCOS and IBS are associated with heightened levels of inflammation, with evidence to suggest that inflammatory markers are increased in individuals with these conditions. Plus, the role of gut bacteria on immune responses is gaining recognition, as alterations in the microbiome may influence the inflammatory state in the gut and throughout the body. This overlap in immune responses provides another potential link between PCOS and IBS, contributing to the incidence of gastrointestinal issues in individuals with PCOS.

Lifestyle and management for PCOS and IBS

People with Polycystic Ovary Syndrome (PCOS) and Irritable Bowel Syndrome (IBS) can benefit from specific lifestyle changes to manage their symptoms. Adopting a targeted approach to diet, engaging in regular exercise, utilising stress management techniques, and understanding when to use medications and other treatments are essential for improving quality of life.

Dietary changes

Food, nutrition and diet can play a role in managing PCOS and IBS. Incorporating high-fibre foods can improve gastrointestinal symptoms while helping with satiety. Additionally, incorporating probiotics may help in improving the gut microbiota, potentially easing IBS symptoms.

Working with a dietitian or registered nutritionist may help you to understand trigger foods that make IBS symptoms worse. Research suggests following a low FODMAP diet may alleviate IBS symptoms by reducing the intake of fermentable carbohydrates. It is essential to follow the guidance of a dietitian following an IBS diagnosis to carry out the low-FODMAP diet safely. Always seek medical advice before removing food groups from your diet.

The role of movement

Regular exercise is recommended for managing PCOS and IBS, as it can help improve insulin resistance. Aerobic exercises, such as swimming or brisk walking, combined with strength training, could be particularly effective. Exercise can also enhance mood and reduce stress, which might indirectly benefit IBS symptoms.

Stress management techniques

Stress management is a critical component of lifestyle management for PCOS and IBS as chronic stress impacts both of these groups. Techniques such as yogameditation, and breathing exercises have been found to help manage stress levels. Maintaining a routine that includes these practices can lead to better overall symptom control.

Medications and treatments

Treatment with medications like metformin may improve insulin resistance in individuals with PCOS. For IBS, both lifestyle modifications and pharmacological treatments are important. Doctors may prescribe medications to alleviate specific symptoms, and in some cases, food avoidance strategies tailored to individual needs are recommended. It’s essential to work with trained healthcare providers to determine the best treatment plan. Learn more about our PCOS experts and work with us in our clinic here.

PCOS and IBS impact on daily life

If you live with Polycystic Ovary Syndrome (PCOS) and Irritable Bowel Syndrome (IBS) you may face significant disruptions in your daily life. This section examines how these conditions affect quality of life, mental health, and social encounters, plus reproductive health.

Quality of life considerations

The co-occurrence of PCOS and IBS can lead to a pronounced decrease in quality of life. Individuals experience physical symptoms that can limit their day-to-day activities. The severity of symptoms such as abdominal pain, bloating, and irregular bowel movements characteristic of IBS, when combined with symptoms of PCOS like an irregular menstrual cycle, infertility, poor body and more, can lead to an overall diminished sense of wellbeing. A study has highlighted that the IBS Quality of Life (QOL) score is lower in individuals with both IBS and PCOS, compared to those with only one of the conditions.

Mental health implications

Mental health challenges such as depression and anxiety are commonly reported in individuals with PCOS and IBS. The psychological distress stemming from managing chronic illnesses can exacerbate these conditions. Sleep disturbances, a common issue in those with IBS, can further deteriorate mental health and contribute to a cycle of distress and discomfort. The need to address these mental health implications is underscored by research highlighting the aggravation of IBS-related sleep and psychiatric disorders in individuals with PCOS.

Social and reproductive challenges

Social interactions and reproductive health are critically impacted in people with PCOS and IBS. Due to the unpredictable nature of IBS symptoms and the challenges with body image in PCOS, people may face social isolation or difficulties in forming and maintaining relationships. Moreover, reproductive issues like infertility or difficulty in getting pregnant can be a significant concern, with disruptions in sex hormones attributing to the complexity of their situation. Research, shared in interviews, reveals the multi-faceted impact of PCOS and other co-morbidities like IBS on their lives, further illustrating the social and psychological dimensions of these health challenges.

Healthcare and support

Navigating the complexities of both Polycystic Ovary Syndrome (PCOS) and Irritable Bowel Syndrome (IBS) requires a multidisciplinary approach to healthcare and the right support mechanisms. Effective management often depends on access to specialised healthcare professionals and the support of networks that understand the nuances of these conditions.

Finding the right healthcare professional

Individuals with PCOS and IBS should seek a gastroenterologist for IBS management and an endocrinologist for PCOS diagnosis. The gastroenterologist may perform an ultrasound or other diagnostic tests to understand the gastrointestinal issues better. Concurrently, the endocrinologist can provide treatment options specific to PCOS symptoms. It is crucial to find doctors who are experienced in treating these co-morbidities, as they can offer a more tailored and effective treatment plan.

For support with diet and supplements, finding a PCOS and IBS-trained dietitian or registered nutritionist is essential for unique support to manage these two conditions. 

Support networks and resources

Support networks provide a platform for sharing experiences and advice. They are invaluable for moral support and practical information. Resources such as patient-led groups and online forums are increasingly available and can help individuals with PCOS and IBS feel less isolated in their healthcare journey. These networks often give tips on day-to-day management and can guide people to professional resources that improve their overall well-being.

Additional considerations

When exploring the complexities of Polycystic Ovary Syndrome (PCOS) and its potential link to Irritable Bowel Syndrome (IBS), several additional factors come into play. Among these are gut symptoms such as constipationbloating, and gas formation, which can lead to substantial discomfort and alter stool frequency. People with PCOS may experience a change in their gastrointestinal transit time also, which could be linked to an imbalance of LH and FSH (sex hormones) in people with PCOS, further exacerbating these symptoms.

Food intolerance and nutrition are crucial considerations. Certain foods, including nuts or gluten-containing products, may intensify IBS symptoms, characterised by subtypes such as IBS-C (constipation predominant), IBS-D (diarrhoea predominant), and IBS-M (mixed). It is beneficial to maintain a diet tailored to one’s specific needs to mitigate symptoms such as nausea and vomiting.

Small intestine bacterial overgrowth (SIBO) is a condition commonly linked with IBS. In PCOS, the altered gut microbiota can lead to disruptions in stool consistency and increase the prevalence of gastrointestinal (GI) distress. The management of GI disorders in individuals with PCOS should include strategies aimed at restoring a healthy microbial balance and providing relief from cramping and other discomforts.

Fatigue is a common complaint amongst individuals with these conditions, with the chronic nature of abdominal discomfort contributing significantly to a lower quality of life. Diet, exercise, and stress management are key in providing relief from such systemic issues.

Factors like stress can influence bowel function, potentially affecting individuals with PCOS. Approaches like yoga may help in managing stress and improving gastrointestinal disorders.

In managing both PCOS and IBS, careful consideration of these variables is fundamental. A holistic approach that encompasses diet, stress-management techniques, and appropriate medical therapy is imperative for improved health outcomes.

Long-term health considerations

People with Polycystic Ovary Syndrome (PCOS) often encounter various long-term health challenges. Insulin resistance is a common condition associated with PCOS, which can increase the risk of developing metabolic syndrome. Proper management of these conditions is crucial to maintaining health and preventing further complications.

Studies have shown that individuals with PCOS may have an increased propensity to experience irritable bowel syndrome (IBS), adding complexity to the management of their overall health. The coexistence of IBS in those with PCOS necessitates a more nuanced approach to dietary and lifestyle changes which could also benefit insulin sensitivity.

Additionally, there is concern about the heightened risk of heart disease in the PCOS population. This stems from the association between PCOS and a range of metabolic syndrome features, such as hypertension and abnormal cholesterol levels, which are known contributors to cardiovascular health issues.

As part of long-term health management, individuals with PCOS should be regularly monitored for these conditions. Healthcare providers typically focus on symptomatic relief which is the easing PCOS and IBS symptoms to enhance quality of life plus preventive care: Identifying and managing risk factors for diabetes and heart disease.

Individuals with PCOS must engage in a multidisciplinary approach to healthcare, incorporating nutrition, physical activity, and possibly medication, to mitigate long-term health risks.

Frequently asked questions: PCOS and IBS

We’ve answered all the commonly asked questions about PCOS and IBS.

How can diet influence symptoms of IBS and PCOS?

The intake of certain foods may improve IBS and PCOS symptoms. For instance, a high-fibre, balanced and varied diet may help manage PCOS-related blood sugar issues, while fibre-rich foods can improve IBS symptoms by promoting healthy digestion.

Is there a connection between PCOS and gastrointestinal disturbances?

Studies suggest that individuals with PCOS may experience a higher prevalence of irritable bowel syndrome (IBS), indicating a potential connection that warrants further research into the mechanisms linking these conditions.

What are common strategies for managing constipation associated with PCOS?

Increasing dietary fibre intake, maintaining adequate hydration, and regular physical activity are common strategies to alleviate constipation for those managing PCOS.

Are PCOS symptoms known to exacerbate IBS flare-ups?

Hormonal imbalances in PCOS can affect gastrointestinal motility, potentially leading to IBS symptoms. It’s understood that IBS flare-ups may be more frequent in people with PCOS due to this. However, more research is required to understand the link between these two common conditions.

How does PCOS affect pain in the lower abdomen after meals?

People with PCOS might experience abdominal pain after meals due to overlapping IBS symptoms. The pain can be attributed to gastrointestinal sensitivity or dysmotility associated with IBS which is more common in individuals with PCOS.

In what ways can PCOS contribute to mood swings and irritability?

Hormonal fluctuations in PCOS can influence neurotransmitters and stress responses, which might contribute to mood swings and irritability, potentially exacerbating the challenges those with PCOS face, including managing gastrointestinal symptoms.

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Alex Okell ANutr Founder and Editor

Founder and Editor | Registered Associate Nutritionist

  Founder of Be The Collective LTD [The PCOS Collective & The Endo Collective] Alex Okell ANutr is a London-based reproductive health nutritionist with experience in research, private practice and digital media. She holds a Master’s degree in Nutrition from King’s College London and has co-authored papers with the University of Cambridge, King’s College London, The Food Foundation and the Food Standards Agency. Alex offers 1:1 PCOS support in our virtual PCOS clinic.

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