Why Regular Bowel Movements Matter for PCOS

When you think about PCOS, you might picture irregular cycles, unwanted hair growth, or struggles with weight. But did you know that your digestive health - and how often you go to the loo - can play a big role too?

Constipation and sluggish digestion are really common in women with PCOS. In fact, research shows women with PCOS are more likely to experience IBS and constipation than those without PCOS. And with the rise of GLP-1 medications (like Ozempic, Wegovy, or Mounjaro), constipation has become an even more frequent side effect.

It might not feel like the most glamorous topic, but ignoring irregular bowel movements can make PCOS symptoms worse - and here’s why.

How Digestive Health Links to PCOS

Your gut and your ovaries are more connected than you might think. A sluggish bowel doesn’t just cause bloating and discomfort - it can actually drive the root causes of PCOS.

• Gut microbiome disruption: When stool sits too long, it changes the balance of bacteria in your gut. Harmful bacteria get more time to grow, leading to dysbiosis. Women with PCOS already tend to have lower gut microbial diversity. Dysbiosis fuels inflammation and makes insulin resistance worse - both key features of PCOS.

  
  

• Inflammation: Slow transit means bacterial toxins like lipopolysaccharides (LPS) can leak into the bloodstream. PCOS is already an inflammatory condition, and extra LPS drives up markers like CRP and cytokines. This chronic “immune activation” makes PCOS symptoms more severe.

  
  

• Insulin resistance: Inflammation makes cells less responsive to insulin. That means higher insulin levels, which push the ovaries to make more testosterone. The result? More acne, irregular periods, and excess hair growth.

  
  

• Hormone recycling (the estrobolome): Your liver packages up hormones like oestrogen to be eliminated in stool. But if you’re constipated, gut bacteria can “unpack” them using an enzyme called β-glucuronidase. Oestrogen is then reabsorbed into the bloodstream. This contributes to hormone imbalances, unopposed oestrogen, and potential endometrial issues - all of which are already common in PCOS.

  
  

👉 In short: constipation and gut imbalance create a vicious cycle - driving inflammation, insulin resistance, and hormone swings that make PCOS harder to manage.

Why GLP-1s Can Make Things Worse

GLP-1 medications (like semaglutide or tirzepatide) are increasingly used in PCOS for weight management and insulin resistance. They work by slowing digestion, helping you feel fuller for

longer.

But that same mechanism can lead to nausea, bloating, and constipation. Studies show around 30% of people on GLP-1s experience constipation. For women with PCOS, who may already have sluggish digestion, this side effect can be especially challenging.

That doesn’t mean GLP-1s aren’t helpful - they can be transformative. It just means gut health support is even more important if you’re on them.

How to Support Regular Bowel Movements

The good news? Supporting your gut can ease constipation and improve PCOS symptoms.

• Fibre is key. Most women in the UK eat only 15–18g per day, but the goal is at least 25–30g. Fibre feeds beneficial gut bacteria, reduces inflammation, and improves insulin sensitivity.

  
  

• Hydration. Fibre only works well if paired with enough water (around 2 litres per day).

  
  

• Movement. Even light activity like a daily walk can stimulate bowel motility and improve insulin resistance.

  
  

• Magnesium-rich foods. Wholegrains, nuts, seeds, and leafy greens provide magnesium, which supports both bowel function and insulin sensitivity.

  
  

Easy fibre wins:

• Chia seeds – 1 tbsp = ~5g fibre

• Ground flaxseed – 1 tbsp = ~3g fibre

• Raspberries – 1 cup (150g) = ~8g fibre

• Cooked lentils – ½ cup = ~8g fibre

• Broccoli – 1 cup = ~5g fibre

• Almonds – 30g = ~4g fibre

• Oats – 40g serving = ~4g fibre

• Dark Chocolate (70%) – 20g serving (2 Squares) = ~2g fibre

• Apple – 80g serving (1 apple) = ~2g fibre

  
  

💡 Aim for variety: different plant foods (fruits, vegetables, legumes, nuts, seeds, and wholegrains) nurture a diverse microbiome - which is exactly what women with PCOS need.

Constipation isn’t just uncomfortable - it can worsen the root drivers of PCOS: inflammation, insulin resistance, and hormone imbalance.

Whether or not you’re on GLP-1 medication, supporting regular bowel movements with fibre, hydration, and movement is a simple but powerful step in managing PCOS.

Frequently Asked Questions about PCOS and Constipation

1. Is constipation common in women with PCOS? Yes. Research shows women with PCOS are more likely to experience constipation and other IBS-like symptoms than women without PCOS. Hormone imbalances, inflammation, and insulin resistance can all affect gut motility.

2. Can constipation make PCOS symptoms worse? It can. Constipation contributes to gut dysbiosis, increased inflammation, and reabsorption of hormones like oestrogen. All of these can worsen PCOS symptoms such as irregular cycles, acne, fatigue, and bloating.

3. Do GLP-1 medications cause constipation? GLP-1 medications (like Ozempic, Wegovy, Mounjaro) often slow down digestion. Around 30% of people taking them experience constipation. For women with PCOS, who may already have sluggish digestion, this side effect can be more noticeable.

4. What helps constipation in PCOS? The best strategies include eating enough fibre (25–30g/day), staying hydrated, moving daily, and including magnesium-rich foods. If constipation persists, it’s worth speaking with a healthcare professional for tailored advice.

5. Should I take a fibre supplement for PCOS? Food sources of fibre are best, as they feed a diverse gut microbiome and provide extra vitamins and minerals. But fibre supplements (like psyllium husk) can be useful if you’re struggling to meet your needs through food alone.

References:

Escobar-Morreale, H.F., 2018. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nature Reviews Endocrinology, 14(5), pp.270–284.

Guo, Y., Qi, Y., Yang, X., Zhao, L., Wen, S., Liu, Y., Tang, L. and Li, L., 2016. Association between polycystic ovary syndrome and gut microbiota. PLoS ONE, 11(4), p.e0153196.

Kelly, C., Lyall, H., Petrie, J., Gould, G. and Connell, J., 2001. Low grade chronic inflammation in women with polycystic ovarian syndrome. Journal of Clinical Endocrinology & Metabolism, 86(6), pp.2453–2455.

Qi, X., Yun, C., Sun, L., Xia, J., Wu, Q., Wang, Y., Wang, L., Zhang, Y., Liang, X., Wang, L., Gonzalez, F.J. and Patterson, A.D., 2019. Gut microbiota–bile acid–interleukin-22 axis orchestrates polycystic ovary syndrome. Nature Medicine, 25(8), pp.1225–1233.

Tremellen, K. and Pearce, K., 2012. Dysbiosis of gut microbiota (DOGMA)–a novel theory for the development of polycystic ovarian syndrome. Medical Hypotheses, 79(1), pp.104–112.

Zhang, J., Sun, Z., Jiang, S., Bai, X., Ma, C., Peng, Q., Guo, H. and Wang, J., 2019. Probiotic Bifidobacterium lactis V9 regulates the balance of Th17/Treg cells via the intestinal microbiota in PCOS patients. Food & Function, 10(7), pp.2750–2761.

Zhang, J., Xu, J., Ruan, Y., Chen, Y., Wei, X., Gong, F. and Yang, H., 2020. Randomized controlled trial of probiotics in the treatment of polycystic ovary syndrome. Fertility and Sterility, 113(1), pp.229–240.

Zhao, Y., Chi, H., Sun, Y., Yang, X., Zhang, M., Bi, Y., Xu, Y., Zhao, Y., 2020. Effects of GLP-1 receptor agonists on weight loss and metabolic profiles in women with polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials. BMC Endocrine Disorders, 20, p.111.