PCOS, Progesterone Deficiency and Gluten Intolerance - PCOS Diva
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PCOS, Progesterone Deficiency and Gluten Intolerance

PCOS menstruation pains

Guest post by Michelle Shwarz, PhD

This month’s guest post is by mental health clinician, Dr. Michelle Shwarz. Her research focus is on psychological aspects of PCOS. She is also the organizer of Philadelphia’s PCOS Meetup Support Group. Michelle is not a dietitian. Please consult a professional before making changes to your lifestyle.


You’ve been diagnosed with PCOS and you’re doing everything you’re supposed to do. You’ve been eating right, increasing your physical activity, taking your medication regularly, and keeping your stress under control. Yet, you still don’t feel quite right. You’re moody and your PMS is—well let’s just say, we should avoid you for the next 5-7 days. You’re particularly tired even though you’re getting enough sleep. Your shoes are suddenly too small, your rings don’t fit, but your weight hasn’t changed. You notice that you’ve been getting headaches more often than normal. Maybe most importantly, you are unable to get pregnant.

Does this sound like you? The possible culprit is progesterone deficiency.

PCOS can be worsened or caused by a progesterone deficiency. Progesterone is important, not just for implantation and sustaining pregnancy, but also for keeping our immune systems healthy in our gut.

What is the role of progesterone? During the follicular phase of the menstrual cycle (the part between the period and ovulation), progesterone is pretty low. Estrogen is busy at work doing prepping us for ovulation by promoting fertile cervical fluid and possible pregnancy. Once we ovulate, the sack that held the egg (the corpus luteum) is responsible for releasing progesterone, which helps prepare the lining of the uterus to attach a fertilized egg. It’s also known as the warming hormone because it causes our basal body temperature (BBT) to increase about half a degree after ovulation. After about 4-8 days, the corpus luteum starts to die off. If an embryo was created and successfully implanted, it will soon take over the progesterone production for the remainder of the pregnancy. If not, you will get your period. If you have a deficiency in progesterone, you may have difficulty getting an embryo to stick (chemical pregnancies), have early miscarriages because you’re not producing enough progesterone to sustain the pregnancy, or even quasi ovulating (you’ll have to look up something called luteinized unruptured follicular syndrome), where it looks ovulation occurs, but the luteinized follicle never releases an egg, but does release progesterone. Bottom line, a lot can go wrong on the way to pregnancy with progesterone deficiency. For those of you who chart your BBT, another sign of progesterone deficiency is a luteal phase (the phase that begins the day of ovulation until the first day of your period) that is less than 12 days long.

What came first, PCOS or progesterone deficiency? Unfortunately the jury is still out on that one. Over 20 years ago, some researchers stumbled upon the PCOS-progesterone deficiency connection (1) but it never gained enough steam for more research. However, it’s likely that PCOS can cause progesterone deficiency and progesterone deficiency can cause PCOS. A small Indian study found that treating insulin resistance with metformin in women with PCOS also improved progesterone levels, which incidentally may be one of the reasons decreasing insulin resistance by any means (medication, diet, and/or exercise) also improves fertility.(1)


Other names for progesterone deficiency are estrogen dominance and luteal phase deficiency. The reason for this is if your progesterone isn’t sufficient, estrogen is trying to take over. A sign of this is that you may have a lot of fertile-looking cervical mucus during the luteal phase of your cycle and your breasts may enlarge or be especially painful.

So, to recap, progesterone deficiency can result is any of the following symptoms (3):

* Moodiness, anxiety, depression

* Infertility, miscarriage

* Menstrual irregularities including heavy and/or unusually painful periods


* Headaches, migraines

* Increased breast issues, including pain, tenderness, especially during luteal phase

* Endometriosis

* Long-term issues during peri-menopause, menopause such as excessive hot flashes and night sweats. However, many premenopausal women also complain of hot flashes and night sweats as well.

* Weight gain, difficulty losing weight, bloating

Pause—did that last symptom catch your attention? Well, this blog post is about PCOS, progesterone deficiency, AND gluten intolerance. So what’s the connection?

The medical literature has readily established a strong association between gluten sensitivity and hormonal issues, especially with progesterone. At its worst, gluten sensitivity can actually be an autoimmune disease called Celiac disease, a condition that is treated with absolute abstention from gluten (i.e.- can’t eat it EVER). Those who do not have celiac disease but are gluten sensitive do not have to be as careful, but should typically avoid gluten when possible. If you read many PCOS blogs, you may notice a huge amount of information about inflammation, fighting inflammation, how PCOS is caused by inflammation, how inflammation makes everything in your body go wrong. Well, no surprises here then. If you are gluten sensitive, every time you eat gluten, you cause inflammation in your body, which could contribute to lots of other disorders, heart disease, arthritis, diabetes. You get the picture. But the specific mechanism that links gluten and your hormones are in your adrenal glands. These little glands that sit above your kidneys and are responsible for your metabolism, keeping stress in check, and producing another hormone which is required to make progesterone, testosterone, and estrogen. Too much stress, the adrenals go in to overdrive and produce more cortisol to keep us going, and as a result, the sex hormones take a back seat. When we’re constantly inflamed, the adrenals read this as stress. Instead of making the good sex hormones, our adrenals are simply working to keep us alive pumping tons of cortisol (you’ve seen this commercial, the one claiming that cortisol causes belly fat—yep, it’s true). And to add insult to injury, the gluten not only messes with the hormone production in our bodies, it wreaks total havoc on our gut. Odds are good that in addition to being gluten intolerant, you’re also bit lactose intolerance, and any additional source of estrogen (dairy and soy) affects you way more than your non-gluten sensitive friends.

So in addition to the symptoms mentioned above, maybe you’re also experiencing:

* Trouble sleeping (difficulty falling asleep, not experiencing refreshing sleep)

* General fatigue – all the time, even with enough sleep and exercise

* Generalized joint and muscle aches, maybe diagnosed with fibromyalgia or chronic fatigue syndrome

* Weight gain for no reason; resistance to weight loss despite healthy diet and exercise

* You’re sick all the time. Colds/flus, infections (bacterial, yeast)

* Lightheadedness

* Fogginess/ poor memory/difficulty concentrating

* Low blood sugar – post-prandial hypoglycemia(after you eat a meal, you feel even more tired and hungry than before you ate)

* Long-term effects: allergies (environmental: hay fever, food allergies), arthritis, asthma, hypothyroidism

If you’re freaking out right now, take a big, deep breath. There is good news. By simply eliminating gluten from your diet, all of these symptoms are entirely reversible. Within a week, you can start feeling like yourself again. Within a month, you may even get a normal period. Within 6 months, perhaps a pregnancy. Within a few years—you may be feeling better than ever. I’m not promising anything here, but it’s a small start and an excellent hypothesis. It’s a cost-free opportunity to play Sherlock Holmes with your health to see if you may be gluten intolerant.

For more information about gluten and gluten-free foods, see Amy’s blog post http://pcosdiva.com/2012/03/go-gluten-free-for-pcos-part-1. For her gluten-free meal plans see www.pcosmealplans.com

Why hasn’t my doctor thought of this? Researchers like me are often responsible for “connecting the dots.” My job is to pose hypotheses and offer reasonable explanations based on what we know about the research that has been done. Your doctor’s job is to treat you based on your individual symptoms during a very short appointment with the tools they have in their medical tool box. They may not be aware of these connections because they would have to read up on all of the latest and greatest research and put it together with what we already know. If it’s not common practice, odds are, they’ll miss it or they may not be willing to test for it because it’s a little off the beaten path. You know your body better than anyone and you have a right to say to your doctor, “hey, do you think I may have progesterone deficiency or be gluten intolerant or have celiac disease?” Most good doctors would be willing to investigate with you.

Final thoughts: Be careful when evaluating your own symptoms. Many symptoms of progesterone deficiency are similar to those of hypothyroidism, congenital adrenal hyperplasia, and anemia, all of which frequently co-occur with PCOS, progesterone deficiency, and gluten sensitivity. Always ask your doctor first, especially if you are experiencing a lot of these symptoms. If your doctor wants to test you for Celiac Disease, you should not give up gluten until after the test. If your Celiac Disease panel is negative but you suspect you may be gluten intolerant, you may cut gluten from your diet. Gluten intolerance is best diagnosed through avoidance. In just a few days, you may start noticing improvements. Please be patient. It may take up to 2-3 years for your body to fully heal and return to normal functioning. In my opinion, it’s well worth the investment.

1) Meenakumari, KJ, Agarwal, S, Krishna, A, Pandey, LK, Effects of metformin treatment on luteal phase progesterone concentration in polycystic ovary syndrome. Braz J Med Biol Res. 2004. 37(11): 1637-44. http://www.ncbi.nlm.nih.gov/pubmed/15517078

2) Filicori, M, Flamigni, C, Meriggiola, MC, Ferrari, P, Michelacci, L, et al. Endocrine response determines the clinical outcome of pulsatile gonadotropin-releasing hormone ovulation induction in different ovulatory disorders. J Clin Endocrinol Metab, (1991),72:965–972. http://www.ncbi.nlm.nih.gov/pubmed?term=1902487[uid]

3) Practice Committee of the American Society for Reproductive Medicine. The clinical relevance of luteal phase deficiency: a committee opinion. Fertil Steril. (2012) 98(5): 1112-7. http://www.ncbi.nlm.nih.gov/pubmed/22819186

4) Ch’ng CL, Jones, MK, Kingham JG. Celiac disease and autoimmune thyroid disease. Clin Med Res. (2007),5(3):184-92. http://www.ncbi.nlm.nih.gov/pubmed/18056028

5) Collin P, Kaukinen K, Valimaki M, Salmi J. Endocrinological disorders and celiac disease. Endocr Rev. (2002), 23(4): 464-83.

6) Toscano V, Conti FG, Anastasi E, Mariani P, Tiberti C, et al. Importance of gluten in the induction of endocrine autoantibodies and organ dysfunction in adolescent celiac patients. Am J Gastroenterol (2000), 95(7): 1742-8. http://www.ncbi.nlm.nih.gov/pubmed/10925978


This blog post does not constitute medical advice. I am not a physician. Recommendations made in the post are for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan.

Amy Medling, PCOS Diva founder and PCOS Health Coach

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  1. This message really hit home. I have been looking into different types of gluten free life style changes. I have found many different benefits in my research but his by far hit he for many reasons.
    Thank you for this very informative study.

  2. Every time I go on a South Beach or Atkins diet, my period starts like clockwork. I have gone two years without a period…I go carb free (ie, gluten free) and voila. I not only restart my periods, they happen in a normal cycle. Whenever I fall off the diet, the periods disappear or become wildly irregular. I’ve told two doctors about this and they look at me like I’m crazy. But this could explain it….interesting.

  3. Hi youansweredit, I totally agree! The same thing happens to me. Last year, I began a paleo diet/lifestyle and I had two completely normal periods. Previous to that, I didn’t have a period for about 4 months! I then let the diet slip up and began eating carelessly (wheat/gluten, dairy, etc) and did not have a period for nearly 7 months. Restarted my paleo/gluten free lifestyle again, and I’m already spotting within the first week. This is a very interesting topic!!

  4. My first two children were conceived while taking metformin. My third was conceived drug free after going GFCF. Great article!

  5. I really found this soooo helpful I just turned 28 and diagnosed with pcos about 9 months ago by an endocrinologist but all he did was blood work which didn’t show much out of the ordinary except my cholesterol was a little high….I hadn’t had a period in over a year …weirdly enough I tried natural progesterone cream for a couple weeks and had a normal period right after ..my gyn laughed I guess he doesn’t believe in that …but it did work…anyhow the endo prescribed me metformin 9 months ago( which is still in my med cabinet) I really rather go the natural route…plus I drink occasionally and don’t want crazy side effects…all my weight goes to my belly and I could honestly pass for pregnant also facial hair (thank God for laser hair removal)….any more tips would help…im having a vag ultrasound next month to be safe…and maybe trying another endocrinologist any advice would helppp please

  6. Thank you so much for this enlightening article. I have been trying to conceive and after taking hormonal check up two months ago, I was diagnosed with PCOS.
    But still I feel something isn’t going right in my body. I frequently feel bloating stomach, anemia, poor gain weight, and other symptoms that lead me to celiac disease article. And honestly it scared me out!
    I keep on searching than I found this article and this is sooooo relieved me. *sob n hug* Thanks again for making me sit back and relax with your easy yet informative writing. I definately will meet and ask my GP, is it celiac disease or just gluten intolerance, and hopefully it’s just the second one.

  7. Doctors have mistreated me very much. It is really hard to trust any of them in regards to my PCOS. I wish more doctors did do research and took time to understand the condition. My experience has been discouraging. The physicians are blaming and condescending when it comes to the symptoms of PCOS. Any advice on how to approach doctors would be appreciated.

  8. I had been trying to figure out the link between progesterone, acne and gut issues and you have done it for me. Glad you did cos it was bugging me! GREAT article – thanks 🙂

  9. Sooo I land here searching some symptoms and read an entire article mentioning PCOS as if everyone in the world should know that term. Most college educated people should remember that you always spell out the term the first time you use it. Very frustrating when you were looking things up because you needed help 🙁

  10. PolyCystic Ovarian Syndrome. 🙂 Hope you find the info you are looking for. PolyCystic Ovarian Syndrome is when your body prepares to ovulate, producing the cyst in your ovaries, but the egg doesn’t ripen and release, so it tries again, producing the next cyst, etc. . . Usually causes infertility or difficulty getting pregnant, and there are also a LOT of other unrelated issues that are actually related 😉

  11. I am better now after
    going glutten free…periods are regular from last 4 months thn before….my
    question is that can I try to conceive now naturally or should I take doctors
    advice ?

  12. I was diagnosed with PCOS 8 years ago. I went to a doctor who claimed he was a specialist in PCOS and even named his practice The PCOS clinic. At first everything was great, but four or five years ago I started gaining weight for no reason, even though I was eating right and still exercising. I complained to my doctor, who put me on fenergen. I continued to gain weight. He just shrugged and gave up. I did stop going to him, but it took all those years and three more doctors to find someone who would look into it. I now know that I have Celiac disease and progesterone deficiency, and both of those discoveries are recent. I’ve had so many health problems these last years! Perhaps it was too much to ask for a PCOS doctor to look fir Celiac disease, but you would think he would have looked at my hormone levels. I guess the moral of the story is, even if they say they’re experts, you are the only one truly invested in your health.

  13. I haven’t been diagnosed with PCOS, but I have my suspicions. I got married young (18) and have never been on any form of birth control. My period was never exactly regular. Horrific cramps, exhaustion, horrible PMS. Anyways, what I noticed is that EVERY SINGLE time I went on a low-carb diet to lose weight, I ended up pregnant several months in. Other than that, I have never had a miscarriage or anything. I just never conceived. After reading this, I wonder if maybe I have had Celiac this whole time a long with my female problems and a few months sent my body back in order.

  14. This is something new. The whole time I was reading and discussed about not consuming a refined flour makes sense. I have PCOD and it used to hurt so much. I think I had lots deficiency back then then I drank indian gooseberry juice early in the morning and the pain disappeared but cyst remained. somehow I got convinced to remove most of the carb from my diet mostly refined flour. it worked in my favour. I never realized connection between gluten and PCOD but now it is dawning upon me. my body goes into too much pressure when I take heavy gluten diet. when I go gluten free i have lost weight too (replaced it with buckwheat and water chestnut chapati). thanks for the insight.

  15. I first had symptoms when i was 17 and was told that i had PCOS (thin people type PCOS) and was officially diagnosed at 22 ans now i am 35. I have always had regular periods and unless on birth control pills were they irregular at times and I had a hard time getting pregnant because of the absent periods. I was always told by doctors that I would have a hard time conceiving so I would only go on the pill periodically which i did for more than 4 years, not for protection against getting pregnant, but just to get a period (since I was told it’s not healthy to have less than 4 or so periods a year). Last time I went on a 3 month birth control pill and then stopped again because the medicine was not curing my pcos nor making me get pregnant. I went in search for a cure and ended up with so many drugs, medicine and even soaps that didn’t work. I actually thought at a point that i was cursed that there is no cure for it, i was prepared to live like that till i read a testimony of a patient who suffered from pcos whose case was even worse than mine and how she was cured completely, I was amazed and at the same time anxious and curious so i had to contact the doctor with the contact details that she left on the note. The doctor gave me so much hope and confidence with her kind words of encouragement to believe in myself and i was lifted because no one has ever given me hope like that before. I ordered the medicine, took it for 8 weeks and to my complete surprise, all the facial hairs, weight gain and all disappeared within 4 weeks and I ended up getting pregnant within a few weeks of completing the treatment! I was in shock. I think the main reasons it happened was that I never gave up and was ready to try alternative treatment so my body was back to normal. Before now i never enjoyed sex because it was very painful but now i do and my husband is the best thing that ever happened to me.. I hope this inspires some of you because I never in a million years would have thought that I would get pregnant and was getting frustrated and now our baby is due next month! You can reach her on aletedwin@gmail.com if you find yourself in a similar situation.4tg

  16. I have Graves disease and Hashimotos as well, so my diet is very restrictive already. I’m going to make an effort again to give up all gluten except for my favourite occasionally which is Boca brand vegetarian spicy chik’n patties. Aside from those occasionally, I will try hard to not consume wheat. I have to watch my sugar, corn, can’t have dairy or egg (don’t eat meat by choice) and soy isn’t even good for me. Ugh. I also have ibs very bad so I have to limit beans very much as well as berries. I relied heavily on hummus for protein, but my ibs just kept getting worse and worse.