PCOS, BV and the vaginal microbiome

Polycystic ovarian syndrome (PCOS) is one of the most commonly diagnosed conditions in premenopausal women and people with a functional female reproductive tract. The main features of PCOS are excess androgen production by the ovaries/androgen sensitivity, lack of ovulation, infertility and insulin resistance^​1​.

PCOS is also linked with menstrual disorders, infertility, excess hair growth (hirsutism), acne, weight management and metabolic disturbances^​1​, with far-reaching impacts beyond irregular periods and into advancing age^​2​.

Research shows changes to the gut and vaginal microbiome in people with PCOS, with differences compared to those without PCOS. Studies suggest changes in microbial diversity and possible dysbiosis (microbial imbalances).^​3​

Low-grade chronic inflammation can occur due to microbiome disturbances, particularly when excess in certain bacterial species contributes to metabolic disorders^​2,4​.

The vaginal microbiome and its relationship to PCOS symptoms is not well understood, but some studies show reductions in Lactobacillus species, particularly L. crispatus, and increases in Prevotella and other atypical pathogens (Mycoplasma, Chlamydia)^​5​.

Pathogen growth is favoured, promoting the growth of bacterial vaginosis (BV)-causing microbes such as Gardnerella vaginalis^​6​.

In one study^​7​ on the vaginal microbiome and women with PCOS, BV was suspected in 64% of the PCOS group, with an increase in G. vaginalis found in 57%. The researchers suggested a higher rate of BV in PCOS patients than the general population.

Studies on the gut, oral cavity and vaginal microbiome in people with PCOS indicate an increased propensity to inflammation, thus destabilisation of the microbial environment^​8,9​. High triglycerides, fasting glucose and insulin levels, and metabolic disturbances are known to impact the microbiome^{​10–12​}.

Achieving a balanced microbiome by controlling the various imbalances inherent in PCOS is important for management of inflammation and the dysbiotic microbiomes, while also working from the microbiome backwards. It is well observed that the gut microbiome impacts sex hormones^​13​.

When the vaginal microbiome is disrupted and there is systematic inflammation, IL-8 and tumour necrosis factor alpha are increased, impacting the hypothalamic-pituitary-ovarian axis (HPA axis) via blood and lymph.^{​5,14,15​}

Interruptions to normal levels of oestrogen and progesterone due to irregular cycles affects the vaginal epithelial lining of the vagina and reproductive tract, which plays an important role in the vaginal microbiome^​3​.

Androgens have been demonstrated to affect the gut microbiome in women with PCOS and androgen excess^{​13,16,17​}. Women with high testosterone have higher gut microbiome diversity, more G. vaginalis, and numbers of lactobacilli^​2,3,6​. The length of menstrual cycles impacts lactobacilli levels^​5,10​, resulting in greater access by disruptive microbes.

References^​7​

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