Bloating and PCOS

As if irregular periods, acne, and hair problems weren’t enough, bloating is another surprising, yet common, symptom of polycystic ovary syndrome (PCOS), a hormonal disorder affecting up to 20 percent of women. You may be tempted to try various probiotics, diets, or tonics for your bloating; however, this article will explain how to identify and treat PCOS bloating by finding your true root cause.

What Causes Bloating in PCOS?

Dysbiosis

Your gut is home to 100 trillion bacteria and divided into three categories: beneficial bacteria, neutral bacteria, and harmful bacteria. Under optimal circumstances, your body maintains a delicate balance of these three groups to optimize function and prevent disease. However, a variety of factors like diet, antibiotics, and your environment can cause detrimental changes to gut bacteria and lead to a condition known as dysbiosis.

Dysbiosis occurs when you have an imbalance of bacteria in your gut. You may have too much bad bacteria, not enough good bacteria, and/or not enough diversity of bacteria. Unfortunately, women with PCOS are more likely to suffer from dysbiosis than women without PCOS (1).

Dysbiosis is one major root cause of abdominal bloating in PCOS. Dysbiosis may also worsen other PCOS symptoms like acne, unwanted hair growth or hair loss, and hormonal imbalances. Pictured below are supplements routinely use at Root to treat Dysbiosis and support gut health.

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Hormonal Imbalances

In a healthy menstrual cycle, your estrogen and progesterone levels change throughout the month. Estrogen levels slowly rise and peak right before ovulation. After ovulation, estrogen levels drop and progesterone takes over. If your egg is not fertilized for pregnancy, progesterone levels eventually drop to trigger the beginning of your period bleed.

However, many women with PCOS have irregular cycles and do not ovulate or bleed each month. Without ovulation, your estrogen levels may be constantly elevated because you do not experience an opposing rise in progesterone. This is known as estrogen dominance, or an excess amount of estrogen in relation to progesterone. Estrogen dominance may also contribute to bloating in PCOS.

PCOS Medications

Conventional medications commonly used to manage PCOS symptoms can cause bloating as a side effect.

Metformin is a prescription medication that lowers insulin and fasting blood sugar levels. It is often prescribed to treat insulin resistance in PCOS. A benefit of metformin is that it does attempt to address insulin resistance as an underlying root cause, which is why some individuals experience positive results while taking it. However, metformin commonly causes symptoms of GI upset like nausea, diarrhea, bloating, and gas. These side effects may be due to metformin’s influence on the gut microbiome, and some studies suggest this drug may also cause dysbiosis (2).

The birth control pill is also commonly prescribed to women with PCOS to manage symptoms of acne, irregular periods, and unwanted hair growth. Unfortunately, many women find that the pill commonly contributes to abdominal bloating among other side effects.

How to Treat PCOS Bloating

If you have bloating and PCOS, you will likely require a multiple thronged approach to treat it for good.

Balance Your Hormones

A healthy menstrual cycle with regular ovulation can reduce bloating by supporting the natural balance of estrogen and progesterone. One way to encourage ovulation is by balancing your blood sugar levels and treating insulin resistance with diet and lifestyle. Here are a few tips to get you started.

Include a real food source of protein, fat, and carb with each meal and snack (see below image for ideas).
Limit foods high in added sugar, like sweetened beverages, cookies/candy, and other grain-based desserts.
Aim for 7-8 hours of sleep each night, and reduce sleep disruptors like caffeine or alcohol close to bedtime.

Note: The pill does not actually make your cycle “regular” as often advertised. Rather, it provides synthetic hormones that prevent ovulation completely. However, balancing your blood sugar levels is still beneficial whether or not you are taking the birth control pill.

Trial a Low FODMAP Diet

When you have dysbiosis, your gut may have difficulty digesting certain foods.

The FODMAP diet is a temporary elimination diet that helps you identify which foods worsen your bloating. FODMAP stands for “fermentable oligosaccharides, disaccharides, monosaccharides and polyols.” Essentially, certain foods contain higher levels of FODMAPs that cause your gut bacteria to release excess gas. By eliminating the foods highest in FODMAPs, you may experience less bloating.

Common foods high in FODMAPs to eliminate include:

Wheat
Dairy (lactose)
Garlic
Onions
High fructose corn syrup
Fruit juice

The low FODMAP diet can provide fast relief from bloating. However, it is fairly difficult to follow on your own, as many foods contain varying levels of FODMAPs. Fortunately, our registered dietitians can help with that in the Root Membership.

Exercise

Introducing a regular exercise routine can help treat PCOS by balancing your hormones, controlling blood sugar levels, and reducing inflammation in your body (3). Exercise may also reduce bloating by promoting optimal digestion and growth of beneficial bacteria in the GI tract. However, avoid exercise that is too vigorous or intense as this may worsen GI side effects. Instead, choose moderate forms of exercise like walking, cycling, strength training, yoga, or swimming.

Bloating and PCOS: Key Takeaways

If you have PCOS, the root cause of your bloating may be due to:

dysbiosis, or an imbalance of gut bacteria;
irregular periods without ovulation;
and medications used to manage PCOS symptoms, like metformin or the pill.

You can encourage regular ovulation and treat dysbiosis by eating wholesome foods that are low in added sugar and rich in protein, healthy fats, and fiber. If you are looking for fast relief, a low FODMAP diet is a temporary elimination diet that helps you identify which foods worsen your bloating. However, this diet is meant to act as a short-term solution while you work to fully address your dysbiosis and other root causes.

The low FODMAP diet works well when combined with the right supplements and lifestyle to treat the underlying imbalance, such as our Microbiome Balance supplement and Gut Health bundle.