What to know about PCOS and pregnancy - Ruth Health

What to know about PCOS and pregnancy

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Fast facts:

  • Polycystic ovary syndrome (PCOS) is a condition that causes a hormonal imbalance and affects 1 in 10 women of reproductive age.
  • It is a leading cause of female infertility and a factor in pregnancy complications such as preeclampsia and gestational diabetes.
  • A  variety of PCOS treatment options can restore ovulation and may help you conceive, including lifestyle changes, metformin, and fertility medications.
  • Staying proactive about your health before and during pregnancy can improve your chances of having a healthy pregnancy.

Polycystic ovary syndrome (PCOS) is a condition that affects women of reproductive age and causes a hormonal imbalance. It is both a leading cause of female infertility and a factor in pregnancy complications.

There are treatment options to address PCOS-related infertility and support your family building journey. And by taking steps to have a healthy pregnancy, you can prevent pregnancy complications associated with the condition.

Here’s what to know about PCOS and pregnancy.

What is PCOS?

Polycystic ovary syndrome affects 1 in 10 women of reproductive age. It is characterized by high levels of male hormones, or androgens, which can lead to the development of cysts in the ovaries as well as irregular menstrual cycles.

The elevated androgen levels may also cause hair loss, extra growth of facial and body hair, and acne.

The exact causes of PCOS are not fully understood. Some researchers believe the condition is rooted in the elevated androgen levels while others attribute its development to insulin resistance.

There is likely a genetic component, and having a mother, sister, or aunt who has PCOS is considered a risk factor for the condition.

PCOS has been linked to the following health conditions, but the specific relationship remains unclear. Researchers have not yet identified if PCOS causes these health issues, or vice versa.

  • Diabetes - more than 50% of those with PCOS will develop diabetes or prediabetes before the age of 40
  • High blood pressure
  • High cholesterol
  • Sleep apnea
  • Endometrial cancer

Much has been written about the relationship between PCOS and obesity. Some sources claim or suggest that PCOS can stem from obesity. 

This isn’t entirely accurate: although there is evidence of a correlation between obesity and PCOS, research has not yet confirmed obesity as a cause.

What are the symptoms of PCOS?

Common symptoms of PCOS include:

  • Cysts on the ovaries
  • Insulin resistance
  • Irregular periods
  • Growth of body hair and facial hair
  • Male pattern baldness
  • Acne
  • Dark, thick patches of skin on the neck, arms, breasts, or thighs
  • Pelvic pain
  • Anxiety
  • Depression

Symptoms of PCOS present differently from one person to another. They also frequently overlap with symptoms of other conditions, which can delay the diagnosis process.

  • Many individuals first learn of a PCOS diagnosis after struggling to conceive and pursuing fertility treatment.

Diagnosis

There are several steps involved in diagnosing PCOS, including a physical exam and several tests.

During the physical exam, your provider will:

  • Ask about your health history
  • Measure blood pressure and body mass index (BMI)
  • Evaluate your skin for symptoms of PCOS such as hair growth, acne, and skin discoloration
  • Conduct a pelvic exam to check for elevated androgens and ovarian abnormalities
  • Conduct a pelvic ultrasound to check for cysts in the ovaries

As a next step, your provider may recommend one or more blood tests to:

  • Measure androgen levels
  • Measure levels of hormones related to similarly presenting conditions
  • Screen for diabetes and high cholesterol

You may be diagnosed with PCOS if other conditions have been ruled out and you have at least two of these core symptoms of PCOS:

  • An irregular menstrual cycle or the absence of a menstrual cycle
  • Elevated androgen levels, as indicated by blood tests and physical signs
  • Cysts in or on the ovaries
  • Ovaries that are oversized or shiny or “white” in appearance

Always seek a doctor’s medical advice for an accurate diagnosis.

Treatment

While there is no cure for PCOS, symptoms can be managed through several treatment options.

  • Hormonal birth control helps regulate menstrual cycles. It can also address other symptoms of PCOS including acne and facial hair. If you take birth control for PCOS but plan to start a family, your doctor can help you adjust your treatment plan.
  • Metformin — an oral diabetes medication — can improve insulin resistance in women with polycystic ovary syndrome. Better insulin functioning often lowers androgen levels. For some individuals, this treatment sufficiently restores ovulation.
  • Anti-androgen medications including spironolactone reduce the effects of androgen hormones, such as facial and body hair growth. They are not safe to take during pregnancy or when trying to conceive and are typically used alongside birth control. If these medications are part of your PCOS treatment, your doctor can help you adjust your plan as you begin your family building journey.
  • Ovarian surgeries including laparoscopic ovarian surgery and ovarian block resection may be used to restore ovulation if medications are unsuccessful.
  • Lifestyle changes like eating a heart-healthy diet, exercising regularly, and maintaining a healthy weight can also help treat irregular menstrual cycles, insulin resistance, and other symptoms of PCOS.

PCOS and fertility

PCOS is a common and treatable cause of infertility. If you have PCOS and are interested in starting or growing your family, your doctor may recommend metformin and/or lifestyle changes to restore ovulation.

Your doctor may also prescribe medications that induce ovulation, such as clomiphene (Clomid®). Some of the most common side effects include hot flashes, headaches, bloating, mood swings, and tender or sore breasts.

If medications and/or lifestyle changes aren’t effective, your doctor may recommend additional fertility treatment such as in vitro fertilization (IVF).

IVF is a widely used form of assisted reproductive technology (ART) in which eggs are retrieved from the ovaries, fertilized with sperm outside of the body, and then implanted into the uterus.

Surgery is typically reserved for cases when other treatment options have proven unsuccessful. Laparoscopic ovarian drilling, in which a doctor makes several holes in the surface of your ovary, may restore ovulation for 6 to 8 months.

PCOS and pregnancy

Polycystic ovary syndrome can also bring an increased risk of pregnancy complications. Birthing people with the condition are more likely to:

  • Have a miscarriage
  • Develop preeclampsia - a pregnancy complication characterized by high blood pressure and high levels of protein in your urine
  • Develop gestational diabetes
  • Have a larger baby
  • Have a preterm delivery

Despite these risks, those with PCOS can have a healthy pregnancy by prioritizing their health before and during pregnancy.

To lower your risk of PCOS-related pregnancy complications, work with your provider to set health targets before trying to conceive. In particular, focus on maintaining healthy blood sugar levels in the months leading up to pregnancy.

Regular physical activity, an anti-inflammatory diet, and medications like metformin may support you in reaching this goal. Your provider can make additional recommendations if needed to restore balanced blood sugar levels.

If pregnancy complications occur as the result of PCOS, it’s important to attend all of your prenatal appointments and share a complete picture of your health with your provider. Both preeclampsia and gestational diabetes can be managed.

Managing preeclampsia

Preeclampsia requires close monitoring until delivery. Treatment depends on the severity of your symptoms. 

For more moderate cases, treatment typically consists of daily blood pressure monitoring at home as well as frequent doctor’s appointments to monitor blood pressure, changes in symptoms, and your baby’s growth.

Severe cases require hospitalization for closer monitoring of blood pressure and potential pregnancy complications.

Your doctor may also prescribe one or more medications including: 

  • Blood pressure-lowering medications
  • Anticonvulsant medications to prevent seizures
  • Corticosteroids to support the development of your baby’s lungs

Healthcare providers frequently recommend preterm delivery for birthing people with preeclampsia. In mild to moderate cases, preterm delivery is typically planned for after 37 weeks.

In severe cases, a provider may recommend delivery before 37 weeks, depending on your symptoms and your baby’s health. If your preeclampsia affects the placenta, a c section may be necessary.

Your doctor can guide you in determining the risks and benefits of delivering early or later.

Managing gestational diabetes

Gestational diabetes is a type of diabetes that develops during pregnancy in someone not previously diagnosed with the condition. 2-10% of pregnancies in the U.S. are affected by it every year. 

Screening for gestational diabetes typically occurs between 24-28 weeks.

Proactively managing the condition lowers the risk of health complications for you and your baby.

Treatment varies by individual, but in most cases, your doctor will make recommendations about diet and physical activity. For some, daily blood sugar monitoring and insulin therapy is also necessary to stay healthy during pregnancy.

Any pregnancy complication can be overwhelming to navigate. Ask your provider as many questions as you need to in order to feel comfortable. Be sure to ask how your partner or a support person can help.

We’re here to support your birthing journey

At Ruth Health, we understand that nobody knows what you need better than you. We deliver expert, evidence-based maternal advice so that you can make the best decisions for yourself. Our providers have experience treating PCOS and other reproductive disorders.

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