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Is PCOS Really An Autoimmune Disease? The Link Between Inflammation & Endocrine Dysfunction

There is a clear link between polycystic ovarian syndrome (PCOS) and autoimmune thyroid disease. Studies have also shown that women with PCOS are more likely to develop autoimmune thyroid disease, such as Hashimoto's thyroiditis. If recent evidence is correct, this could completely change the way we approach PCOS treatment.

PCOS and autoimmune disease often occur together, and evidence suggests they share at least one major underlying cause—inflammation. This leaves one question unanswered: Does this mean PCOS is autoimmune?

Let's dive deeper into the link between PCOS and autoimmune disease, and then learn why PCOS patients should also be screened for autoimmune thyroid dysfunction. We will explain the effects of hypothyroidism on the ovaries and how PCOS can lead to problems with the thyroid gland. We will also discuss what explains the higher prevalence of autoimmune thyroid disease in patients with PCOS.

Learn more about conditions we treat: Hormone Imbalance

Thyroid autoimmunity is increased in patients of PCOS

PCOS patients have higher levels of thyroid antibodies and are more likely to have abnormalities in the thyroid gland or with overall thyroid function. Thyroid peroxidase (TPO) antibodies are present in 27% of PCOS patients compared to 8% in controls (1). 

Whether autoimmune thyroiditis predisposes individuals to develop characteristics suggestive of PCOS, or whether PCOS sets the stage for autoimmune thyroiditis, remains a topic of speculation.

What happens to the ovaries with thyroid problems?

With hypothyroidism (a low or underactive thyroid), the ovaries can become polycystic. This means multiple cysts may be seen on the ovaries. Because of this, doctors should screen for potential thyroid disorders before making a diagnosis of PCOS.

Low thyroid hormones cause polycystic ovaries because of the downstream effect on other chemical messengers, such as TSH and prolactin. In the brain, the hypothalamus ramps up production of thyroid stimulating hormone (TSH) to try to prompt the thyroid gland to increase output of thyroid hormones. Too much prolactin inhibits ovulation as a result of the change in the ratio of follicle stimulating hormone (FSH) and luteinizing hormone (LH), and increased DHEA from the adrenal gland (2).

These hormone changes can cause characteristics similar to PCOS.

What happens to the thyroid with PCOS?

For women in their reproductive years, the overall prevalence of thyroid disorders is low (somewhere between 4 to 6 percent), except when looking at patients with PCOS (3).

One study compared 80 PCOS patients with 80 controls and found a significantly higher prevalence of thyroid abnormalities and subclinical hypothyroidism (22.5% vs. 8.75%) in PCOS patients as compared to controls (4). 

It's estimated that around 10 percent of the general population have some kind of thyroid dysfunction. This is often referred to as subclinical thyroid dysfunction, where the thyroid isn't functioning optimally, but hasn't yet reached the threshold for a clinical diagnosis. 

Read: 5 Signs & Symptoms of Low Thyroid in Women

Want to learn more?

If you have PCOS, are you more predisposed to autoimmune diseases?

If you have PCOS, there’s a higher chance you may develop autoimmune thyroid disease, such as Hashimoto’s, but PCOS itself doesn’t appear to increase risk for other types of autoimmune diseases.

Why so much crossover between PCOS and autoimmune thyroid issues? New research suggests that chronic inflammation may play a significant role in our understanding of both PCOS and autoimmune diseases.

PCOS doesn’t cause autoimmune disease, but it might be one

There is a growing body of evidence to suggest that PCOS is an autoimmune disease. One study found a strong association between PCOS and antibodies for one or more autoimmune diseases. The most common were (5):

  • Thyroid peroxidase (TPO) antibodies
  • Anti-ovarian antibodies 
  • Anti-thyroglobulin antibodies 
  • Insulin autoantibodies

Autoimmune diseases are characterized by chronic inflammation. And while some inflammation is a normal immune response to protect the body from infection or injury, with autoimmune disease this prolonged systemic inflammation can damage healthy cells and tissues.

In both PCOS and autoimmune thyroiditis, there is an increase in levels of certain proinflammatory cytokines. Cytokines are small proteins that are involved in cell signaling, and they play a role in the development of chronic inflammation. 

One study found that women with PCOS had higher levels of pro-inflammatory cytokines, including c-reactive protein levels that were 96% higher than controls, as well as elevated IL-6, IL-18, and TNF-alpha (6,7).

Related: Do You Have PCOS? Here’s Why You Should See an Integrative Doctor

Immune-driven processes affect female hormone function at multiple levels

Communication between the endocrine (hormone) system and the immune system regulates a large number of biological processes that affect gene expression, cytokine release, and hormone action (8). These processes control things like:

  • Fertility (ovulation, implantation, etc.)
  • Mood
  • Sleep-wake cycles
  • Blood sugar regulation
  • Appetite

Normally, the female immune system is supportive of all of the above processes, but autoimmunity has the potential to interfere with hormone function at multiple levels.

Related: The Holistic Approach to Fight Inflammation 

Inflammation as the root cause of both PCOS and autoimmune thyroid disease

So, what does this all mean?

There is a growing body of evidence to suggest that PCOS is an inflammatory condition, and that inflammation may play a role in the development of both PCOS and autoimmune thyroiditis. Second, PCOS and Hashimoto’s thyroiditis share common underlying causes, such as genetic predisposition and hormonal imbalances.

The association between inflammation and autoimmunity in women with PCOS has been extensively discussed in recent years. Chronic, low-grade inflammation seems to be a link connecting metabolic dysfunction, weight gain, and insulin resistance and well.

Read: How to Lose Weight with a Low or Underactive Thyroid

How to reduce inflammation and improve autoimmunity associated with PCOS and hypothyroidism

A nutrient-dense, anti-inflammatory diet that can help to calm chronic inflammation associated with autoimmune disease and PCOS. This protocol eliminates common food triggers of inflammation, such as:

  • Gluten
  • Dairy
  • Soy
  • Eggs
  • Nightshades
  • Nuts

In addition, an anti-inflammatory diet focuses on consuming plenty of vegetables, healthy fats, and quality sources of protein.

The conventional approach to both autoimmune disease treatment and the management of PCOS symptoms generally focuses on immunosuppressive drugs, corticosteroids, or—in the case of PCOS—hormonal birth control. While these are valid treatment options, they can have adverse side effects and may not be the right course of action for each patient. 

To decrease chronic inflammation associated with PCOS and autoimmune thyroiditis, you have other options outside of (or in addition to) conventional treatments:

Get into a consistent diet and exercise routine—one that fights inflammation, not fuels it. Studies have shown that a diet rich in nutrients and vitamins and low in processed food, and physical activity is an effective treatment to manage PCOS symptoms (9).

Optimize glutathione—Increasing this powerful antioxidant has shown to decrease inflammatory markers.

Explore natural anti-inflammatories, like curcumin and acupuncture. Curcumin, ginger, and omega-3 fatty acids are all excellent natural anti-inflammatories that can help mediate inflammatory markers. There is also growing support for treatments like massage therapy and acupuncture for reducing inflammation.

Is acupuncture the treatment you need to restore balance to your health? Learn more here.

If you are struggling with PCOS and/or hypothyroidism, I encourage you to seek out the help of a qualified healthcare practitioner. With the right diet and lifestyle changes, you can heal your body and improve your quality of life.

Anti-inflammatory PCOS-friendly diet

There is no one-size-fits-all diet for PCOS, but there are some general dietary guidelines that can help to reduce inflammation and improve symptoms. Some of the best foods to eat for reducing inflammation include:

The following diet recommendations may help reduce chronic inflammation associated with Hashimoto’s thyroid disease and PCOS:

  • Reduce refined carbohydrates and sugars.
  • Address nutrient deficiencies associated with PCOS and thyroid issues, such as magnesium, B vitamins, iodine, and selenium
  • Get more fiber, vitamins & minerals, and phytonutrients from vegetables and fruits. Choose organic when possible.
  • Improve the quality of fats by eating more omega-3 fatty acids from fish and seafood, and omit inflammatory seed oils.
  • Eat high-quality animal protein by choosing grass-fed beef, naturally-raised chicken, and sustainably caught or farmed, low-mercury fish. Avoid processed and cured meats, like bacon and deli meat.
  • Aim for whole foods, and decrease consumption of ultra-processed foods that contain preservatives and other potentially inflammatory ingredients.

For more, check out Top 5 Anti Inflammatory Foods & Anti Inflammatory Diet 

You’re in control of your health

Though traditionally thought of as a hormone and metabolic condition, some research suggests polycystic ovarian syndrome has more in common with autoimmune disease than previously believed. While scientists are still exploring the relationship between PCOS and autoimmune diseases, we know that chronic inflammation is a common underlying factor in both conditions. Fortunately, there are things you can do to decrease inflammation and improve your health. By following the tips in this article, you may be able to effectively manage PCOS symptoms and reduce your risk of developing an autoimmune disease, as well as other inflammatory conditions. What changes will you make today to help decrease inflammation and improve your health?

Resources 

  1. https://pubmed.ncbi.nlm.nih.gov/23548659/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4287775/
  3. https://academic.oup.com/humupd/article/21/3/378/676494 
  4. https://pubmed.ncbi.nlm.nih.gov/23776908/
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4871972/ 
  6. https://pubmed.ncbi.nlm.nih.gov/22553983/ 
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7079227/ 
  8. https://pubmed.ncbi.nlm.nih.gov/24189508/
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8876590/

Tags

autoimmune disease, Hormone imbalance, pcos


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