Autoimmune Conditions and PCOS/PMOS: What We Know
Many women with PCOS or PMOS feel as though their symptoms extend far beyond periods, ovulation and fertility alone. Fatigue, digestive symptoms, brain fog, joint aches, skin changes, anxiety, hair thinning and ongoing exhaustion are all commonly reported, yet many women are told that their blood tests are “normal” or that these symptoms are simply part of having hormonal issues.
Over the last few years, researchers have become increasingly interested in the relationship between PCOS/PMOS, inflammation and immune health. In particular, studies have explored whether women with PCOS may be more likely to experience certain autoimmune conditions, especially autoimmune thyroid disease.
This does not mean PCOS/PMOS is automatically an autoimmune disease. It is currently understood as a complex endocrine, metabolic and reproductive condition. However, the research does suggest that, for some women, there may be important connections between hormones, metabolism, inflammation and the immune system.
Is PCOS/PMOS an inflammatory condition?
PCOS/PMOS is now understood to involve far more than reproductive hormones alone.
Research consistently suggests that many women with PCOS have higher levels of chronic low-grade inflammation compared with women without the condition. This does not necessarily mean there is obvious inflammation that will always be picked up on standard blood tests. Instead, it refers to subtle, ongoing activation of inflammatory pathways within the body.
Several factors may contribute to this, including insulin resistance, oxidative stress, disrupted sleep, chronic stress, altered body composition, gut health disturbances and blood sugar dysregulation. This matters because the immune system does not operate separately from the rest of the body - it is constantly responding to signals from hormones, blood sugar, the gut microbiome, stress hormones and inflammatory messengers.
Over time, a more inflammatory internal environment may affect immune tolerance. Immune tolerance is the process that helps the immune system recognise what is “self” and what is “foreign”. When this becomes dysregulated, the immune system may become more likely to react inappropriately to the body’s own tissues. That does not mean inflammation alone causes autoimmune disease. Genetics, environment, infections, stress, gut health, hormones and other triggers may all play a role. However, this inflammatory and metabolic picture may help explain why autoimmune conditions appear more common in some women with PCOS/PMOS.
Thyroid autoimmunity and hormonal health
The strongest and most consistent autoimmune link in the research is between PCOS/PMOS and autoimmune thyroid disease, particularly Hashimoto’s thyroiditis. Hashimoto’s is an autoimmune condition where the immune system produces antibodies that target the thyroid gland. Over time, this can contribute to reduced thyroid hormone production in some people.
Several studies and reviews have found that autoimmune thyroiditis and thyroid antibodies are more common in women with PCOS compared with women without PCOS. One large 2025 study found higher anti-thyroid peroxidase antibody levels in women with PCOS, with anti-TPO antibodies positive in 12.89% of women with PCOS in that cohort.
Subclinical hypothyroidism also appears to be more common in PCOS. A 2025 systematic review and meta-analysis of 29 studies involving 5,765 women with PCOS found that around 19.7% had subclinical hypothyroidism. It also found that women with both PCOS and subclinical hypothyroidism had higher fasting insulin and HOMA-IR, a marker of insulin resistance.
This overlap is important because thyroid symptoms can look very similar to PCOS/PMOS symptoms. These may include fatigue, hair thinning, weight changes, low mood, brain fog, constipation, cold intolerance and irregular cycles. This is why it can be worth discussing thyroid testing with your GP if symptoms persist, especially where fatigue, hair loss, menstrual changes or unexplained changes in weight are present.
Other autoimmune conditions seen alongside PCOS/PMOS
Although thyroid autoimmunity has the strongest evidence base, newer research has started to look at other autoimmune and inflammatory conditions too.
A 2026 study looking at autoimmune diseases across different PCOS phenotypes found that organ-specific and systemic autoimmune disorders affected 22.6% of women with PCOS in their cohort. Autoimmune thyroiditis was the most common, affecting 20.3% of women. Non-thyroid autoimmune conditions were less common overall, but the most frequently reported were psoriasis, type 1 diabetes, alopecia areata and rheumatoid arthritis.
Psoriasis
Psoriasis is an immune-mediated inflammatory skin condition. In the 2026 PCOS cohort, psoriasis was the most common non-thyroid autoimmune condition reported, although still present in a small percentage of women.
This link is biologically plausible because both PCOS/PMOS and psoriasis are associated with inflammation, insulin resistance and metabolic risk factors. However, more research is needed before we can say whether PCOS directly increases psoriasis risk or whether shared inflammatory and metabolic pathways explain the overlap.
Type 1 diabetes
Type 1 diabetes is an autoimmune condition in which the immune system targets insulin-producing beta cells in the pancreas.
The 2026 study found type 1 diabetes among the more common non-thyroid autoimmune conditions in women with PCOS, although again at a low overall percentage. The authors suggested that autoimmune markers may be particularly relevant in women with PCOS who have dysglycaemia, because not all blood sugar problems in PCOS are necessarily driven by classic insulin resistance alone.
This is a useful reminder that personalised assessment matters. Two women may both have PCOS/PMOS and blood sugar issues, but the underlying drivers may not be identical.
Alopecia areata
Alopecia areata is an autoimmune condition that causes patchy hair loss. This is different from androgen-related scalp hair thinning, which can occur in PCOS/PMOS.
This distinction matters because hair loss in PCOS can have several possible drivers. Higher androgen levels may contribute to female pattern hair thinning, whilst thyroid dysfunction, iron deficiency, stress, autoimmune activity and nutrient insufficiencies may also play a role.
If hair loss is sudden, patchy, rapidly worsening or associated with other symptoms, it is important to seek medical advice rather than assuming it is “just PCOS”.
Why might autoimmune conditions be more common in PCOS/PMOS?
There is unlikely to be one single explanation. Instead, the overlap probably reflects several interacting mechanisms.
Insulin resistance is one key factor. Higher insulin levels can stimulate inflammatory pathways and oxidative stress. Inflammation can then affect hormone signalling, immune regulation and metabolic health.
Hormonal patterns may also matter. PCOS/PMOS is often associated with irregular ovulation, altered progesterone exposure and higher androgen levels. Oestrogen, progesterone and androgens all interact with the immune system, which may help explain why autoimmune diseases are generally more common in women and why symptoms can fluctuate across hormonal life stages.
Adipose tissue may also contribute. Body fat is not inert tissue. It produces inflammatory signalling molecules that can influence insulin sensitivity and immune activity. This does not mean weight is the whole story, as lean women with PCOS/PMOS may also experience inflammation and autoimmune conditions. However, metabolic health is an important part of the picture.
Gut health is another area of growing interest. The gut microbiome plays a central role in immune education, inflammation and metabolic signalling. Changes in microbial diversity, gut barrier function and short-chain fatty acid production have all been explored in relation to both PCOS/PMOS and autoimmune disease.
Again, this does not mean gut support can cure autoimmune disease. However, it may form one part of a broader strategy to support immune resilience, digestion, inflammation balance and overall wellbeing.
Gut health, immune function and lifestyle factors
Because a large proportion of the immune system is associated with the gut, supporting gut health can be a useful foundation for many women with PCOS/PMOS.
This does not need to mean extreme elimination diets, expensive testing or complicated protocols. In fact, highly restrictive approaches can sometimes create more stress, reduce dietary diversity and make symptoms harder to manage long term.
A more supportive approach may include:
A Mediterranean-style dietary pattern may be particularly useful because it naturally includes fibre, polyphenols, omega-3 fats, extra virgin olive oil, legumes, vegetables, herbs, spices and oily fish. This way of eating has been widely studied in relation to metabolic and inflammatory health. For women with PCOS/PMOS, this can be a more sustainable and nourishing approach than trying to cut out more and more foods.
When to speak to your GP
It is important not to self-diagnose autoimmune conditions based on symptoms alone, as many symptoms overlap with PCOS/PMOS, thyroid dysfunction, nutrient insufficiencies, stress and other health issues.
However, it may be worth speaking to your GP if you experience:
Depending on symptoms, your GP may consider blood tests such as thyroid function, thyroid antibodies, inflammatory markers, full blood count, ferritin, B12, folate, vitamin D or referral for further assessment.
The bigger picture
The research does not suggest that every woman with PCOS/PMOS will develop an autoimmune condition. It also does not mean that PCOS/PMOS should be treated as an autoimmune disease.
However, the evidence does suggest that immune and inflammatory pathways deserve more attention.
Bone Health and PCOS: Is There a Link?
Key Takeaways
Polycystic ovary syndrome (PCOS) is often discussed in relation to hormones, menstrual cycles, fertility and metabolic health. However, an area that receives much less attention is bone health.
Many people with PCOS ask whether the condition affects their long-term risk of osteoporosis, joint pain or muscle loss. These concerns are understandable, particularly if symptoms such as fatigue, inflammation or reduced physical activity make movement more difficult.
Research suggests that the relationship between PCOS and bone health is complex. Hormones, insulin resistance, inflammation and lifestyle factors may all influence bone turnover and skeletal strength over time.
Understanding these connections can help guide practical steps to support bone, joint and muscle health across the lifespan.
Hormones, Bone Turnover and PCOS
Bone is living tissue that is constantly being remodelled through a process known as bone turnover. Two types of cells are involved: osteoclasts break down old bone, while osteoblasts build new bone.
Hormones play an important role in regulating this process.
Oestrogen is one of the most important hormones for bone protection. It helps maintain bone density by slowing the breakdown of bone tissue. This is why bone loss often accelerates during menopause when oestrogen levels decline.
PCOS presents a more complicated hormonal picture. Although some individuals with PCOS may experience irregular or absent ovulation, oestrogen levels are not always low. In fact, some studies suggest that bone mineral density may be similar or even slightly higher in some people with PCOS compared with those without the condition.
However, hormonal patterns in PCOS can vary significantly between individuals. Irregular cycles, lower progesterone exposure and altered androgen levels may influence bone metabolism over time.
Vitamin D status may also play a role. Low vitamin D levels are common in people with PCOS and may affect calcium absorption, bone mineralisation and muscle function.
Ensuring adequate vitamin D, calcium and protein intake can therefore be important for supporting skeletal health.
Insulin Resistance, Inflammation and Bone Health
Insulin resistance is one of the key metabolic drivers of PCOS and may influence bone and muscle health in several ways.
Insulin itself has anabolic effects, meaning it can support tissue growth and repair. However, when insulin resistance develops, the body's metabolic environment changes.
Chronic low-grade inflammation, which is commonly observed in PCOS, may negatively influence bone turnover. Inflammatory cytokines (signalling molecules) can increase bone breakdown while also affecting joint comfort and recovery after exercise.
Muscle health is also closely connected to bone health. Muscle contractions stimulate bone formation through mechanical loading. If fatigue, pain or metabolic challenges reduce physical activity levels, this stimulus for bone maintenance may decline.
This highlights the importance of maintaining muscle mass and strength as part of long-term PCOS management. Strength-based movement, adequate dietary protein and sufficient micronutrients all play a role in supporting this process.
What This Means Across the Lifespan
Bone health is influenced by habits built over decades.
Peak bone mass is typically achieved by the late twenties or early thirties. Supporting bone density during these years can help reduce the risk of osteoporosis later in life.
For individuals with PCOS, focusing on metabolic health, movement and nutrition may help support both bone and muscle function.
Several lifestyle factors are particularly important:
These strategies align closely with many of the core lifestyle recommendations already used in PCOS management.
If you are unsure where to begin, working with a qualified nutritional therapist, such as our team here at PCOS Clinics, can help you develop an approach tailored to your individual needs. Why not book a free call here?
Inflammation, PCOS and Heart Health
If you have PCOS and you feel tired, puffy, achy or stuck in a cycle of cravings and crashes, you have probably come across the idea that inflammation is part of the picture. This can sound vague online, but in research terms, PCOS is often associated with chronic low-grade inflammation, particularly when insulin resistance, central weight gain, poor sleep and ongoing stress are present.
This matters for long-term health because atherosclerosis (the process that underpins most heart disease) is not just about cholesterol. It is also an inflammatory process that affects the blood vessel wall over time.
In this blog, I will explain why PCOS is often described as an inflammatory condition, how inflammation influences cardiovascular risk, and what actually helps in real life.
Why PCOS is an inflammatory condition
Inflammation is a normal immune response. The issue is when the body stays in a low-grade, switched-on inflammatory state for months or years.
In PCOS, several factors can contribute to this:
In studies, inflammatory markers such as CRP and interleukin-6 are often higher in women with PCOS compared with controls, supporting the concept of chronic low-grade inflammation as part of PCOS pathophysiology.
How inflammation drives cardiovascular risk
Inflammation affects the cardiovascular system in a few key ways.
First, it impacts the endothelium, the inner lining of blood vessels. Healthy endothelium helps blood vessels relax and regulates clotting and immune activity. Chronic inflammation makes this lining less resilient, contributing to endothelial dysfunction, which is an early step in cardiovascular disease.
Second, inflammation is involved in plaque development. Cholesterol particles enter the vessel wall and trigger an immune response. Over time, the combination of lipids plus inflammatory signalling drives plaque formation and instability.
This is one reason it can be helpful to think about heart health using more than one marker.
A major 2024 study following nearly 28,000 initially healthy women over 30 years found that a combined measure of LDL cholesterol, Lp(a), and high-sensitivity CRP (hs-CRP) predicted long-term cardiovascular events.
Nutrition and lifestyle factors that matter most
When inflammation is part of your PCOS picture, the goal is not to eliminate inflammation entirely. Inflammation is a normal and necessary part of immune function. The aim is to reduce the chronic drivers that keep the body in a persistently activated state, while supporting metabolic flexibility, vascular health and recovery.
This is where many women with PCOS feel stuck. They are eating well, exercising, and still feel inflamed. In those cases, the issue is rarely a single food or nutrient. It is usually a combination of metabolic, gut, immune and lifestyle factors.
Overall dietary pattern still matters most
High-quality evidence consistently shows that overall dietary pattern is more important than individual foods or supplements for cardiovascular and inflammatory risk.
Mediterranean-style dietary patterns are associated with lower inflammation, improved lipid profiles and reduced cardiovascular events. In PCOS, this approach is particularly relevant because it also supports insulin sensitivity, gut health and fibre intake, all of which influence inflammatory signalling.
In practice, this means building meals around vegetables, beans and lentils, fruit, nuts and seeds, and fish, alongside stable whole-food fats. The focus is not restriction, but food quality and consistency.
Ultra-processed diets tend to be lower in fibre and phytonutrients, and higher in refined carbohydrates, additives and industrial fats. Population-level evidence links these patterns with higher inflammatory markers and poorer cardiometabolic outcomes. For women with PCOS, reducing reliance on ultra-processed foods often improves both inflammation and blood sugar regulation, even without intentional calorie reduction.
Gut health and inflammation in PCOS
The gut plays a central role in immune regulation, and this is increasingly relevant in PCOS research.
Emerging evidence suggests that women with PCOS often show differences in gut microbiota composition compared with controls. Reduced microbial diversity, altered short-chain fatty acid production and increased intestinal permeability have all been described. These changes can promote systemic inflammation by allowing immune-activating compounds to enter circulation more readily.
Fibre intake is particularly important here. Fermentable fibres feed beneficial gut bacteria and support the production of short-chain fatty acids such as butyrate, which help regulate immune activity and maintain gut barrier integrity.
If gut symptoms such as bloating, pain or irregular bowel habits are present, inflammation may be driven as much by digestive strain as by diet quality alone. In these cases, supporting gut tolerance, meal timing and digestion can be as important as what foods are chosen.
Food sensitivities and immune activation
Food sensitivities are common in PCOS discussions and are often misunderstood.
True immune-mediated food reactions are relatively uncommon, but many women with PCOS experience food-related symptom flares due to gut permeability, altered digestion or heightened immune responsiveness. This does not mean long-term avoidance is always necessary or helpful.
Overly restrictive diets can increase stress and reduce dietary diversity, which may worsen gut health and inflammation over time. A more effective approach is usually to identify triggers carefully, address gut integrity and digestion, and then reintroduce foods where possible.
The aim is to calm immune activation, not to permanently shrink the diet.
Omega-3 fats and inflammatory balance
Omega-3 fats remain relevant in PCOS because of their role in inflammatory balance and triglyceride metabolism. A 2021 meta-analysis reported improvements in several cardiometabolic markers in women with PCOS following omega-3 supplementation, and subsequent reviews continue to support omega-3 as beneficial for inflammation and metabolic risk. Food sources such as oily fish also fit naturally into dietary patterns associated with lower cardiovascular risk.
Omega-3s are not a stand-alone solution, but they can support resolution of inflammation when combined with improvements in diet quality and lifestyle factors.
Movement as an anti-inflammatory signal
Physical activity is one of the most reliable ways to reduce inflammatory signalling over time.
Exercise improves insulin sensitivity, supports endothelial function and promotes anti-inflammatory cytokine release. A 2024 review of physical activity in PCOS highlights improvements in cardiometabolic markers, even without significant weight loss.
This does not require intense training. Regular walking, resistance training and movement that supports muscle mass and metabolic health can all contribute. Consistency matters more than intensity.
Sleep, stress and recovery are not optional
Sleep disturbance and chronic stress are common in PCOS and are strongly linked to inflammation and cardiovascular risk factors.
Poor sleep increases insulin resistance, raises inflammatory markers, and disrupts appetite regulation. Chronic stress activates inflammatory pathways and can undermine the benefits of otherwise supportive nutrition.
For women who feel they have “tried everything” and still feel inflamed, this is often the missing piece. Not more rules or restriction, but better recovery, nervous system support and sleep consistency.
Inflammation in PCOS is rarely about doing more. It is usually about doing less, more consistently, and giving the body the conditions it needs to recover.
If you’d like to dig deeper into what might be triggering your inflammation, why not get in touch? You can book a free call here.
Short disclaimer
This blog is for educational purposes only and is not medical advice. As a BANT-registered Nutritional Therapist, I do not diagnose or treat medical conditions and I do not advise on prescription medications. If you have concerns about cardiovascular risk, inflammation or blood test results, please speak with your GP or relevant medical specialist.
If you have PCOS and you have ever been told you are “too young” to think about heart health, think again.
PCOS is often framed as a fertility or period issue, but it is actually a lifelong metabolic and inflammatory condition. This is important to understand, as the metabolic drivers that sit underneath PCOS, particularly insulin resistance, abdominal weight, and chronic low-grade inflammation, can affect cardiovascular health over time.
The good news is that you can do a lot to support your long-term risk, especially when you understand which markers matter and what your results actually mean.
In this blog, I will cover:
Why cardiovascular risk is higher in PCOS
Over the past few years, higher-quality research has strengthened the evidence that women with PCOS have a higher risk of cardiovascular disease over the long term compared with women without PCOS (by a staggering 47-68% depending on the study).
It is important to say this clearly and calmly. Higher risk does not mean heart disease is inevitable. It means PCOS is a reason to take prevention seriously, earlier, and with a focus on the underlying drivers rather than quick fixes.
The 2023 International Guidelines for PCOS reflect this – they recommend awareness of cardiovascular risk in PCOS and highlights the importance of regular assessment of cardiometabolic risk factors such as blood pressure and lipids.
So, what is driving that increased risk?
The role of insulin resistance and inflammation
For many women, insulin resistance is one of the central features of PCOS. When insulin levels remain higher for longer, this can influence cardiovascular risk in several ways, including changes in lipid metabolism (cholesterol levels), higher triglycerides, lower HDL cholesterol, and a tendency towards a more atherogenic lipid profile – meaning a higher risk of cardiovascular disease.
Chronic low-grade inflammation is also common in PCOS, particularly when insulin resistance, poor sleep, chronic stress or central weight gain are present. Inflammation can damage the lining of blood vessels which can lead to a greater risk of heart disease. This is one reason heart health is about more than cholesterol alone.
Cholesterol, blood pressure and PCOS
In practice, the most common cardiovascular markers that come up in PCOS include:
The PCOS guidelines recommend that all women with PCOS have blood pressure measured at least annually. Cholesterol testing is also recommended, with follow-up frequency based on results and overall risk.
Cholesterol explained: what it is and what the markers mean
Cholesterol is a waxy, fat-like substance that your body uses to build cell membranes, make vitamin D, and produce hormones and bile acids. It is super important for your wellbeing! Your liver makes most of the cholesterol you need, and you also get a small amount from food.
Cholesterol only becomes a problem when cholesterol-containing particles build up in artery walls over time, contributing to atherosclerosis (narrowing and hardening of the arteries). This process is influenced by many things - including blood pressure, blood sugar balance, inflammation, smoking, genetics, hormone balance, stress, sleep and how much exercise you do.
What is a lipid profile actually measuring?
A standard lipid profile usually includes:
Why “LDL cholesterol” is not the whole story
LDL cholesterol tells you how much cholesterol is being carried inside LDL particles. But it does not tell you how many particles are carrying it.
This matters because atherosclerosis is driven by the number of atherogenic particles entering the artery wall. Two people can have the same LDL cholesterol but a very different number of LDL particles. This is one reason why measuring something called ApoB can actually be more helpful in ascertaining your risk of heart disease.
ApoB: the marker that helps you understand what’s going on
Apolipoprotein B (ApoB) is a protein found on the surface of atherogenic lipoproteins (including LDL, VLDL and remnants), ie the cholesterol carriers that may lead to heart disease. Each particle carries one ApoB, so ApoB is effectively a count of the number of “risk-carrying” particles.
Recent reviews and expert consensus documents have highlighted ApoB as a strong predictor of cardiovascular risk, particularly in people with insulin resistance, obesity, metabolic syndrome or higher triglycerides.
How is ApoB linked to PCOS?
PCOS is commonly associated with insulin resistance and altered lipid metabolism. Emerging research suggests ApoB-related particle patterns may be relevant in PCOS, especially where triglycerides are higher or weight gain is present, although larger studies are still needed.
The practical take-home is that ApoB can sometimes help clarify risk when standard cholesterol results do not match the rest of the clinical picture.
ApoB levels can be measured in a simple blood test. It is not always part of routine NHS lipid testing, but it can be requested in some settings. This is something you can request from your GP, or there are many private labs that offer this measurement. If this is something that you’d like to look at, please do get in touch as this is something that I can potentially help with.
Lp(a): a genetic risk factor worth knowing about
Lipoprotein(a), written as Lp(a), is an LDL-like particle with an additional protein attached (apolipoprotein(a)). Lp(a) is largely genetic and remains fairly stable across your lifetime.
However, elevated Lp(a) is now recognised as an independent risk factor for cardiovascular disease. It can contribute to risk even when other cholesterol markers look “fine”. European guidance and consensus documents support measuring Lp(a) at least once in adulthood, to identify inherited elevation and refine risk assessment.
Research shows that high Lp(a) increases heart disease risk by acting like "sticky" LDL cholesterol, promoting plaque buildup (atherosclerosis) and blood clots in arteries, potentially leading to heart attacks and strokes, even with normal cholesterol. This is because its unique protein (Apo(a)) hinders plaque breakdown and encourages clot formation. This genetic factor causes more aggressive plaque, calcification, and inflammation, independently raising cardiovascular danger, especially with other risk factors present.
A 2023 systematic review and meta-analysis found that women with PCOS had higher Lp(a) levels compared with controls, including in both overweight and non-overweight women.
This does not mean every woman with PCOS will have high Lp(a). It means Lp(a) is one of the markers that may be relevant for some women, particularly those with a family history of early cardiovascular disease.
How do you test Lp(a)?
Lp(a) is also tested with a simple blood test. Like ApoB, it is not routinely included in standard lipid panels.
A helpful approach is to ask your GP whether Lp(a) testing is appropriate for you, especially if you have:
Lp(a) can be reported in different units (mg/dL or nmol/L), and results should be interpreted accordingly. Many clinical sources use approximately 50 mg/dL or 125 nmol/L as a threshold associated with higher risk, but your overall clinical picture matters.
Because Lp(a) is genetic, lifestyle changes tend not to shift the number very much. The focus is usually on lowering overall risk by improving other modifiable factors (LDL cholesterol, blood pressure, blood sugar, inflammation, smoking status, fitness, sleep).
Specialist medications specifically targeting Lp(a) are under investigation, but lifestyle still matters because it reduces the total risk burden.
Blood pressure and PCOS: an often-overlooked risk factor
Blood pressure is one of the most important and modifiable cardiovascular risk factors, yet it is often under-discussed in PCOS, particularly in younger women.
Evidence from large observational studies and recent systematic reviews shows that women with PCOS have a higher prevalence of elevated blood pressure and hypertension compared with women without PCOS, even after adjusting for body weight. This suggests that PCOS itself, not just weight, contributes to blood pressure dysregulation.
Several mechanisms appear to be involved. Insulin resistance plays a central role, as higher circulating insulin levels promote sodium retention in the kidneys and increase sympathetic nervous system activity, both of which raise blood pressure. Chronic low-grade inflammation and endothelial dysfunction, which are common in PCOS, also reduce the ability of blood vessels to relax appropriately.
Hormonal factors may contribute as well. Elevated androgens have been associated with higher blood pressure in women with PCOS, and emerging research suggests that altered renin–angiotensin signalling may further influence vascular tone in this population.
Importantly, raised blood pressure in PCOS can occur even when readings are only mildly elevated or fluctuate between normal and borderline ranges. These early changes still matter. Long-term data show that cumulative exposure to higher blood pressure over time is strongly associated with cardiovascular risk later in life.
What this means in practice
The current international PCOS guideline recommends that all women with PCOS have their blood pressure checked at least annually, regardless of age. This is a key prevention step, not an indication that something is already wrong.
From a nutrition and lifestyle perspective, blood pressure in PCOS often responds well to the same foundations that support insulin sensitivity and inflammation balance. Dietary patterns rich in vegetables, fruit, legumes, wholegrains, nuts and seeds are consistently associated with lower blood pressure, while high intakes of ultra-processed foods are linked to higher readings.
The Gut–Immune Connection: Why Your Microbiome Matters More in Winter
Winter often brings a rise in colds, flu, a touch of COVID, but overall slower recovery and lower energy. While many people blame the weather alone, the gut actually plays a major role in how well the immune system responds at this time of year. The gut and immune system are closely linked, and the bugs living in your gut help shape how your body reacts to viruses, inflammation and stress.
For women living with PCOS, this connection is especially important. Gut health influences inflammation, metabolic balance, cravings, hormone regulation and resilience, all of which can feel more sensitive during winter.
How Gut Health Shapes Immunity
Around seventy per cent of the immune system sits in and around the gut. The gut lining acts as a physical barrier, while immune cells monitor what enters the body. A healthy microbiome helps regulate inflammation, supports nutrient production, and contributes to a calm, balanced immune response.
When the microbiome becomes disrupted, the immune system may overreact or become less efficient. This can mean slower recovery from viruses, greater sensitivity to seasonal changes and more fatigue.
Winter brings natural shifts that can challenge the gut. Less sunlight (so less vitamin D0, dietary changes, comfort eating, reduced movement, and increased stress all influence the gut microbial environment and may alter immune resilience.
Microbiome Diversity and Immune Defence
A diverse microbiome is linked with stronger immune defence, better metabolic balance, reduced inflammation and improved digestion. Lower diversity is associated with greater susceptibility to infections and inflammatory conditions.
Some beneficial bacteria can work to strengthen the gut barrier. When the barrier is strong, the immune system remains calm and balanced. When it becomes compromised, the immune system becomes more alert and inflammation can rise.
Women with PCOS often show lower microbial diversity and higher inflammation. This can contribute to fatigue, cravings, hormonal symptoms and reduced winter resilience.
Prebiotics and Probiotics Explained
Prebiotics are fibres that feed beneficial gut bacteria. They help increase diversity and support the production of short chain fatty acids that regulate inflammation. Examples include garlic, leeks, onions, asparagus, oats, flaxseed and green bananas.
Probiotics are live microorganisms found in fermented foods. They help introduce and maintain beneficial species. Examples include kefir, sauerkraut, kimchi, miso and live yoghurt.
Including even one or two sources of these foods daily can support a healthier microbiome.
Digestive Issues That Affect Immunity: Dysbiosis, SIBO and Reflux
Gut health is not simpply about what you eat. Digestive symptoms can also influence the immune system, inflammation and overall wellbeing. Winter often brings these issues to the surface because the body is under more seasonal stress.
Dysbiosis
Dysbiosis refers to an imbalance in gut bacteria in our microbiome. This may involve too few beneficial microbes, too many inflammatory species or microbial patterns that contribute to excess gas or digestive discomfort.
Signs can include bloating, irregular bowel movements – diarrhoea and/or constipation, fatigue after meals, sugar cravings and skin flare ups. Dysbiosis is associated with inflammation and can influence insulin sensitivity and hormonal balance.
SIBO (Small Intestinal Bacterial Overgrowth)
SIBO occurs when bacteria that belong in the large intestine migrate into the small intestine. This can interfere with digestion and nutrient absorption.
Common signs include bloating that worsens through the day, abdominal discomfort, diarrhoea or constipation, nausea and persistent food reactions. SIBO is often assessed through a breath test which measures hydrogen or methane gases produced by gut bacteria.
Reflux and Upper Digestive Issues
Reflux, heartburn and upper abdominal discomfort can also affect the gut–immune connection. These symptoms may relate to imbalanced gut bacteria, delayed stomach emptying, stress or certain trigger foods.
Reflux can reduce sleep quality and contribute to inflammation, both of which weaken immune resilience. Supporting digestion through balanced meals, eating slowly and avoiding late eating can help.
When Testing Can Help
Testing is not always required, but it can be helpful for people with ongoing digestive symptoms.
Comprehensive stool tests: These provide information on microbial diversity, beneficial and opportunistic bacteria, digestion and absorption markers, inflammation levels and yeast overgrowth.
Breath tests for SIBO: These measure hydrogen and methane gases produced after a specific carbohydrate substrate is ingested. This helps determine whether bacterial overgrowth may be contributing to symptoms.
These tools help build a clearer picture of what is happening in the gut and can guide more personalised nutrition and lifestyle strategies. If you are interested in any of this testing, please do get in touch.
Best Foods for a Winter Proof Gut
Focusing on gut friendly foods at this time of year supports both digestion and immunity.
These foods help create a microbiome that is more resilient and better equipped to support your immune system through winter.
Bringing It All Together
Your gut plays a central role in how well your immune system copes during winter. A diverse and balanced microbiome supports a calmer immune response, steadier energy, healthier digestion and lower inflammation. Digestive issues such as dysbiosis, reflux or SIBO can place extra strain on the gut–immune axis which is why symptoms often feel more noticeable during colder months.
This connection matters even more for women with PCOS. Gut health influences inflammation, insulin sensitivity and hormone regulation, which means that an imbalanced microbiome can make PCOS symptoms feel stronger. Research shows that women with PCOS are more likely to experience dysbiosis and lower microbial diversity, and this can contribute to cravings, fatigue, irregular cycles and higher inflammatory markers. Supporting the gut is therefore not only helpful for immunity but also for managing the wider metabolic and hormonal picture of PCOS.
By focusing on simple, consistent changes such as increasing fibre, including fermented foods, supporting digestion and reducing ultra processed foods, you can strengthen your microbiome and support both immune and hormonal balance. Many women notice fewer flare ups, more stable energy and improved symptoms when they support their gut in this way.
If you feel run down every winter, struggle with digestion or suspect your microbiome needs more attention, this is an ideal time to start making changes. Or if you’d like to know more, why not get in touch?
Tired, Run-down and Inflamed? Is Inflammation Driving your PCOS?
What is inflammation?
Inflammation is the body’s natural defence mechanism. When you injure yourself or catch an infection, your immune system releases chemical messengers to repair tissue and fight off pathogens. This short-term, or acute inflammation, is essential for healing.
However, when the immune system stays slightly switched on over time, a state of chronic low-grade inflammation develops. It’s subtle, often without clear symptoms, but measurable in the body through elevated inflammatory markers such as C-reactive protein (CRP), interleukin-6 (IL-6), or tumour necrosis factor-alpha (TNF-α).
Unlike acute inflammation, this persistent “background” inflammation can quietly affect many systems, including metabolism, hormones, fertility, gut health, and immune resilience. In other words, even though you may not feel overtly unwell, your body may still be under a gentle but ongoing immune strain.
The link between PCOS and chronic low-grade inflammation
Many studies show that women with Polycystic Ovary Syndrome (PCOS) tend to have higher levels of inflammatory markers compared to women without PCOS. This suggests that inflammation is part of the underlying physiology of the condition rather than just a by-product.
Researchers describe PCOS as a metabolic–endocrine–immune disorder, where factors like insulin resistance, excess androgens, and oxidative stress contribute to immune activation. The picture is complex: insulin resistance can increase inflammation, while inflammation itself can worsen insulin resistance, creating a vicious cycle.
Obesity and central fat accumulation often amplify this process because adipose tissue releases inflammatory cytokines. However, even lean women with PCOS can show signs of immune dysregulation, suggesting that the inflammation is not simply weight-related.
This persistent low-level inflammation may also influence how the ovaries function, affect egg quality, and disrupt normal ovulation. For many clients, this explains why symptoms such as fatigue, sluggish recovery from illness, acne, and irregular cycles tend to flare during times of increased stress or poor immune health.
How inflammation affects hormones
Inflammation has wide-reaching effects on hormone balance:
1. Hormone production and clearance.
Pro-inflammatory molecules can disrupt ovarian function, reducing the ability of follicles to mature properly and affecting ovulation. Chronic inflammation also alters the way hormones are processed in the liver, which can lead to higher circulating androgens.
2. Insulin resistance and androgen excess.
Inflammation reduces insulin sensitivity, which in turn raises insulin levels. Elevated insulin drives the ovaries to produce more androgens (such as testosterone), worsening typical PCOS symptoms like acne, hair growth, and irregular periods.
3. Egg quality and implantation.
Within the ovaries, inflammatory cytokines and oxidative stress can damage developing follicles and reduce oocyte quality. This can make conception more difficult and may increase miscarriage risk.
4. Metabolic and cardiovascular risk.
Long-term inflammation contributes to higher risk of metabolic syndrome, type 2 diabetes, and cardiovascular disease, all conditions that are more prevalent in women with PCOS.
When clients describe being “constantly run down” or “taking ages to recover from colds,” it may reflect immune system overactivity and low resilience driven by this chronic inflammatory state.
Signs of inflammation in PCOS
Low-grade inflammation often goes unnoticed because it doesn’t cause the typical redness, swelling, or pain associated with acute inflammation. Still, there are patterns and symptoms that suggest it may be at play:
Feeling “drained and exhausted by December” can often reflect a combination of immune strain, nutrient depletion, and chronic inflammation.
Steps to reduce inflammation
While inflammation is part of the body’s natural defence, long-term low-grade inflammation can be influenced by lifestyle and nutrition. The goal isn’t to “switch it off”, but to bring the body back into balance.
1. Improve insulin sensitivity and body composition.
Because insulin resistance drives inflammation, improving metabolic health is key. Regular movement, strength training, balanced meals, and reducing visceral fat all help reduce inflammatory signals. See more details here.
2. Eat an anti-inflammatory diet.
A Mediterranean-style pattern, one rich in vegetables, herbs, olive oil, oily fish, nuts, seeds, legumes (if tolerated), and colourful plant foods, is linked with lower inflammatory markers. Reducing refined sugars and ultra-processed foods helps stabilise blood glucose and reduce oxidative stress.
3. Support gut health.
Around 70% of the immune system sits within the gut. A disrupted microbiome or increased intestinal permeability (“leaky gut”) can promote systemic inflammation. Include diverse fibres, fermented foods, and prebiotic vegetables while avoiding excessive alcohol or ultra-processed foods that irritate the gut lining. Or get in touch if you’d like to investigate the root cause of your gut issues.
4. Optimise key nutrients.
Certain nutrients have been shown to help regulate inflammation, including omega-3 fatty acids, vitamin D, magnesium, selenium, and antioxidants such as polyphenols. While these can come from food, clients may wish to discuss testing or supplementation with their practitioner.
5. Manage stress and prioritise rest.
Chronic stress keeps cortisol high and the immune system on alert. Techniques such as yoga, walking, breathwork, journalling, or meditation can help regulate the body’s stress response and reduce inflammatory signalling.
6. Focus on winter resilience.
During the colder months, clients often experience more colds and fatigue. I encourage them to maintain vitamin D levels, eat adequate protein, include immune-supportive foods like garlic, mushrooms, and zinc-rich seeds, and make space for recovery instead of pushing through fatigue.
7. Support hormone balance through the cycle.
Because inflammation can vary with hormonal changes, I recommend balanced meals with protein, fibre and healthy fats throughout the month. Regular sleep, exercise, and stress management help buffer the hormonal impact of inflammation.
Have a go at tracking your energy, mood, cycle regularity, and immune resilience over time to identify improvements and patterns.
And if you’re interested in working with one of our practitioners on your gut health, looking to see if that or food sensitivities or intolerances may be driving your symptoms, please get in touch. We offer a range of testing options that we can discuss further with you.
For any conditions other than PCOS, please feel free to be in touch with our sister clinic Alex Allan Nutrion
PCOS Clinics is part of the Green Leaf Company (London) Ltd, a limited company registered in England and Wales. Registered number: 10990293
Disclaimer: ‘Please note that nutritional therapy is not medical advice - this should always be sought from your doctor or other medical provider. We aim to work alongside your doctor or GP to provide nutritional and lifestyle advice to support any underlying imbalances.'
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