Polycystic Ovary Syndrome (PCOS) affects up to 13% of women of reproductive age, yet it remains widely misunderstood and often mismanaged. While much attention has been given to hormones, insulin resistance, and ovarian function, an emerging area of interest—and promise—is the connection between PCOS and gut health. As a naturopath, I find that addressing gut health can be a powerful and often overlooked key in supporting women with PCOS. In this article, we’ll explore how these two systems are intertwined and how naturopathic support for PCOS can start with healing the gut.
What Is PCOS?
Polycystic ovary syndrome (PCOS) isn’t a single condition, but rather a complex endocrine disorder with multiple biological causes. Put simply, it’s a cluster of symptoms—most notably excess androgens and irregular or absent ovulation (anovulation)—driven by different underlying mechanisms (source).
But PCOS is more than just a reproductive condition—it affects metabolic, cardiovascular, and mental health too.
One of the lesser-discussed, yet crucial, aspects of PCOS is chronic inflammation and the role of the microbiome in influencing hormonal balance and metabolic function.
Gut Health: More Than Just Digestion
When we talk about PCOS and gut health, we’re referring to the balance and diversity of microbes in the gastrointestinal tract (known as the gut microbiota), as well as the integrity of the gut lining and immune system function within the gut.
A healthy gut:
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Supports efficient digestion and absorption of nutrients
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Regulates immune responses
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Produces short-chain fatty acids (SCFAs) that reduce inflammation
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Interacts with hormones through the gut-brain and gut-endocrine axes
An imbalanced gut, or dysbiosis, can lead to increased intestinal permeability (leaky gut), systemic inflammation, and metabolic dysfunction—all of which are relevant in PCOS.
How Gut Health Impacts PCOS
1. Insulin Resistance and Gut Health
Insulin resistance is a common underlying driver of PCOS. Research shows a connection between insulin resistance and gut health, and that dysbiosis can influence insulin sensitivity through multiple mechanisms. Certain gut bacteria produce lipopolysaccharides (LPS), which trigger inflammation and worsen insulin resistance [source].
In women with PCOS, reduced microbial diversity and an overrepresentation of inflammatory bacteria such as Bacteroides and Escherichia/Shigella have been found [source].
Supporting the gut microbiota with prebiotics, probiotics, and a fibre-rich diet can improve insulin sensitivity, helping to regulate ovulation and reduce androgen excess.
2. PCOS and the Estrobolome
Your gut bacteria also influence hormone metabolism. The estrobolome—a collection of microbes that metabolise oestrogen—can affect oestrogen levels by regulating how much is excreted in the stool and how much is recirculated around the body.
In PCOS, relative oestrogen dominance or imbalances with progesterone are common. A sluggish estrobolome can exacerbate these issues by reactivating conjugated oestrogens and recycling them back into circulation (source).
Supporting microbial diversity and liver detoxification pathways can reduce this hormonal recycling, providing a more balanced hormonal environment.
3. Inflammation and Immune Activation
Chronic low-grade inflammation is both a cause and consequence of PCOS. A leaky gut allows bacterial fragments like LPS into the bloodstream, igniting the immune system and leading to systemic inflammation.
This inflammation not only worsens insulin resistance but also disrupts ovarian function, reducing follicle quality and contributing to anovulation [source].
Natural anti-inflammatory strategies—including turmeric, sulforaphane, omega-3 fatty acids—can soothe the gut lining and reduce inflammatory signalling.
Naturopathic Strategies: Natural Support for PCOS Through Gut Health
As a naturopath, I take a systems-based approach. Here’s how I typically support PCOS and gut health:
1. Dietary Foundations
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Whole-food, anti-inflammatory diet: Emphasising vegetables, legumes, healthy fats, and lean proteins.
- Address insulin resistance: Focusing on macronutrient balance.
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Increase dietary fibre: To support microbial diversity and blood sugar regulation. Think: flaxseeds, lentils, leafy greens.
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Avoid gut irritants: Minimise processed foods, excessive sugar, alcohol, and refined carbs.
2. Targeted Probiotics
Studies have shown that specific strains such as Lactobacillus and Bifidobacterium can reduce testosterone levels and improve insulin resistance in women with PCOS [source]. I always select probiotic strains based on the latest research for the most effective naturopathic support for PCOS.
3. Prebiotics and Resistant Starch
Depending on symptom picture, certain prebiotic fibres such as PHGG and resistant starch from green bananas can feed beneficial bacteria and promote SCFA production.
4. Herbal and Nutritional Medicine
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Suforaphane: A compound from broccoli sprouts that modulates the gut microbiome, and supports detoxification processes.
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Licorice root (Glycyrrhiza glabra): Anti-inflammatory and androgen-lowering, often used in combination with peony for hormonal balance.
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Turmeric: Potent anti-inflammatory and liver-supportive, especially in the presence of gut inflammation.
- Myo-Inositol: a sugar made in the body and found in foods that improves insulin resistance and regulated ovarian function.
5. Stress Management
The gut-brain axis means stress directly impacts gut health—and therefore PCOS symptoms. Mindfulness, sleep and nervous system support (think magnesium, taurine and adaptogenic herbs), and gentle movement can calm the gut and hormonal chaos alike.
Final Thoughts: Heal the Gut, Heal the Hormones
If you’re struggling with PCOS and haven’t yet considered gut health as a factor, it might be time to start. And if you’re seeking naturopathic support for PCOS, working with a qualified naturopath who can assess your individual needs and tailor a gut-hormone protocol may be the missing link.
Want to Work Together?
I offer personalised naturopathic support for women navigating PCOS, hormonal imbalances, and digestive health. Book a free discovery call here to find out how we can work together to restore balance from the inside out.