'How I manage my PCOS bloating (and IBS) with this healthy living plan'

PCOS Bloating - Women's Health UK
What causes PCOS bloating?David M. Benett - Getty Images

Bloating is annoying for anyone who suffers, but a recent study by menstrual tracking app Flo showed that 77% of people with PCOS suffer regularly from bloating, making it the condition's most common symptom.

PCOS, a handy acronym for for polycystic ovarian syndrome, affects around one in ten women. To add to that stat, an estimated 70% of all PCOS cases are undiagnosed, according to the latest figures from the World Health Organisation, leaving many women suffering with PCOS symptoms, which can include PCOS bloating, cramping, irregular periods, chin acne and excessive facial, without support.

If you think you might have PCOS, or have any other health concerns, seek expert advice from your GP.

Living with these debilitating symptoms, is, of course, challenging. That said, there are some lifestyle changes, such as doing the correct exercise for PCOS, which can work wonders to help manage your symptoms, with a 2019 Australian review finding lifestyle interventions may improve hormonal balance.

Firstly, what is PCOS?

'PCOS is a condition which can affect the female reproductive organs,' explains Mr Sachchidananda Maiti, a consultant gynaecologist and obstetrician at Pall Mall Medical.

'A women’s ovaries contain immature eggs surrounded by a follicle. For women with a healthy menstrual cycle, each month an egg and its follicle matures and is released into the fallopian tube around mid-cycle, where it remains in the hopes of becoming fertilised.

'For women with PCOS, eggs with multiple follicles remain underdeveloped, and none are able to be released. Instead, the follicles remain in the ovary as small cysts.'

However, in order to be diagnosed with PCOS, you need to meet at least two of the possible three criteria, according to the NHS:

  • irregular periods

  • excess androgen

  • polycystic ovaries (despite the name of the condition, you do not actually have to have cysts to have PCOS)

Sometimes PCOS is linked with other conditions such as: IBS, insulin resistance, depression. The condition cannot be cured, but its symptoms can be managed with lifestyle changes and various medications. When it comes to those who want to conceive but experience PCOS-linked fertility issues, surgeries are available.

PCOS bloating: why does it happen?

A quick note to say that bloating from PCOS is totally natural and normal and you do not need to try and stop it. But it can be painful, irritating and impact your confidence. Knowing how to fix it starts by working out why it occurs.

'Studies have shown that those with PCOS [often] have dysbiosis of the gut microbiome –an imbalance of the gut bacteria which includes a lack of diversity and low levels of "good" gut bacteria,' shares Jodie Relf, a PCOS Dietitian and spokesperson for MyOva. An imbalance in gut health can impact how foods are digested, resulting in bloating.

'Research also indicates those with PCOS have a higher prevalence of irritable bowel syndrome (IBS) in comparison to those without PCOS. The exact reasons for this are not clear, however, we know that both gut dysbiosis and IBS can result in symptoms such as bloating, diarrhoea, constipation, increased gas and cramping,' says Relf.

PCOS bloating can also come down to hormones. Estrogen is associated with increased fluid retention, as per a Exercise and Sport Sciences Reviews study, and many women with PCOS are estrogen dominant.

PCOS bloating: lifestyle tweaks that might help

Many women are finding that simple lifestyle changes, such as doing effective exercise for PCOS, can make a massive difference in the severity and how regular the symptoms come - particularly PCOS bloating.

One such woman – Maeve Madden – previously shared her years of trial and error experiences (along with the knowledge amassed from her PT and nutritional qualification) with others in her book Beat Your Bloat, so they can benefit, too.

'I haven't always eaten the way I do today,' says Madden, referring to the dishes in her book. 'When I was at uni, I followed every the faddy diet going from only eating strawberries and prawns to living off juices. All those eating plans that aren't sustainable. I didn't understand nutrition and the impact what I ate could have on my body. That's why I think Instagram is amazing – it's given us this giant encyclopedia of knowledge and access to what real women – not solely celebrities - around the world are doing. And that's really inspiring.'

'When I was diagnosed with PCOS in my final year of uni, it was a real shock for me. Having put up with cramping, PCOS bloating, adult acne and irregular/no periods, I realised my fertility could be at risk. So I decided to research nutrition more and find out how I could heal myself - or at least manage my symptoms - through food, as opposed to relying on medication.'

Does your diet impact PCOS Bloating?

Yes, your diet has a significant impact on PCOS, says Relf. 'It can both worsen and improve symptoms depending on the food choices you make.'

That's because two of the biggest drivers of PCOS symptoms are inflammation and insulin resistance. 'Both are largely influenced by our diet and the foods we eat. In addition to this, studies have shown that a imbalance in gut microbiota plays a role in the development of PCOS through triggering low grade chronic inflammation and insulin resistance.'

Research shows that pro-inflammatory diets are associated with an increased risk of PCOS, while anti-inflammatory diets - such as the Mediterranean diet, famous for its gut health and immune-supporting properties - is associated with lower instances of PCOS. In those already with the condition, eating a Mediterranean diet is associated with lower severity of symptoms, according to a 2019 Nutrients study.

Relf adds: 'Both inflammation and insulin resistance play a role in increasing testosterone levels, and it’s these elevated testosterone levels (hyperandrogenism) that cause many of the symptoms of PCOS such as acne, male pattern hair growth, anovulation and imbalances in sex hormones, such as LH and FSH.'

PCOS Bloating: which foods may help?

Individual foods may trigger or help with PCOS bloating, and the foods that lead to digestive discomfort will be different for everyone.

You can keep a symptom diary to see if you can spot a trend between foods that trigger your symptoms. But the most important thing is to try and aim for a balance of good and bad gut bacteria that will reduce the risk of digestion problems, says Relf. 'To do this it’s important that you consume foods which contain good bacteria and eat foods that nourish those bacteria. The bacteria in our gut are live organisms and therefore require good nourishment to keep them alive.'

As gut health experts recommend eating 30+ different plant foods a week. This spans fruit and veg, nuts, seeds, extra virgin olive oil, legumes and herbs and spices. In doing so, you create an environment in which your gut microbiome can thrive.

'It’s important to feed the good bacteria with lots of fibre by including plenty of fruits and vegetables in your diet, as well as wholegrain foods,' says Relf. 'When increasing fibre intake remember to increase your fluid intake as well, as fibre draws water into the bowels.'

How to work out with PCOS, according to Maeve Madden

Move your body daily

'It doesn’t have to be a full-on HIIT class; a 30-minute walk around the park will suffice.'

Read why strength training is good for PCOS weight loss.

Reduce the intensity

'This year, I’ve been exploring different forms of exercise and doing more Barre classes, Pilates and swimming, as opposed to repeatedly lifting weights at the gym. My body doesn’t feel under as much pressure, as a result, and, thanks to focusing on more functional movements, I feel more mobile – especially first thing in the morning.'

Choose workouts that challenge the body and mind

'PCOS can leave you feeling constantly tired. By doing more yoga and Pilates, which are both mentally and physically challenging, I find myself more balanced and, because they help me sleep better, more energised.'

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