Inflammation

Inflammation is a core part of PCOS, even though irregular ovulation, high testosterone and abnormal ovaries are the stand-out features of the condition. ⁱ For many (but not all) women the inflammation is closely linked to obesity and insulin resistance:

• 80% of obese PCOS women have insulin resistance
• 30-40% of lean PCOS women have insulin resistance

Insulin resistance is a key contributor to PCOS as it stimulates the adrenal glands and follicles in the ovaries to produce more androgens (mainly testosterone), and at the same time, it reduces SHBG levels. 

SHBG

SHBG (sex hormone binding globulin) reduces the bioavailability of sex hormones by binding to them, and it’s an adaptation to control sex hormone levels. A side effect of high insulin-reducing SHBG levels is it increases how much testosterone is available, which further increases the impact of testosterone on follicles in the ovaries and makes ovulation more difficult.

Obesity is an inflammatory state that’s characterised by an altered metabolism (which can become “metabolic syndrome”, and it encourages insulin resistance, which causes higher insulin levels as the body tries to control blood sugar levels.

Whether they’re normal weight or not, all women with PCOS have:

• Low-level chronic inflammation
• An elevated LH/FSH ratio ⁱⁱ

Inflammation

PCOS is a condition of chronic inflammation with permanently elevated inflammatory cytokines and white blood cells that affects women of all BMIs. Interestingly, it shares these features with endometriosis, the other significant fertility issue for women of all ages.

Inflammation is essential for our survival following infections and injuries as it prevents the spread of disease, and the immune system must rid itself of an invader and restore order to heal. Cytokines and white blood cells are crucial parts of this process, and they generate heat, swelling and also reduce function. 

Restoring health relies on removing these inflammatory markers once the injury or infection has passed. Without this, a cytokine storm causing sepsis is a worst-case outcome and something we’ve become familiar with since Covid-19. Auto-immune diseases, diabetes, neurological disorders and cardiac issues are other possibilities.

Reducing Inflammation

Resolving inflammation in a healthy manner involves anti-inflammatory “Specialised Pro-resolving Mediators” (SPMs) playing an active role in the process, and while we make PSMs ourselves, the diet is an important source of many of them.

Although 80% of women with PCOS are obese, most are malnourished due to a restricted diet (usually carbohydrate-based) that lacks antioxidants and essential nutrients. The body needs a wide range of minerals, oils and vitamins to function well and reduce oxidative damage. It’s becoming clear that diets lacking SPMs could contribute to a wide range of inflammatory diseases, including PCOS.

Essential fatty acids (EPA and DHA, also known as n-3 PUFAs) are important sources of SPMs, and a popular source is marine fish oils. Vegans are advised to take flaxseed or chia seed oils, and when obese women supplement with n-3 PUFAs, an increase in inflammatory resolution receptors is seen. ⁱⁱⁱ

As with all supplements, choosing the right ones is crucial, and fish oils have the potential risk of heavy metal contamination. We recommend “Foodstate” and organic supplements that are available from the morefertile Shop.