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PCOS: How to Deal With Bloating

By Dr. Kate Dudek

Polycystic Ovary Syndrome (PCOS) cannot be defined as a simple disorder, with a simple list of symptoms. Instead, it is a multifactorial condition, with a range of symptoms that can affect sufferers to a greater or lesser extent. Predominantly, it is considered to be a driving cause of female infertility, with anovulatory cycles one of the three main diagnostic criteria (along with hyperandrogenism and polycystic ovaries). Despite it's wide-ranging aetiologies, it is fundamentally a condition of hormonal imbalance and, as such, women with the condition are susceptible to a range of hormonally-induced side effects, or secondary symptoms. These include excess hair loss, facial hair, acne and weight gain.

Bloating is common in women with PCOS. One study exploring the quality of life for women with the condition, found that 60% experienced bloating. Despite having a significant impact on a person's wellbeing, many doctors class bloating as 'unimportant' from a clinical perspective. Thus, there is a lack of understanding into why it happens and the best way of relieving it.

What is bloating?  
Bloating is the uncomfortable sensation of being too full and having a tight or swollen abdomen. It often occurs alongside excessive gas and stomach rumbling. Bloating is very common in cases of irritable bowel syndrome (IBS), with up to 90% of people with the condition experiencing this type of abdominal discomfort. It can also accompany other medical conditions, including inflammatory bowel disease, food intolerances and mental health issues. In rare cases it can be a symptom of a serious health issue, so repeated bouts of bloating should always be monitored and reported to a healthcare professional.

Why are women with PCOS more susceptible to bloating?
The answer to this question remains elusive. There are theories however, which make sense from a biological perspective. For a start, PCOS is considered to have an inflammatory component and therefore, very often coexists with other inflammatory conditions, including inflammatory bowel disease. It is important to note that IBS is not inflammatory, but this too, often co-exists with PCOS. As mentioned previously, bloating is a common symptom of disorders affecting the bowels; although, once again, the reason why this happens is not fully understood. One explanation is a poorly developed gut microbiome; other possibilities include bacterial overgrowth in the gut and excessive gas accumulation in the intestines.

Women in general are more susceptible to bloating. There is an association between bloating and the menstrual cycle, with the suggestion that altering hormone levels throughout the cycle might affect gut motility. Considering that PCOS is primarily a hormonal disorder, this is an entirely feasible mechanism for the increased bloating experienced by women with PCOS.

How to relieve uncomfortable bloating
The best way of achieving relief from any PCOS-related symptoms is to try and resolve the condition itself. There is substantial evidence that making relatively minor lifestyle adjustments can reverse PCOS status; for example, losing weight can restore fertility in those with the condition who are struggling to conceive.

Another option is to monitor food intake in an attempt to identify whether there are any specific triggers exacerbating the condition. Certain food types are particularly prone to causing gastrointestinal discomfort. Women with an intolerance to lactose may find that by restricting their dairy consumption, they reduce their bloating. Alternatively, there are foods known to be  'gassy', such as cruciferous vegetables, dried beans and lentils, which can all contribute to the issue. Many people with IBS find that by following the low fermentable, oligo-, di-, mono-saccharides and polyol (FODMAP) diet they experience fewer flare ups and reduced bloating. This is a diet low in fermented carbohydrates, which on the surface seems to avoid eliminating a lot of different food types (a non-exhaustive list includes, wheat, rye, legumes, milk, soft cheese, yoghurt, sweeteners, both artificial and naturally occurring; as well as various fruits and vegetables). As such it can feel a little intimidating initially and may be worth consulting a nutritionist first.
  
Sometimes people with IBS are successfully treated with antibiotics or probiotics; although the evidence for any efficacy of the latter is very limited. This is based on the faulty microbiome hypothesis. This may be an option to consider for women with concurrent PCOS and IBS, but lifestyle adjustments should be attempted first.

Sources:

  • Marsh, A, et al. “Does a Diet Low in FODMAPs Reduce Symptoms Associated with Functional Gastrointestinal Disorders? A Comprehensive Systematic Review and Meta-Analysis.” European Journal of Nutrition, vol. 55, no. 3, Apr. 2016, pp. 897–906., doi:10.1007/s00394-015-0922-1.
  • Martin, Mona L., et al. “Understanding Polycystic Ovary Syndrome from the Patient Perspective: a Concept Elicitation Patient Interview Study.” Health and Quality of Life Outcomes, vol. 15, no. 1, 18 Aug. 2017, doi:10.1186/s12955-017-0736-3.
  • Seo, A Young, et al. “Abdominal Bloating: Pathophysiology and Treatment.” Journal of Neurogastroenterology and Motility, vol. 19, no. 4, 2013, pp. 433–453., doi:10.5056/jnm.2013.19.4.433.
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