PCOS in women with Hashimoto’s disease

Polycystic ovary syndrome (PCOS) or Stein-Leventhal syndrome is the most common endocrine disorder that affects 6 to 12% of women of reproductive age. The clinical manifestation of PCOS varies from mild menstrual abnormalities to severe disturbances in reproductive function and metabolism.

Women with PCOS have altered metabolism of estrogen and androgenic hormones such as testosterone, androstenedione and dehydroepiandrosterone sulfate (DHEAS). The vast majority of women with PCOS have severe insulin resistance, insulin spikes or constantly elevated insulin levels called hyperinsulinemia, which are all the underlying causes of PCOS.

Excess of insulin stimulates the ovary’s hormone production causing high androgen levels. At PCOS, conversion of testosterone to estrogen in the ovaries is impaired and results in an excess of testosterone. Male pattern baldness and hair loss are common symptoms of PCOS due to conversion of excess of testosterone to its metabolite DHT. Balancing hormones and reversing PCOS can help to stop hair loss and promote its re-growth.

In addition, women with PCOS have lower adiponectin levels in comparison to women without PCOS that contributes to the weight gain. Adiponectin is a hormone secreted by adipocytes that regulates lipid metabolism and glucose levels.

Who is at risk for PCOS?

Development of PCOS is determined by genetics, gender, diet, lifestyle and excess of body fat. The disease often runs in the family. A combination of several genes many of which also involved in action of insulin and in the production or metabolism of the sex hormones suggests a predisposition to PCOS.

Environmental factors such as diet high in carbohydrates, lack of physical exercise, weight gain and steroid medication can trigger insulin resistance and PCOS. As overweight or obese women become insulin resistant, this can cause metabolic and hormonal changes that make the development of PCOS more likely.

The symptoms of PCOS can occur at any age, however the disease often begins around puberty due to a natural raise in insulin. The first signs of PCOS could be seen in teenage girls as early as ten years old.

As the women with PCOS get older, they tend to have more regular cycles because levels of male hormone decline with age. The disease also continues after menopause and in some women testosterone may remain high promoting health issues such as cardiovascular disease and endometrial cancer.

Connection to Hashimoto’s disease

Insulin resistance also promotes inflammation and immune system abnormalities that predispose women to the development of autoimmune diseases and can trigger Hashimoto’s thyroiditis.

About one third of women with PCOS have elevated thyroid antibodies. Thyroid tissue damage typical of Hashimoto’s disease was found in more than 40% of the PCOS women who also had high levels of TSH.

Ask Dr. Brady Hurst at True Health Labs about the tests and treatment options for PCOS and Hashimoto’s disease here.

Hormonal changes in women with PCOS such as high estrogen in comparison to progesterone could be related to the increase of autoimmune thyroiditis during menopause and also account for the higher prevalence of Hashimoto’s in PCOS. As patients with PCOS have low progesterone levels because of non-ovulatory cycles, the immune system in these patients seems to be over stimulated, which may contribute to autoimmune disease.

Other autoimmune diseases such as lupus are also more common in women with PCOS. In general, about 40% of patients with PCOS show high levels of antibodies and predisposition to any autoimmune disease.

Women with PCOS are prone to have not only a thyroid imbalance but also are genetically predisposed to development of depression or bipolar disorder which was found in about 28% of the patients with PCOS.

Besides Hashimoto’s disease, diabetes and insulin resistance could be the other underlying cause of hypothyroidism in women with PCOS. Impaired blood sugar metabolism in PCOS patients leads to elevated testosterone levels that affect conversion of thyroid hormones T4 into T3 and production of thyroid binding globulin (TGB). Excess of T3 causes the cells develop resistance to the thyroid hormone. The women experience hypothyroid symptoms because T3 could not get into the cells. Reversing insuline resistance with diet, supplements and exercise is critical for reversing the hypothyroid symptoms in this group of patients.

Health risks

PCOS can be an early warning for more serious health issues. Due to insulin resistance up to 40% of women with PCOS develop impaired glucose tolerance or progress to diabetes by the age of forty.

Having PCOS increases the likelihood that the following medical problems will arise over time:

  • Metabolic syndrome
  • Type 2 diabetes
  • Heart disease and stroke
  • Early miscarriages
  • Preeclampsia which is hypertension in pregnancy
  • Sleep disorders and depression
  • Alzheimer’s disease
  • Hypertension
  • Fatty liver
  • Cancer of the uterus.

Symptoms and signs of PCOS

  • Irregular periods or no periods
  • Painful or unusually heavy or light periods
  • Irregular or absent ovulation
  • Hirsutism with excessive hair in unwanted areas such as face, stomach, thighs, arms and breasts due to high levels of testosterone
  • Alopecia with thinning hair or male pattern baldness
  • High blood pressure
  • Infertility
  • Obesity and weight gain especially around the midsection
  • Difficulty to lose weight because of high insulin which can also suppress the use of fat as a source of energy
  • Insulin resistance or hypoglycemia
  • Sugar cravings
  • Fatigue, especially after meals
  • Depression or seasonal affective disorder due to a possible vitamin D deficiency
  • Mood swings, some women report feelings of anger or aggression
  • Acne and oily complexion
  • Abnormal ovarian cysts are present in many but not all women with PCOS
  • Dark skin patches, often found on the nape of the neck, groin and under the breasts
  • High cholesterol and triglycerides levels
  • Decreased sex drive
  • Excessive male hormones such as androgens, DHEAS or testosterone
  • Decreased breast size
  • Enlarged ovaries
  • Enlarged uterus

Diagnosis and tests

It is vital to diagnose and treat women and girls as early as possible in order to prevent their PCOS progressing to the fully developed disease. To be diagnosed with PCOS a woman must have minimum two out of three following features:

  • lack of ovulation manifested by irregular or absence of periods
  • signs of excessive male hormones such as acne, facial and body hair
  • polycystic ovaries (not in all cases)

The diagnosis of PCOS can be made based on the following test:

  • Evaluation of the insulin resistance using fasting glucose, fasting insulin and hemoglobin A1C blood tests
  • Elevated triglycerides and cholesterol, especially if triglycerides are higher than cholesterol
  • Measurement of free testosterone and DHEAS to evaluate the levels of androgens
  • Blood tests for thyroid TPO and Tgb antibodies to establish possible connection to autoimmune thyroid diseases such as Hashimoto’s thyroiditis
  • Ultrasound of ovaries

You can get tested for PCOS at True Health Labs.

Conventional treatment for PCOS

Management of PCOS in women depends on the symptoms that could be ovulatory dysfunction related infertility, menstrual disorders or androgen related symptoms.

Losing weight is the most important component in the treatment of PCOS. After losing some weight, periods may become regular, excess hair growth may go away and infertility problems may disappear. Reducing simple sugars in the diet is one of the most important ways in PCOS management.

Hormonal changes normally occur slowly and to see the first benefits of any treatment it will take a minimum of five to six months. The key to success is early diagnosis and treatment combined with diet and exercise.

It is important for women with PCOS to continue medical management beyond menopause. Life style modifications such as diet and exercise might be a life-long requirement. This makes it all the more critical that the diet and life style women choose is one that is able to be followed for a long period of time.

Until recently, the popular medical approach of treating PCOS was to use an oral contraceptive pill in order to suppress the ovarian function and replace estrogen. While this is effective, birth control pills do not address the insulin resistance which is the underlying cause of PCOS.

There is also a growing controversy over using pills. The use of oral contraceptives can have a short-term benefits such as reduction of testosterone production and help to restore periods. However, with time it can actually disrupt natural hormone levels, worsen the insulin resistance and PCOS.

In recent years, and with a better understanding of the metabolic basis of PCOS, the emphasis has shifted to managing insulin resistance in PCOS with an integrated program of diet, regular exercise and insulin sensitizing drugs such as metformin and others.

Metformin also helps with weight loss, improvement of acne, normalization of testosterone and insulin levels, resumption of regular periods, ovulation and pregnancy, however the results vary. Many women who take Metformin have gastrointestinal side effects such as diarrhea, gas and bloating, abdominal discomfort, nausea and vomiting.

How to reverse PCOS naturally

Natural PCOS Diet is a safe and effective alternative to using Metformin and oral contraceptives.  In response to thousands of women asking for a professional information about PCOS Dr. Jenny Blondel wrote her e-book the Natural PCOS Diet. She is a leading Australian Naturopath who provides you with an easy step-by-step guide how to reverse PCOS, increase your chances of conceiving,  end food cravings, achieve clearer skin, reduce excess hair growth, lose weight and start to feel good again.

Figuring out how to overcome PCOS is not only difficult but next to impossible without expert help. Dr. Blondel will provide you with an expert information on how to improve insulin resistance, balance major hormones and reverse PCOS using healthy foods, supplements and herbs as well as making simple lifestyle changes and following an eating plan that brings results.

P.S. If you would like to learn more about Hashimoto’s thyroididis please subscribe to Outsmat Disease blog updates and get an e-mail course Nutritional guide for Hashimoto’s disease for FREE


The new glucose revolution guide to living well with PCOS by J. Brand-Miller, N.R. Farid, Kate Marsh, Da Capo Press, 2004

What you must know about women’s hormones: Your guide to natural hormone treatments for PMS, Menopause, Osteoporosis, PCOS, and more by Dr. P.Wartian Smith, Square One Publishers, 2009

Why do I still have thyroid symptoms? When my Lab tests are normal: a revolutionary breakthrough in understanding Hashimoto’s disease and hypothyroidism by D. Kharrazian, Morgan James Publishing, 2010


Treatment options for polycystic ovary syndrome. Int J Womens Health.2011 Feb 8;3:25-35.

High prevalence of autoimmune thyroiditis in patients with polycystic ovary syndrome. Eur J Endocrinol. 2004 Mar;150(3):363-9.

About Marina Gutner, PhD

Marina Gutner, PhD, researcher, medical writer, thyroid blogger, founder and Admin of Outsmart Disease who writes about life-changing treatments for hypothyroidism, Hashimoto's thyroiditis and autoimmune disease and how to balance hormones in women