The Connection Between PCOS and IBS

A dual PCOS and IBS diagnosis is not uncommon. Gastroenterologists and ob-gyns weigh in on the link between the two common syndromes.

If one new, potent truth has emerged from food and health trends in the past few years, it's that it's crazy just how much your gut's microbiome impacts your overall health. But you may be surprised how it's also connected to your reproductive system, too — specifically, if you have polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) affects 1 in 10 women in the United States, according to the U.S. Department of Health and Human Services. And irritable bowel syndrome (IBS) is one of the most common gut problems, affecting up to 20 percent of the population, says Carolyn Newberry, M.D., a gastroenterologist at New York-Presbyterian and Weill Cornell Medicine.

As common as each of these is on its own, there's even more overlap: Up to 42 percent of patients with PCOS also have IBS, according to a 2009 study published in the journalDigestive Diseases and Sciences.

What gives? According to experts, the one-two punch of a PCOS and IBS diagnosis is real. Here's everything you need to know about the connection, and what to do if you think you have it.

What Are PCOS and IBS?

First, get a little introductory course on both conditions.

Polycystic Ovarian Syndrome

PCOS is a hormonal disorder affecting women without any real cause or cure, "though there's likely a combination of genetic and environmental factors at play," says Julie Levitt, M.D., ob-gyn at The Women's Group of Northwestern in Chicago. Telltale signs of PCOS include lack of ovulation, high male hormone (androgen) levels, and small ovarian cysts, though women may not present with all three. It's also a common cause of infertility.

Irritable Bowel Syndrome

IBS is a condition characterized by "chronic abnormal bowel patterns and abdominal pain in people who don't have another explanation for the symptoms (like an infection or inflammatory disease)," says Dr. Newberry. The exact causes of IBS are unknown, but it likely has to do with increased sensitivity of nerve endings in the gut, which can be altered by external environment triggers like diet, stress, and sleep patterns.

The Connection Between IBS and PCOS

While the 2009 study found a potential link between the two, it was a small sample size, and (as is usually true in medicine) experts believe more research needs to be done to prove the link is absolutely definitive.

"There's no known link between IBS and PCOS; however, both conditions often affect young women, and therefore many people with one condition may also have the other," says Dr. Newberry. (It's true: IBS and other GI issues are disproportionally more common in women.)

And, after all, IBS and PCOS do have very similar symptoms: bloating, constipation, diarrhea, and pelvic and abdominal pain, says Dr. Levitt.

One possible reason for the interaction is that the hormonal issues tied to PCOS may affect your gut as well: "It's biologically plausible that patients with PCOS may have IBS symptoms since PCOS is associated with excessive amounts of androgen hormones (like testosterone) and abnormalities in the endocrine/hormonal system can alter bowel function," says John Pandolfino, M.D., chief of gastroenterology at the Digestive Health Center at Northwestern Medicine.

Other PCOS symptoms can trigger digestive issues, too. More severe cases of PCOS are associated with insulin resistance (when cells start resisting or ignoring signals from the insulin hormone, affecting how your body handles blood sugar) and inflammation, which can manifest in the bacteria that live in the small intestine, says Dr. Levitt. An overgrowth of that bacteria (which you may know as SIBO) is strongly linked to IBS.

In turn, an imbalance of the bacteria in your gut can cause inflammation and make PCOS symptoms worse, turning the IBS/PCOS link into a sort of vicious cycle. "This inflammation can contribute to insulin resistance, which can act on the ovaries to overproduce testosterone, which in turn disrupts the menstrual cycle, and prevents ovulation," says Dr. Levitt.

Even things outside your abdomen can affect the two conditions. "The stress associated with PCOS could also cause worsening symptoms such as anxiety and depression, which can also lead to abdominal pain and changes in bowel habits due to the delicate interplay between the central nervous system and the gut," says Dr. Pandolfino.

While there are many factors that link them, researchers are still trying to pinpoint whether there's a direct correlation between PCOS and IBS, and exactly the cause.

What should you do if you think you have both PCOS and IBS?

Since many of the symptoms of IBS and PCOS can overlap, it's important to talk to your doctor about all of your symptoms.

"If you're having abnormal gastrointestinal symptoms (including changes in bowel habits, abdominal pain, bloating, nausea, or vomiting), you should visit your doctor to determine if you need additional testing and what your treatment options are," says Dr. Newberry. If your symptoms are consistent with IBS, you might consider lifestyle modifications, stress management techniques, changes in diet, or medications as treatment.

And the same goes if you suspect you have PCOS.

PCOS can have similar symptoms, including abdominal pain, bloating, and abnormal periods, and should also be checked out by a doctor, says Dr. Newberry. They can determine if additional testing is needed and/or which medications are available to control the symptoms.

If you think you have both, "some medications that address abdominal distress may be effective for both conditions," she says. "But many of the treatments address one condition or the other."

How to Get Diagnosed and Treated

There are a few changes you can make if you suspect you have either IBS or PCOS that could help alleviate symptoms.

"You could consult your gynecologist first for potential IBS symptoms, but ultimately a gastroenterology referral would be the next step to assist in dietary modifications or medical management," says Dr. Levitt.

Dietary changes are a big factor in treating both IBS and PCOS.

"Women with PCOS can treat symptoms related to IBS by making dietary modifications (specifically, a low-FODMAP diet), avoiding foods that may be triggers for symptoms of gas pain and bloating, attention to bowel habits, and employing a regular exercise plan to reduce weight if that's a concern," says Dr. Levitt.

Plus, exercise can help with IBS. Recent research, including a 2015 study published in the World Journal of Gastroenterology, found that regular physical activity — notably walking, aerobics, and cycling — can have significant long-term positive effects on IBS symptoms.

Other mental health and holistic therapies may help. (Here's how to find the right therapist for you.)

Behavioral therapies like hypnosis have been shown to help with IBS, says Dr. Pandolfino. Psychiatric or behavioral therapy may also prove useful for PCOS too, since women with the condition have an increased tendency to struggle with mental health issues, including anxiety, depression, and eating disorders, a 2018 study confirmed.

If you're concerned that you may have both PCOS and IBS, talk to your doctor, who can help with diagnosis and find the right treatment plan for you.

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