Inflammatory PCOS: What It Is, Symptoms, and How to Treat It

Inflammatory PCOS (Type 4)

The final root cause of PCOS is inflammation. 


All women with PCOS have some degree of chronic inflammation, but in Inflammatory PCOS, this is the primary cause of your symptoms.


For this type of PCOS to be your primary root cause, you should have ruled out Insulin Resistance, Adrenal, and Post-Pill PCOS. 


This type of PCOS often overlaps with Insulin-Resistant PCOS because long-term insulin resistance causes inflammation and inflammation worsens insulin resistance.


If you feel you fit the Insulin-Resistant PCOS picture covered earlier in this section as well as the signs of inflammation here, start by working on insulin before moving on to inflammation.

How does inflammation cause PCOS symptoms?

Inflammation is a normal part of your immune system response.

We want inflammation in the right amounts because it is how our body sends immune cells to help us heal wounds and fight infections. 

For example, when you cut your finger, your body creates an inflammatory response to that area, bringing extra blood and immune cells to fight any bacteria that got into the wound and help close it up.

When inflammation continues for a long time unchecked however, this can lead to worsened PCOS symptoms.

Chronic inflammation has been shown to stimulate your ovaries to produce higher amounts of testosterone.

This is similar to the way that high levels of insulin cause your ovaries to produce more testosterone. 

Higher levels of testosterone are converted into DHT, which gets into your follicles, causing acne, scalp hair loss, and facial hair growth. 

The testosterone affects your egg quality and causes issues with regular ovulation.

How does inflammation cause PCOS symptoms?

There are many factors that contribute to increased inflammation levels in your body. 


Autoimmune diseases, which involve the over-activation of your immune system, are a common contributor to Inflammatory PCOS. 


In these conditions, your immune system becomes disoriented. 


Instead of fighting foreign invaders it starts attacking your own tissues – creating high levels of inflammation.


Hashimoto’s thyroiditis is the most common autoimmune condition I see alongside PCOS in my clients, and research shows that it is much more prevalent in women with PCOS.


Hashimoto’s causes your body to attack your thyroid gland, creating damage that prevents your body from producing enough thyroid hormones, leading to weight gain, fertility problems, and fatigue.


There are more than 80 other autoimmune conditions, which vary in symptoms based on the body system they affect. 


All autoimmune conditions cause inflammation and tissue damage, which can contribute to the symptoms of PCOS by increasing testosterone production.


Some of the other autoimmune conditions commonly occurring alongside PCOS include celiac disease, Psoriasis, and arthritis. 


Chronic skin conditions like eczema and hives also contribute to higher levels of inflammation through immune system activation.


Gastrointestinal disorders are another key contributor to body-wide inflammation. 


Conditions like irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO) cause a weakening of the lining of your digestive system, allowing particles of food to escape into your bloodstream. 


These particles float around in your blood where they shouldn’t be, triggering your immune system to activate and start attacking them.


This is a common cause of food sensitivities and increased inflammation. 


If this is you, you might find that the list of foods you can’t tolerate is growing by the day, or that you are often bloated or have alternating bowel patterns. 


Parasites, imbalances in gut bacteria, fungi overgrowth, and nutritional deficiencies are also contributing factors to increased inflammation.


Finally, a relatively common but overlooked cause of inflammation I have observed in women with PCOS is excess iron. 


Women of menstruating age are frequently low in iron due to monthly blood loss, so iron excess is not commonly examined. 


In PCOS, however, long gaps between bleeds are a common feature. 


This means that if you have a genetic tendency toward higher iron levels, plus you aren’t getting a regular period, you may be dealing with high iron levels. 


Iron is an important nutrient for energy and oxygen levels in the body, but in excess causes increased inflammation in the body.

What causes chronic inflammation?

Take the quiz below to rate the likelihood of inflammation being the root cause of your PCOS. 


Each time you answer yes, give yourself one point.

If you said yes to four or more of the points above, there’s a high chance chronic inflammation is the root cause of your PCOS symptoms, especially if you have ruled out the other three PCOS types. 


If you aren’t sure or would like to confirm this with testing, see below for the best tests to confirm this. 


Testing is optional and if it’s not within your budget right now, but you relate to the symptoms above, you can

jump ahead and start implementing the Inflammatory PCOS Protocol later in this post.

Testing for Inflammatory PCOS

There are many causes of inflammation in Inflammatory PCOS, so asking your doctor to complete a range of tests to assess both your body-wide inflammation levels plus potential contributors to the inflammation is the best way to confirm this PCOS root cause. 


This way you’ll be able to identify the most important areas to focus on to reduce inflammation (e.g., thyroid versus gut health).

Tests to measure inflammation levels:

  • High sensitive C-reactive protein (hsCRP)
  • Erythrocyte sedimentation rate (ESR).

Tests to assess causes of inflammation:

  • Full thyroid panel (including TSH, T3, T4, and rT3)
  • White blood cells
  • Thyroid antibodies (thyroid peroxidase antibodies and antithyroglobulin antibodies)
  • Gluten antibodies
  • Vitamin D
  • Iron studies (including ferritin).

Free 3 min Quiz 

PCOS? Which Type Do You Have?

Inflammatory PCOS Core Treatment

In this PCOS type, inflammation is the root cause of increased testosterone production in your ovaries. 


Inflammatory PCOS is the fourth category because it serves as a bit of a “catch all” for Cysters who don’t fit into the insulin resistance, adrenal, or post-pill pictures. 


It includes many different “hidden” causes that in turn create inflammation and worsen PCOS symptoms.


To create your core treatment, we first need to work out where your excess inflammation is coming from. 


You could have an imbalance in your thyroid hormones, poor gut health, an overactive immune system, or be eating foods you are sensitive to. 


There is not one treatment for Inflammatory PCOS – it’s a process of elimination to work out what will be most impactful for you.


You might already be confident in the most important areas to work on based on your symptoms or testing that you had done earlier to determine this PCOS type. 


If not, I’ve outlined some extra tests to consider to help you hone in on what’s driving your inflammation.


Along with removing the source of increased inflammation, eating an anti-inflammatory diet and taking a natural anti-inflammatory supplement will help to lower your body-wide inflammation levels and support your immune system to be less reactive.

About The Author - Tamika Woods

Tamika Woods | PCOS Author | Nourished Natural Health
Tamika Woods, Clinical Nutritionist (B.HS; B.Ed), Bestselling Author

For a decade, Tamika battled chronic acne, irregular cycles, mood swings, hair loss, painful periods, severe digestive issues and Polycystic Ovary Syndrome (PCOS). You name it - she's been there!

Tam was finally able to clear her skin, regulate her cycle, be free of period pain and fall pregnant naturally with her daughter in 2020. It took Tam 10 years and tens of thousands of dollars in tertiary education to get the answers she needed to get better.

She didn’t want other women to suffer as long as she did which is why she has dedicated her life to helping women in the same position as she was.

Tam helps women interpret what their bodies are trying to communicate through frustrating symptoms, and then develop a step-by-step roadmap to find balance again. She's here to help you get on track!

Tamika Woods is the author of the Amazon best seller PCOS Repair Protocol. She holds a Bachelor of Health Science degree (Nutritional Medicine) as well as a Bachelor of Education, graduating with Honours in both.

She is a certified Fertility Awareness Method (FAM) Educator and a certified member of the Australian Natural Therapists Association (ANTA).

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Inflammatory PCOS Core Treatment

The formal criteria for diagnosis of PCOS specifically mentions that hypothyroidism must be ruled out before officially diagnosing PCOS.

This is because thyroid hormone imbalances can create similar symptoms to those of PCOS. 

Unfortunately, many of the women I have worked with have not had the appropriate blood work done and go on to discover their thyroid has been an underlying cause of their symptoms for some time.

Hypothyroidism (where your thyroid produces too little thyroid hormone) is the most common type of thyroid imbalance. 

Hypothyroidism causes increased androgen production and imparied ovulation – leading to irregular or missing periods and trouble falling pregnant. 

As you can see, these presenting signs are very similar to those of PCOS, and this is why diagnosis can often be missed.

It is also common to have both PCOS and a thyroid condition.

Research shows that up to 25% of women with PCOS have thyroid hormone imbalances.

An underactive thyroid reduces your body’s sensitivity to insulin, which contributes to the number one root cause of PCOS. Research shows that treating hypothyroidism improves insulin sensitivity.

"If you have struggled to improve insulin resistance through diet and lifestyle alone, your thyroid might be what’s holding you back."

Signs and symptoms of hypothyroidism

  • Weight gain (even on a low calorie diet)

  • Feeling cold and low basal body temperatures

  • Fatigue, feeling sluggish

  • Hair loss

  • Depression and low moods

  • Dry skin

  • Constipation

  • Heavy periods

  • Direct family member with thyroid disease.

Testing for hypothyroidism

If you have a direct family member with thyroid disease, particularly if they are female (e.g., your mother or sister), there is at least a 43% chance that you will go on to develop thyroid problems yourself.


If you relate to the symptoms above or have a family history, visit your doctor for a checkup.


Hypothyroidism is diagnosed via a blood test. 


Your doctor might have told you your thyroid is normal based on your Thyroid Stimulating Hormone (TSH) results, however research shows that this test alone is not accurate enough to diagnose the early stages of hypothyroidism.


The current guidelines state hypothyroidism cannot be diagnosed until your TSH is higher than 4.5 or 5mIU/L. However, many experts argue that this upper limit should be reduced to 2.5 or 3mIU/L. Large population studies have demonstrated improved outcomes for pregnancy and fertility when TSH is below 2.5. Ask your doctor for a full thyroid panel including TSH, T3, and T4.


Additionally, I recommend asking your doctor to check your blood for thyroid antibodies. 


Most cases of hypothyroidism are caused by an underlying immune problem where your body mistakenly attacks your thyroid gland, such as Hashimoto’s thyroiditis.


In the early stages of autoimmune thyroid disease, raised antibodies are often the only sign. 


TSH tends to remain normal as the attack on your thyroid gland has not yet damaged the organ significantly enough to change your thyroid hormone production.


Ask your doctor to order thyroid peroxidase antibodies (TPO) and antithyroglobulin antibodies (TGAbs). 


The reference ranges for these tests vary in each country so follow the normal range from your laboratory.


If your doctor is reluctant to order these extra tests, mentioning the symptoms above which you relate to and/or that you have a direct family member with thyroid disease can be helpful. 


If you are really stuck, many countries have laboratories where you can request these tests privately (i.e., without the need for a referral). Please note these tests may not be covered by your insurance.

What to do if you have raised TSH and/or antibodies

Talk to your doctor or specialist about whether trialing a hormone replacement medication could be helpful for your PCOS. 


Prescription medications include T4 (such as thyroxine) or a combination of T4 plus T3 (such as desiccated thyroid).


Combined with the lifestyle changes in the PCOS Repair Protocol, many of my clients have achieved incredible results by getting their thyroid functioning properly again.


In some cases, this can be the final missing link preventing you from falling pregnant naturally.


Additionally, I strongly encourage you to consider removing gluten from your diet. 


A fascinating study found that people with Hashimoto’s had significant improvements in symptoms and thyroid hormone levels when they removed gluten from their diet, regardless of if they had celiac disease or not.


Another study found that strictly removing gluten for one year single-handedly reversed thyroid abnormalities, whereas failing to adhere to the diet worsened the condition.


Finally, consider taking the herbal medicine ashwagandha like that in Calm + DeStress. 


This herb has demonstrated an ability to regulate thyroid hormone production.

Core Treatment #2: Heal Your Gut Lining

Research shows that women with PCOS have fewer healthy gut bacteria and more unhealthy bacteria than the general population.

This microbiome dysbiosis directly contributes to insulin resistance, weight gain and metabolic disorders.

In a healthy gut, the cells lining your intestine are closely held together – keeping food inside. 

In PCOS, chronic inflammation causes damage to the gut lining, weakening the cells and allowing gaps to form. 

This is known as intestinal permeability.

These gaps allow small particles of food and bacteria to escape the digestive tract and enter the bloodstream, triggering an immune response. 

This further contributes to inflammation, insulin resistance, higher levels of androgens, and problems with ovulation.

As you can see, inflammation both causes, and is worsened by, gut issues. 

If you suffer from regular bloating, indigestion, IBS, constipation, loose stools, or flatulence, improving your gut health will go a long way in reversing your root cause.

In my practice I have found the most common cause of chronic bloating is a condition called small intestinal bacterial overgrowth (SIBO).

This is where normal bacteria from your lower bowel have migrated up to your small intestine where they don’t belong.

Bacteria in the small intestine ferment the foods you have eaten, leading to gas, bloating, and stool changes. 

The hallmark symptom of SIBO is painful bloating that lasts all day. 

Treating this overgrowth can greatly improve symptoms.

If you suspect you may have SIBO or your gut issues are severe, I suggest seeking out a practitioner who specializes in gut health. 

This person will be able to order the appropriate tests and assess your unique microbiome to provide you with an individualized treatment protocol. 

Like PCOS, the root cause of gut issues is extremely diverse and sometimes requires a deeper understanding that is beyond the scope of this post.

SPOTLIGHT: Rachel’s journey with chronic gut health issues and Inflammatory PCOS

I first met Rachel when she had been living with severe gut issues for more than 10 years. 

She had long cycles (around 45 to 50 days) and acne which triggered her PCOS diagnosis at 19. 

She was chronically bloated, suffering from loose stools, IBS and a growing list of food intolerances.

In the past Rachel had tried Accutane for her acne which helped temporarily, but she found that her spots returned with a vengeance once she stopped using the medication. 

Rachel’s gut issues were extreme, and we discovered that they were causing high levels of inflammation in her body, triggering her ovaries to make more testosterone. 

This extra testosterone was getting into her skin and causing acne, and making it harder for her body to ovulate.

It was clear that Rachel’s gut issues were at the heart of her PCOS symptoms, so I encouraged her to work with a gut specialist alongside addressing her hormones. 

In severe cases like Rachel’s, in depth stool testing can provide incredible insight into the unique factors that are triggering inflammation in your digestive system.

Through testing, we discovered that Rachel had very low levels of healthy bacteria, poor stomach acid and markers of chronic stress.

She worked with her gut specialist to improve these markers. 

helped Rachel find hormone-nourishing foods she could enjoy that wouldn’t flare up her gut and we tweaked her high intensity exercise routine to include more restorative sessions. 

She found a new job which was more fulfilling and less stressful.

After two years of working together, Rachel had greatly improved her gut symptoms and her cycle reduced from 50 to 28 days. 

Her skin cleared and her most recent ultrasound revealed she no longer had polycystic ovaries.

Rachel’s story is a reminder of the importance of finding the right team to support your overall health when improving your PCOS.

By working with a gut specialist, she was able to make changes for her unique microbiome, and in doing so lower the inflammation which was driving her PCOS. 

For you this might mean seeking out an endocrinologist to help you with your thyroid, or a counselor to help you deal with stress.

Our body systems don’t function in silos. When one area is out of balance, it has a flow on effect to other areas.

Without working on the core issue of her gut imbalances, Rachel would not have been able to reduce her cycle length and clear her acne.

Core Treatment #3: Eat an Anti Inflammatory Diet

Minimizing foods that promote inflammation and filling your plate with anti-inflammatory foods is a great way to calm your immune system and lower your inflammation levels. 

Research shows that a diet rich in antioxidants and omega-3 fatty acids helps to lower chronic inflammation.

Along with the meal principles covered earlier in other posts on our blog, aim to include foods from the list below to support your immune system and lower inflammation.

Anti-Inflammatory Foods to Eat More Of:

  • Fatty fish like salmon, sardines and mackerel - these contain high levels of omega-3 fatty acids, which lower inflammation as well as support healthy hormone balance and stable moods

  • Chia seeds and ground flax seeds - these are rich in ALA – a plant-based precursor to omega-3

  • Olive oil - this has anti-inflammatory compounds like oleocanthal

  • Dark red berries like strawberries, raspberries, blueberries, and blackberries - these are high in antioxidants that fight free radicals

  • Dark leafy greens like kale, spinach, bok choy and silverbeet - these are packed full of many nutrients including vitamin K, calcium, and B-vitamins

  • Nuts like almonds, walnuts, Brazil nuts, and seeds like pumpkin seeds and sunflower seeds - for their beneficial levels of vitamin E and selenium

  • Cruciferous vegetables like broccoli, cauliflower, cabbage, and Brussels sprouts - which contain compounds that support detoxification of hormones

  • Herbs and spices like ginger, turmeric, cinnamon, garlic, black pepper, and rosemary - these help to make food taste better and also contain anti-inflammatory compounds.

Start by filling your plate with the foods above. This will make it easier to “crowd out” some of the foods below that promote increased inflammation.

Foods To Limit on an Anti-Inflammatory Diet:

Gluten:

If you have an autoimmune condition like Hashimoto’s, celiac disease, endometriosis, or rheumatoid arthritis, or if you have a chronic skin condition like eczema, I strongly suggest removing gluten from your diet completely for a minimum of three months and observing the difference. 


Research shows that gluten can exacerbate immune-related conditions, increase intestinal permeability, disrupt microbiome balance, and increase inflammation.


If you don’t have an immune condition but you are experiencing gut issues like bloating or IBS, consider significantly reducing your gluten intake for three months and slowly adding it back in to observe for symptoms. 


A condition called non-celiac gluten sensitivity (NCGS is a common cause of a wide range of symptoms including bloating, IBS, stomach pain, headaches, migraines, foggy thinking, joint pain, fatigue, eczema, and mood disorders.


If you have Inflammatory PCOS, the primary driver of your symptoms is chronic inflammation, therefore removing or reducing gluten is an important step in healing your root cause. 


This can feel overwhelming if you regularly eat bread, pasta, crackers, and other flour-based foods, but it doesn’t have to be. 


There are so many great gluten-free alternatives out there that can be just as satisfying as the real deal.


Here are some anti-inflammatory and gluten-free starches to try:

  • Quinoa (also packs a protein punch)

  • Buckwheat (despite the name, this grain is gluten free and also high in protein)

  • Brown rice

  • All starchy root vegetables are gluten free (potatoes, pumpkin, sweet potato, beetroot, corn)

  • Beans and legumes - these contain around a 50:50 mix of anti-inflammatory carbs and protein

  • Oats - these are technically not 100% gluten free (unless marked as so) because they are usually processed in facilities that also handle gluten. If you have diagnosed celiac disease or a true wheat allergy, look for certified gluten-free oats. Otherwise, any oats are fine as the amount of gluten present is very minimal and won’t impact inflammation.

Dairy:

Like gluten, cow’s dairy can increase inflammation in some women. 


Cow’s milk contains a protein called A1 protein, which can stimulate the immune system and lead to inflammation.

Sheep and goat milk products contain mostly A2 protein so don’t cause the same issues when it comes to inflammation. 


This means you can most likely enjoy sheep and goat milk products without issues. 


You can also include ghee and butter made from cow milk as these products are mostly fat and contain very little protein.


Other great alternatives to cow milk are coconut milk and yogurt, almond milk, and cashew cheese. 


Oat milk is a common dairy substitute, however tends to contain fairly high levels of carbohydrates, so is best enjoyed in small amounts if you have any issues with insulin.


Processed and Deep Fried Foods

These foods are not only low in nutrients but high in inflammatory compounds, which is not good news for Inflammatory PCOS. 


They also tend to be higher in sugar and refined carbohydrates that contribute to insulin resistance. Keep these foods to a minimum and focus on replacing them with the anti-inflammatory foods we covered earlier.


You’ll notice many of these inflammatory foods are high in fat. 


We want adequate fat in our diet to support satiety and hormone balance, however opt for anti-inflammatory sources like avocado, olive oil, oily fish, and nuts and seeds instead of the processed forms below:

  • Margarine

  • Commercial cookies, cakes, pastries (and any other foods containing trans fat)

  • Chocolate bars and candy bars

  • Deep fried food including fries and battered food

  • Processed meats: ham, salami, etc.

  • Processed snack foods like potato chips

  • Vegetable oil (like canola, soybean and sunflower oil) - olive oil, avocado oil, and ghee are best for cooking with

Core Treatment #4: Consider an Anti Inflammatory Supplement

Along with following an anti-inflammatory diet, consider adding a natural anti-inflammatory curcumin supplement such as Anti-Inflame + Mood. 

Curcumin is the active ingredient in turmeric and has been proven to lower body-wide inflammation in PCOS.

We combined curcumin with black pepper in Anti-Inflame + Mood to enhance absorption and directly support this root cause of PCOS.

Core Treatment #5: Correct Nutrient Deficiencies

Certain nutritional deficiencies and excesses can increase inflammation and cause your immune system to be activated, worsening the symptoms of Inflammatory PCOS.

It’s worth assessing your current levels of vitamin D, vitamin B12, and iron through testing. 

If you find you are deficient, consider adding a supplement to correct this.

Less known but almost as common as iron deficiency in women with PCOS is iron excess (too much iron). 

This can directly cause inflammation and worsen insulin resistance.103 

Iron excess is particularly common in Cysters who aren’t having regular periods as our monthly bleed is how we get rid of excess iron. 

If you discover you have high iron levels, consider donating blood to help lower your levels quickly.

You’ll not only be helping yourself but also your community! Ultimately, restoring ovulation and bleeding regularly will help to balance your iron levels.

Core Treatment #6: Reduce Exposure to Environmental Toxins

We know that exposure to environmental toxins while your mother was pregnant with you can predispose you to developing PCOS later in life. 

Emerging research is now finding a link between environmental toxin exposure and chronic inflammation. 

This topic can become a little overwhelming when you delve into it too deeply, however being mindful of some of the top sources of environmental toxins that you can easily avoid will be helpful in supporting your Inflammatory PCOS root cause.

One of the most common and most easily avoided sources of environmental toxins is plastics. 

We have known for a long time now that bisphenol-A (BPA) contributes to many health concerns, and research is now suggesting other plastics may have similar effects.

The easiest way to minimize your exposure to plastics is to swap your water bottle for a stainless steel bottle and your food containers for glass containers.

Another common exposure to BPA is cash receipts. 

This is due to the ink used to print receipts. 

Ask for your receipt to be emailed to you, or minimize touching your receipts as much as possible. 

If you work in an industry that requires you to handle receipts, consider using gloves as a preventative measure.

The final environmental toxin to consider is pesticides. While avoiding pesticides altogether can be overwhelming and expensive, consider following the “Dirty Dozen and Clean Fifteen” list published by the Environmental Working Group.

This list outlines the most highly contaminated fruits and vegetables to prioritize buying organic, and others which are safer to enjoy non-organic.

Core Treatment #7: Find The Right Movement

The right level of exercise for your body can dramatically improve inflammation levels whilst also supporting your mood and healthy weight maintenance.

However, over-exercising can contribute to increased inflammation, so it’s important to find your own unique sweet spot.

The best way to gauge if your level of movement is right for you is to assess how you feel afterward. You should feel energized and refreshed within 30 minutes of exercise. 

If you feel more fatigued, this is a sign that you might have overdone it. Similarly, some mild muscle soreness is normal after working out, but significant muscle or joint pain is a sign of increased inflammation.

Experiment with your current routine to find a balance that’s best for you. 

While you are working on lowering inflammation, you may find that walking, swimming, or some low intensity resistance training is best for you.

SUMMARY: Core Treatments for Post-Pill PCOS

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About The Author - Tamika Woods

Tamika Woods | PCOS Author | Nourished Natural Health
Tamika Woods, Clinical Nutritionist (B.HS; B.Ed), Bestselling Author

For a decade, Tamika battled chronic acne, irregular cycles, mood swings, hair loss, painful periods, severe digestive issues and Polycystic Ovary Syndrome (PCOS). You name it - she's been there!

Tam was finally able to clear her skin, regulate her cycle, be free of period pain and fall pregnant naturally with her daughter in 2020. It took Tam 10 years and tens of thousands of dollars in tertiary education to get the answers she needed to get better.

She didn’t want other women to suffer as long as she did which is why she has dedicated her life to helping women in the same position as she was.

Tam helps women interpret what their bodies are trying to communicate through frustrating symptoms, and then develop a step-by-step roadmap to find balance again. She's here to help you get on track!

Tamika Woods is the author of the Amazon best seller PCOS Repair Protocol. She holds a Bachelor of Health Science degree (Nutritional Medicine) as well as a Bachelor of Education, graduating with Honours in both.

She is a certified Fertility Awareness Method (FAM) Educator and a certified member of the Australian Natural Therapists Association (ANTA).

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