PCOS and gut issues? Here’s what you need to know

Many women with PCOS don’t only deal with hormonal symptoms, but also with bloating, a sensitive stomach, fluctuating bowel habits, or vague digestive issues. These symptoms are often viewed separately: PCOS here, gut issues there.

But a growing body of research shows that this separation doesn’t hold up. What happens in your gut (your gut health) is directly connected to your hormones, immune system and energy levels. In this article, you’ll read how PCOS and gut health are linked, why that matters for how you feel, and what you can influence.

What is PCOS?

To understand the connection between PCOS and gut health, it helps to know what PCOS actually is. Polycystic ovary syndrome is a hormonal condition that affects many women. It is often recognised by a combination of:

• irregular or absent ovulation
• reduced insulin sensitivity
• higher levels of male sex hormones, such as testosterone

Clear signals, but PCOS looks different for everyone. One woman mainly struggles with her cycle, while another deals with low energy, skin issues, cravings, or mood swings. There isn’t one single PCOS symptom, and therefore there isn’t one fixed complaint, cause, or approach.

PCOS is best understood as a set of systems working together. And the gut stands out as a connecting factor between hormones, metabolism and the immune system. That’s why gut health matters in PCOS.

Read more about PCOS here.

So what is gut health – the health of your gut and microbiome?

Your gut is anything but a passive pipe that food simply passes through. It’s an active, sensitive system that constantly responds to what you eat, how you live, and how much stress you’re under. That’s largely down to your gut microbiome: a vast community (trillions of bacterial species) of all kinds of microorganisms.

These microorganisms don’t only help you digest food. They’re also involved in breaking down, activating and clearing hormones. A specific group of bacteria within the microbiome, also known as the oestrobolome, plays a role in how oestrogen is processed in your body. When this bacterial balance is disrupted, oestrogen may be cleared less efficiently and can re-enter circulation. That can contribute to hormonal symptoms such as bloating, tender breasts, or mood swings.

Think of your microbiome as an orchestra. Each type of bacterium plays its own part. When the instruments are well tuned to one another, there’s harmony. But when certain instruments fall out of time or stop playing altogether, you can hear it throughout the whole orchestra. That’s dysbiosis: an orchestra that’s lost its cohesion.

When this balance is disrupted, the gut lining can become more sensitive and there may be a persistent, low-grade increase in immune activity. That costs energy, and can also intensify existing hormonal symptoms.

What new research shows about PCOS and the gut

More and more, researchers are looking at the gut as well as hormones in PCOS. Those studies paint a recognisable picture: in many women with PCOS, the gut microbiome functions differently than it does in women without PCOS.

On average, women with PCOS have:

• a lower microbial diversity
• more signs of increased inflammatory activity
• more disruptions in metabolism (for example, how the body handles glucose and insulin)

These microbiome changes are part of a broader imbalance in which hormones, metabolism and the immune system influence one another.

Nuance matters here. The microbiome does not cause PCOS, and PCOS does not automatically lead to gut issues. What the research mainly shows is that these processes often occur together and influence each other, which helps explain why symptoms can stack up — and why a fragmented approach often doesn’t work.

What does this mean for you if you have PCOS? Fluctuating symptoms

If you have PCOS, your hormones, metabolism and gut don’t always run in sync. At certain times, your body needs more energy to regulate inflammatory processes or keep your blood sugar stable. At other times, the strain shifts towards digestion or your stress system.

Because these systems are connected, that internal pressure shows up in different ways. Sometimes you feel it mainly as fatigue, other times as an unsettled gut, cravings, or a mind that struggles to stay sharp.

• Fatigue can be a sign that your body is constantly working to regulate inflammatory processes.
• Cravings often arise when your blood sugar fluctuates and your body struggles to regulate satiety and calm.
• Brain fog and mood swings fit the same pattern, where the body has to keep switching between supplying energy, processing stimuli and recovering.

When you look at PCOS and gut health together, the perspective shifts: there is more focus on stability and strengthening the foundation so your body can function well.

Three ways to improve your gut health

When symptoms persist, it’s understandable to look for a drastic solution. Many people with PCOS are told it’s “just part of it”, or that hormonal contraception is the only way to reduce symptoms.

The ideas below help create conditions in which your body has to work less hard — and has to compensate less.

1. Learn to recognise your patterns

Many people with PCOS have learned to ignore or normalise their symptoms. Stomach pain, fatigue or mood swings are quickly brushed off as hormonal, or “not serious enough”. As a result, you miss valuable information.

Recognising patterns doesn’t mean tracking or analysing everything. It’s about tuning into your body and observing: when does your gut feel unsettled? When does your energy dip? Which phases of your cycle feel heavier?

2. Create a rhythm your body can recover in

Your digestion and nervous system work best when there is predictability. Quick meals, irregular eating times, and being “on” all the time keep your body in a state of alert. In that state, energy goes into reacting and adjusting — not into digesting and recovering. Regularity and pauses aren’t a luxury; they’re a basic requirement.

3. Let food support you

Food doesn’t have to become an all-consuming project. Small, repeatable choices can genuinely support your gut, without turning eating into something to perfect.

• Vary what you eat: variety in vegetables, grains, legumes, nuts and seeds helps feed different gut bacteria. Lentils on Monday, leeks on Wednesday, broccoli on Friday. 
• Add fermented foods: think a little kefir at lunch or a spoonful of miso in soup. Fermented foods can support balance in the gut, helping digestion respond more steadily.
• Include fibre-rich ingredients daily: onion, garlic, leek and parsnip are good examples. These fibres act as food for gut bacteria and support a steadier digestive process. Fruit, vegetables and legumes are also rich in fibre.
• Support your rhythm with movement: a short walk after eating helps your body process glucose more efficiently and can support digestion. It doesn’t need to be intense; regularity matters more than intensity.
• Get outside regularly: spending time in green spaces, gardening, or repotting plants brings you into contact with a natural environment. This supports the diversity of your microbiome and helps you relax at the same time.

Tried everything?

Maybe you’ve followed diets, had your hormones tested, and it’s especially frustrating that nothing really lasts. That doesn’t mean you weren’t consistent enough. It mainly shows your body needs more than isolated actions.

That’s exactly when it can help to zoom out and look together at what’s going on beneath the surface. Not to add yet another thing, but to find direction. We’re happy to help: get in touch and our team of experts will gladly explore it with you.

In conclusion

When PCOS and gut symptoms show up together, it doesn’t mean your body is failing. It means multiple systems are out of balance at the same time, and they’re asking for support.

When you understand the connection between gut health and PCOS, you also see what you can influence. Not by pushing harder, but by creating conditions in which your body can respond again. Think of your body as a compass: reliable, once you learn how to read what it’s pointing to.