How Gut Health Affects PCOS: What You Need to Know

Lisa Smith Nutritionist
Jun 29
4 min read

Updated: 6 days ago

PCOS and gut health friendly yoghurt with berries in a glass

When you think about managing PCOS, gut health might not be the first thing that comes to mind. But more and more research shows that what’s going on in your gut can affect everything from hormone balance to inflammation, cravings, and energy.

If you’ve been dealing with bloating, IBS-type symptoms, sugar cravings, or stubborn weight gain, your gut may be playing a bigger role than you realise, especially if you’ve tried eating well and still don’t feel your best.

In this guide, I’ll take you through:

How your gut and hormones are connected in PCOS
Signs your gut may need support
Common PCOS–gut health imbalances
How to improve your gut health using a food-first, practical approach

Why Gut Health Matters in PCOS

Your gut isn’t just about digestion, it’s involved in almost every major system in the body, including your metabolism, immune function, and hormone regulation.

In PCOS, the gut can impact your health in four key ways:

1. Insulin Sensitivity

The microbes in your gut help regulate blood sugar and insulin. If the balance is off (dysbiosis), it can worsen insulin resistance, a driver of PCOS symptoms like irregular periods, weight gain and skin breakouts.

2. Inflammation

Women with PCOS often have low-grade, chronic inflammation. A disrupted gut lining (often called “leaky gut”) can increase inflammatory signals in the body, making hormone balance harder to achieve.

3. Oestrogen Detoxification

Your gut helps process and remove excess hormones. If gut bacteria (like those in the estrobolome) aren’t functioning well, you may end up reabsorbing oestrogen instead of clearing it, leading to symptoms like PMS, heavy periods, or oestrogen dominance.

4. Mood and Cravings

Your gut and brain are closely linked. A disrupted gut can influence anxiety, low mood and sugar cravings through the gut-brain axis. This makes it harder to stick to supportive habits when your body feels constantly out of sync.

Signs Your Gut Might Be Affecting Your PCOS

You don’t need a formal diagnosis of IBS or SIBO to know something’s off.

Here are some signs your gut may need more support:

Frequent bloating (even after “healthy” meals)
Constipation or loose stools
Undigested food in stools
Burping, gas, or reflux
Sugar or carb cravings that feel hard to control
Brain fog, anxiety, or fatigue after meals
Skin issues like acne, eczema or hives
Periods that are heavy, painful or irregular

Common Gut Health Issues I See in PCOS

Every client is different, but there are a few patterns I see regularly in women with PCOS:

Dysbiosis

An imbalance of gut bacteria, often after antibiotics, stress, poor diet or hormonal shifts. This can affect metabolism, digestion and oestrogen clearance.

Constipation

Common in PCOS and often overlooked. If you’re not having a full bowel movement daily, your body can struggle to eliminate excess hormones and waste.

SIBO (Small Intestinal Bacterial Overgrowth)

Symptoms often include bloating, discomfort, fatigue and food intolerances. While not exclusive to PCOS, it can worsen systemic inflammation and hormone symptoms.

Candida or yeast overgrowth

May contribute to cravings, bloating, brain fog and recurrent vaginal thrush, often linked to blood sugar imbalance.

How to Improve Gut Health (Without Cutting Out Everything)

Gut health doesn’t require an extreme protocol or endless restriction. For most women with PCOS, simple, consistent actions make the biggest difference.

Here’s what I focus on with clients:

1. Eat Enough Fibre

Fibre feeds the beneficial bacteria in your gut and supports hormone clearance via the bowel.

Aim for:

25–30g daily
Variety from oats, flaxseed, berries, root veg, lentils, chia, broccoli

If fibre causes bloating, we ease in gently and explore why your gut may be reacting.

2. Balance Blood Sugar

Stable blood sugar reduces inflammation and helps the gut–brain axis function properly.

Key tips:

Protein at every meal
Eat within an hour of waking

Include slow-release carbs (quinoa, oats, lentils, sweet potato)

3. Support Regular Bowel Movements

You need to go daily to clear oestrogen and metabolic waste. If not, your liver and gut can get overwhelmed.

Support with:

Warm lemon water on waking
Ground flaxseed + chia
Magnesium citrate if needed

4. Include Fermented Foods (If Tolerated)

Foods like kefir, sauerkraut or plain yoghurt can support microbiome diversity, but may not suit everyone, especially those with histamine issues.

Start small, observe symptoms, and only include if well tolerated.

5. Reduce Gut Irritants

Alcohol, ultra-processed foods, and too much caffeine can disrupt the gut lining and affect hormone detox.

Instead, try:

Herbal teas (peppermint, ginger, chamomile)
Cooked foods if your digestion feels sensitive
Anti-inflammatory spices like turmeric or cinnamon

6. Look at Stress + Nervous System Support

Stress slows digestion, reduces stomach acid, and increases gut permeability. All of this worsens hormone symptoms.

Build in 10–15 minutes of “rest and digest” time before meals: deep breathing, short walks, or eating away from your desk.

Optional Testing

If gut symptoms are ongoing or not improving with food-first strategies, functional testing (like a stool test or SIBO breath test) may be helpful. This is something we can discuss during your 1:1 support, not everyone needs it, but it can offer clarity in more complex cases.

Final Thoughts

Gut health and PCOS are deeply connected. If your digestion feels off, you’re bloated most days, or your symptoms fluctuate with food, your gut may be asking for support, and your hormones are likely affected too.

You don’t need a restrictive diet or a supplement shelf full of powders to get started. A step-by-step approach that focuses on blood sugar, fibre, inflammation, and stress can make a real difference.

That’s exactly what we focus on inside the 12-week PCOS Hormone Shift Method. If you’re ready to improve your gut health, balance hormones, and finally feel like your body is working with you, I’d love to support you.

Want personalised support for your PCOS symptoms?

Book a free 30-minute discovery call to learn how we can work together online.

Lisa is a BANT registered nutritionist and health coach working with women locally in Manchester and online across the UK and Europe. Her online nutrition programmes are suitable for busy women struggling with PCOS symptoms, fertility and stubborn weight gain.