PCOS and Constipation

Constipation is a fairly common symptom among women with polycystic ovary syndrome (PCOS). 

 In this article, we’ll discuss the relationship between PCOS and constipation, and how you can treat the root cause of both of these conditions with diet, lifestyle, and targeted supplementation.

There are a few factors which may explain why an individual may suffer from both constipation and PCOS. 

First of all, irritable bowel syndrome (IBS) is a GI disorder that causes painful digestive symptoms including diarrhea, constipation, or a mixture of both. IBS is more common in women with PCOS, especially the IBS-constipation subtype (1).  Dysbiosis, or an imbalance of gut bacteria, may be to blame for the increased prevalence of constipation in women with PCOS. Dysbiosis occurs when you have too many bad bugs, too little good bugs, or not enough bacterial diversity. Women with PCOS are more likely to have dysbiosis of the gut than women without this condition (2).

Small intestinal bacterial overgrowth (SIBO) may also cause constipation in certain individuals. SIBO is a form of dysbiosis which occurs when too many bacteria end up in the small intestine. SIBO can cause hormonal imbalances, constipation, weight gain, acne, and more.

Finally, diet and lifestyle may also cause constipation. The standard American diet is rich in calories, inflammatory fats, and refined sugar while lacking in fiber, fruits, and vegetables. In fact, the average American only consumes about 14 grams of fiber per day—half of the daily reference value of at least 28 grams. This type of diet can cause dysbiosis and slow GI transit time.

Daily bowel movements are crucial to effectively remove waste byproducts through the stool for detoxification and optimal health.

Hypothyroidism, not PCOS, may be to blame for your constipation. Women with PCOS are three times more likely to suffer from Hashimoto’s thyroid disease than women without PCOS (3). Hashimoto’s is an autoimmune thyroid disease involving chronic inflammation of the thyroid gland. It is also the most common cause of hypothyroidism in the United States. 

In hypothyroidism, the movement of food through the GI tract is slowed, which is why many individuals with Hashimoto’s complain of constipation. Other symptoms of hypothyroidism include brittle nails, thinning hair, cold intolerance, weight gain, and more. 

If you have PCOS and suffer from constipation, ask your doctor to rule out Hashimoto’s with a simple blood draw. More specifically, you will want to request a full thyroid panel (TSH, Free T4, Free T3, and thyroid peroxidase antibodies). A high TSH with or without a low free T4 first confirms the presence of hypothyroidism. The additional presence of high thyroid antibodies in your blood indicates Hashimoto’s. 

Fiber is a type of nondigestible carbohydrate that provides numerous health benefits for individuals with PCOS and constipation. First of all, fiber provides bulk to your stool and softens it for easier passage. Fiber is also the main fuel source for your healthy gut bacteria. Your gut microbiome needs enough fiber to help these beneficial gut bugs flourish and provide great benefits like reducing inflammation, improving insulin resistance, and promoting regular bowel movements. Furthermore, fiber slows the absorption of carbohydrates into your bloodstream which prevents blood sugar spikes after a meal. Aim for a goal intake of 25 – 35 grams of fiber per day. Some people may need to gradually increase their fiber intake over a few days or weeks to prevent side effects like bloating and gas. Read more about Bloating and PCOS.

Fruits, vegetables, nuts, seeds, and whole grains provide rich sources of fiber. Don’t be afraid of carbs! Instead, focus on prioritizing foods rich in complex carbohydrates (like those previously listed).

In our practice, we prescribe foods or recipes for our clients’ specific health needs. For example, if you have PCOS and constipation, we may suggest including a chia pudding as a snack or quick breakfast a few times per week. Just two tablespoons of chia seeds offers 11 grams of dietary fiber! Chia seeds also provide antioxidants and healthy omega-3 fats to fight off inflammation.

Here are a few other high-fiber snack ideas to incorporate into your diet:

Constipation and dehydration are closely linked, so drinking enough water is crucial to promote regular bowel movements, especially as you increase the fiber in your diet. Aim to drink at least half of your bodyweight in ounces. For example, if you weigh 200 pounds, you should try to drink around 100 ounces of water each day. Tired of water? Try sparkling or mineral water, unsweetened coconut water, or unsweetened green tea. Alternatively, you could also try homemade infused water with fresh produce and herbs, like cucumber mint, orange lime, or strawberry lemon.

Exercise is a great prescription for constipation as daily movement promotes optimal digestion and increases gut transit time. Exercise can also reduce insulin resistance, enhance sleep quality, and boost your mood. The best type of exercise is the one you will consistently maintain! Moderate walking, yoga, cycling, strength training, or swimming are a few great options.

Magnesium is one of the key supplements in our PCOS treatment plan because of the widespread benefits of this mineral. Taking a magnesium supplement for PCOS can improve insulin resistance, reduce inflammation, and ease PMS symptoms (4). Plus, magnesium citrate, a specific form of this mineral, has a gentle laxative effect when taken properly. If trying a magnesium supplement for constipation, aim for around 200 mg of magnesium citrate each day. 

Women with PCOS often complain of constipation, which may be due to gut dysbiosis, bacterial overgrowth, or diet and lifestyle. Hypothyroidism can also cause constipation and is fairly common in PCOS, so ask your doctor to rule out a thyroid disorder. You can treat PCOS and constipation by increasing daily fiber, drinking at least half of your body weight in fluid ounces, incorporating daily movement, and considering a magnesium supplement.