For years we have seen Patients with PCOS struggling to varying degrees with the multi-faceted symptoms that present with this hormonal condition that affects ~15% of the reproductive age population. Many Patients had come in after failing to get their cycle back after coming off of the birth control pill or simply have not had a period on their own in years! Obviously this is quite the problem when you are ready to conceive. While there are treatments which can increase ovulation rates for Patients with PCOS that are not having cycles naturally, treating the underlying cause in parallel has, in my observation, improved outcomes and helped Patients to see positive outcomes quicker.
So why is the gut microbiome so important in the treatment of polycystic ovarian syndrome?
The fact is that PCOS in itself drives changes in the gut microbiome, causing dysbiosis. Mainly, the increase in androgen hormones in PCOS has been shown to be associated with increased levels of Bacteroides and reduced diversity in the gut microbiome (reduced levels of anti-inflammatory microbes like Lactobacillus spp and Bifidobacteria spp).
Changes in Short-Chain Fatty Acid Productions:
The reduced microbiome diversity disrupts the production of important short-chain fatty acids (SCFAs) which are needed to help regulate inflammation, insulin sensitivity, the integrity of the gut mucosa, and hormone production. These underlying and often silent mechanisms will further drive worsening PCOS symptoms and the higher androgen (testosterone) levels can further worsen the gut microbiome as well. This vicious cycle can make the management of PCOS quite difficult when using treatments that completely ignore the drastic role of the gut microbiome on PCOS.
Changes in the Bile Acid Production:
Another common observation is that Patients with PCOS have a gut microbiome that discourages the production of bile acids. Bile acids produced in the liver and secreted in to the digestive tract interact with the gut microbiome to produce secondary bile acids. These secondary bile acids, including tauroursodeoxycholic acid (TUDCA) and glycodeoxycholic acid (GDCA), help to reduce insulin resistance, support hormone balance, reduce inflammation and can help to reestablish a healthy ovulatory menstrual cycle in Patients with PCOS. This is all accomplished as these secondary bile acids stimulate the production of interleukin-22 (IL-22) from the immune system which can help to regulate the diverse systems that are disrupted with PCOS.
In order for the above mentioned changes to occur requires supporting healthy bile acid production as well as supporting growth of healthy gut bacteria that interact with the bile acids to achieve the above mentioned changes. Once this occurs, the bile acids themselves help to encourage the growth of gut bacteria that will further support the production of more bile acids, creating a positive and beneficial feedback loop.
We have summarized the valuable findings of a new research paper published in July 2022 in the Journal of Frontiers in Endocrinology that reviewed studies available on this exact topic in to the video above for you to view. It also covers how healthy lifestyle habits like exercise and healthy food intake can help to regulate both the gut microbiome and PCOS.
This article is being shared as educational content and is in no way a replacement for medical advice or medical care, it is advised that anyone concerned about their Health should speak with their Naturopathic Doctor. Please discuss with your healthcare provider and only make changes to your medications regimen if recommended by your doctor and under their guidance and supervision.
Zhang, M., Hu, R., Huang, Y., Zhou, F., Li, F., Liu, Z., Geng, Y., Dong, H., Ma, W., Song, K., & Song, Y. (2022). Present and future: Crosstalks between polycystic ovary syndrome and gut metabolites relating to gut microbiota. Frontiers in Endocrinology, 13.