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Polycystic Ovary Syndrome (PCOS) and hypothyroidism are two prevalent endocrine disorders that often intersect in a complex combination that can present unique challenges for those affected. The convergence of these two conditions is unique, especially because there is often an overlap of symptoms that can cause specific and complex health challenges. Studies show that the incidence of hypothyroidism is higher in patients also diagnosed with PCOS. This tricky combination means that it’s crucial to address both conditions simultaneously.

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Polycystic ovary syndrome (PCOS) is a common hormonal imbalance that affects up to 15% of women of reproductive age. It affects 1 in 10 women worldwide, with 50% of women going undiagnosed. PCOS causes the ovaries to produce excess androgens (such as testosterone) and can cause symptoms such as irregular menstrual cycles, unpredictable ovulation, excess facial and body hair growth, severe acne, insulin resistance, anxiety and depression, infertility (PCOS is the leading cause), unintentional weight gain, and male pattern hair loss. Women with PCOS may also experience mood swings, fatigue, and sleep disturbances. In addition, some women develop small follicle cysts in the ovaries.

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Here’s how PCOS is diagnosed:

1. Medical History: The first step in diagnosing PCOS is discussing your symptoms and medical history with your healthcare provider. They will ask about your menstrual cycles, any difficulties getting pregnant, and any other symptoms you may be experiencing.

2. Physical Examination: A physical examination is usually performed to check for physical signs of PCOS. This exam may include measuring your blood pressure, checking for excess hair growth, and examining your abdomen and pelvis for abnormalities.

3. Blood Tests: Blood tests are often conducted to measure hormone levels and rule out other conditions that may have similar symptoms to PCOS. These tests can include measuring levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, and insulin. High levels of androgens and insulin are common in women with PCOS.

4. Pelvic Ultrasound: A pelvic ultrasound is typically done to examine the ovaries for any cysts or enlarged ovaries. This is not a definitive test for PCOS, as not all women with PCOS will have cysts. However, it can provide helpful information in combination with other diagnostic criteria.

5. Diagnostic Criteria: Different sets of diagnostic criteria are used to diagnose PCOS. The most commonly used is the Rotterdam criteria, which requires that a patient meets two of the following three criteria:

1. Irregular ovulation, an irregular menstrual cycle, or lack of a menstrual cycle
2. Tests confirming elevated androgen levels
3. Multiple small cysts on the ovaries

It is important to note that the diagnosis of PCOS can be complex, as symptoms can vary widely among individuals. It may require multiple visits and tests to reach a definitive diagnosis. Other conditions with similar symptoms may need to be ruled out, such as thyroid dysfunction or adrenal gland disorders.

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The symptoms of PCOS and hypothyroidism share a lot of similarities. Symptoms of hypothyroidism that are also seen in women with PCOS include unintentional weight gain or difficulty losing unwanted weight, depression, irregular menstrual cycles, and fertility challenges.

It is unclear whether one condition causes the other; however, the prevalence of both conditions occurring together is more common in women today. The Indian Journal of Endocrinology and Metabolism mentions that the risk of thyroid autoimmunity is higher in PCOS patients, who also tend to have higher thyroid antibody levels. Those with high TSH (thyroid stimulating hormone) levels and other thyroid abnormalities may also be at risk of worsened cardiometabolic health or other reproductive issues, both often seen in those with PCOS. For those with subclinical hypothyroidism, it has been shown that abnormal fasting plasma glucose levels and insulin resistance index may occur versus those women without subclinical hypothyroidism. Results of a clinical study of over 4,000 PCOS patients indicated the incidence of metabolic syndrome was higher in those with subclinical hypothyroidism, which indicated that subclinical hypothyroidism may aggravate the metabolic disorders seen in PCOS patients. 

PCOS is also connected to Hashimoto's thyroiditis, the autoimmune disorder that is the most common cause of hypothyroidism in the United States. Women with PCOS are at a higher risk of developing autoimmune diseases like Hashimoto's thyroiditis. This may be due to shared genetic factors or the impact of hormonal imbalances on the immune system.

Furthermore, studies have shown that women with PCOS often have higher levels of thyroid-stimulating hormone (TSH), which indicates an underactive thyroid. This elevation in TSH levels may be an early sign of Hashimoto's thyroiditis in individuals with PCOS. Conversely, women with Hashimoto's thyroiditis may be more prone to developing PCOS due to the disruption of hormonal regulation caused by their thyroid condition.

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What might cause someone to develop both PCOS and hypothyroidism?  Below are some of the more common underlying factors:

• Inflammation: Chronic inflammation, which is heightened in those with PCOS and/or hypothyroidism, can contribute to hormonal disruptions and insulin resistance
• Insulin resistance: This is a condition where cells cannot respond appropriately to insulin and, as a result, can lead to metabolic dysfunction, unwanted weight gain, and disruptions to thyroid function. Insulin resistance can negatively impact the thyroid’s ability to produce and regulate hormones, and hypothyroidism can contribute to insulin resistance. This cyclical relationship can be such a headache!
• Genetic predisposition: Those with a family history of either condition may find themselves at a higher risk of developing both disorders simultaneously. This can cause someone to be more susceptible to one disorder while amplifying the likelihood of the other.
• Excess androgen: In those with PCOS or hypothyroidism, often there is an insufficient level of sex hormone binding globulin (SHBG). This can lead to increased levels of free androgens, thus causing similar symptom characteristics across both conditions.
• Environmental factors: Experts believe that certain environmental factors, such as the use of BPA (bisphenol-A) products, may suggest a possible role of endocrine disruption that might be a cause of PCOS

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Treating both PCOS and hypothyroidism at the same time requires an approach that recognizes each condition and their interconnected nature. An integrative approach will help to approach both conditions and, more importantly, the various underlying factors that cause the conditions to manifest in the first place.

Medications are pivotal in managing PCOS and hypothyroidism at the same time. Thyroid hormone replacement therapy stands as a cornerstone in helping to treat hypothyroidism because it helps to ensure that the thyroid gland is producing adequate levels of thyroid hormones.

Anti-androgen medications are commonly prescribed for PCOS, as they help mitigate symptoms related to androgen excess and promote overall hormonal balance. Spironolactone is a frequently prescribed anti-androgen drug that blocks the androgen receptors, reducing the effects of excess androgen production in the body. By doing so, spironolactone helps alleviate PCOS symptoms such as acne, hirsutism (excessive hair growth), and hair loss. Another anti-androgen drug commonly used for PCOS treatment is cyproterone acetate, which also works by inhibiting the action of androgens. These medications can be beneficial in controlling the symptoms and restoring hormone balance in individuals with PCOS. 

If someone is using medication to treat one or both conditions, it is advised to continuously monitor progress through regular blood tests to check how effective the treatment is and make any necessary adjustments as needed.

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In addition to medication, lifestyle interventions can help ensure a more comprehensive and personalized approach to managing PCOS and hypothyroidism. 

Lifestyle modifications are vital to holistically treating both conditions. Dietary interventions and a focus on nutrition hold such importance for both PCOS and hypothyroidism. Some of the critical lifestyle interventions include the following approaches.

Nutrition and diet

A healthy and balanced diet is crucial for managing PCOS and hypothyroidism and also aids in managing insulin resistance and hormonal imbalances associated with PCOS. Focus on consuming whole foods, including fruits, vegetables, lean proteins, and whole grains. Also, limit the intake of processed foods, refined sugars, and saturated fats. 

Nutrients that those with PCOS should bear more focus on include vitamin D, vitamin A, vitamin E, B vitamins, calcium, magnesium, zinc, and omega-3 fatty acids. For hypothyroidism, many of these nutrients are just as crucial, including zinc, B vitamins, vitamin D, and vitamin A, as well as iodine, iron, and selenium. 

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Physical activity

Weight concerns, more commonly the inability to lose unwanted weight, are shared by both PCOS and hypothyroidism patients. Physical activity and exercise help manage weight, alleviate insulin resistance, and promote overall metabolic health. The international PCOS guidelines recommend 150 minutes of moderate exercise per week or 30 minutes of exercise five days a week. Keep in mind that exercise regimens, as well as nutrition, should both be personalized as each person’s condition and health history varies.

Sleep and rest

Sleep hygiene is often overlooked and not prioritized. However, sleep management is vital. When sleep patterns are disrupted, it can negatively impact endocrine function - which will aggravate common symptoms of PCOS and hypothyroidism. Establishing healthy sleep patterns and routines is imperative in supporting the body’s natural hormonal rhythms and optimizing overall well-being. Aim for 7-9 hours of quality sleep every night to support your body’s natural healing processes and hormone production.

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Stress management

We cannot mention lifestyle modifications without the mention of stress management. The impact of stress on hormones and hormonal balance is crucial since chronic stress can exacerbate symptoms of both PCOS and hypothyroidism. Each person will have a different way of reducing stress, so finding the method that interests you and ultimately brings you a sense of calm will be the best. Examples of common stress management techniques include yoga, meditation, breathwork, hobbies, arts and crafts, journaling, or connecting with friends and loved ones. Aim for at least 10 to 15 minutes daily of a stress-reducing activity. 

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The management of polycystic ovary syndrome and hypothyroidism requires a holistic approach that addresses both conditions. As seen in the literature, the co-occurrence of PCOS and hypothyroidism presents unique challenges that require comprehensive testing, diagnosis, and personalized management.

Paloma Health can play a pivotal role in this process by offering specialized care for hypothyroid patients, including comprehensive testing through home thyroid test kits, which test thyroid stimulating hormone and other key biomarkers. Paloma also offers convenient virtual appointments with top thyroid practitioners. By leveraging Paloma Health’s expertise, individuals can proactively address the complexities of their hypothyroidism, ultimately optimizing their health and well-being. Through ongoing support and tailored interventions, Paloma Health empowers individuals to navigate the intricacies of hormonal health, paving the way for improved quality of life and long-term health outcomes.

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