Inflammatory PCOS: What It Is, Symptoms, and How to Treat It
In This Article
What is Inflammatory PCOS? (Type 4)
Inflammation is one of the main reasons behind PCOS, a condition that affects many women.
In some cases, like Inflammatory PCOS, inflammation is the main factor causing the symptoms.
However, before concluding that this type of PCOS is your main issue, you should make sure it's not Insulin Resistance, Adrenal PCOS, or Post-Pill PCOS that's causing your symptoms.
Interestingly, Inflammatory PCOS and Insulin-Resistant PCOS often go hand in hand.
Insulin resistance, which happens when your body doesn't respond well to insulin, can lead to inflammation, and inflammation can make insulin resistance worse.
If you think you have both the signs of Insulin-Resistant PCOS and the symptoms of inflammation described here, it's a good idea to tackle the insulin problem first before addressing the inflammation.
How does inflammation cause PCOS symptoms?
How does inflammation cause PCOS symptoms?
There are several things that can make the inflammation in your body go up.
One big factor is autoimmune diseases, where your immune system goes a bit haywire.
Instead of protecting you, it starts attacking your own body tissues, creating lots of inflammation.
Hashimoto's thyroiditis is a common one that happens alongside PCOS. It makes your immune system attack your thyroid, leading to problems like weight gain, fertility issues, and tiredness.
There are more than 80 other autoimmune conditions, and they can cause different symptoms depending on which part of your body they target.
But all of them bring extra inflammation, which can make PCOS symptoms worse by boosting testosterone production.
Some other autoimmune conditions linked with PCOS include celiac disease, psoriasis, and arthritis.
Even chronic skin problems like eczema and hives can add to inflammation because they activate your immune system.
Another thing that can cause a lot of inflammation is problems in your gut, like irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO).
They can make the lining of your digestive system weaker, letting bits of food escape into your blood where they don't belong.
This makes your immune system get active and attack those bits, leading to more inflammation. If you're dealing with this, you might notice more foods you can't eat without feeling bad or having tummy troubles.
Other factors that can raise inflammation include parasites, imbalances in the good and bad bacteria in your gut, too much fungi, and not getting all the nutrients your body needs.
Surprisingly, having too much iron can also cause inflammation, which is often overlooked. Most women lose some iron every month when they have their period.
But if you don't get regular periods and you have a genetic tendency to have high iron levels, you might end up with too much iron in your body.
While iron is important for your energy and oxygen levels, having too much of it can lead to more inflammation.
What causes inflammatory PCOS?
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
To confirm that Inflammatory PCOS is the main reason for your symptoms, it's a good idea to ask your doctor for various tests.
These tests can check both how much inflammation is happening throughout your body and what might be causing it.
By doing these tests, you can pinpoint which areas need the most attention when it comes to reducing inflammation.
For example, the tests can help figure out if it's more about your thyroid or if your gut health is a bigger factor in your inflammation. This way, you can focus on the right areas to help manage your PCOS better.
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).
Inflammatory PCOS Treatment
In Inflammatory PCOS, the main issue causing extra testosterone in your ovaries is inflammation.
This type of PCOS, which is the fourth category, is like a "catch-all" for those with PCOS who don't quite fit into the insulin resistance, adrenal, or post-pill categories.
It covers a bunch of different hidden reasons that end up causing inflammation and making PCOS symptoms worse.
To come up with the best treatment plan, we first need to figure out where your extra inflammation is coming from.
It could be because of problems with your thyroid hormones, issues with your gut health, an immune system that's too active, or foods that you're sensitive to.
There's no one-size-fits-all treatment for Inflammatory PCOS.
It's more about figuring out what will help you the most. You might already have a good idea of what areas to focus on based on your symptoms or previous tests.
If not, here are some extra tests you can think about to help pinpoint what's causing your inflammation.
Along with getting rid of the source of inflammation, following an anti-inflammatory diet and taking natural supplements that reduce inflammation can lower the overall inflammation in your body and help your immune system be less reactive.
About The Author - Tamika Woods
Related Products
Quizzes & Calculators For Your Hormones
Inflammatory PCOS Core Treatment
"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 close family member, like your mom or sister, who has thyroid disease, especially if they are female, there's a 43% chance that you might develop thyroid problems too.
If you notice symptoms that match what we talked about earlier or if there's a family history of thyroid issues, it's a good idea to see your doctor for a checkup.
To diagnose hypothyroidism, your doctor will usually do a blood test. Sometimes, your doctor might say your thyroid is fine based on a test called Thyroid Stimulating Hormone (TSH). But research shows that this test alone might not be good enough to catch early stages of hypothyroidism.
Right now, the guidelines say you can't be diagnosed with hypothyroidism until your TSH level is higher than 4.5 or 5 milli-international units per liter (mIU/L).
However, many experts think this limit should be lower, maybe 2.5 or 3 mIU/L. Studies with big groups of people have found that it's better for pregnancy and fertility when TSH is below 2.5.
You can ask your doctor for a full thyroid panel, which includes TSH, T3, and T4, to get a clearer picture.
Also, it's a good idea to ask your doctor to check your blood for thyroid antibodies.
Most cases of hypothyroidism happen because of a problem with your immune system.
Your body mistakenly attacks your thyroid, like in Hashimoto's thyroiditis. In the early stages of this autoimmune thyroid disease, raised antibodies are often the only sign.
TSH might stay normal because the attack on your thyroid hasn't caused big damage yet. You can ask your doctor for thyroid peroxidase antibodies (TPO) and antithyroglobulin antibodies (TGAbs) tests.
The normal ranges for these tests can vary by country, so use the reference range from your lab.
If your doctor is hesitant to order these extra tests, you can mention your symptoms, family history, or both to help convince them.
If you're really stuck, some countries have labs where you can request these tests without a doctor's referral, but keep in mind that your insurance might not cover them.
What to do if you have raised TSH and/or antibodies
It's a good idea to talk to your doctor or a specialist to see if trying hormone replacement medication could help with your PCOS.
These medications could include T4 (like thyroxine) or a combination of T4 and T3 (like desiccated thyroid).
When combined with the lifestyle changes in my PCOS Repair Protocol book, many people have seen great improvements by getting their thyroid working properly again.
In some cases, it can even be the missing piece that helps you get pregnant naturally.
I also strongly recommend considering cutting gluten from your diet.
An interesting study found that people with Hashimoto's, a thyroid problem, got better in terms of symptoms and thyroid hormone levels when they removed gluten from their diet, even if they didn't have celiac disease.
Another study found that sticking to a gluten-free diet for a year actually reversed thyroid issues, while not following the diet made things worse.
Lastly, think about taking an herbal medicine called ashwagandha, like the one in Calm + Destress Ashwaghanda For PCOS. This herb has shown the ability to regulate thyroid hormone production.
Core Treatment #2: Heal Your Gut Lining
Rachel’s journey with chronic gut health issues and Inflammatory PCOS
References used for this article
in Pathogenesis of PCOS. Int J Mol Sci. 2021;22(7). doi:10.3390/ijms22073789
2013;169(2):248-251.
roid disorders in polycystic ovarian syndrome subjects: A tertiary hospital based cross-sectional study from Eastern India. Indian J Endocrinol Metab.
2013;17(2):304-309.
Effects of levothyroxine treatment on insulin sensitivity, endothelial function
and risk factors of atherosclerosis in hypothyroid women. Ann Endocrinol.
2014;75(4):220-226.
of Hashimoto’s thyroiditis. Acta Clin Belg. 2018;75(2):104-108.
ity. J Clin Endocrinol Metab. 2018;103(2):632-639.
Kratzsch J, Fiedler GM, Leichtle A, et al. New reference intervals for thy-
rotropin and thyroid hormones based on National Academy of Clinical Bio-
chemistry criteria and regular ultrasonography of the thyroid. Clin Chem. 2005;51(8):1480-1486.
Chen S, Zhou X, Zhu H, et al. Preconception TSH and pregnancy out-
comes: a population-based cohort study in 184 611 women. Clin Endocrinol. 2017;86(6):816-824.
(HT) and the importance of iodine, selenium, vitamin D and gluten on the
autoimmunity and dietary management of HT patients.Points that need more
investigation. Hell J Nucl Med. 2017;20(1):51-56.
in untreated adult celiac disease patients and effect of gluten withdrawal: an
Italian multicenter study. Am J Gastroenterol. 2001;96(3):751-757.
Panda S, Kar A. Changes in thyroid hormone concentrations after adminis-
tration of ashwagandha root extract to adult male mice. J Pharm Pharmacol. 1998;50(9):1065-1068.
Lam YY, Ha CWY, Campbell CR, et al. Increased gut permeability and micro-
biota change associate with mesenteric fat inflammation and metabolic dys-
function in diet-induced obese mice. PLoS One. 2012;7(3):e34233.
Inflammation and the Role of Nutrients. Nutrients. 2020;12(4):1185.
Lerner A, Ramesh A, Matthias T. Going gluten free in non-celiac auto-
immune diseases: the missing ingredient. Expert Rev Clin Immunol. 2018;14(11):873-875.
Di Sabatino A, Volta U, Salvatore C, et al. Small Amounts of Gluten in Sub-
jects With Suspected Nonceliac Gluten Sensitivity: A Randomized, Double-
Blind, Placebo-Controlled, Cross-Over Trial. Clin Gastroenterol Hepatol. 2015;13(9):1604-1612.e3.
of Curcumin on TNF-α, IL-6 and CRP Expression in a Model of Polycystic Ovary Syndrome as an Inflammation State. Journal of reproduction & infertil-
ity. 2017///Oct-Dec;18(4):352-360.
Ford ES, Cogswell ME. Diabetes and serum ferritin concentration among
U.S. adults. Diabetes Care. 1999;22(12):1978-1983.
Thompson PA, Khatami M, Baglole CJ, et al. Environmental immune dis-
ruptors, inflammation and cancer risk. Carcinogenesis. 2015;36 Suppl 1(Suppl1):S232-S253. Dirty Dozen EWG’s 2021 Shopper’s Guide to Pesticides in Produce. Environ-
mental Working Group. https://www.ewg.org/foodnews/dirty-dozen.php
effects in overweight/obese women with polycystic ovary syndrome. Cytokine.
2019;120:66-70.
Core Treatment #3: Eat an Anti Inflammatory Diet
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 PCOS Diet:
Gluten Free To Reduce With PCOS Inflammation
If you have certain health problems like Hashimoto's, celiac disease, endometriosis, or rheumatoid arthritis, or even skin issues like eczema, it might be a good idea to stop eating foods with gluten for at least three months. See how you feel during that time.
Scientists have found that gluten can make immune-related conditions worse, mess up your gut, upset the balance of good bacteria inside you, and make inflammation worse.
Even if you don't have a specific immune problem, but your tummy feels bad with things like bloating or IBS, you could try cutting back on gluten for three months. After that, slowly bring it back into your diet to see if any symptoms return.
Some people get bothered by gluten even if they don't have celiac disease.
They call it non-celiac gluten sensitivity (NCGS). It can cause all sorts of troubles like bloating, tummy pain, headaches, fuzzy thinking, joint pain, tiredness, eczema, and mood problems.
If you have Inflammatory PCOS, which is a condition with lots of inflammation, getting rid of or cutting down on gluten can help make things better.
I know it sounds tough if you love eating things like bread, pasta, and crackers, but don't worry! There are plenty of delicious gluten-free options out there that can make you just as happy.
Here are some tasty gluten-free starchy foods you can try that also help reduce inflammation:
- 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 Free To Reduce With PCOS Inflammation
Just like gluten, cow's dairy can make some women's bodies more inflamed.
Cow's milk has a protein called A1 protein, and it can make your immune system go into action and cause inflammation.
But here's some good news! Sheep and goat milk products mostly have A2 protein, and they don't usually cause the same inflammation problems.
So, if you want, you can probably enjoy things like sheep and goat milk products without any issues.
You can also have ghee and butter made from cow milk because they're mostly fat and don't have much protein.
If you want to switch things up, there are other tasty options too! You can try coconut milk and yogurt, almond milk, and cashew cheese.
Oat milk is another choice, but it has quite a bit of carbohydrates, so it's best to have it in small amounts if you're worried about insulin issues.
Processed and Deep Fried Foods
Some foods are not very nutritious and can make Inflammatory PCOS worse because they have things in them that cause inflammation.
These foods also usually have a lot of sugar and processed carbs, which can make your body not respond well to insulin.
Try to eat these foods less often and choose the anti-inflammatory foods we talked about earlier instead.
Many of these not-so-good foods are also high in fat.
We do need some fat in our diet to stay full and keep our hormones in balance, but it's better to pick fats that fight inflammation.
Go for things like avocados, olive oil, fatty fish, and nuts and seeds instead of the processed fats you see in the list 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
Core Treatment #5: Correct Nutrient Deficiencies
Core Treatment #6: Reduce Exposure to Environmental Toxins
Core Treatment #7: Find The Right Movement
SUMMARY: Core Treatments for Post-Pill PCOS
About The Author - Tamika Woods
Related Products
Quizzes & Calculators For Your Hormones
Hormone Healing Recipes
References used for this article
in Pathogenesis of PCOS. Int J Mol Sci. 2021;22(7). doi:10.3390/ijms22073789
González F. Inflammation in Polycystic Ovary Syndrome: underpinning of
insulin resistance and ovarian dysfunction. Steroids. 2012;77(4):300-305.
Garelli S, Masiero S, Plebani M, et al. High prevalence of chronic thyroiditis
in patients with polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol.
2013;169(2):248-251.
Harvey LJ, Armah CN, Dainty JR, et al. Impact of menstrual blood loss and
diet on iron deficiency among women in the UK. Br J Nutr. 2005;94(4):557-564.
Wessling-Resnick M. Iron homeostasis and the inflammatory response. Annu
Rev Nutr. 2010;30:105-122.
Sinha U, Sinharay K, Saha S, Longkumer TA, Baul SN, Pal SK. Thy-
roid disorders in polycystic ovarian syndrome subjects: A tertiary hospital based cross-sectional study from Eastern India. Indian J Endocrinol Metab.
2013;17(2):304-309.
Deyneli O, Akpınar IN, Meriçliler OS, Gözü H, Yıldız ME, Akalın NS.
Effects of levothyroxine treatment on insulin sensitivity, endothelial function
and risk factors of atherosclerosis in hypothyroid women. Ann Endocrinol.
2014;75(4):220-226.
Kust D, Matesa N. The impact of familial predisposition on the development
of Hashimoto’s thyroiditis. Acta Clin Belg. 2018;75(2):104-108.
Orouji Jokar T, Fourman LT, Lee H, Mentzinger K, Fazeli PK. Higher TSH Levels Within the Normal Range Are Associated With Unexplained Infertil-
ity. J Clin Endocrinol Metab. 2018;103(2):632-639.
Kratzsch J, Fiedler GM, Leichtle A, et al. New reference intervals for thy-
rotropin and thyroid hormones based on National Academy of Clinical Bio-
chemistry criteria and regular ultrasonography of the thyroid. Clin Chem. 2005;51(8):1480-1486.
Chen S, Zhou X, Zhu H, et al. Preconception TSH and pregnancy out-
comes: a population-based cohort study in 184 611 women. Clin Endocrinol. 2017;86(6):816-824.
Liontiris MI, Mazokopakis EE. A concise review of Hashimoto thyroiditis
(HT) and the importance of iodine, selenium, vitamin D and gluten on the
autoimmunity and dietary management of HT patients.Points that need more
investigation. Hell J Nucl Med. 2017;20(1):51-56.
Sategna-Guidetti C, Volta U, Ciacci C, et al. Prevalence of thyroid disorders
in untreated adult celiac disease patients and effect of gluten withdrawal: an
Italian multicenter study. Am J Gastroenterol. 2001;96(3):751-757.
Panda S, Kar A. Changes in thyroid hormone concentrations after adminis-
tration of ashwagandha root extract to adult male mice. J Pharm Pharmacol. 1998;50(9):1065-1068.
Torres PJ, Siakowska M, Banaszewska B, et al. Gut Microbial Diversity in Women With Polycystic Ovary Syndrome Correlates With Hyperandrogen-ism. J Clin Endocrinol Metab. 2018;103(4):1502-1511.
Lam YY, Ha CWY, Campbell CR, et al. Increased gut permeability and micro-
biota change associate with mesenteric fat inflammation and metabolic dys-
function in diet-induced obese mice. PLoS One. 2012;7(3):e34233.
Farré R, Fiorani M, Abdu Rahiman S, Matteoli G. Intestinal Permeability,
Inflammation and the Role of Nutrients. Nutrients. 2020;12(4):1185.
Lerner A, Ramesh A, Matthias T. Going gluten free in non-celiac auto-
immune diseases: the missing ingredient. Expert Rev Clin Immunol. 2018;14(11):873-875.
Di Sabatino A, Volta U, Salvatore C, et al. Small Amounts of Gluten in Sub-
jects With Suspected Nonceliac Gluten Sensitivity: A Randomized, Double-
Blind, Placebo-Controlled, Cross-Over Trial. Clin Gastroenterol Hepatol. 2015;13(9):1604-1612.e3.
Mohammadi S, Kayedpoor P, Karimzadeh-Bardei L, Nabiuni M. The Effect
of Curcumin on TNF-α, IL-6 and CRP Expression in a Model of Polycystic Ovary Syndrome as an Inflammation State. Journal of reproduction & infertil-
ity. 2017///Oct-Dec;18(4):352-360.
Ford ES, Cogswell ME. Diabetes and serum ferritin concentration among
U.S. adults. Diabetes Care. 1999;22(12):1978-1983.
Thompson PA, Khatami M, Baglole CJ, et al. Environmental immune dis-
ruptors, inflammation and cancer risk. Carcinogenesis. 2015;36 Suppl 1(Suppl1):S232-S253. Dirty Dozen EWG’s 2021 Shopper’s Guide to Pesticides in Produce. Environ-
mental Working Group. https://www.ewg.org/foodnews/dirty-dozen.php
Dantas WS, Neves W das, Gil S, et al. Exercise-induced anti-inflammatory
effects in overweight/obese women with polycystic ovary syndrome. Cytokine.
2019;120:66-70.