PCOS & Autoimmune Disease

By Amy Medling, founder of PCOS Diva

PCOS and autoimmune disease are closely related. While diagnosis with PCOS does not necessarily lead to autoimmune issues, research indicates that it increases the likelihood. 

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders affecting women of child-bearing age. PCOS affects approximately 10% of women worldwide, with less than 50% diagnosed. The syndrome is present throughout a woman’s life from puberty through post-menopause and affects women of all races and ethnic groups.  Women with PCOS wrestle with an array of possible symptoms including obesity, irregular menstrual cycles, infertility, depression, acne, hair loss, and more.

Women with PCOS typically have excess androgens (“male” hormones such as testosterone) and irregular ovulation. These two symptoms are also associated with autoimmunity in women. Many reports indicate that there is a deep link between autoimmune disease and PCOS, but what exactly links the two together?

Defining Autoimmune Disease

An autoimmune disease is a condition where the body misreads your own cells and attacks them. This condition normally targets joints and skin, but it can also target specific organs such as the case with Type 1 Diabetes and how it damages the pancreas. A severe autoimmune disease, lupus, is a systemic autoimmune disease that can affect the entire body.

Autoimmune diseases are more or less a combination of genetics and environmental effects. You could inherit an autoimmune disease or an infection may trigger it. 

Some experts believe having PCOS increases your risk of acquiring an autoimmune disease. Others say having PCOS means you are prone to an autoimmune disease, as our thyroid is a common denominator for autoimmunity disease and PCOS.

6 Common PCOS-Linked Autoimmune Diseases

To date, experts say there are at least 80 different types of autoimmune diseases. These are 5 of the most common ones.

1. 1. Type 1 Diabetes. People diagnosed with Type 1 Diabetes have a condition where their immune system attacks and gets rid of insulin-producing cells in the pancreas. This can lead to high blood sugar levels which can trigger a series of symptoms and conditions on its own such as high blood pressure and organ damage. 
   2. Systemic Lupus Erythematosus. This disease is characterized by the appearance of a butterfly-shaped rash on a person’s face and in other parts of the body. Being systemic, this means this type of autoimmune disease affects more than one organ. The common symptoms include joint pain, fatigue, rashes, which are all found in many other types of diseases and explains why Lupus is difficult to diagnose.
   3. Celiac Disease. This is an actual autoimmune disorder that causes people to be extra sensitive to food with gluten, a protein found in various wheat, grain, and rye products. When a person with Celiac Disease ingests gluten, the immune system attacks that person’s small intestines, causing inflammation.
   4. Grave’s Disease. This disease attacks the thyroid gland and causes the organ to overproduce hormones such as testosterone and even insulin. 
   5. Addison’s Disease. This affects the adrenal glands. Our adrenals are responsible for producing cortisol, aldosterone, and androgen hormones. When you have Addison’s, your body’s ability to produce cortisol is impaired and can cause you to poorly metabolize and store carbs and sugar. 
   6. Hashimoto’s Disease. This type of immune disorder can cause hypothyroidism or what you call an underactive thyroid. With this disorder, the immune system treats the thyroid as a target which leads to thyroid damage. A damaged thyroid can lead to hormonal disruption. Learn more about PCOS and Hashimoto’s here. 

Are women with PCOS at Increased Risk for Autoimmune Diseases?

PCOS is largely an inflammatory disease, especially because insulin resistance and hypersecretion of hormones are forms of inflammation. The link between inflammation and autoimmunity in women with PCOS have been extensively studied by experts. 

Some studies note that women with PCOS have antiovarian antibodies. These antibodies have been associated with cases of amenorrhea, absence of menstrual periods, and hypoestrogenemia, a deficiency of estrogen. 

Other research suggests autoimmune disorders are caused by non-organ specific autoantibodies in women with PCOS, and consequently lead scientists to believe women with PCOS are also likely to have autoimmune thyroid diseases or AITD. 

AITD is the most common autoimmune disease that affects 5% of women in a population. It is a disorder that causes an immune attack and leads to chronic inflammation of the thyroid. This, in turn, can lead to excessive hormone secretions as seen in women with PCOS.

“Since thyroid autoimmune markers are present in patients of PCOS, therefore, PCOS patients should be investigated for autoimmune markers of thyroid. Further, disturbances of estrogen, progesterone, and thyroid profile are causative factors of gynaecological problems that eventually may lead to fetal loss and occurrence of endometrial, ovarian, and breast cancers.” – Mobeen H.

Progesterone, PCOS, & Autoimmune Disease

Other researchers point out that low progesterone causes overstimulation of the immune system. This results in more progesterone which leads to various autoantibodies. 

When the level of progesterone is decreased, the body’s ability to suppress Gonadotropin-releasing hormone (GnRH) or Luteinizing Hormone (LH) is impaired. This can lead to elevated levels of estrogen which could then lead to autoantibodies. 

Some of the common autoantibodies detected in PCOS are:

1. ANA
2. Anti-RO
3. Anti-dsDNA

Anti-TPO

Anti-spermatic antibody

Anti-histone antibody

Insulin autoantibodies

It should also be noted that disturbances in progesterone, estrogen, and overall thyroid profile are considered factors for gynaecological problems which could lead to a variety of reproductive problems and diseases.

Treating Autoimmune Diseases

Since autoimmune diseases are tied to genetics, there is no real cure out for it yet. However, the symptoms can be managed by controlling or suppressing the overactive immune response as well as by lowering inflammation. Some of these medications include NSAIDs (naproxen) and immune-suppressing drugs. 

Fighting Autoimmunity Disease Through Our Gut

While the conventional options in reducing the symptoms of autoimmunity often come in the form of pills, you can also help alleviate the condition by strengthening your health through the gut.

As mentioned in my article on PCOS and Autoimmune Diseases, how susceptible you are to autoimmune disorders depends on your gut health. 

Our gut is home to billions of bacteria and accounts for about 80% of our immune system. Unfortunately for women with PCOS, we have the type of bacteria that renders our gut’s protective coating vulnerable to toxin-induced damages. Common medications such as metformin and the birth control pill further alter the gut biome. Our body then responds with inflammation and worsens our gut health even more. 

A healthy gut means a lower risk for autoimmunity, so it’s only natural to want to care for it. Here are some diet tips to improve your gut health.

1. Eat more fiber. High-fiber foods are sources of nutrition for gut flora. Without fiber, the growth of gut flora slows down, which can lead to disease and an overall poor quality of immune response.
2. Eat more Prebiotic-rich foods. Good sources of prebiotics are artichokes, chicory root, leeks, onions, asparagus, spinach, beans, bananas, and oats. 
3. Fermented foods are your friends. Probiotics thrive in fermented foods like sauerkraut, miso, tempeh, kefir, and kimchi. 
4. Take a probiotic. Probiotics help replace your lost natural intestinal tract organisms, providing support for GI health and promoting a healthy immune response.

PCOS and autoimmune disease often coexist, but a PCOS diagnosis does not necessarily mean you will have thyroid or autoimmune issues. Testing and gut health are the place to start.

References:

1. Romitti M, Fabris VC, Ziegelmann PK, Maia AL, Spritzer PM. Association between PCOS and autoimmune thyroid disease: a systematic review and meta-analysis. Endocr Connect. 2018;7(11):1158-1167. Published 2018 Oct 26. doi:10.1530/EC-18-0309
2. Chattopadhyay D, Sen MR, Katiyar P, Pandey LK. Antiovarian antibody in premature ovarian failure. Indian J Med Sci. 1999;53(6):254-258.
3. Hefler-Frischmuth K, Walch K, Huebl W, Baumuehlner K, Tempfer C, Hefler L. Serologic markers of autoimmunity in women with polycystic ovary syndrome. Fertil Steril. 2010;93(7):2291-2294. doi:10.1016/j.fertnstert.2009.01.056
4. Escobar-Morreale HF, Roldán B, Barrio R, et al. High prevalence of the polycystic ovary syndrome and hirsutism in women with type 1 diabetes mellitus. J Clin Endocrinol Metab. 2000;85(11):4182-4187. doi:10.1210/jcem.85.11.6931
5. Mobeen H, Afzal N, Kashif M. Polycystic Ovary Syndrome May Be an Autoimmune Disorder. Scientifica (Cairo). 2016;2016:4071735. doi:10.1155/2016/4071735