A PCOS Series by Dr. Felice Gersh: Part One

Thank you for joining me for the first of five blogs on the myriad ways the microbiome affects the health of patients with polycystic ovary syndrome, or PCOS. In this first installment, we’ll talk about how our new understanding of the gut microbiome holds promise for treating PCOS.

In future posts, we’ll discuss the complex interplay of the gut microbiome, the immune system, and inflammation, and how this impacts liver health and function. I’ll also talk about the impact of stress and poor lifestyle choices on the gut microbiome, and present practical approaches to improving its diversity.

My PCOS blog series will conclude with a discussion of the critically important microbiomes of the mouth, skin, and vagina of those with PCOS and reveal how each microbiome can be improved to optimize their health.

Part One: Hope and a New Understanding

Polycystic ovary syndrome, known as PCOS, affects up to 12% of reproductive-aged females. As common as it is, it is still under-diagnosed, under-researched, and under-appreciated for its widespread impact on those afflicted. Too many experience life-altering symptoms without hope of relief.

Those with PCOS often manage:

  • irregular or absent menstrual cycles
  • high rates of infertility and pregnancy complications
  • diabetes
  • irritable bowel syndrome (IBS)
  • mood swings
  • insomnia
  • vaginitis
  • arthritis
  • high incidence of elevated blood pressure and heart disease
  • and more

This wide array of suffering often begins at the very cusp of adulthood, when a young person is discovering who they are, what their goals and passions are, and with whom they might want to share their life.

It doesn’t help that the symptoms of PCOS are external as well as internal. Individuals with PCOS can experience weight gain, thinning scalp hair, excessive facial and body hair, and recalcitrant cystic acne. In a society that focuses heavily on physical appearance, many with PCOS feel shame for bodily changes that are out of their control.

The suffering of those with PCOS has motivated me to search widely for solutions to this condition. In addition to studying the standard medical literature, I have explored scientific literature across all fields — environmental, veterinary, wildlife, and the basic sciences — searching for multidisciplinary clues to the causes and potential cures for PCOS.

Several years ago, I came across a hypothesis paper proposing that the gut microbiome may play a key role in the development of PCOS. This immediately struck a chord with me and fit with other research I had read. Finally, in just the past year, papers have been published confirming that those with PCOS have a different and more inflammatory set of microbes residing in their guts, along with a lower diversity of microbial species.

This unhealthy gut microbiome leads to an impairment in the epithelial layer of the intestines. A poor functioning gut barrier develops. Toxins produced by abnormal gut bacteria leak through the failing gut barrier between the lining cells. These toxins can then enter the surrounding immune tissue known as the gut associated lymphoid tissue (GALT). Significantly, over 70% of the immune cells of the human body reside in the GALT.

This situation causes inflammation! Endotoxins stimulate immune cells to release inflammatory products, or cytokines, as if they were battling a severe infection. The inflammatory response cascades into a state of total body inflammation, fueling problems as diverse as acne, irritable bowel syndrome, insulin resistance, ovarian dysfunction, and elevated levels of testosterone.

Dietary changes can improve the microbial population of an individual’s gut — in turn healing the gut epithelial cell lining, correcting the impaired gut barrier, and lowering the body’s inflammatory state.  Since chronic inflammation triggers many of the health problems experienced by people with PCOS, a healthy gut should significantly improve their health and well being.

As we build scientific knowledge and understanding of the relationship between PCOS and the gut microbiome, we can develop much better treatments for those suffering from the physical and emotional impacts of the condition. A better and healthier life for them is absolutely possible.


Felice Gersh, MD,  is a multi-award-winning, board-certified obstetrician and gynecologist and the founder of the Integrative Medical Group of Irvine in California. Felice was educated at Princeton University and USC and has more than 40 years of experience in all matters relating to women’s health. Her main area of expertise is hormonal management and, specifically, polycystic ovary syndrome. Felice is a prolific lecturer, writer, podcaster, and broadcaster on ZubiaLive and is soon to finish her first book. You can follow her blog and connect with her on Twitter.