A Guide to Managing PCOS
for Fertility and Pregnancy

In addition to the hallmark symptoms above, women with PCOS may experience:

Women with PCOS also have an increased risk of the following health conditions:

Experts aren’t entirely sure what causes PCOS.⁷ Genetic and environmental factors may contribute to a woman’s risk of developing PCOS, but beyond that, it gets a bit complicated.

Up to 75 percent of women with PCOS have insulin resistance, a condition in which the cells become less responsive to insulin. This can lead to higher blood glucose levels and an increased risk of developing type 2 diabetes. Insulin resistance is also linked to some of the common symptoms of PCOS.

However, excess androgen can affect insulin sensitivity—so does PCOS cause insulin resistance, or does insulin resistance cause PCOS? The answer is still unclear. Experts sometimes refer to this as a “chicken or egg” problem with PCOS.⁸

If you’ve been diagnosed with PCOS, you’re not alone. According to the CDC, PCOS affects up to 5 million women in the U.S.—somewhere between six and 12 percent of reproductive-aged women—which makes it one of the most common endocrine disorders among women.⁹

But PCOS was a relatively unknown condition until fairly recently. The condition was first described in 1935 by gynecologists Irving Freiler Stein and Michael Leventhal. Stein and Leventhal reported a series of patients who were experiencing polycystic ovaries, hirsutism and irregular cycles.¹⁰

However, it wasn’t until 1990 that the National Institutes of Health established a clinical definition for PCOS. The NIH criteria defined PCOS as the combined presence of high androgen levels and irregular periods.¹¹

A turning point came in 2003 at a conference in Rotterdam, where experts expanded the criteria for PCOS to include hyperandrogenism, polycystic ovaries, irregular cycles and common features such as obesity and insulin resistance.¹² This is the Rotterdam criteria that is still commonly used today. This standardized set of criteria has made it easier to get a diagnosis for PCOS.

Getting a PCOS diagnosis may take time and patience.

Self-assessment for PCOS can sometimes be tricky because certain symptoms—like irregular cycles, hormonal acne and weight gain—are fairly commonplace among women. If you’re experiencing multiple symptoms of PCOS, talk to a doctor.

Of course, PCOS is a complicated condition, so you may be wondering which doctor to talk to. Your primary care physician is a good place to start, as they can take note of your symptoms and refer you to specialists if needed. From there, you may be referred to an endocrinologist, who can diagnose and treat hormone imbalances. And if you’re trying to get pregnant with PCOS, a reproductive endocrinologist can guide you through fertility options.

Depending on your symptoms, you may also be referred to a:¹³

Be aware that there’s no single test that can diagnose or rule out PCOS. Instead, your doctor may recommend a series of tests to get a better idea of whether PCOS may be causing your symptoms.¹⁵ These tests may include:

Your healthcare providers will use the results of these tests to rule out other possible causes for your symptoms and to gain a clearer picture of your overall health.

Stress relief techniques such as meditation, acupuncture, or deep breathing can have a ripple effect that benefits your hormone balance, sleep habits and overall health.

2. Sleep

Research suggests poor sleep quality is associated with an increased risk of obesity and insulin resistance¹⁷—which makes good sleep vital for those with PCOS.

3. Exercise

Regular exercise can help to manage your stress levels, hormones, and blood sugar levels. If you don’t feel up to a high-intensity workout, opt for gentle movement like a long walk.

Keeping your BMI within a healthy range can help to improve cardiovascular risk factors and support ovulation.²⁰

2. Exercise

Regular exercise has been linked to improvements in menstrual regularity, ovulation, weight loss, and reduced insulin resistance.²¹

3. Eat to Support Fertility

Research suggests a low-glycemic diet can help to improve insulin sensitivity and maintain healthy blood glucose levels.²² To get the most out of your diet, load up your plate with foods that support fertility by providing important nutrients like folate, omega-3 fatty acids, iron and antioxidants.

PCOS can increase the risk of certain pregnancy complications, but you can help to mitigate these risks with healthy lifestyle changes.

Women with PCOS have an increased risk of developing gestational diabetes²³—so continue to maintain a healthy diet throughout your pregnancy, with a focus on low-glycemic foods that won’t spike your blood sugar and insulin levels.

Prenatal care is vital to a healthy pregnancy with PCOS, so be sure to adhere to any scheduled appointments and bloodwork. Your doctor will monitor you for complications like high blood pressure and gestational diabetes and can recommend pregnancy-safe exercises to help manage PCOS symptoms.

Taking a prenatal vitamin designed for your current stage of pregnancy can also help to ensure you’re getting the nutrients you need to support you and your baby, every step of the way.

In addition to the general health risks associated with PCOS, women with PCOS are also at a higher risk for certain pregnancy complications.¹⁹ These may include:

If you’re currently pregnant or trying to conceive, talk to your doctor about what steps you can take to promote a healthy pregnancy and delivery with PCOS.