PCOS, Leaky Gut and Inflammation: What’s the Real Link?

If you’ve been diagnosed with PCOS, or suspect something isn’t quite right after coming off the pill, bloating, fatigue, stubborn weight gain and hormone symptoms can feel relentless.

You’re eating well (mostly), exercising when you can, and trying to stay on top of your health. But it’s like your body just isn’t responding the way it used to.

One piece of the puzzle that’s often overlooked in PCOS? Your gut health, specifically, a compromised gut barrier or gut permeability (often called “leaky gut”).

In this post, we’ll look at what leaky gut really is, how it may worsen inflammation and hormone symptoms in PCOS, and what you can do to support your gut and feel more in control of your health again.

What Is Leaky Gut?

The lining of your gut acts as a selective barrier, absorbing nutrients, but keeping out unwanted substances like toxins, pathogens and undigested food particles.

In a healthy gut, tight junctions between cells maintain this barrier. But when those junctions become weakened, often due to stress, alcohol, diet, medications like NSAIDs or antibiotics, infections, or underlying inflammation, substances can “leak” through into the bloodstream. This can trigger the immune system and lead to chronic low-grade inflammation.

In clinical terms, this is referred to as increased intestinal permeability. The term “leaky gut” isn’t a formal medical diagnosis, but it’s widely used in nutrition and functional medicine to describe what’s happening.

The Gut–Hormone–PCOS Connection

If you have PCOS, you’re already more prone to systemic inflammation. Research shows that chronic low-grade inflammation plays a role in many PCOS symptoms, from insulin resistance and fatigue to acne, irregular periods and trouble losing weight.

When your gut lining becomes more permeable, it allows bacterial fragments like lipopolysaccharides (LPS) to enter the bloodstream. These compounds can trigger an inflammatory cascade, amplifying the very symptoms many women with PCOS are already struggling with.

Some key links between leaky gut and PCOS include:

• Higher inflammation – Studies have shown that women with PCOS often have raised inflammatory markers (such as CRP). Gut barrier issues may be one of the drivers.

• Disrupted insulin signalling – Inflammation from LPS and gut dysbiosis can worsen insulin resistance, which is a core feature in many types of PCOS.

• Worsening hormone imbalance – Gut health plays a role in oestrogen clearance, androgen metabolism, and even production of neurotransmitters that affect your mood and appetite.

• Increased cravings and fatigue – A disrupted gut microbiome and leaky gut may influence appetite-regulating hormones like ghrelin and leptin, making it harder to manage cravings or energy dips.

But Is Leaky Gut Causing Your PCOS?

No, and this is important to clarify. Leaky gut isn’t a root cause of PCOS, but poor gut health can amplify symptoms and make it harder to rebalance hormones, improve metabolic health, or lose weight.

Think of it as an aggravating factor. If you’re doing the right things but still feel inflamed, tired or bloated, gut health is a smart place to investigate.

What Triggers Leaky Gut in Women with PCOS?

There’s no single cause, but women with PCOS may be more vulnerable to intestinal permeability due to:

• Inflammation from insulin resistance

• Diet high in ultra-processed foods or low in fibre

• Stress and poor sleep quality

• Nutrient deficiencies – especially zinc, vitamin D, and omega-3s

• Post-pill changes in microbiome diversity

• Frequent antibiotic or painkiller use

The pill itself alters gut bacteria composition and may contribute to increased permeability, which is important to know if you’ve recently stopped hormonal contraception.

How Do You Know if Leaky Gut Is Affecting You?

There’s no single test for leaky gut that’s widely used in conventional settings, but in practice, I often see the following symptoms alongside PCOS when the gut lining may be compromised:

• Bloating or digestive discomfort (especially after certain foods)

• Brain fog or low mood

• Fatigue that isn’t improved with rest

• Food sensitivities or reactions

• Skin flare-ups (eczema, acne, rosacea)

• Joint pain or headaches

• Cravings for sugar or refined carbs

• Stubborn weight gain despite healthy habits

If this sounds familiar, your gut may be sending signals that it’s under strain.

Supporting Gut Health with a PCOS-Friendly Approach

Improving your gut health doesn’t require an extreme cleanse or supplement overload. In fact, many of the best strategies are simple, food-first and sustainable.

Here’s what I focus on with clients inside my 12-week PCOS programme:

1. Increase Anti-Inflammatory Fibre

Aim for 7+ plant-based foods a day - especially colourful veg, berries, herbs, and sources of resistant starch like oats, cooked/cooled potatoes and lentils. These are anti-inflammatory, feed beneficial gut bacteria and support a healthier intestinal lining.

2. Add Gut-Lining Nutrients

Foods rich in zinc (pumpkin seeds, seafood), omega-3s (sardines, flaxseed, chia), and polyphenols (olive oil, green tea) help repair the gut lining and reduce inflammation.

3. Limit Gut Disruptors

Cut back on alcohol, ultra-processed snacks, refined oils and added sugars where possible, they can aggravate gut permeability and promote dysbiosis.

4. Include Fermented Foods (if tolerated)

Live yoghurt, kefir, sauerkraut or kimchi can help support microbiome balance, although these aren’t tolerated by everyone. Start slow and watch how your body responds.

5. Support Stress Resilience

High cortisol (your stress hormone) directly impacts the gut barrier. Even short bursts of daily calm, like 10 minutes of walking outside, breathing techniques or journaling can help regulate this.

6. Work with a Functional Nutritionist

If symptoms are persisting, targeted support may help. I sometimes use advanced testing for gut health (including microbiome mapping or intestinal permeability markers), especially if clients have persistent bloating, fatigue, or skin issues alongside PCOS.

Final Thoughts

For women with PCOS, gut health isn’t just about digestion, it’s about hormones, inflammation, mood, metabolism and energy.

If your symptoms aren’t improving with the basics, it may be time to zoom out and look at the whole picture. Supporting your gut could be the missing piece that helps everything else work better. You can read more about leaky gut myths and management in the National Library of Medicine here.

Need help getting started?

My 12-week PCOS Hormone Shift Method includes easy, food-first gut support as part of your weekly plan, no detoxes, just real food, practical tools, and step-by-step changes that make sense for your body.

I am a BANT registered nutritionist and health coach specialising in hormone balance and weight loss. My nutrition programmes are suitable for women struggling with hormone imbalances and weight gain conditions like PCOS.

Book a free strategy call to discuss how nutritional therapy can help you heal leaky gut, and improve your digestive health. Online consultations are available for clients across the UK & Europe.

Updated in July 2025 to reflect new PCOS research and nutrition strategies. 

DISCLAIMER: The content on this webpage is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or qualified healthcare provider. Never disregard professional medical advice or delay in seeking it because of something you have read on my website.