Gut-Brain Axis and PCOS: What Science Says

Q: How does an unhealthy gut affect PCOS symptoms?

An imbalance in gut bacteria, often referred to as gut dysbiosis , can play a major role in worsening PCOS symptoms. When the gut loses its ability to maintain a healthy variety of microbes and generate important metabolites, it can lead to increased intestinal permeability and inflammation. This inflammation, in turn, can amplify issues like insulin resistance , high androgen levels , and disruptions in ovarian function , often resulting in irregular menstrual cycles. On top of that, gut dysbiosis is linked to other common PCOS challenges, including weight gain , acne , and mood swings . Taking steps to improve gut health - through diet, lifestyle changes, or medical interventions - may offer a more effective way to manage these symptoms.

The gut-brain axis plays a key role in managing PCOS symptoms by linking gut health, hormone regulation, and mental well-being. Disruptions in this connection, often caused by gut bacteria imbalances, can worsen PCOS-related issues like insulin resistance, inflammation, and mood disorders. Here's what you need to know:

Gut Dysbiosis and PCOS: Imbalances in gut bacteria can lead to chronic inflammation, insulin resistance, and increased androgen production, which exacerbate PCOS symptoms.
Hormonal Impacts: Reduced gut hormones like serotonin and ghrelin affect the hypothalamus, disrupting menstrual cycles and hormone balance.
Mental Health: Women with PCOS often experience anxiety and depression, partly due to altered neurotransmitter production influenced by gut health.
Probiotic Support: Certain probiotics, including Lactobacillus and Bifidobacterium strains, can improve insulin sensitivity, reduce inflammation, and support mental health.
Lifestyle Changes: Diets rich in fiber, plant-based proteins, and low-glycemic foods, combined with regular exercise, can improve gut health and PCOS symptoms.

Addressing the gut-brain connection with targeted strategies, like probiotics and lifestyle adjustments, offers a practical way to manage PCOS effectively. Services like Oana Health provide personalized treatments to support hormonal and mental health.

How the Gut-Brain Axis Affects PCOS: A Visual Guide

Research on the Gut-Brain Axis and PCOS

Gut Bacteria Imbalance and PCOS

Research has uncovered a strong connection between gut bacteria imbalances and the worsening of hormonal and metabolic symptoms in PCOS. A clinical study conducted between January and July 2014 at Shanghai General Hospital by researchers Yongde Peng and Xiaoying Ding examined 33 women with PCOS. Their findings revealed significantly lower plasma levels of serotonin, ghrelin, and peptide YY (PYY) compared to 15 control participants. The study also highlighted that certain gut bacteria, such as Bacteroides and Escherichia/Shigella, were positively associated with higher testosterone levels and BMI. Meanwhile, Akkermansia, a beneficial bacterium known for maintaining gut barrier integrity, was notably reduced.

An imbalance in gut microbiota increases intestinal permeability, allowing lipopolysaccharides (LPS) to enter the bloodstream. This triggers chronic inflammation and insulin resistance, leading to hyperinsulinemia, which then prompts the ovaries to produce excess androgens, further exacerbating PCOS symptoms.

"Dysbiosis of gut microbiota can increase the ovaries' production of androgens, and then interfere with normal follicle development via triggering a chronic inflammatory response and insulin resistance." - Rui Liu et al.

Specific bacterial patterns have also been observed in women with PCOS. These individuals often show elevated levels of Bacteroides, Escherichia/Shigella, and Streptococcus, while beneficial bacteria like Akkermansia, Bifidobacterium, and Butyricicoccus are reduced. One standout finding is the significant increase of Bacteroides vulgatus, which correlates with lower levels of glycodeoxycholic acid and tauroursodeoxycholic acid - bile acids involved in metabolism and hormone regulation.

Another key factor involves short-chain fatty acids (SCFAs), such as butyrate, which are produced by beneficial gut bacteria. SCFAs play a role in strengthening the gut barrier and may even help regulate ovarian androgen production. Women with PCOS often have fewer SCFA-producing bacteria, contributing to both metabolic problems and hormonal imbalances.

These bacterial shifts don’t just affect metabolism - they also disrupt neural pathways that are critical for hormonal control.

Brain Signaling and Hormone Regulation

Gut imbalances can interfere with neural communication, directly affecting hormonal regulation. A study published in April 2024, using data from the Northern Finland Birth Cohort 1966 (NFBC1966), examined 102 women with PCOS and 205 BMI-matched controls. Led by Terhi Piltonen, the study found that women with PCOS and mood disorders had a lower diversity of gut bacteria. Specifically, they observed reduced alpha diversity (median observed features of 208 in PCOS patients with mood disorders compared to 272 in those without) and a lower abundance of beneficial bacteria like Butyricicoccus (log-fold change of -0.90). Additionally, the genus Sutterella was linked to increased waist circumference and fasting glucose levels.

When gut microbiota are disrupted, neurotransmitter production is affected, worsening both mood symptoms and hormonal dysfunction in PCOS. For example, high levels of GABA in the cerebrospinal fluid of PCOS patients can lead to dysfunctional GABAergic signaling, which has been associated with heightened anxiety and fear. This GABA dysregulation can also overstimulate gonadotropin-releasing hormone (GnRH) neurons, increasing the frequency of luteinizing hormone (LH) pulses and further driving hyperandrogenism.

"Gut microbiota can influence the activity of gonadotropin-releasing hormone (GnRH) neurons through the vagus nerve or serotonin pathways, thereby modulating the function of the hypothalamic-pituitary-ovarian (HPO) axis." - Mei Zhao et al.

Gut hormones like ghrelin and PYY also play a role in signaling the hypothalamus to regulate the HPO axis. In PCOS patients, reduced levels of these hormones disrupt both metabolic and reproductive hormone balance. This creates a damaging cycle where gut dysbiosis worsens hormonal symptoms, which in turn further destabilize gut health.

Probiotics for Gut-Brain Health in PCOS

Probiotic Strains for Hormonal Balance

Clinical trials have highlighted the potential of specific probiotic strains in supporting hormonal health for women with PCOS. For instance, Lactobacillus reuteri has been shown to reduce hyperandrogenism and improve ovarian function. Similarly, strains like L. rhamnosus and L. casei enhance insulin sensitivity and help lower blood glucose levels. Inflammation-targeting strains, including L. acidophilus, L. plantarum, L. fermentum, and L. gasseri, can reduce inflammatory markers such as Interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hsCRP). Meanwhile, Bifidobacterium lactis 420 and B. breve B-3 have shown promise in aiding weight management efforts.

Probiotics also play a role in regulating testosterone by reducing the Free Androgen Index (FAI) and increasing levels of Sex Hormone-Binding Globulin (SHBG). When choosing a probiotic, look for multi-strain options containing at least 2 × 10⁸ colony-forming units (CFU). For more pronounced effects, high-potency formulations with up to 50 billion CFU may be beneficial.

"Probiotic supplements could be a viable option for treating PCOS in adults." - Pharmacology & Therapeutics

By addressing hormonal imbalances, these probiotics pave the way for improved neurotransmitter production, which can positively impact mental health in PCOS.

Probiotics for Mental Health in PCOS

Probiotics aren't just about physical health - they also influence the gut-brain connection, which plays a key role in mood regulation and stress response. The gut is responsible for producing 90% of the body's serotonin, a neurotransmitter essential for maintaining emotional balance. Probiotic strains like Lactobacillus helveticus and Bifidobacterium longum have been shown to lower cortisol levels and improve overall mood. Additionally, probiotics assist in regulating neurotransmitters such as GABA, serotonin, and dopamine, which are often disrupted in women with PCOS.

Clinical studies suggest that an 8- to 12-week course of probiotics - especially when paired with vitamin D or selenium - can significantly enhance both hormonal and mental health outcomes. For example, a 12-week trial combining probiotics with vitamin D led to noticeable reductions in anxiety, depression, and stress among women with PCOS. Between 20% and 30% of women with PCOS experience elevated levels of DHEA-S, a hormone linked to higher anxiety and depression scores. By balancing the gut-brain axis and regulating the hypothalamic-pituitary-adrenal (HPA) axis, probiotics help break this cycle of stress and mood dysregulation.

"Dietary factors such as probiotics and micronutrient supplementation may significantly improve psychiatric symptoms in PCOS patients while helping regulate neurotransmitter levels in the body." - F&S Reports

The combination of probiotics with vitamin D or selenium amplifies their positive effects, offering additional support for mood regulation, inflammation reduction, and oxidative stress management.

Practical Applications for PCOS Management

Lifestyle Changes for Better Gut Health

The connection between gut health and PCOS provides practical steps to improve symptoms. Start by increasing your fiber intake with foods rich in microbiota-accessible carbohydrates (MACs) like quinoa, oats, and legumes. These help boost butyrate production, which can enhance insulin sensitivity. Including plant-based proteins such as nuts and legumes in your diet can also promote beneficial gut bacteria like Bifidobacterium and Lactobacillus while reducing inflammation.

Adopting an anti-inflammatory diet, such as the Mediterranean or DASH diet, can lead to noticeable improvements. For instance, an 8-week study on the DASH diet showed reductions in insulin resistance, inflammation markers, and abdominal fat. Opt for low-glycemic-index foods to help regulate blood sugar and lower free testosterone levels. At the same time, steer clear of artificial sweeteners like sucralose and saccharin, which can disrupt your gut bacteria and impair glucose tolerance.

Pairing regular aerobic exercise with stress management techniques can further support PCOS management. Aerobic activities not only improve gut microbial diversity but have also been shown to regulate menstrual cycles and stimulate ovulation in about half of women with PCOS. Practices like yoga and meditation can help lower cortisol levels and balance the HPA axis, while maintaining a consistent sleep schedule supports the circadian rhythms crucial for reproductive health.

"The International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2018 has suggested healthy lifestyle practices as the first line of treatment for PCOS irrespective of their clinical signs and symptoms." - Ramadurai Sivasankari, Department of Genetic Engineering, SRM Institute of Science and Technology

Small additions to your daily routine, like spearmint tea for its anti-androgen properties or chamomile and lemon balm teas for gut and mood support, can also make a difference. Together, these lifestyle adjustments create a strong foundation for managing PCOS by addressing the gut-brain axis.

How Oana Health Can Help

Oana Health

While lifestyle changes are essential, personalized medical care can amplify their effects. Oana Health provides telehealth services with tailored, prescription-based treatments aimed at optimizing the gut-brain-ovary axis. Their offerings include options for insulin resistance, such as Oral Metformin ER ($22/month) or a combination of Metformin and Spironolactone ($32/month). For mental health support, they provide Bupropion XL ($25/month). They also address unwanted facial hair with Spironolactone ($14/month) or Eflornithine 12% ($69/month), and hair loss with Oral Minoxidil ($25/month). Advanced weight management options, such as Oral Semaglutide GLP-1, are available for $199/month.

Oana Health’s licensed medical professionals craft targeted therapies to enhance insulin sensitivity, balance hormones, and support emotional well-being. This is especially critical for the 20-30% of women with PCOS who experience elevated DHEA-S levels tied to mental health challenges. With free shipping and direct-to-home delivery, Oana Health simplifies the process of integrating comprehensive, gut-brain-focused treatments into your PCOS management plan.

The Gut–PCOS Connection: Inflammation, Insulin Resistance, and Solutions | Felice Gersh, MD

Conclusion: Using Gut-Brain Science to Manage PCOS

Recent research highlights that PCOS is more than a hormonal condition - it’s a complex disorder influenced by gut health, inflammation, and disrupted neuroendocrine pathways. Studies reveal that about 50% of women with PCOS experience insulin resistance, regardless of their weight, and they are at a 5 to 7 times greater risk of developing Type 2 Diabetes. These findings pave the way for practical, science-backed approaches to managing PCOS.

The gut-ovary-brain connection plays a critical role here. Mechanisms like SCFA-driven insulin sensitivity and neurotransmitter regulation can become imbalanced, contributing to hormonal disruptions. Strategies such as dietary adjustments, the use of probiotics like Lactobacillus and Bifidobacterium, and lifestyle changes can help address both physical and mental symptoms effectively. These approaches, when combined, offer targeted solutions that complement broader lifestyle improvements.

"Future research needs to further explore the complex interactions between gut microbiota and PCOS to offer more personalized and effective treatment options for people with PCOS." - Mei Zhao et al., Frontiers in Endocrinology

Personalized care is emerging as a cornerstone of PCOS management. For women looking for a comprehensive approach, combining lifestyle changes with tailored medical treatments offers the most robust support. Oana Health provides telehealth services that integrate gut-brain science into their care plans, offering prescription treatments for insulin resistance, hormonal imbalances, and mental health - all delivered with free shipping to your doorstep. By embracing these strategies, women can take meaningful steps toward managing PCOS more effectively.

FAQs

How does an unhealthy gut affect PCOS symptoms?

An imbalance in gut bacteria, often referred to as gut dysbiosis, can play a major role in worsening PCOS symptoms. When the gut loses its ability to maintain a healthy variety of microbes and generate important metabolites, it can lead to increased intestinal permeability and inflammation. This inflammation, in turn, can amplify issues like insulin resistance, high androgen levels, and disruptions in ovarian function, often resulting in irregular menstrual cycles.

On top of that, gut dysbiosis is linked to other common PCOS challenges, including weight gain, acne, and mood swings. Taking steps to improve gut health - through diet, lifestyle changes, or medical interventions - may offer a more effective way to manage these symptoms.

Probiotics, which are live microorganisms that can support health, may play an important role in improving mental well-being for women with PCOS by interacting with the gut-brain axis. Research suggests that probiotics can help restore balance to gut bacteria, reduce inflammation, and influence the production of key neurotransmitters like serotonin and dopamine. These changes might help ease anxiety, depression, and stress-related symptoms often associated with PCOS.

Additionally, studies show that women with PCOS frequently experience gut imbalances that can worsen mood disorders. By promoting a healthier gut microbiome, probiotics could not only improve emotional health but also help curb stress-related eating habits. For a tailored approach, Oana Health offers telehealth services that combine evidence-based probiotic recommendations with treatments for hormone balance and weight management, addressing both the mental and physical challenges of PCOS.

What lifestyle changes can help improve gut health and manage PCOS symptoms?

Improving gut health is a crucial step in managing PCOS symptoms, such as hormonal imbalances, inflammation, and insulin resistance. Studies show that making specific lifestyle changes can positively influence the gut microbiome and help alleviate PCOS-related challenges.

One of the most powerful tools for gut health is diet. A Mediterranean-style eating pattern - featuring plenty of vegetables, fruits, whole grains, nuts, olive oil, and fatty fish - encourages the growth of beneficial gut bacteria while reducing inflammation. Adding fermented foods like yogurt, kefir, or kimchi to your meals - or even taking a probiotic supplement - can further boost gut health. Meanwhile, cutting back on refined sugars and processed foods helps regulate insulin levels, which is essential for a healthier gut.

Physical activity also plays a big role. Activities like brisk walking or strength training can improve insulin sensitivity and support a balanced gut microbiome. Even a small amount of weight loss, around 5–10% of your body weight, can lead to noticeable improvements. On top of that, getting quality sleep (aim for 7–9 hours a night) and managing stress with mindfulness techniques or yoga can help maintain a healthy connection between your gut and brain.

For those looking for expert guidance, Oana Health offers telehealth services tailored to PCOS and hormonal health. They provide personalized nutrition and exercise plans, all delivered directly to your home, making it easier to take charge of your health.