Some women who have problems getting pregnant can trace them back to polycystic ovary syndrome, or PCOS. Understood to be the most common female hormone condition [1] affecting 1 in 10 women in the UK, it has been identified since 1935 and one particular presentation of the condition was formerly known as Stein-Leventhal syndrome.
With its name referring to the surplus of ‘cysts’ in each ovary that characterises the condition ( many more than in ovaries without PCOS), it can be a confusing term – as the ‘cysts’ in question are not cysts at all but simply immature follicles (that contain the eggs) which do not develop to maturity. This confusion is enough to prompt ongoing calls for the name to be changed [2].
Despite the anxiety about becoming pregnant with PCOS, pregnancy can often be successfully achieved either naturally or with simple support. Here, the experts at Fertility Family not only explain the basics of PCOS and how it affects fertility but offer answers and practical advice for before and after becoming pregnant with PCOS.
What are the symptoms of PCOS?
According to the international guidelines on PCOS, there are three main ways [3] in which PCOS tends to manifest itself in women. These are:
- Irregular or infrequent periods, meaning that your ovaries do not regularly release eggs
- Hirsutism or having excessive testosterone, a ‘male’ hormone that may cause physical symptoms such as excessive body hair
- Polycystic ovaries, which are enlarged and contain many of the fluid-filled follicles (sacs) mentioned above
The presence of at least two of these signs is required to confirm a diagnosis of PCOS. PCOS can cause symptoms that are no unique to PCOS, including weight gain, low mood, fatigue, inappropriate hair distribution (unwanted hair growth, thinning hair or hair loss), acne and oily skin. If left untreated, PCOS can trigger other health problems such as type 2 diabetes in later life.
What impact does PCOS have on fertility?
As part of the menstrual cycle, follicle-stimulating hormone (FSH) is secreted by the brain and selects one of the follicles within the ovary to mature and ovulate, eventually releasing an egg. However, follicles do not mature with PCOS, instead accumulating without maturing – meaning that ovulation does not take place or does so sporadically. This makes for longer time to achieve a pregnancy.
What happens if you have PCOS and go off birth control?
There are a number of things that may happen when you come off birth control pills if you have untreated PCOS. Your periods may return to an irregular pattern that you may have seen previously [4], and other PCOS symptoms may worsen. Birth control supplies the body with the right balanced amount of hormones, so stopping it will simply allow your hormonal status to show.
How does PCOS affect ovulation tests?
With PCOS, ovulation tests are much more likely to give an inaccurate result [5], as they are not designed to account for the irregularities that can be caused by a condition like PCOS. Because of the hormonal imbalances it causes, women with PCOS can have a consistently high level of LH (luteinizing hormone), which means the surges in LH that are usually detected by ovulation tests may not be accurate. Speak to your GP, a Consultant Gynaecologist or Reproductive Medicine Specialist to get appropriate guidance on how to understand when you are most fertile.
“Women with a history of irregular periods possibly indicating Polycystic Ovaries or women with heavy and painful periods probably suggesting endometriosis should be aware that their fertility may be compromised, and they should seek fertility advice even if they are not planning a baby ‘just yet’.”
How to prevent miscarriages with PCOS
Miscarriages are common in women without PCOS, and are more frequent in women who have this condition. We cannot know why all miscarriages occur, but research shows that there are things that cause miscarriages or make it more likely to occur. Women who are underweight or overweight have significantly more risk of losing a pregnancy. Studies show that miscarriages occur in roughly 30 to 50% of women with PCOS compared with 10 to 15% of women without PCOS. Keeping a healthy weight within the normal BMI can significantly reduce the chances of miscarriages.
While there is no single prevention method, making the same kinds of lifestyle changes – such as daily walking and a balanced diet that increase the chance of pregnancy with PCOS also help to decrease the risk of miscarriage.
When to take a pregnancy test with PCOS
Many of the symptoms that indicate pregnancy are similar to those that come from the onset of a period – with the exception, of course, of the missed period which is the key sign. However, if you have irregular periods due to PCOS you may not have these indicative symptoms.
If you have PCOS it is not advisable to take an ‘early result’ pregnancy test as false negatives with these can be relatively common. If you had unprotected sex two to three weeks ago and have not had a period, it is worth taking a test even if you are not expecting a period or have not had one for a long time.
What estrogen levels do women with PCOS have?
One of the problems caused by PCOS is a hormonal imbalance, which can manifest itself in a number of ways such as a surplus of androgen. For this reason, it is surprising to note that estrogen levels for those with PCOS can often be within the normal.
Getting pregnant with PCOS if you are overweight
Most women with PCOS can get pregnant but there are a number of factors that can make it more difficult, and one of these is excessive weight. Hormonal imbalance can contribute to weight gain, but keeping a stable healthy weight with PCOS will improve the chances of conceiving.
There are a number of changes to your diet that you can make in order to help you lose weight:
- Ensuring you eat regular meals every day, including wholegrain carbohydrates like brown bread and brown pasta which are rich in inositols.
- Ensuring you have snacks and do not skip meals. Ideal snacks are plain yoghurt, berries and nuts.
- Including lean protein and healthy fats (nuts, seeds, olive oil, oily fish)
- Including fibre, non-starchy vegetables and fruit
Adding a bit of movement on a daily basis – even just taking a brisk walk each day – can make a real difference too.
PCOS during pregnancy
Women with untreated PCOS have higher risk pregnancies.
PCOS women have an increased risk of:
Miscarriage, gestational diabetes, hypertension in pregnancy and preeclampsia, fetal growth restriction and low birth weight, preterm delivery, caesarean section.
Make sure you continue taking care of yourself with daily brisk walks and speak to a nutritionist early on during your pregnancy to get all the important nutrients in your daily routine to nourish your baby and make you feel well during your pregnancy.
Taking myoinositol has been shown to reduce the chance of developing gestational diabetes.
PCOS after pregnancy
Much of the advice and coverage around PCOS is focused on getting pregnant, but what happens to your PCOS symptoms after pregnancy?
It is important to remember that some of the symptoms of PCOS, such as hormonal imbalance and associated weight gain, can return and even worsen after pregnancy if you disregard your health, especially if you are busy with your baby– and that being pregnant and successfully giving birth does not mean that PCOS has gone away.
For this reason, it is especially important to maintain a healthy weight and diet during pregnancy in order to prevent these from spiraling during the postpartum phase and making insulin resistance a bigger problem.
PCOS can become a highly manageable condition, and if you have any concerns you should seek medical advice from your GP or Specialist.
References:
[1] https://www.verity-pcos.org.uk/
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4818834/
[3] https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/
[4] https://onlinedoctor.lloydspharmacy.com/uk/contraception/pcos-and-birth-control
[5] https://uk.clearblue.com/how-to-get-pregnant/fertility-problems/pcos
