PCOS and its link with low-grade systemic inflammation

Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders affecting women of reproductive age. Characterised by a range of symptoms, including irregular menstrual cycles, hyperandrogenism, and polycystic ovaries, PCOS significantly impacts women's health and quality of life. 

In my clinic, working with clients with chronic illness and autoimmune disease, many of my female clients also suffer from PCOS, so that got me thinking: what is the link between PCOS and autoimmune disease? The answer is inflammation. 

Recent research has illuminated a critical link between PCOS and low-grade systemic inflammation, offering new insights into the root cause of this complex condition.

What is PCOS?

PCOS affects approximately 5-10% of women worldwide. Similar to autoimmune conditions, the exact cause remains unclear, but it is believed to result from genetic, hormonal, and environmental factors. 

The hallmark features of PCOS include elevated levels of male hormones, leading to symptoms like hirsutism, acne, and alopecia. Ovarian dysfunction can lead to irregular or absent ovulation, resulting in irregular menstrual cycles and infertility. As the name implies, polycystic ovaries result in enlarged ovaries with numerous small cysts visible on ultrasound, although you don’t always have to have cysts present to have PCOS. 

Beyond these symptoms, women with PCOS are at an increased risk of developing metabolic complications such as insulin resistance, type 2 diabetes, dyslipidemia, and cardiovascular disease.

One interesting fact that I learnt about PCOS is that the elevated levels of male hormones in women may have had an evolutionary advantage in early human tribes. Women with higher testosterone had increased physical strength, assertiveness, and competitive drive, which could enhance their ability to protect resources, lead hunting expeditions, or defend against threats.

This advantage would ensure the propagation of genes associated with higher testosterone, which is why these traits are likely embedded within the population over generations. So, PCOS isn’t all bad, and those with it may have other beneficial attributes. 

Low-grade systemic inflammation in PCOS

Recent studies have identified low-grade systemic inflammation as a critical player in the pathogenesis of PCOS. This chronic, mild inflammation is characterised by slightly elevated levels of inflammatory markers in the blood, including C-reactive protein (CRP), interleukin-6 (IL-6), and tumour necrosis factor-alpha (TNF-α).

These markers are checked routinely if you have a chronic illness or autoimmune disease. Still, if you have PCOS and you haven’t checked these inflammatory markers, it is worth checking them in case inflammation is driving the symptoms of your condition. 

There are several ways in which low-grade systemic inflammation is linked to PCOS. For example, adipose tissue dysfunction occurs when women with PCOS have increased adiposity, particularly visceral fat. Adipose tissue, especially in excess, acts as an endocrine organ, secreting pro-inflammatory cytokines (adipokines) such as TNF-α and IL-6. This secretion contributes to a state of chronic inflammation. Increasing muscle mass with strength training and weight-bearing exercise can help decrease the amount of adipose tissue. 

Then there is insulin resistance, which is prevalent in PCOS and is both a cause and consequence of inflammation. Hyperinsulinemia, resulting from insulin resistance, can stimulate ovarian theca cells to produce more androgens, such as testosterone, exacerbating hyperandrogenism.

Additionally, insulin resistance is linked to increased production of inflammatory cytokines. Improving insulin sensitivity at the cellular level through diet by increasing antioxidant-rich foods and omega-3 fatty acids is helpful. One way I test insulin sensitivity in my clients is by doing the Metabolomix panel (which I refer to as the cell health test), which provides insight into metabolic and cellular health. 

Elevated androgen levels, such as testosterone in PCOS, can also promote inflammation. Androgens can influence immune cell function and increase the production of inflammatory markers, further perpetuating the cycle of inflammation and metabolic dysfunction. You can keep track of your androgen levels and their metabolites using the DUTCH Plus test. Improving insulin sensitivity can also help to bring down testosterone levels.  

Lastly, people with PCOS have been found to have higher levels of oxidative stress, which can trigger inflammation. Oxidative stress results from an imbalance between free radical production and antioxidant defences, leading to cellular damage and inflammation. Free radicals can damage the vessels and organs of the body, so neutralising their impact is vital. 

In times of emotional or physical stress, free radical production increases, meaning an even greater need for antioxidants. When I work with clients who have oxidative stress and PCOS, finding the root cause is critical, whether it be chronic viruses, chemical exposure, imbalanced gut microbiome or a stressful event. You need to address the underlying imbalances to see relief from symptoms, including those related to PCOS.

Natural therapies to manage PCOS

Natural therapies for managing PCOS and inflammation focus on dietary and lifestyle modifications, as well as specific herbal and nutritional supplements. 

Increasing fibre intake can help reduce inflammation by improving gut health and insulin sensitivity, which are often compromised in PCOS. Foods rich in fibre, such as fruits, vegetables, and whole grains, can also help regulate blood sugar levels and promote a healthy weight. 

Inositol, a type of sugar alcohol found in fruits and grains, has shown promise in improving insulin resistance and reducing androgen levels, thereby addressing both metabolic and hormonal aspects of PCOS. Many of my clients, including those with thyroid issues, see improvements in their symptoms by taking this daily. 

Herbal remedies such as saw palmetto, chamomile, green tea, and spearmint also offer anti-inflammatory benefits:

• Saw palmetto can help balance hormone levels by inhibiting the conversion of testosterone to dihydrotestosterone, potentially reducing symptoms like hirsutism. However, knowing your baseline before taking this supplement is always best. 
• Chamomile has anti-inflammatory and antioxidant properties that may soothe systemic inflammation. I enjoy a cup of chamomile tea before bed in the evening. 
• Green tea, including matcha powder, rich in catechins, can improve insulin sensitivity and support weight management. I love adding matcha powder to a chia seed pudding I make and starting my day with a cup of green tea. 
• Spearmint has been shown to reduce androgen levels, which can alleviate some PCOS symptoms. There is nothing better than fresh spearmint tea straight from a teacup. Give it a try. All you need is spearmint leaves and hot water!

Additionally, berberine, a compound found in several plants, has anti-inflammatory effects and can improve insulin sensitivity and fat metabolism. In addition, berberine has antimicrobial properties so it can help eradicate unhelpful bacterial overgrowth in the gut too. 

Complementing these with lifestyle practices such as exercising or stretching after meals can enhance insulin sensitivity and reduce inflammation. Evening primrose oil, known for its support of progesterone production, can help balance hormones, addressing another critical aspect of managing symptoms of PCOS.

The link between PCOS and low-grade systemic inflammation underscores the multifaceted nature of this syndrome. Understanding the inflammatory processes involved in PCOS helps those with PCOS to address the root of their condition rather than just focusing on symptoms. By addressing inflammation, we can improve the reproductive and metabolic health of people with PCOS as well as their inflammatory symptoms.  

As research continues, a more comprehensive understanding of these mechanisms will hopefully lead to more effective treatments and improved outcomes for people affected by this condition.