Uncovering the Connection Between PCOS and Autoimmune Disease

Polycystic ovary syndrome (PCOS) is a metabolic and hormonal condition that affects 6%–12% of women of reproductive age in the United States, making it one of the most common reproductive hormone disorders in young women. However, the effects of PCOS also extend far beyond the reproductive system, affecting a woman’s future risk of chronic health conditions, including diabetes and cardiovascular disease. (Source) 

Autoimmune disease affects an estimated 50 million Americans, and 80% of those affected are women. Autoimmune disease occurs when immune cells mistakenly attack healthy cells and tissues in the body, causing dysfunction either in a specific organ (such as the thyroid gland with Hashimoto’s thyroiditis and Grave’s disease), or throughout the body (as with systemic lupus erythematosus). (Source) 

While PCOS and autoimmunity may seem like entirely different conditions, a growing body of research suggests they may share a connection. Read on to uncover the relationship between PCOS and autoimmune disease, and learn 4 healthy nutrition habits to help you live well with these conditions. 

Causes of PCOS

What causes PCOS? Research indicates four primary causes: genetics, hormonal imbalances, insulin resistance, and environmental factors.

Genetic Factors

Several genetic factors may put you at risk for PCOS. Genes involved in ovarian and adrenal hormone production, genes that mediate the effects of sex hormones, and genes involved in insulin secretion and action all appear to play roles in PCOS. (Source)

It’s important to understand that having these genes does not guarantee you’ll experience PCOS. However, these genes may put you at a disadvantage in our current environment, which is rife with processed foods and environmental toxins, factors that may “activate” the genes involved in PCOS. (Source)

Hormonal Imbalance

PCOS is characterized by several hormonal imbalances, including imbalances in androgens, luteinizing hormone, follicle-stimulating hormone, and anti-Mullerian hormone. Let’s discuss each of these hormonal imbalances in turn.

• androgens. Androgens are defined as hormones required for the development and maintenance of male sexual characteristics and features. This group of hormones includes testosterone and DHEA. However, both men’s and women’s bodies produce androgens; men just produce vastly more. Excess androgens, including high levels of testosterone and DHEA, are a key feature of PCOS, and appear to originate from excessive ovarian androgen production, elevated insulin levels, and insulin resistance. When androgens are elevated in women with PCOS, symptoms such as hirsutism (excessive hair growth), acne, and androgenic hair loss (also known as “male pattern balding”) may result. Elevated androgens are referred to as “hyperandrogenism.” (Source, Source)
• luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Luteinizing hormone is made in the brain and controls the release of eggs from the ovaries, known as ovulation. Follicle-stimulating hormone is also made in the brain and stimulates the ovaries to release a single mature egg each month, with the designated egg maturing inside a tiny sac called a follicle. High LH and low FSH in PCOS impairs ovulation, allowing numerous small undeveloped follicles called “cysts” to continue growing in the ovaries. The term polycystic in polycystic ovary syndrome is derived from poly (meaning multiple) and cystic (meaning follicles). (Source)
• anti-Mullerian hormone (AMH). This hormone is made in the ovaries of reproductive-age women and controls follicle formation. Women with PCOS tend to have higher levels of AMH than women without PCOS. (Source) 
• progesterone: Progesterone is a crucial reproductive hormone made by the corpus luteum, which is formed in the ovary after ovulation. Women with PCOS who are not ovulating don’t get the post-ovulation boost in progesterone and may experience low progesterone levels. In addition, research suggests that women with PCOS may be less sensitive to the effects of progesterone. (Source) 

Insulin Resistance

Insulin is a hormone your pancreas produces that moves glucose (sugar) from the blood into cells, where it is needed for energy. Insulin resistance is when your body’s cells become less sensitive to insulin, making it challenging to provide them the glucose they need. This may also trigger the pancreas to churn out even more insulin in an attempt to usher glucose into cells. Too much insulin can promote inflammation, impair ovulation, and cause the ovaries to produce testosterone, making insulin resistance a key component of PCOS. Left unmanaged, insulin resistance can also drive the development of type 2 diabetes and cardiovascular disease later in life. (Source, Source, Source) 

Not everyone with PCOS has insulin resistance, but insulin resistance is quite common in women with this condition. According to the research, 64% of obese women and 20% of non-obese women with PCOS are insulin resistant. (Source)

Environmental Factors

Another factor that may increase your risk of developing PCOS is early life exposure to hormone-disrupting chemicals. These chemicals are called “endocrine disruptors” because they interfere with the normal functioning of your endocrine, or hormonal, system. 

Research indicates that prenatal exposure to endocrine disruptors and exposure during childhood can alter hormone communication throughout the body later in life, predisposing a woman to PCOS. Environmental toxins involved in PCOS include bisphenol A (BPA), found in the lining of canned foods, plastics, and thermal receipt paper, and phthalates, found in personal care products and children’s toys. (Source)

Symptoms of PCOS

What are the symptoms of PCOS? Possible symptoms include:

• missed, irregular, or very light periods
• ovaries with many cysts
• excess body hair, especially on the face, stomach, or chest
• weight gain, especially around the abdomen
• acne 
• male pattern baldness (androgenic alopecia) or thinning hair 
• skin tags, which are small pieces of excess skin
• dark or thick skin patches known as acanthosis nigricans in the armpits, nape of the neck, and other skinfolds 

(Source)

Symptoms of Autoimmune Diseases

Signs and symptoms of autoimmune diseases can be nonspecific; this is one reason why it can be difficult to get a timely diagnosis. However, some of the most common symptoms of autoimmune diseases include:

• joint pain or stiffness
• muscle aches
• rashes
• fatigue
• swollen glands
• hair loss
• brain fog
• tingling or numbness in the extremities 
• swollen glands
• recurring fever

(Source) 

Diagnosis, Treatment, and Management of PCOS

The diagnostic process for PCOS is not well defined. There are currently 2 sets of criteria that are used to diagnose PCOS. Your health care provider will use these criteria, along with blood work, ultrasound, and your symptoms, to make a diagnosis. 

The Androgen Excess and PCOS Society Criteria (AE-PCOS)

This set of criteria states that a woman qualifies for a PCOS diagnosis if she meets all 3 of the following criteria:

• irregular periods and/or polycystic ovaries
• high levels of androgens on a blood test or symptoms of elevated androgens, such as hirsutism (excess facial and body hair) 
• other reasons for high androgens have been ruled out

(Source) 

The Rotterdam Criteria

The Rotterdam Criteria is a broader set of criteria that says a woman qualifies for a PCOS diagnosis if she meets 2 of the following 3 criteria:

• irregular periods or no ovulation (anovulation)
• high levels of androgens on a blood test or symptoms of elevated androgens, such as hirsutism (excess facial and body hair)
• polycystic ovaries on ultrasound 

(Source) 

Treating PCOS

The conventional treatment for PCOS includes hormonal birth control to suppress androgens; spironolactone, an androgen suppressor that can improve hirsutism and acne; and metformin, a drug that corrects insulin resistance. While these treatments can alleviate symptoms and deserve a place in the medical approach to PCOS, they technically do not address the underlying causes of PCOS. (Source)

Is PCOS an Autoimmune Disease?

To all appearances, PCOS and autoimmune disease seem like distinctly different health conditions. While PCOS isn’t classified as an autoimmune disease, there is an association between PCOS and your risk of experiencing autoimmune disorders. There may even be certain autoimmune elements to PCOS, such as antibodies to ovarian tissue.

The Immune System and Autoimmunity in PCOS

Polycystic ovarian syndrome may include elements of autoimmunity. For example, a 2009 study published in Fertility and Sterility found that women with PCOS have significantly elevated levels of autoimmune markers in their blood, leading the researchers to conclude that “a role of autoimmunologic processes in PCOS can be suspected.” (Source)

In addition, for reasons that aren’t entirely clear, the immune system can make antibodies to ovarian tissue, which may lead to ovarian conditions like PCOS. Several studies suggest that antibodies to ovaries can be detected in about half of PCOS patients, while others disagree. The role of these ovarian antibodies is yet to be determined. (Source, Source) 

PCOS also affects the immune system, and possibly autoimmunity, by promoting chronic inflammation. Chronic inflammation is a common thread underlying many autoimmune diseases, ranging from inflammatory bowel disease to rheumatoid arthritis. (Source, Source) 

While there are multiple immune effects of PCOS, more research is needed to determine how PCOS affects the immune system and what we can do to support the immune system in the presence of PCOS.

Autoimmune Diseases Potentially Linked to PCOS

Certain autoimmune conditions are more common in women with PCOS than women without the condition. For example, autoimmune thyroid disease is more common in women with PCOS. Thyroid peroxidase antibodies are elevated in 27% of women with PCOS, compared to 8% of women without PCOS. People with PCOS have a higher risk of Hashimoto's thyroiditis (autoimmune hypothyroidism), and those with Hashimoto's have a higher risk of PCOS, suggesting a bidirectional relationship between the two conditions. Women with PCOS also have a higher incidence of Grave’s disease (autoimmune hyperthyroidism) than we’d expect to see by chance. However, more research is needed before conclusions about thyroid autoimmunity and PCOS can be drawn. (Source, Source, Source, Source, Source) 

Scientists theorize that high estrogen levels in PCOS may adversely affect the immune system, skewing it towards an autoimmune state. In addition, low progesterone in PCOS, caused by anovulation, may lead to excessive immune stimulation and autoantibody production, creating a link between PCOS and autoimmunity. Anti-nuclear antibodies, which are involved in many autoimmune disorders including systemic lupus erythematosus and Sjogren’s syndrome, are also elevated in some women with PCOS. (Source, Source)

While the debate is far from settled, the available research makes a convincing argument that PCOS may have an autoimmune component and may be related to several autoimmune diseases. More research is needed to clarify the relationship between PCOS and autoimmunity and identify health strategies to help women manage these conditions. 

Managing PCOS and Optimizing Autoimmune Health

While more research is needed to clarify the relationship between PCOS and autoimmune disease, we know that nutrition and lifestyle strategies can help support your health if you're dealing with these conditions. Read on for 4 healthy nutrition habits that can help balance your hormones and nurture your immune system if you’re dealing with PCOS and autoimmunity.

Optimize Your Vitamin D Level

Low vitamin D levels are associated with both autoimmunity and PCOS. Research suggests that boosting vitamin D intake may improve symptoms of both PCOS and autoimmunity. For example, vitamin D supplementation improves insulin resistance and decreases androgen levels in women with PCOS. Vitamin D supplementation also decreases thyroid antibodies in individuals with Hashimoto’s thyroiditis (Source, Source, Source) 

Vitamin D levels can be checked through blood tests, with the ideal range thought to be 40–60 ng/mL. While our bodies make vitamin D in response to UVB light exposure from the sun, many of us don’t get enough sun exposure to optimize our vitamin D levels and will need to take a supplement. It’s possible to take too much of this essential vitamin, though, so it’s important to test your vitamin D level before supplementing to determine how much you should take. 

Try Inositol

Inositol is a type of sugar made in the body and found in certain foods, such as cantaloupe and citrus fruits. Research indicates that supplemental inositol, in quantities larger than we can obtain from food alone, may improve aspects of PCOS and alleviate autoimmunity. 

A systematic review of 26 randomized controlled trials found that inositol supplementation significantly improved insulin sensitivity and lowered androgen levels over a placebo. Myo-inositol, a form of inositol often used in supplements, combined with selenium lowered thyroid antibody levels in people with Hashimoto’s thyroiditis. Inositol may improve features of PCOS by supporting healthy insulin signaling and address autoimmunity by improving thyroid-stimulating hormone (TSH) levels. (Source, Source) 

Eat a Low Glycemic Index Diet 

A low glycemic index diet can improve insulin sensitivity and support a healthier menstrual cycle in women with PCOS. A low glycemic index diet swaps out refined carbohydrates that can spike blood sugar, such as bread and pasta, for whole food carbohydrates that have less of an effect on blood sugar. (Source) 

A low glycemic index diet typically includes high quality animal protein, vegetables, nuts, seeds, and dairy (if tolerated), and prioritizes whole food carbohydrates such as sweet potatoes, winter squash, root vegetables, fruit, and legumes. As you can see, a low glycemic diet contains many anti-inflammatory foods that can help naturally combat inflammation, an underlying driver of autoimmunity. 

Sip Spearmint Tea and Munch on Flaxseed

Research suggests that spearmint herbal tea and flaxseed extract reduce androgens in PCOS. In addition, an animal study found that consuming spearmint and flaxseed extracts together balanced hormones and reduced the number of ovarian cysts in PCOS more effectively than either ingredient alone. Spearmint offers natural anti-androgen effects, helping lower levels of androgen hormones. Flaxseed may aid hormone balance through its lignans, plant compounds that regulate estrogen levels. Spearmint can be consumed as a tea, while flaxseed can be added to smoothies, salads, and baked goods such as muffins. (Source, Source, Source)

The Bottom Line

Fascinating research shows that PCOS and autoimmune diseases may be related. A potential implication of this connection is that addressing PCOS may help address autoimmunity, and vice versa. More research is needed to clarify the relationship between these conditions.

In the meantime, if you are dealing with PCOS and autoimmune disease, there’s much you can do with nutrition to balance your hormones and your immune system. WellTheory’s Care Team can provide you with personalized nutrition and lifestyle support to help you find relief from PCOS and autoimmune symptoms, so you can feel and function your best.