PCOS bloating: Causes, symptoms, and effective solutions

Many women with polycystic ovary syndrome (PCOS) suffer with PCOS bloating. PCOS impacts the gut, with many sufferers reporting digestive problems, including irritable bowel syndrome (IBS), changes in bowel habits, and bloating.

PCOS affects up to 20% of reproductive-age women. PCOS can cause lots of different symptoms, including irregular cycles, fatigue, and bloating. Though bloating is a common PCOS symptom, many women don’t connect this symptom to their diagnosis.

What is PCOS bloating?

PCOS belly bloat is an uncomfortable, tight feeling in the abdomen. Your tummy might feel full, like you have just eaten a huge meal. You may experience distension when the stomach looks bigger, too.

A 2017 study published in Health and Quality of Life Outcomes found that many clinicians didn’t consider bloating to be important to PCOS sufferers despite 60% of participants experiencing this symptom.

Does PCOS cause bloating?

While it’s not as simple as saying PCOS causes bloating, there is undoubtedly a strong link between bloating and polycystic ovaries. A 2021 study published in Reproductive Biology & Endocrinology found that bloating was the symptom most commonly reported by women with a PCOS diagnosis, so it is a crucial symptom to understand and treat.

Though scientists are still researching PCOS and its impact on the body, they have identified a clear link between PCOS and digestive health. There are a few reasons why PCOS may interfere with healthy digestion and gut health, including:

PCOS hormonal imbalance

Anovulation is a common symptom of PCOS. The hormones in your body aren’t functioning as they should, which can lead to lower levels of progesterone. Bloating is a symptom of low progesterone, so this could be one reason why PCOS is associated with bloating.

Scientists don’t yet fully understand PCOS and its impact on health, but they do know it is related to gut bacteria. A 2022 study published in the Journal of the Endocrine Society found that dysbiosis in the gut microbiome can cause symptoms associated with PCOS and that fixing this may help to manage the condition.

A 2022 article published in the Indian Journal of Endocrinology and Metabolism stated that reduced gut flora and digestive bile acids impact digestion. The author also explains that the psychological impact of PCOS can alter the relationship between the gut and the brain. Both of these changes can lead to PCOS bloating.

Medication side effects

Unfortunately, some of the medications used to treat PCOS can cause bloating as a side effect. Metformin is a commonly prescribed medication to manage insulin resistance, but it can cause side effects, including bloating and fatigue. Clomiphene is used to trigger ovulation in women with PCOS; a 2005 study published in the Journal of Psychosomatics and Gynaecology found that bloating was a common side effect of this medication.

How long does PCOS bloating last?

How long PCOS bloating lasts depends on the cause. Some women notice bloating is worse during specific points of their cycle. Others notice it daily after eating. It’s worth keeping a symptom diary to track how frequently you experience bloating and how long each attack lasts. Doing this can help you build up a detailed understanding of your symptoms and how they relate to your digestive and reproductive health.

Treatment for PCOS bloating

Bloating is an uncomfortable and unpleasant symptom of PCOS. It can be a difficult symptom to manage because of the number of potential causes, but there are things you can do to try and reduce bloating, such as:

Eat a low-FODMAP diet

Some foods are known to trigger digestive discomfort. Eating a low-FODMAP diet cuts out any potentially problematic foods and then slowly reintroduces them so you can identify your triggers. FODMAP stands for:

• Fermentable - foods that don’t fully digest and ferment in the digestive system
• Oligosaccharides (including Fructans and Galactooligosaccharides) - poorly absorbed foods, including pulses, artichokes, and wheat
• Disaccharides - lactose
• Monosaccharides - fructose
• And
• Polyols - sugar alcohols commonly found in sugar-free sweeteners

Examples of FODMAP foods to avoid:

• Gluten
• Artichoke
• Cauliflower
• Apricot
• Nectarine
• Garlic
• Onion
• Sugar and sweeteners
• Cashew
• Pistachio nuts
• Lactose dairy products

You should eat a low-FODMAP diet for six weeks initially to see if your symptoms improve. After six weeks, you can slowly start introducing foods again. Doing this slowly is vital to identify problematic foods to cut out of your diet long-term.

Avoid bloating foods

Some foods are known to cause gas and digestive issues. These foods can also cause bloating, so you may wish to cut them from your diet to reduce sKeepp to keep a food diet for a few weeks to identify trigger foods.

PCOS bloating foods to avoid:

• Fizzy soda
• Beans
• Cabbage
• Lentils
• Some ultra-processed foods

Take prebiotics and probiotics

PCOS is associated with poor gut health, including a poor gut microbiome. Prebiotics provide a helpful food source for good gut bacteria. Probiotics are bacteria and yeasts that can improve gut health and aid digestion.

A 2024 study published in Microorganisms found that probiotics and prebiotics could help restore healthy gut bacteria and reduce digestive symptoms. Both prebiotics and probiotics can improve digestion and reduce bloating, so add both to your daily routine.

Regular exercise

Exercising regularly can improve digestive health and reduce bloating. While this can be a tough lifestyle change to make if you’re suffering from PCOS fatigue, it could make a big difference to your symptoms.

Find a form of exercise you enjoy and a friend to do it with so you can support each other as you take up a new exercise regime. A 2024 study published in Nutrients found that aerobic exercise, such as running, swimming, and cycling, improved the diversity and number of healthy bacteria in the gut biome.

If bloating occurs after eating, a short walk might help. A 2021 study published in Gastroenterology and Hepatology from Bed to Bench found that a 10-15 minute walk after each meal alleviated bloating.

When to seek medical help about PCOS bloating

It’s always worth discussing your symptoms with your OBGYN. With their wealth of experience and knowledge, they’ll be able to offer tailored health advice for how to manage your symptoms. If you’ve made a symptom diary, be sure to take that to your appointment so they can get a clear understanding of how the symptom impacts your daily life and what may be triggering it.

Final verdict

Unfortunately, you are not alone in experiencing PCOS belly bloating. Bloating is a common symptom associated with PCOS. Reduced gut bacteria, food sensitivities, hormonal imbalances, and side effects from medication could be to blame. Bloating can be a frustrating symptom. The discomfort and appearance of PCOS belly bloat can leave you pretty miserable.

Luckily, there are steps you can take to reduce your symptoms. Eating a low-FODMAP diet for six weeks before slowly introducing potential food triggers could help you to identify problem foods. Cutting out gassy foods, like soda and junk food, could also help alleviate symptoms.

Taking both prebiotics and probiotics and regular aerobic exercise can help improve the gut microbiome. Diversifying and encouraging healthy gut bacteria could reduce bloating and associated digestive issues. Be sure to visit your OBGYN for tailored health advice to help you manage your condition and alleviate bloating.

References:

Choi, So-Hyun et al. “Psychological side-effects of clomiphene citrate and human menopausal gonadotrophin.” Journal of psychosomatic obstetrics and gynaecology vol. 26,2 (2005): 93-100. doi:10.1080/01443610400022983 https://pubmed.ncbi.nlm.nih.gov/16050534/

Crucillà, Salvatore et al. “Functional Abdominal Bloating and Gut Microbiota: An Update.” Microorganisms vol. 12,8 1669. 14 Aug. 2024, doi:10.3390/microorganisms12081669 https://pubmed.ncbi.nlm.nih.gov/39203511/

Jain, Tarun et al. “Characterization of polycystic ovary syndrome among Flo app users around the world.” Reproductive biology and endocrinology : RB&E vol. 19,1 36. 3 Mar. 2021, doi:10.1186/s12958-021-00719-y https://pubmed.ncbi.nlm.nih.gov/33658043/

Li, Chunpeng et al. “Effects of Physical Exercise on the Microbiota in Irritable Bowel Syndrome.” Nutrients vol. 16,16 2657. 11 Aug. 2024, doi:10.3390/nu16162657 https://pubmed.ncbi.nlm.nih.gov/39203794/

Martin, M.L., Halling, K., Eek, D. et al. Understanding polycystic ovary syndrome from the patient perspective: a concept elicitation patient interview study. Health Qual Life Outcomes 15, 162 (2017). https://doi.org/10.1186/s12955-017-0736-3

Tsushima, Yumiko et al. “Ketogenic diet improves fertility in patients with polycystic ovary syndrome: a brief report.” Frontiers in nutrition vol. 11 1395977. 12 Sep. 2024, doi:10.3389/fnut.2024.1395977 https://pubmed.ncbi.nlm.nih.gov/39328462/

Vishnubhotla, Deepa Switha1,2; Tenali, Shouni Niveditha2; Fernandez, Mini2; Madireddi, Sujatha1,. Evaluation of Prevalence of PCOS and Associated Depression, Nutrition, and Family History: A Questionnaire-based Assessment. Indian Journal of Endocrinology and Metabolism 26(4):p 341-347, Jul–Aug 2022. | DOI: 10.4103/ijem.ijem_467_21 https://journals.lww.com/indjem/Fulltext/2022/07000/Evaluation_of_Prevalence_of_PCOS_and_Associated.6.aspx

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