PCOS Bloating: Why Does It Happen?

The symptoms of PCOS can be truly annoying — menstrual irregularity, acne, excessive hair growth… and bloating. 

Bloating can indeed be a symptom of PCOS. So, why does it happen, and what can you do about it?

What is PCOS?

Polycystic ovary syndrome (PCOS) is an endocrine condition that affects 1 in 10 people assigned female at birth during their reproductive years. While the condition and its causes are not fully understood, PCOS is characterized by multiple cysts on the ovaries, irregular menstrual periods, and high levels of androgens (male hormones) in the body.

PCOS is also associated with impaired glucose metabolism and a high risk of type 2 diabetes.

What is PCOS bloating?

Around 40–80% of patients with PCOS are overweight or obese and have a so-called PCOS belly caused by increased visceral fat, that is, fat around the organs.¹

However, they also may have issues with bloating. When you are bloated, your tummy feels fuller than usual, you may experience pain, pressure, or discomfort, you may fart more than usual, and there may be visible swelling. Bloating can also be caused by water retention. 

If you experience bloating at the time of your menstrual period, this is a result of your hormones affecting the fluid balance of your body.

PCOS is one of several conditions that can cause increased bloating.

What causes PCOS bloating?

So, why does PCOS cause bloating? There are two possible reasons:

1. Sex hormones impacting fluid regulation. Estrogens and progesterone impact body fluids and sodium content. People with PCOS tend to have unusually low levels of progesterone as well as high male hormones. This may make them more vulnerable to water retention, which can also cause a bloating sensation.

2. People with PCOS often have issues with an imbalance in their gut microbe composition. This impacts intestinal wall permeability and also digestion. Conditions such as constipation or slow gastric emptying can develop. An unbalanced gut can cause bloating, which may be triggered by certain foods.

While there is little you can do about water retention other than follow your doctor's instructions to control your PCOS in general, there are things you can do to manage bloating caused by gut imbalance. Bloating is an annoying but not dangerous symptom that can impact your quality of life by making it harder for you to do things.

How to manage PCOS bloating

Diet is key to reducing bloating caused by PCOS. Foods you should consider avoiding are:

• Foods that contain raffinose, a specific carbohydrate that is not always well digested. This includes asparagus, beans, broccoli, Brussels sprouts, cabbage, and cauliflower. (Yes, this is why some people get gas after eating beans.)

• Dairy products

• Whole grains

• Fruits

• Carbonated drinks

• Artificial sweeteners

Not all of these foods will cause problems for every PCOS patient. Keeping a food diary can help you track what is causing your issues so that you know which foods to avoid. If dairy causes bloating, you could also be lactose intolerant, and switching to a dairy alternative or lactose-free milk can make a significant difference to your quality of life. 

Do not do elimination diets to try and find triggers without first talking to a dietician. Restrictive diets should only be done under medical supervision. 

Working with a dietitian can help you come up with a diet and lifestyle that you find sustainable in the long term and will not find yourself resenting and fighting in the future.

Gentle, regular exercise helps gut motility and can reduce bloating. If you are feeling bloated, exercise can sometimes get everything moving again and relieve discomfort. Also:

• Stay well hydrated, especially if you are prone to constipation.

• Avoid swallowing air. Chew with your mouth closed and try not to drink through a straw.

• Increase fiber, especially if you are constipated.

• Eat smaller, more frequent meals.

• Reduce your consumption of caffeine and alcohol.

• Avoid large meals right before bed. Eating and then lying down can increase gas. This then impacts your sleep and general health. 

If you are repeatedly constipated, you may also want to talk to your doctor about medication, such as antispasmodics and laxatives, to help improve pain and your bowel function. There is also some evidence that probiotics can help with PCOS symptoms by supporting gut balance and health.

Probiotics also appear to improve fertility in PCOS patients, lending more evidence to gut imbalance as a key feature of PCOS.

When to see a doctor

If you are experiencing regular bloating as well as other symptoms of PCOS and are of childbearing age, you should talk to your doctor about PCOS.

PCOS is commonly associated with irritable bowel syndrome (IBS). Women with PCOS often experience symptoms such as bloating, abdominal pain, and constipation, which are also common symptoms of IBS.

Currently, the theory is that both conditions may be linked as they are both in part due to chronic inflammation. If you have both conditions, you are also more likely to develop metabolic syndrome, greatly increasing your risk of diabetes and heart disease. 

Whether or not you have PCOS, if you are experiencing bloating as well as the following symptoms, you may have IBS:

• Abdominal pain and cramping

• Diarrhea, constipation, or both

• Excessive wind

• Occasional urgent need to move your bowels

If you have IBS, you will benefit from adjusting your fiber intake, avoiding trigger foods increasing fluid intake, exercising regularly, managing stress, and using medications if needed, which include antispasmodics, laxatives, or antidepressants. 

Chronic or recurring bloating may indicate an underlying issue, and it is advisable to consult a medical professional for further evaluation.

The lowdown

People with PCOS may experience bloating either from hormone-related water retention, a gut imbalance, or both. Managing your diet is the best way to reduce bloating caused by PCOS (and often also from other causes).

If you are chronically or regularly bloated, it is a good idea to talk to your doctor, especially if you have other symptoms that might indicate PCOS, IBS, both, or another condition.

It's important to remember that everyone's experience with PCOS and bloating is unique, and what works for one person may not work for another. Often PCOS bloating can be well managed with diet and lifestyle changes. 

If you are struggling with bloating, it's important to speak with your healthcare provider to determine the best approach for managing your symptoms.