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Polycystic Ovaries Frequently Occur with a Fatty Liver

Most gynecologists and hepatologists do not work together, yet patients with polycystic ovaries and fatty liver have similar metabolic profiles.

Two increasingly common, problematic health conditions appear to co-exist more frequently than most healthcare providers realize. During the last several years there is growing evidence of an association between non-alcoholic fatty liver disease (NAFLD) and polycystic ovary syndrome (PCOS). Because recently published research claims that women with PCOS have twice the risk of NAFLD, those with either condition must realize the crossover.

About PCOS

Polycystic ovary syndrome is the most common endocrine problem in women, affecting approximately one in six American women. Its designation as a syndrome means that it consists of several conditions and symptoms that are complex and can have a collection of contributing causes.

Typically, PCOS involves:

  • Small, fluid-filled cysts accumulate in the ovaries from trapped eggs that were never released for menstruation.
  • A hormone imbalance where progesterone is inadequate and estrogen levels are high.
  • High levels of male hormones or androgens are often present, which are produced in the ovaries, adrenal glands, and in body fat.
  • Obesity, insulin resistance, and Type 2 diabetes are prominent metabolic characteristics of PCOS.
  • Some sources include PCOS under the umbrella of metabolic syndrome, or at least list it as an associated condition.
  • There seems to be a genetic tendency towards developing PCOS, where experts suspect that insulin resistance is due to a defect in what happens after insulin binds to a resistant cell.

Polycystic ovary syndrome can be the source of infertility, menstrual problems, pelvic pain, and a host of hormone-related problems.


An accumulation of excess fat in the liver that is not a result of drinking alcohol, non-alcoholic fatty liver disease is the most common cause of chronic liver disease in the U.S. Associated with obesity, high cholesterol, insulin resistance, and Type 2 diabetes, approximately one in three American adults are believed to have some degree of NAFLD.

If lifestyle changes are instituted when NAFLD is in its early stage, it can be reversed. However, a fatty liver that progresses to its more advanced stage can have severe, or even fatal consequences:

  • Early stage NAFLD – Known as steatosis, the early stage is a simple fatty liver without liver inflammation.
  • Late stage NAFLD – Known as non-alcoholic steatohepatitis (NASH), this advanced stage is fat accumulation in the liver with liver inflammation. The inflammation can cause fibrosis, or scars in the liver. NASH can progress to cirrhosis, the permanent hardening and death of liver tissue.

Connections Between PCOS and NAFLD

Several different studies have concluded that non-alcoholic fatty liver disease is frequent in patients with polycystic ovary syndrome.

The two biggest contributing factors these conditions share are:

  1. Obesity
  2. Insulin Resistance

Although, experts have found that another similarity between NAFLD and PCOS is hormonal, with an excess quantity of androgens endemic to both conditions.

A recent English study published in March of 2018 in the journal PLOS Medicine found that in women with PCOS, the risk for non-alcoholic fatty liver disease is increased twofold, with androgen excess contributing to the progression of the disease. According to Wiebke Arlt, MD, director of the University of Birmingham’s Institute of Metabolism and Systems Research, “Our research has highlighted significant and previously unknown health risks in women with PCOS and increased male hormone levels. Our findings suggest that regular screening for fatty liver disease should be considered in these women, to make sure the disease is caught early.”

Androgen Excess

Men’s and women’s bodies produce androgens, just in different amounts. In women, androgens have more than 200 actions – and are present in higher amounts than estrogens. In a woman’s body, one of the main purposes of androgens is to be converted into estrogens.

9 Most Common Signs and Symptoms of Hyperandrogenism (Excess Androgen) in Women

  1. Hirsutism (excess facial or body hair)
  2. Persistent acne and/or oily skin
  3. Alopecia (thinning hair on the head)
  4. Insulin resistance
  5. Acanthosis nigricans (rough, darkly pigmented areas of skin)
  6. High blood pressure
  7. Low HDL cholesterol (“good cholesterol”) and high LDL cholesterol (“bad cholesterol”)
  8. Obesity around the mid-abdomen
  9. Irregular or absent periods or frequent skipped cycles

The connections between polycystic ovary syndrome and non-alcoholic fatty liver disease are concrete. It seems that women with PCOS are especially vulnerable to developing a fatty liver – especially if they also have hyperandrogenism. According to Dr. Arlt from the recently published English study, “Our research shows that PCOS does not only affect fertility but also comes with significantly increased rates of metabolic complications.”

This means that if you have PCOS, you should also be evaluated for a fatty liver – preferably before a fatty liver can develop into NASH.

In the U.S., our healthcare system is not integrated, but fractured off into specialties where this connection could easily be missed. Signs of metabolic syndrome as well as hyperandrogenism, insulin resistance, obesity, hyperlipidemia, and Type 2 diabetes need to be looked at with a wider lens that includes polycystic ovaries and a fatty liver.

Editor’s Note: Did you know that some helpful suggestions for reversing fatty liver include: diet, exercise, diabetes control, cholesterol control, avoiding toxic chemicals, avoiding over-the-counter medications, and supplementing with milk thistle? Milk thistle is the #1 herb recommended to support and protect your liver. Studies have shown that silymarin, the active ingredient in milk thistle, is effective in reducing inflammation and steatosis in liver cells and regenerating new, healthy liver cells. Silymarin has also been shown to provide antioxidant protection and have anti-fibrotic properties. Learn more about the world’s highest potency milk thistle formula, UltraThistle., PCOS doubles risk for nonalcoholic fatty liver disease, Kumarendran B, et al, Retrieved May 6, 2018, PloS Med, March 2018., Androgen, James Simon, MD, CCP, NCMP, IF, FACOG, Retrieved May 6, 2018, National Women’s Health Resource Center, Inc., 2018., What is Polycystic Ovarian Syndrome?, Retrieved May 6, 2018, Liver Doctor, 2018., Nonalcoholic fatty liver disease and polycystic ovary syndrome, Evangeline Vassilatou, Retrieved May 6, 2018, World Journal of Gastroenterology, July 2014., MANAGEMENT OF ENDOCRINE DISEASE: Polycystic ovary syndrome and nonalcoholic fatty liver disease, Macut D, et al, Retrieved May 6, 2018, European Journal of Endocrinology, September 2017.

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About the Author

Nicole Cutler, L.Ac., MTCM, Dipl. Ac. (NCCAOM)®

Nicole Cutler, L.Ac., MTCM is a long time advocate of integrating perspectives on health. With a Bachelor's degree in Neuroscience from the University of Rochester and a Master's degree in Traditional Chinese Medicine from Five Branches Institute, Nicole has been a licensed acupuncturist since 2000. She has gathered acupuncture licenses in the states of California and New York, is a certified specialist with the National Acupuncture Detoxification Association, has earned diplomat status with the National Commission of Chinese and Oriental Medicine in Acupuncture and Chinese Herbology and is a member of the Society for Integrative Oncology. In addition to her acupuncture practice that focuses on stress and pain relief, digestion, immunity and oncology, Nicole contributes to the integration of healthcare by writing articles for professional massage therapists and people living with liver disease.

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