Polycystic Ovary Syndrome, or PCOS, is a hormonal disorder that affects many women of childbearing age. It is characterized by a range of symptoms including irregular periods, excess hair growth, adult acne, and weight gain. One common symptom that many women with PCOS experience is bloating.

And as a dietitian who also has PCOS: I know exactly how awful it feels when bloating is taking over…and exactly how great it can feel to get bloating under control. I want you to feel that same relief!

Bloating and abdominal pain is an incredibly common complaint for women with PCOS. In this blog post I’ll explain exactly why this is happening and what you can do about it.

What is PCOS?

If you’re new to this condition, let’s do a quick overview of what PCOS is.

PCOS is a hormonal disorder that also affects the reproductive system. It’s common, with an estimated 5-20% of women being affected by it.

Chronic inflammation, high levels of androgens (aka male hormones such as testosterone), insulin resistance, and other hormone imbalances are associated with PCOS. It has also been linked to an increased risk of additional health problems such as type 2 diabetes and heart disease. 

The following symptoms are common in PCOS: 

• Irregular periods
• Fertility issues
• Excessive hair growth (both facial and body hair)
• Fatigue 
• Hair loss 
• Painful periods
• Acne

And another common symptom…the topic of today: bloating (1). 

PCOS is also linked to insulin resistance – this is where your body has trouble using the hormone insulin which helps regulate your blood sugar levels. When you’re insulin resistant, high insulin levels can cause weight gain, especially around the abdomen (which is commonly referred to as PCOS belly) – leading to that dreaded bloating.

What Is Bloating?

We all know how uncomfortable bloating can be…that fullness and tightness in your belly can be super painful! You may be frustrated that your belly looks bigger and pants are less comfortable than usual. Have you ever wondered what is actually going on inside your body?

Bloating can happen for a few different reasons. Bloating happens when there’s too much gas production in your digestive system, you’re retaining fluids, or you’re constipated (or worse – all of the above).

The bad news: bloating is extremely common for those dealing with PCOS (2).

Why Does Bloating Happen With PCOS?

There are several reasons why it is so common for women with PCOS to struggle with bloating:

• Hormonal imbalances: Anovulation, or the absence of ovulation, is a common symptom of PCOS. When ovulation does not occur, the body may not make enough progesterone, resulting in water retention and bloating (3). 

• Medications: Certain medications, such as metformin and birth control pills, can also cause bloating as one of their side effects (4).

• Gut health: Research has shown that women with PCOS have gut dysbiosis (an imbalance in their gut bacteria, including less diverse gut bacteria strains), which may contribute to the pathogenesis of PCOS and how it presents itself in certain women (5, 6). 

It is also worth noting that it is common for some with PCOS to have irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO) as well (ugh – right?) (7).

As a dietitian, trust me when I say there is SO much that we can do to improve gut health and reduce your symptoms. Let’s discuss!

Tips for Minimizing Bloating

Now that we have a better understanding of why bloating happens with PCOS, let’s talk about how to make things better. 

The good news is that a healthy diet, along with lifestyle changes, can make a significant impact on your bloating.

The overall goal is to improve gut health and increase diversity in your microbiome. This makes you less vulnerable to the hormonal shifts that can happen with PCOS and therefore means you will have less trouble with those symptoms, including bloating.

Here are some tips to help minimize this uncomfortable symptom:

Eat smaller meals

Instead of eating three large meals per day, try breaking it down into five or six smaller meals. This can help with digestion because you’re reducing the workload for your stomach at one time (8). This also helps with gut motility, which is the pace that your food travels down your digestive tract; we don’t want this to be too slow, or your bloating will be worse. 

Chew foods thoroughly and eat mindfully

Take your time while eating and make sure to properly chew your food. This can help prevent swallowing excess air, which can lead to bloating.

Consume fiber-rich foods 

Foods high in fiber, such as vegetables, fruits, and whole grains, can help with digestion and promote bowel movements. Most of us don’t get enough fiber on a regular basis, but having enough fiber can reduce the likelihood of constipation and bloating.

One more benefit of fiber? It is a prebiotic: which means that it is food for the probiotics (good bacteria) that live in your digestive tract. More on that in a moment. 

Let’s start with getting more fiber at breakfast, shall we? Here are 12 Easy PCOS Breakfast Ideas (Dietitian Approved).

Diversify gut bacteria

Did you know that you should have a complex community of bacteria and other helpful organisms in your digestive tract? In fact, having diverse gut bacteria is a hallmark of health. 

To cultivate your gut bacteria community (aka your gut microbiome), eat enough fiber on a daily basis and aim for as much diversity as you can. You can also boost your microbiome by eating probiotic foods such as fermented dairy products (Greek yogurt, kefir, cottage cheese), fermented veggies, tempeh and by drinking kombucha. 

Here’s some of my favorite smoothie recipes to incorporate some of these foods: 

Mango Kefir Smoothie

Strawberry Cottage Cheese Smoothie

Avoid any known food triggers

If you have a known food intolerance or have identified certain trigger foods that tend to make your bloating worse, try to avoid or limit them in your diet.

Stay hydrated

Adequate fluid intake can help with digestion and promote regular bowel movements. 

Drink enough water so that when you go to the bathroom, your urine is pale most of the time, not dark in color (like apple juice). 

And if you think that plain water can be boring, you’re not alone! Herbal teas can be a lot more interesting to your taste buds AND provide additional benefits to you as someone with PCOS. Here is a bit more info about the 5 Best Herbal Teas for PCOS: Are They Worth The Hype?

Exercise regularly

Regular physical activity can also help with gut motility and reduce bloating. Try incorporating various forms of gentle exercise into your daily routine, especially stretching and yoga (9). 

This low-intensity movement helps to lower your stress levels and let your body get out of the stressful “fight or flight” mode, which actually inhibits your digestion.

When you’re feeling up to it, including strength training as part of your regular exercise routine is a good idea. It can improve insulin sensitivity, which can help to reduce insulin resistance and high testosterone levels. 

How Long Does PCOS Bloating Last?

I wish I could offer a concrete answer here, but I can’t: everyone is different.

What I do know is that bloating isn’t going to go away until you can address your root causes. While there is no known cure for PCOS, we can work on making some of the symptoms much more manageable if we can do the detective work together. 

What If I’m Still Bloated?

Ugh – I’m sorry! Sometimes getting down to the underlying cause of bloating can be tricky and frustrating.

If the suggestions above aren’t enough to reduce your bloating symptoms, here is what I’d recommend for the next level of our anti-bloat crusade.

Chat with your doctor

Your doctor can order tests to help rule in (or rule out) health conditions that might be contributing to your bloating. Your doctor may consider ordering testing to help figure out what is going on. The exact tests that they might order (or a GI doc) could include a hydrogen breath test to diagnose lactose intolerance or SIBO, or they may consider an endoscopy or colonoscopy depending upon your symptoms. 

You and your doctor may also consider a new medication, either to manage symptoms, or to help treat a new condition if the testing that you did unearthed a new diagnosis.

Consider low FODMAP

A low FODMAP diet is often recommended for people with IBS, but it can also be helpful for those with PCOS and bloating. This type of diet eliminates certain carbohydrates that are known to cause digestive distress in some individuals. 

If you suspect certain foods may be causing your bloating, consider working with a registered dietitian to try out a low FODMAP diet. A low-FODMAP diet can be a bit tricky to follow, so I definitely recommend not starting here; the tips I shared above have helped many of my clients, without having to follow a restrictive diet.

PCOS & Bloating Wrap Up

Bloating is one of the common symptoms of PCOS that can really disrupt your day to day life. There are a number of factors that can help to provide you with relief, including lifestyle and dietary changes.

As a dietitian, I have helped many women to find peace and relief with their PCOS. While nothing you do can make this condition go away completely, you can find a custom strategy that helps manage PCOS symptoms effectively.

The PCOS Playbook is your downloadable guide to kick your PCOS symptoms to the curb. It reviews everything you need to know about how to eat for PCOS in a non-restrictive and balanced way. Get your copy today!

Disclaimer: This information is for educational purposes only. It is not intended to be substituted for medical advice for health conditions including polycystic ovarian syndrome (PCOS). Always consult with your healthcare provider for personalized medical care and recommendations.