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