PCOS & Gut, Mood, Sleep and Blood Sugar
Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder, affecting 6-20% of women in their reproductive age (4). The condition is characterized by menstrual disorders, such as anovulation and amenorrhea, often linked to an increase in luteinizing hormone (LH) secretion relative to follicle-stimulating hormone (FSH) (3). Hyperandrogenism, manifested by elevated testosterone levels, is also common in PCOS. Additional symptoms include ovarian cysts, infertility, obesity, and diabetes (4).
Recent research has highlighted the significance of microbiome dysregulation in understanding PCOS (4). Both human and mouse studies have demonstrated a connection between dysregulated gut microbiota and PCOS. Specifically, an overabundance of gram-negative bacteria like Bacteroides and Escherichia/Shigella, coupled with a decrease in beneficial bacteria like Akkermensia and Ruminococcaceae, has been observed (2). Gram-negative bacteria produce lipopolysaccharides (LPS), which contribute to elevated inflammatory markers in PCOS (3). However, whether PCOS is the cause or consequence of microbiome imbalance remains unclear.
Insulin resistance also plays a pivotal role in PCOS. Approximately 75% of lean women and 95% of obese women with PCOS experience insulin resistance (5). This condition impairs the body's ability to utilize blood glucose effectively. Obesity and insulin resistance often coexist, both being metabolic dysfunctions. Weight gain and obesity are highly prevalent among women with PCOS, affecting around 88% of individuals, further aggravating insulin resistance (5).
In addition to blood sugar and microbiome imbalances, emerging research suggests a link between PCOS and sleep disorders, restless leg syndrome, anxiety, and depression. A case-control study by Caltekin (2021) examined 73 outpatient women with PCOS and 63 healthy women. The study measured blood levels of testosterone, fasting glucose, and fasting insulin, alongside collecting questionnaires on sleep quality, depression, anxiety, and restless leg syndrome.
The findings were striking, revealing that 61.6% of women with PCOS had poor sleep quality compared to only 34.9% of healthy women (p=0.003). The PCOS group also reported significantly higher rates of restless leg syndrome (23.3% vs. 6.3% in healthy women). Moreover, based on specific questionnaires, the PCOS group exhibited higher scores for depression, anxiety, insomnia, and sleepiness. It's crucial to recognize that psychiatric and sleep disorders, along with restless leg syndrome, are associated with PCOS. Understanding these connections is essential for healthcare practitioners, as addressing the underlying hormonal imbalance may also alleviate these related conditions. Given that hormones and neurotransmitters regulate sleep and mood, this relationship is biologically plausible.
References:
1. Çaltekin, M. D., Hamamcı, M., Onat, T., Kırmızı, D. A., Başer, E., & Yalvaç, E. S. (2021). Evaluation of Sleep Quality, Restless Legs Syndrome, Anxiety and Depression in Polycystic Ovary Syndrome. Journal of Turkish Sleep Medicine, 8(3), 243–249. https://uws.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=pbh&AN=151870297&site=eds-live&scope=site
2. Liu R, Zhang C, Shi Y, Zhang F, Li L, Wang X . Dysbiosis of gut microbiota associated with clinical parameters in polycystic ovary syndrome. Front Microbiol. 2017;28(8):324. doi: 10.3389/fmicb.2017.00324.
3. Moslehi, N., Zeraattalab-Motlagh, S., Sakak, F. R., Shab-Bidar, S., Tehrani, F. R., & Mirmiran, P. (2023). Effects of nutrition on metabolic and endocrine outcomes in women with polycystic ovary syndrome: an umbrella review of meta-analyses of randomized controlled trials. Nutrition Reviews, 81(5), 555–577.
4. Xenou, M., & Gourounti, K. (2021). Dietary Patterns and Polycystic Ovary Syndrome: a Systematic Review. Maedica - a Journal of Clinical Medicine, 16(3), 516–521. https://uws.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=153405506&site=eds-live&scope=site
5. Yujie Shang and others, Effect of Diet on Insulin Resistance in Polycystic Ovary Syndrome, The Journal of Clinical Endocrinology & Metabolism, Volume 105, Issue 10, October 2020, Pages 3346–3360, https://doi.org/10.1210/clinem/dgaa425
