Inflammation, PCOS and Heart Health

If you have PCOS and you feel tired, puffy, achy or stuck in a cycle of cravings and crashes, you have probably come across the idea that inflammation is part of the picture. This can sound vague online, but in research terms, PCOS is often associated with chronic low-grade inflammation, particularly when insulin resistance, central weight gain, poor sleep and ongoing stress are present. 

This matters for long-term health because atherosclerosis (the process that underpins most heart disease) is not just about cholesterol. It is also an inflammatory process that affects the blood vessel wall over time. 

In this blog, I will explain why PCOS is often described as an inflammatory condition, how inflammation influences cardiovascular risk, and what actually helps in real life.

Why PCOS is an inflammatory condition

Inflammation is a normal immune response. The issue is when the body stays in a low-grade, switched-on inflammatory state for months or years.

In PCOS, several factors can contribute to this:

• Insulin resistance is one of the most common drivers. Higher circulating insulin can increase oxidative stress and promote inflammatory signalling. It also tends to worsen lipid metabolism and blood pressure patterns, which feeds into cardiovascular risk.

• Adipose (or fat) tissue, particularly around the abdomen, is metabolically active. When it expands beyond what the body can manage well, it can release inflammatory cytokines and contribute to higher inflammatory markers.

• Sleep disruption is also common in PCOS, and a systematic review and meta-analysis found that sleep disturbances are associated with cardiovascular risk factors in women with PCOS. Poor sleep can raise inflammatory signalling and make blood sugar regulation harder the next day. 

In studies, inflammatory markers such as CRP and interleukin-6 are often higher in women with PCOS compared with controls, supporting the concept of chronic low-grade inflammation as part of PCOS pathophysiology. 

How inflammation drives cardiovascular risk

Inflammation affects the cardiovascular system in a few key ways.

First, it impacts the endothelium, the inner lining of blood vessels. Healthy endothelium helps blood vessels relax and regulates clotting and immune activity. Chronic inflammation makes this lining less resilient, contributing to endothelial dysfunction, which is an early step in cardiovascular disease.

Second, inflammation is involved in plaque development. Cholesterol particles enter the vessel wall and trigger an immune response. Over time, the combination of lipids plus inflammatory signalling drives plaque formation and instability.

This is one reason it can be helpful to think about heart health using more than one marker. 

A major 2024 study following nearly 28,000 initially healthy women over 30 years found that a combined measure of LDL cholesterol, Lp(a), and high-sensitivity CRP (hs-CRP) predicted long-term cardiovascular events. 

Nutrition and lifestyle factors that matter most

When inflammation is part of your PCOS picture, the goal is not to eliminate inflammation entirely. Inflammation is a normal and necessary part of immune function. The aim is to reduce the chronic drivers that keep the body in a persistently activated state, while supporting metabolic flexibility, vascular health and recovery.

This is where many women with PCOS feel stuck. They are eating well, exercising, and still feel inflamed. In those cases, the issue is rarely a single food or nutrient. It is usually a combination of metabolic, gut, immune and lifestyle factors.

Overall dietary pattern still matters most

High-quality evidence consistently shows that overall dietary pattern is more important than individual foods or supplements for cardiovascular and inflammatory risk.

Mediterranean-style dietary patterns are associated with lower inflammation, improved lipid profiles and reduced cardiovascular events. In PCOS, this approach is particularly relevant because it also supports insulin sensitivity, gut health and fibre intake, all of which influence inflammatory signalling.

In practice, this means building meals around vegetables, beans and lentils, fruit, nuts and seeds, and fish, alongside stable whole-food fats. The focus is not restriction, but food quality and consistency.

Ultra-processed diets tend to be lower in fibre and phytonutrients, and higher in refined carbohydrates, additives and industrial fats. Population-level evidence links these patterns with higher inflammatory markers and poorer cardiometabolic outcomes. For women with PCOS, reducing reliance on ultra-processed foods often improves both inflammation and blood sugar regulation, even without intentional calorie reduction.

Gut health and inflammation in PCOS

The gut plays a central role in immune regulation, and this is increasingly relevant in PCOS research.

Emerging evidence suggests that women with PCOS often show differences in gut microbiota composition compared with controls. Reduced microbial diversity, altered short-chain fatty acid production and increased intestinal permeability have all been described. These changes can promote systemic inflammation by allowing immune-activating compounds to enter circulation more readily.

Fibre intake is particularly important here. Fermentable fibres feed beneficial gut bacteria and support the production of short-chain fatty acids such as butyrate, which help regulate immune activity and maintain gut barrier integrity.

If gut symptoms such as bloating, pain or irregular bowel habits are present, inflammation may be driven as much by digestive strain as by diet quality alone. In these cases, supporting gut tolerance, meal timing and digestion can be as important as what foods are chosen.

Food sensitivities and immune activation

Food sensitivities are common in PCOS discussions and are often misunderstood.

True immune-mediated food reactions are relatively uncommon, but many women with PCOS experience food-related symptom flares due to gut permeability, altered digestion or heightened immune responsiveness. This does not mean long-term avoidance is always necessary or helpful.

Overly restrictive diets can increase stress and reduce dietary diversity, which may worsen gut health and inflammation over time. A more effective approach is usually to identify triggers carefully, address gut integrity and digestion, and then reintroduce foods where possible.

The aim is to calm immune activation, not to permanently shrink the diet.

Omega-3 fats and inflammatory balance

Omega-3 fats remain relevant in PCOS because of their role in inflammatory balance and triglyceride metabolism. A 2021 meta-analysis reported improvements in several cardiometabolic markers in women with PCOS following omega-3 supplementation, and subsequent reviews continue to support omega-3 as beneficial for inflammation and metabolic risk. Food sources such as oily fish also fit naturally into dietary patterns associated with lower cardiovascular risk.

Omega-3s are not a stand-alone solution, but they can support resolution of inflammation when combined with improvements in diet quality and lifestyle factors.

Movement as an anti-inflammatory signal

Physical activity is one of the most reliable ways to reduce inflammatory signalling over time.

Exercise improves insulin sensitivity, supports endothelial function and promotes anti-inflammatory cytokine release. A 2024 review of physical activity in PCOS highlights improvements in cardiometabolic markers, even without significant weight loss.

This does not require intense training. Regular walking, resistance training and movement that supports muscle mass and metabolic health can all contribute. Consistency matters more than intensity.

Sleep, stress and recovery are not optional

Sleep disturbance and chronic stress are common in PCOS and are strongly linked to inflammation and cardiovascular risk factors.

Poor sleep increases insulin resistance, raises inflammatory markers, and disrupts appetite regulation. Chronic stress activates inflammatory pathways and can undermine the benefits of otherwise supportive nutrition.

For women who feel they have “tried everything” and still feel inflamed, this is often the missing piece. Not more rules or restriction, but better recovery, nervous system support and sleep consistency.

Inflammation in PCOS is rarely about doing more. It is usually about doing less, more consistently, and giving the body the conditions it needs to recover.

If you’d like to dig deeper into what might be triggering your inflammation, why not get in touch? You can book a free call here. 

Short disclaimer

This blog is for educational purposes only and is not medical advice. As a BANT-registered Nutritional Therapist, I do not diagnose or treat medical conditions and I do not advise on prescription medications. If you have concerns about cardiovascular risk, inflammation or blood test results, please speak with your GP or relevant medical specialist.