Hot New PCOS Research: The Microbiome and PCOS
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Hot New PCOS Research: The Microbiome and PCOS

Microbiome and PCOS
Microbiome and PCOS

Guest Post by Dr. Felice Gersh

The Microbiome and PCOS: An Evolving Area of Research of Huge Importance

Until fairly recently, you could look at yourself in a mirror and believe that the reflection was the real “you.” No longer is that the case! It is now recognized that more DNA exists within us that derives from our Microbiome than from our own genetic tissues. The Microbiome consists of the trillions of bacteria which live both on and in us. And what is now understood is that those little critters are not freeloaders! To the contrary, they are key players in all aspects of our health, and unfortunately for those of us suffering from PCOS, the bacteria comprising our Microbiome are unlikely to be the right ones, nor to be present in the correct amounts, for our maximal wellbeing.

The particular areas of the Microbiome I’ll touch on in this article will include the mouth, along with the rest of the gastrointestinal system, and the female reproductive system. Next month, I will deal with acne, so I’ll touch on the skin Microbiome at that time. The topic of the Microbiome is truly “hot!” New information is coming out about the enormous significance of these bacterial colonies on a weekly basis. In fact, along with a colleague of mine, I am currently designing a study of the Microbiome of PCOS women. If you’re interested in being a part of it, I may actually be soliciting your help in the near future!

Let’s start our review of the Microbiome by beginning at the top, with the mouth. I would say that virtually no one has been thinking of the mouth bacteria as important except as an annoyance, as something to wipe out as much as possible with mouthwash. Let’s all kill those germs on contact!! Well….unfortunately, it turns out that the bacteria in our mouths are actually critical to making nitric oxide, a necessary ingredient for the proper function of our cardiovascular system. It has been realized that when we eat certain vegetables which contain nitrates, the bacteria in our mouths, after being swallowed with our saliva, works in the stomach with our stomach acid, on the food, to create nitric oxide.

Without the right bacteria, nitric oxide quite simply will not be made. Nitric oxide is an essential part of our health. Unfortunately, we have done a great job of killing off the essential bacteria within our mouths through the use of mouthwash, antibiotics, toothpastes, and numerous bacteria-killing chemicals in foods. Also, drugs such as Nexium and Prilosec, which block stomach acid production, prevent proper nitric oxide production in the stomach.

Even without the things we do to kill off our bacteria, it seems from several small studies, that women with PCOS have different bacteria in their mouths than do “normal” woman.  What that means is still unclear, but most probably, PCOS women do not, as a group, produce nitric oxide properly. One thing that is clear is that women with low nitric oxide have higher pregnancy complications, which we know is true of PCOS women, and more cardiovascular conditions.

Moving down the GI tract, we come to the Microbiome of the Gut. These bacteria are critical to every function of our bodies and the wrong Microbiome results in increased risk of cardiovascular disease, autoimmune disease, depression and anxiety, cognition issues, and cancer. It is beyond the scope of this small article to go into great detail on all aspects of the Microbiome, but it is important that you at least learn that it exists and its critical import to your health.

The analogy I like to use is the following: there is a complex society-an advanced civilization of microscopic people living in our intestinal tract, and they perform many critical functions necessary for our wellbeing. By not realizing their importance, we’ve systematically gone about trying, inadvertently, to destroy them. We’ve dropped bombs on them (antibiotics), starved them (inadequate fiber in our diets), and tortured and killed them (additives and chemicals in foods). Most of us weren’t even given the best start to the formation of our Microbiomes since we weren’t breast fed for at least a year. For all of these reasons and more, our Microbiomes have reduced diversity and absolute numbers and may include many wrong players as well. When the conditions within our Gut are not right and the Microbiome is “wrong,” there is typically inflammation of a low grade in the Gut, resulting in inflammation throughout our bodies. Systemic (body-wide) inflammation leads to increased insulin levels, insulin resistance, weight loss resistance, elevated levels of IGF 1, and higher levels of testosterone. Now, with this new knowledge, evaluating my patients’ Microbiome has become commonplace for me and healing the inflamed Gut and remediating the Microbiome is an essential part of my treatment plan.

Lastly, I want to mention the Microbiome of the female genital tract. The bacteria in the vagina are essential to the health of the organs which lie above-the uterus, fallopian tubes, and ovaries. We’ve known that there are bacteria within the vagina, but the essential functions they perform for the health of the reproductive tract and their role in fertility was minimally comprehended. What is now coming to light is that the vaginal Microbiome is related to the proper function of the sperm, facilitating proper motility and ultimate fertilization of the egg. Additionally, in the past we believed that the environments within the uterus and fallopian tubes were sterile, but in fact, that is not true. The bacteria within those spaces are critical to having normal fertility. Even the ovary can contain some bacteria, and they must be of the right sort for all to work properly.

So what can you do today? Do not use mouthwash or chemical toothpaste-use a natural one. Do not take a drug to lower stomach acid production. If you are on one, work with a doctor who knows how to wean you off. I can help, if necessary. Do not take antibiotics unless it is absolutely essential…. and I mean that! Don’t put chemicals in or near your vagina. Use organic aloe vera gel or coconut oil as a lubricant. Use Vitamin E suppositories or oil for irritations. In general, use natural products for all treatments of the vulva and vagina.

Recognize that oral contraceptives are bad for nitric oxide production and the Microbiome. If you use them, there are risks and benefits which must be considered. This is, unfortunately, one of the risks. Eat lots of root vegetables (all vegetables from below the surface), as well as beans and lentils, buckwheat and millet. Those items contain resistant starch-hard for you to digest but great for the bacteria to ferment! Eat above ground vegetables too. Avoid all sweeteners, soft drinks, bread, processed foods, dry and instant cereal, alcohol, and please try to eat all organic. Eat fermented foods. Work with a doctor who can test your Microbiome and treat it. Also work with a doctor who understands nitric oxide. These are all really important items. Email me if you need help, and I will see what I can do:

Treat your Microbiome like the important complex civilization it is! You need them as much as they need you!! It is the ultimate symbiotic relationship!

DrGersh 2014.2Dr. Felice Gersh is one of only a small number of fellowship trained integrative gynecologists in the nation. She blends the best of the world of natural and holistic medicine with state of the art functional and allopathic medical treatment. Because of her extensive knowledge of the complex inter-relationships of the body’s organs, she recognizes the need to investigate all aspects of health, always working to re-establish a healthy gastrointestinal tract, adequate sleep, good mood, great nutrition, high energy, and balanced hormones.

Expert in all areas of women’s health, and particularly of gynecological and reproductive matters, Dr. Gersh deals in an integrative manner with such uniquely female issues as polycystic ovary disease (PCOS).

She is currently writing a book on Polycystic Ovary Syndrome and writing a chapter on the same topic for a medical textbook.

You may contact Dr. Gersh at:

Integrative Medical Group of Irvine, 4968 Booth Circle, Suite 101, Irvine, California 92604



Phone: 949-753-7475

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  1. Hello,

    I’m a little confused since in this article Dr. Gersh recommends eating starchy vegetables and some grains, beans etc. that all contain a lot of carbs. In a recent post, she recommends to avoid carbs as much as possible. Please advise. Thanks!

    1. This is a reply from Dr. Gersh – “Natural, unprocessed plants, buckwheat, millet, lentils, and beans, contain lots of carbohydrates, but they do not turn quickly into sugars in the bloodstream as the fibers they contain are both soluble and insoluble and have incredibly key functions in keeping the good bacteria in our intestinal tracts thriving. These are the carbs I want you to eat. Processed carbohydrates, such as bread, cake, cookies, white rice, pasta, dried or instant cereals, and sugars turn rapidly into sugar through the digestive process and rapidly can raise your blood glucose levels, creating uncontrolled inflammation. The inflammation then travels through the body.

      The goal is to eat as many vegetables as possible, including leafy greens and above ground vegetables, and roots and tubers as well! This is what helps to put the flames in your body out! Avoid processed grains like the plague they are!!! If you can’t tolerate the fiber due to bloating and gas, you should try the FODMAP or specific Carbohydate diet under the guidance of a knowledgable health care provider.”