Table of Contents

• Tackling Polycystic Ovary Syndrome (PCOS) and Hashimoto’s
• What is PCOS?
• How is PCOS diagnosed?
• When should you get a medical assessment for PCOS?
• What causes PCOS?
• How are Hashimoto’s and PCOS connected?
• How to overcome PCOS with Hashimoto’s?
• Conclusion

Tackling Polycystic Ovary Syndrome (PCOS) and Hashimoto’s

Polycystic ovary syndrome affects 6.7% of all women, but up to 18 – 40% of women with Hashimoto’s also have PCOS. If you’re of Asian, European, or South American descent, your risk of PCOS is higher [1].

Hashimoto’s is difficult enough to manage on its own, but also having PCOS makes it worse. Also, because PCOS is obscure, a large study found that 1 in 3 PCOS patients took over 2 years, and 47% of them saw 3 or more doctors before they finally got diagnosed [2].

One of the reasons PCOS adds difficulty to Hashimoto’s is that both cause similar problems in your body. Weight gain, insulin resistance, mood issues, fatigue and elevated blood lipids are common to both conditions. Over time, the metabolic problems lead to increased risks for diabetes, obesity, and heart disease. 

For those looking to start a family, both Hashimoto’s and PCOS can cause infertility. When they occur together, chances of infertility are worse than either alone.

The good news is that you can thrive despite having both conditions. In this article, we will first cover what PCOS is and whether you should see a doctor to rule it out. Then we’ll discuss how it’s connected to Hashimoto’s, and how you can lose weight and feel great with both PCOS and Hashimoto’s.

What is PCOS?

PCOS is a neuro, hormonal, and metabolic condition. These abnormalities can disrupt egg or uterine lining development, causing ovarian cyst and infertility. 

The following symptoms and changes are common in PCOS, but none is present in all PCOS patients: 

• Weight gain and obesity
• Absent or irregular menstrual cycles, due to hormone changes
• Elevated testosterone or other androgens (male sex hormones)
• Male sex characteristics such as balding, male-pattern hair growth, excess hair growth, and acne 
• Insulin resistance and high blood sugar
• Acanthosis nigrans (dark and thickened skin in armpits, neck, knuckles, and skin folds) from high insulin
• Anxiety and depression
• Headaches
• Fatigue

How is PCOS diagnosed?

PCOS is hard to diagnose because there is no one test or symptom that can definitively diagnose PCOS. Your doctor will take symptoms, history, some blood tests, and potentially imaging of the ovaries.

Diagnosis of PCOS is based on the presence of at least two out of three criteria. 

1. Clinical signs of androgen excess and/or elevated androgen blood test 
2. Lack of or irregular ovulation/menstrual cycle
3. Polycystic ovaries on ultrasound

Because PCOS symptoms are obscure and easily confused with other conditions, the diagnosis is often delayed. 

Other blood tests that help point toward PCOS are insulin, hemoglobin A1C, other sex hormone labs, and Anti-Müllerian hormone (AMH). Elevated AMH is present in ~92% of women with PCOS [3].

When should you get a medical assessment for PCOS?

If any of the signs and symptoms mentioned here are present, it is important to have your hormones and blood sugar control measured. While conventional doctors may not immediately recognize PCOS, most natural and functional medicine practitioners are very familiar with the diagnosis and treatment of PCOS. 

If you are taking the necessary steps to address Hashimoto’s and you are still experiencing the symptoms that can be caused by PCOS, you should get assessed.

What causes PCOS?

PCOS, like most complex chronic illnesses, is likely the result of many different factors, which may include:

• Genetic susceptibility
• Whole-body inflammation and autoimmunity that contribute to [1,4]. 
• Exposure to high AMH, insulin, and androgens in the womb [5–7].  
• Infections and environmental exposure to hormone disruptors, which may happen in the womb or later in life [8].

Exposures in the womb can mark on your DNA, changing your gene readouts well into adulthood. These are called epigenetic (without changing your DNA sequence) marks. The marks can increase the risk of PCOS. The combined effects of genetic and epigenetic changes may explain why PCOS runs in the family.

How are Hashimoto’s and PCOS connected?

In the diagnosis of PCOS, your doctor will try to rule out hypothyroidism as both conditions present similarly [9]. 

Key differences between Hashimoto’s and PCOS:

• Hashimoto’s doesn’t tend to cause elevated androgens to the same extent as PCOS in premenopausal women. So, Hashimoto’s alone also doesn’t tend to cause male characteristics. However, postmenopausal women with Hashimoto’s do have somewhat higher testosterone than those without Hashimoto’s [10].
• PCOS doesn’t come with thyroid antibodies, thyroid dysfunction, or nodules
• The genes that increase the risk of Hashimoto’s relate to immune function, whereas genes that predispose for PCOS relate to producing sex hormones [10,11]. 

Key similarities may include: 

• Both conditions involve autoimmunity and whole-body inflammation. Inflammation can make both worse.
• Obvious common symptoms, such as weight gain, insulin resistance, anxiety/depression, and fatigue. When both conditions are present, these symptoms can be worse than if you have either alone [12].
• Both can cause polycystic ovarian cysts, but in different ways. With Hashimoto’s, you may not have enough thyroid hormones to stimulate egg development and ovulation [13]. Whereas, with PCOS, the excess testosterone and estrogen can interfere with egg growth and ovulation [14]. 
• Both can cause infertility. When both conditions are present, the compound effects on fertility are worse than either alone[12].  

 Aside from managing Hashimoto’s, you have to address PCOS appropriately to minimize the compounding effect.

How to overcome PCOS with Hashimoto’s?

The severity of PCOS in the presence of Hashimoto’s depends on how long your immune system has been attacking the thyroid and how long it has been dysfunctional. In addition, PCOS may respond more poorly to treatment when present with uncontrolled Hashimoto’s [12]. 

For these reasons, you have to first get thyroid hormones in optimal ranges by working with your doctor and functional medicine doctor.

After you take the steps to tackle Hashimoto’s, many of the following steps are in parallel for both PCOS and Hashimoto’s.

Diet

Inflammation influences the severity of PCOS and Hashimoto’s. And food is one of the ways to manage inflammation. 

The autoimmune protocol (AIP) diet is a foundational diet for autoimmune diseases that can help with both Hashimoto’s and PCOS. The AIP diet removes potential inflammatory and immune activating foods, while also helping you balance your blood sugar. When you re-introduce some of the foods, you’ll also identify potential food intolerances that create inflammation.

Intermittent fasting (IF) can help manage blood sugar, improve insulin sensitivity, and reduce inflammation, all of which are beneficial for PCOS[15]. If you also have Hashimoto’s, you do have to be careful with fasting as too aggressive fasting can reduce thyroid function through the starvation response. So, I recommend fasting no longer than 16 hours. Everyone can benefit from fasting 12 hours between dinner and breakfast, but you may benefit more from prolonging the fast for up to 16 hours.

A ketogenic diet may be beneficial for PCOS as well since it helps with insulin sensitivity, hormone balance, and inflammation[16]. However, keto can activate your starvation response, which dials down your thyroid function. If you go keto with Hashimoto’s and PCOS, it’s a good idea to work with a practitioner to monitor your labs. Also, cycling out of keto at least weekly as appropriate can help maintain your thyroid function. 

Exercise and Resistance Training

Regular exercise can improve insulin sensitivity, metabolism, and mental health symptoms associated with both PCOS and Hashimoto’s. Exercise can also help with menstrual cycle regularity and ovulation frequency [17].

In combination with diet, exercise may decrease testosterone levels, decrease excess hair growth, improve insulin sensitivity, and lead to significant weight loss in women with PCOS [18].

But having Hashimoto’s can present many symptoms that make it harder to exercise, such as joint pain, hypermobility, debilitating fatigue, and exercise intolerance. Common ways people exercise can aggravate these symptoms. This is why I created Thyroid Strong to help you build muscles and overcome these roadblocks without making your symptoms worse. 

Stress Management

Unmanaged stress is associated with insulin resistance, weight gain, and more inflammation. So, you want to engage in regular stress management practices.

If you struggle with anxiety or depression, it’s also important to see a mental health professional. They’ll also help you build skills to cope with and dissipate the effects of stress.

Herb and Supplement Support

Many natural supplements can help you balance hormones, immune function, and blood sugar. Herbs like turmeric, cinnamon, and Siberian ginseng can balance inflammation and promote healthy blood sugar control. 

Specific nutrients like B vitamins, selenium, magnesium, and inositol may be beneficial for PCOS as well.

Since there are many moving parts in managing PCOS and Hashimoto’s, it’s important to consult a naturopathic physician who will thoroughly review your case before deciding on what supplements are best for you.

Conclusion

If you suspect you have PCOS, get an appropriate medical workup to rule it out or get diagnosed. If you do have PCOS and Hashimoto’s, don’t get discouraged. With appropriate treatment and commitment to lifestyle changes, you can manage Hashimoto’s and begin to balance much of what is going wrong in PCOS. In fact, when you dial in your nutrition, lifestyle, and exercise, it’s possible to thrive and look great despite both.

In good health,

Dr. Emily Kiberd

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