PCOS and Thyroid Disorder are two of the most common hormone imbalance disorders in women. Of course, men never have to deal with PCOS. However, hypothyroidism, which affects both genders, is about 6-10 times more prevalent in women than in men.
Though both conditions are very different, yet they share some similar features and even symptoms. For example, they both affect fertility adversely.
In this post, we dig into how PCOS and Thyroid are related to each other. What causes what? And What should you do, if you are are diagnosed with both PCOS and Thyroid.
Before we decode the link. Let’s First, check out what are polycystic ovarian syndrome and hypothyroidism health disorders.
What is PCOS?
The pathophysiology of PCOS is pretty complicated, and it is yet to be fully understood.
However, we can still get a fundamental overview of how PCOS works. That will facilitate a better understanding of how it all links us with hypothyroidism.
PCOS is a hormonal imbalance. It involves more than just one hormone.
Insulin resistance and PCOS
Insulin is a hormone. Its function is to push excess sugar into the tissues.
Unfortunately, sometimes, the tissues resist this action. They refuse to take in the excess sugar. This phenomenon is insulin resistance. Eventually, the levels of sugar in the blood become very high, and there is excess sugar.
It is known that insulin resistance leads to type-II diabetes.
Furthermore, when insulin is also produced and is not getting used-since the body is resisting its action- it also gets excessive. This is a condition known as hyperinsulinemia.
To complicate things further, hyperinsulinemia also stimulates the production of excess androgens (male hormones).
Now, the increase in androgen is coupled with a reduction in the sex hormone-binding globulin(SHBG).
So, with more sex hormones running around and less SHBG to catch them, androgen levels also shoot up. This leads to hyperandrogenism or excess androgens.
Hyperandrogenism and PCOS
Androgens are “male hormones”, like testosterone for example. This does not mean that these so-called male hormones are not present in females at all. Rather, they are only present in little quantities.
The problem only arises when the androgen levels rise higher than they should go, as in this case. It can happen due to excessive insulin levels in your blood, or because the enzyme regulating the formation of androgen is not well regulated itself.
When the levels of male hormones get too high, it disturbs the regular female processes, like ovulation and reproduction.
Abnormal Function of Hypothalamic-Pituitary-Ovarian – HPO Axis
We can say this is a pathway, or a network of communication between the hypothalamus and the pituitary gland in the brain, including the ovaries.
They exchange information that helps to regulate the hormones that govern the reproductive cycles. If there is a disturbance in communication, then there will be hormonal/chemical imbalances.
Consequently, there will be an increase in the ratio of the Luteinizing Hormone (LH) to Follicle Stimulating Hormones (FSH). So, the LH:FSH ratio will now become 3:1 or higher.
A normal balance of these hormones is necessary for proper reproduction processes.
All these cause some really undesirable PCOS symptoms
A lot of symptoms that significantly reduce the quality of life of the patient present in this polycystic ovarian syndrome. Just a few of them are as below:
- Anovulation (inability to produce eggs);
- Menstrual irregularities
- Weight gain (obesity);
- Cysts on the ovaries;
- Acne on face and back
- Excessive hair growth on the face
- Thinning of scalp Hair
- Thick or pigmentation of the skin and on the neck
- Irritability or depression
- Long terms complications like:
- Endometrial hyperplasia.
- Endometrial carcinoma.
- Diabetes mellitus.
- Cardiovascular disease.
- High blood cholesterol
Let’s talk about Hypothyroidism!
Before going to examine how PCOS and thyroid interact, it is necessary to get an overview of hypothyroidism also.
So, what is hypothyroidism? Let’s take it this way
The thyroid gland and your Hormones
The thyroid gland is a butterfly-shaped gland that is located just right at the base of your neck. It is responsible for the production of thyroid hormones.
Two forms of the thyroid hormone are produced: triiodothyronine (T3) and thyroxine (T4).
The gland is just barely 2-inch long and weighs just about a pound, but its importance is nothing to joke with.
This is because the hormones it produces are very important for the proper functioning of your body.
Why? They regulate your metabolism-that is, the reactions going on in your body that keeps you alive.
So, if there is a thyroid disorder, your metabolism could speed up excessively, or become so slow that you even begin to move slowly yourself.
In the case of hypothyroidism, metabolism slows down because of an under active thyroid gland. You produce too little thyroid hormones, and this manifests as several symptoms that include:
- Weight gain
- Feeling cold when others are hot
- Joint and muscle pain
- Puffiness in the face
- Dry and thinning hair
- dry skin
- decreased sweating
- heavy or irregular menstrual periods
- impaired fertility
- reduced heart rate
Pretty much every part of your body is affected. After all, you are a sum total of your metabolic processes.
What causes Hypothyroidism?
The thyroid gland can become underactive due to:
- Hashimoto’s disease: This is an auto-immune disease, in which case the immune system attacks the thyroid gland.
- Inflammation of the thyroid: this is called thyroiditis. Here, thyroid hormones leak out of the gland.
- Congenital hypothyroidism: Hypothyroidism is present at birth.
- Surgical removal of part or all of the thyroid gland.
- Radiation treatment of the thyroid.
Can Thyroid Cause PCOS or Vice-versa?
Okay, now we’re getting to it. How are these two conditions related? Does one cause another, or puts you at risk of the other one? Are they worse together, separately, or it doesn’t even matter? How can these significantly impact your health?
All these and more, you will get to see soon. Stick with it!
Research Indicates PCOS and Thyroid are Related For Some, But Not For All
The association between polycystic ovarian syndrome (PCOS) and thyroid disease is increasingly being recognized.
1. Hashimoto’s Thyroiditis is common in women with PCOS
Remember that one of the causes of hypothyroidism is Hashimoto’s disease. This is what is also referred to as Hashimoto’s thyroiditis. We stated that it is an auto-immune disease.
Just for the sake of clarity, autoimmune disease is one in which the body’s immune system attacks the body itself. In this case, the immune system attacks the thyroid gland, causing it to under perform.
A study that was completed in 2013 showed that women with PCOS are three times more likely to have this autoimmune problem that affects the thyroid gland. Four in ten women with Hashimoto’s disease also have PCOS.
Also, there seems to be some connection between the genes that control this autoimmune disease and the one that leads to PCOS. Therefore, though it is not perfectly clear, there seems to be some genetic basis for a connection between the two.
It might interest you to know that PCOS could be hereditary. Hence, it is no surprise that there are genes that make it more likely that a woman will have PCOS.
2. The Hormone Imbalance in PCOS and Thyroid causes a vicious cycle
The thyroid hormones and the hormones involved in polycystic ovarian syndrome interact with each other. These interactions could be direct or indirect.
All cells in your body depend on thyroid hormones to function properly
You know, throid hormones call the shots on your body’s overall metabolism. Basically, how fast your body can work! So, certainly, thyroid malfunction affects the functioning of the reproductive system also. And this creates your chances of having PCOS.
Hypothyroidism, PCOS, and excess Androgens
Another link between hypothyroidism and PCOS can be found in the levels of androgens present.
If you recall, we mentioned above that hyperandrogenism (excess androgens) is one of the complicating factors for PCOS symptoms.
Also, hyperandrogenism can happen in hypothyroidism. How so?
When you have low levels of thyroid hormones in your body, it can cause an increase in Testosterone (the most common androgen). It does this by reducing the number of sex hormone-binding globulin (SHBG).
On a normal day, this SHBG binds with Testosterone and clears it out of the bloodstream. But in this case, the number of the SHBG has gone down, leaving the Testosterone free to run around. This is similar to what happens in PCOS.
When this happens in hypothyroidism, however, it leads to PCOS symptoms. If the patient already has PCOS, then the symptoms are worsened.
LH:FSH ratio is disturbed
This was also mentioned while discussing how PCOS works above.
LH is the Luteinizing Hormone. It has the responsibility of stimulating ovulation. That is, it causes an egg to be released.
On the other hand, FSH, the Follicle Stimulating Hormone, is responsible for making eggs matured enough. It ensures that the eggs are ripe for release.
However, when the ratio of LH to FSH is above 3:1, there is a problem. Eggs will be released faster than they can mature. So, there are many immature follicles (things that eggs grow in) on the ovary.
This ratio is a big problem in PCOS. But guess what? Hypothyroidism can also play that trick. It does it like so:
When the thyroid is underactive, the levels of prolactin and thyroid-stimulating hormone (TSH) increase. Prolactin goes on to affect the LH:FSH ratio. This has poor effect on the menstrual cycle.
There is, however, no evidence that hypothyroidism can directly cause polycystic ovaries on its own.
3. Both PCOS and hypothyroidism have some symptoms in common
As we have seen earlier, they share some symptoms in common. Though these symptoms might even arise by different means, they could still result in the same things.
Both conditions can cause hyperandrogenism. When male hormones are in excess, then the normal ‘female’ functions are disturbed.
One of those is the menstrual cycle. Irregular periods can occur in either of the two but can be worse when both conditions present together.
Difficulty in getting pregnant
They both affect fertility significantly.
This can follow from the fact that the periods are irregular. The appearance of cysts can also be a factor here.
Remember that the cysts are immature follicles (or immature eggs). Eggs that are not matured cannot get fertilized. Hence, there is difficulty getting pregnant.
Weight gain and effects on metabolism
Weight gain is another symptom that they have in common. Again, this can be a result of hyperandrogenism.
However, in the case of hypothyroidism, weight gain can result from a slow metabolism. This happens when the food that you eat is not digested fast enough.
It can also be due to nutrients that are not utilized properly. These get accumulated till you have more than you need. Eventually, weight gain results.
PCOS also causes weight gain in its own way. In this case, insulin resistance is the culprit. Since the cells refuse to take in excess sugar, the sugar accumulates.
Eventually, this sugar gets converted to fat for storage. This can lead to obesity, which will, in turn, worsen PCOS symptoms.
This is another common symptom between hypothyroidism and PCOS.
Diet, Lifestyle, and Herbs to Manage your Health with PCOS and Thyroid
The first and most vital step is getting the proper diagnosis.
As you have observed, these two conditions share a lot of symptoms. That’s why, it is possible to think that you have PCOS, when actually you have hypothyroidism.
For some women, the problems might not even show up till they try to get pregnant.
In either case, early detection and prompt management are key. Here are some diet and lifestyle tips manage your health and hormone balance with PCOS and Thyroid:
1. Manage your Blood Sugar Level
This is beneficial in eliminating both PCOS and hypothyroidism.
In PCOS, one of the major issues is insulin resistance, which prevents proper sugar metabolism. So, you want to assist your body as much as you can.
One way is to manage your sugar levels. Taking a PCOS diet can help you do this appropriately.
Some studies have also linked insulin resistance and Hashimoto’s disease.
When you take a PCOS diet plan, it not only helps manage sugar levels but can help break the vicious cycle of PCOS symptoms.
A PCOS diet plan should look something like this:
- Take sufficient protein in your diet
- Reduce your sugar intake (obviously). Your sources of sugar should be slow-carbs (low GI foods)
- Reduce your intake of processed foods. Eat plenty of natural, wholesome, and freshly prepared foods.
- Take lots of fruits, vegetables, and fiber.
- Eat healthy fats. You can find healthy fats in seeds, nuts, fatty fish, and some fruits such as Avocado
- Eat an anti-inflammatory diet, which includes fresh foods with high intake of vegetables, whole grains, seeds, nuts, and fruits
- Be moderate in your consumption of cauliflower, cabbage, and capsicum. These are known to trap iodine in the bloodstream, and this can worsen hypothyroidism.
- Remove all processed foods and inflammatory food products from your diet. Some examples are packaged snacks, ready meals, packaged drinks, sugar, refined oils, and pastries, and candies.
2. Improve your lifestyle to Balance your Hormones
Both PCOS and thyroid disorder significantly affect how your body operates. Hence, you do not want to stress your body further, especially if you have these two conditions to deal with.
- Sleep well. Aim for 7-8 hours of adequate sleep each night
- Regularly practice breathing exercises (pranayama), yoga, and meditation. These activities help you relax from the inside out.
- Exercise is important. Eating healthy alone without exercising will not cut it. However, be careful to not stress yourself out with excessive exercise.
- Manage your stress levels
- Practice self care and take time off on regular intervals
3. Ayurvedic Herbs and Home Remedies for PCOS and Thyroid
- Have fenugreek seeds before eating food, that is, on an empty stomach.
- Licorice root is highly effective for restoring the levels of androgens back to normal. High androgen is a problem in both hypothyroidism and PCOS, so this helps a lot.
- Apply asafoetida (a pinch in warm water)over your stomach during your menstrual cycle. This will help relieve the intense pain that PCOS can cause.
- Coriander and mint juice can also serve the above purpose.
- Adaptogens as Shatavari and Ashwagandha are two highly effective Ayurvedic herbs that support your Thyroid function and Reproductive System.
- Cinnamon is another culinary herb/spice that works well to manage insulin resistance.
4. Iodine is essential
The thyroid gland cannot function without iodine. There is no way it can make the hormones that it does without this mineral. Therefore, for hypothyroidism, you should include sufficient iodine in your diet.
You can find iodine in:
- Iodized salt
- Dairy products
If you intend to take herbal solutions or home remedies, alone or alongside medications, then discuss it with your doctor.
If you would prefer to take medications, ensure that you are fully aware of whatever side effects those might cause you in the long run.
Can PCOS and Thyroid Patients Get Pregnant?
PCOS and Thyroid patients may find it difficult to get pregnant due to several hormones being in disturbed state. However, it is not impossible!
Check out the pregnancy success story of Jenna Louise Barrett on how she finally got there despite being diagnosed with PCOS and Thyroid dysfunction.
Since having under functioning thyroid affects your health and your baby’s health during pregnancy, it is important that you discuss your health conditions and your intention to conceive with your gynae.
She will be able to advise you on the link between your medications, if you are on any, and how to prepare for a pregnancy.
Do write to us for any queries, comments, and feedback. We will try to get back the soonest we can!
- Thyroid disorders and polycystic ovary syndrome: An emerging relationship
- MECHANISMS IN ENDOCRINOLOGY: Thyroid and polycystic ovary syndrome
- Subclinical Hypothyroidism in PCOS: Impact on Presentation, Insulin Resistance, and Cardiovascular Risk