Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder impacting up to 20% of women of reproductive age worldwide, characterized by hormonal imbalances and metabolic disturbances. This condition is widely recognized for symptoms like irregular menstrual cycles, excess androgen levels, and the presence of small cysts on the ovaries. Beyond its reproductive and metabolic effects, a growing body of research indicates that PCOS significantly interacts with the body’s defense mechanisms, raising questions about whether it causes a disruption in immune function. Understanding this complex relationship is important for a more complete management of this multisystem condition.
PCOS and Chronic Systemic Inflammation
The foundation of the connection between PCOS and immune function lies in systematic low-grade chronic inflammation (SLCI). This is a persistent, subtle activation of the immune system throughout the body. This constant inflammatory environment acts as a precursor to immune system dysregulation.
Several factors inherent to PCOS contribute to this inflammatory state. Insulin resistance, where cells do not respond effectively to insulin, triggers the release of inflammatory markers. High levels of insulin further promote this inflammation, establishing a self-perpetuating cycle of metabolic and immune stress. Additionally, the excess androgens characteristic of PCOS promote inflammation and disrupt immune system regulation, while fat storage around the abdomen (visceral adiposity) releases inflammatory molecules that intensify the problem.
How Hormonal and Metabolic Changes Alter Immune Response
The chronic inflammatory state in PCOS directly influences the activity and function of specific immune components. There is a measurable imbalance in the production of signaling proteins called cytokines. Pro-inflammatory cytokines, such as Tumor Necrosis Factor-alpha (TNF-α) and Interleukin-6 (IL-6), are found at elevated concentrations in women with PCOS.
These altered cytokine profiles disrupt the delicate balance required for an effective immune response. For example, the function of T-cells, responsible for cellular immunity, is altered, sometimes showing a reduced proportion of certain subsets. Furthermore, natural killer (NK) cells, part of the innate immune system, can be indirectly affected by elevated androgen levels and may even mistakenly target ovarian tissues. This cellular dysregulation suggests that the immune system in PCOS is unbalanced and primed for an inappropriate or exaggerated response.
Elevated Health Risks Associated with Immune Dysregulation
The practical consequence of this underlying immune dysregulation is an increased susceptibility to certain health issues. The persistent low-grade inflammation compromises the immune system’s ability to respond appropriately to external threats, evidenced by reports of increased susceptibility to infections, including sexually transmitted diseases.
The dysregulated immune environment also increases the risk for more severe outcomes following viral exposure. For example, women with PCOS have shown a higher incidence of infection and more severe clinical symptoms from viruses like SARS-CoV-2 (COVID-19). The underlying hyperandrogenism and inflammation are contributing factors to this increased vulnerability.
Beyond infections, the immune system changes in PCOS are strongly linked to the development of autoimmune diseases. Autoimmunity occurs when the immune system mistakenly attacks the body’s own tissues. Women with PCOS show a higher prevalence of conditions such as Hashimoto’s thyroiditis, an autoimmune disease affecting the thyroid gland.
Hashimoto’s thyroiditis is reported to be up to three times more common in women with PCOS. Prevalence rates are estimated to be between 18% and 40%. Other autoimmune disorders, including systemic lupus erythematosus (SLE) and Type 1 diabetes, also show an increased association with PCOS. The presence of various autoantibodies, such as anti-nuclear (ANA) and anti-thyroid peroxidase (anti-TPO) antibodies, are often detected, indicating an underlying autoimmune predisposition.
Supporting Immune Health Through Effective PCOS Management
Since the immune changes in PCOS are intrinsically tied to metabolic and hormonal factors, effective management focuses on addressing these root causes. Strategies that reduce chronic systemic inflammation and improve insulin sensitivity are helpful for supporting immune health. Lifestyle modifications are a cornerstone of this approach.
Adopting a diet rich in whole foods and anti-inflammatory nutrients, such as those found in the Mediterranean diet, helps reduce the body’s inflammatory burden. Regular exercise is also an effective tool, as it decreases insulin resistance and reduces overall inflammation. Additionally, medical management may include insulin-sensitizing agents, such as metformin, and anti-androgen therapies. These can indirectly modulate the immune system by lowering the levels of pro-inflammatory hormones. Prioritizing stress management and consistent sleep hygiene are also important steps, as they help regulate hormone balance and optimize immune function.