Why Digestive Issues Are So Common in PCOS
Digestive symptoms are one of the most common — and confusing — parts of the diagnosis. Bloating in PCOS, unpredictable digestion, food sensitivity, or ongoing discomfort often come with additional labels attached. Understanding what those labels mean can help you make sense of your symptoms, rather than feeling defined by them.
Irritable Bowel Syndrome (IBS)
Irritable bowel syndrome is a functional diagnosis. It’s used when digestion is clearly uncomfortable or irregular — bloating, pain, constipation, diarrhoea, or a mix of both — but no structural disease is found on tests.
In other words, IBS describes how the gut is behaving, not a single cause. In PCOS, hormonal shifts, blood sugar instability, and nervous system stress can all influence digestion. The gut becomes more sensitive and reactive, even when standard tests look “normal.”
SIBO and PCOS
SIBO stands for Small Intestinal Bacterial Overgrowth. It refers to bacteria being present in higher amounts — or in the wrong place — within the small intestine, where digestion and nutrient absorption occur.
SIBO and PCOS are often discussed together because factors common in PCOS can affect gut motility — meaning how effectively food and waste move through the digestive tract.
When motility slows, bacteria have more time to build up, increasing the likelihood of bloating, pressure, discomfort, and food reactions. This doesn’t mean PCOS directly causes SIBO, but it can create conditions where the gut struggles to stay balanced.
Insulin Resistance, Hormones, and the Gut
PCOS insulin resistance also plays an important role in digestive health. When blood sugar regulation is under strain, it can affect inflammation levels, gut movement, and the way nutrients are processed.
Androgens — often referred to as “male hormones,” (though all bodies produce them), tend to be higher in PCOS. Research into the androgen excess microbiome suggests that gut bacteria may influence how these hormones are processed and cleared.
The relationship between gut flora and androgen regulation is gradual. Gut flora is the community of bacteria living in your digestive tract, which plays a role in digestion, immune balance, and hormone metabolism. When this ecosystem is under stress, hormonal signals may become less stable over time.
Gut Permeability and “Leaky Gut”
You may also have heard the term “leaky gut,” otherwise known as gut permeability. This refers to changes in how tightly the gut lining functions as a barrier.
The gut lining is designed to allow nutrients through while keeping irritants out. When it’s under ongoing strain — from inflammation, stress, blood sugar swings, or hormonal imbalance — it can become more permeable. The gut isn’t technically “broken,” but it may become more reactive, triggering immune responses that show up as bloating, discomfort, or sensitivity.
Putting the Pieces Together
These labels — irritable bowel syndrome, SIBO, gut permeability — describe patterns of response in a system that’s working under a high hormonal load.
Rather than pointing to multiple separate problems, they often reflect the same underlying imbalance showing up in different ways. Seeing them through that lens can shift the focus from chasing diagnoses to understanding what your body is responding to — and how to support it more effectively.
