What does PCOS look like after pregnancy?

Polycystic ovary syndrome (PCOS) is the leading cause of infertility and affects one in ten menstruating people. (1). Despite what you may have heard, having a healthy and safe pregnancy is absolutely possible for those with PCOS. But, your journey before, during, and after pregnancy may look a bit different due to existing hormone imbalances associated with PCOS.

When it comes to PCOS and having kids, there is a major emphasis on managing PCOS before and during pregnancy, but what about after pregnancy? The postpartum period with PCOS is oftentimes a bit more nuanced, which is why we will be focusing on how you can nourish your body during this stage while your hormones are “resetting.” 

This article will help you navigate your symptoms after pregnancy and how to better work with your body during this stage. Below are the topics that we will cover:

• How does PCOS affect fertility?
• How does PCOS influence postpartum recovery?
• How may PCOS impact breastfeeding?
• What can you do if you are having trouble breastfeeding with PCOS?
• How can you manage PCOS symptoms after pregnancy?

How does PCOS affect fertility?

Before we dive into PCOS and postpartum, let’s first talk a bit about the relationship between PCOS and fertility. 

As mentioned, PCOS is the leading cause of infertility and the main driver of this is due to the irregular (or even absent!) ovulation that is almost always associated with having PCOS. When there is absent or irregular ovulation, there is not enough progesterone produced to allow for proper implantation. 

Another potential cause of infertility is a blockage in egg release for fertilization due to the ovaries having too many fluid-filled follicles. For these reasons, trying to conceive can be quite challenging for those with PCOS.  

Want more information on PCOS and fertility? Read more here.

How does PCOS impact postpartum recovery?

PCOS increases risk for some complications in menstruating people during the recovery postpartum period, which is why it is crucial to be aware of them to catch any signs and symptoms. 

These include higher risk for postpartum depression and cardio-metabolic disorders including postpartum pre-eclampsia or eclampsia, hypertensive heart disease, thrombotic disease, and congestive heart failure (2). 

Advocating for proper screening and surveillance by your healthcare provider is necessary during this time. If you feel something is off, make sure to proactively speak with your provider as soon as you notice potential symptoms. 

What is the relationship between PCOS and breastfeeding?

Not all mothers with PCOS will struggle with breastfeeding. However, challenges in this area are possible and can be frustrating. If you have complications with breastfeeding, do not blame yourself because that is not the case!

With PCOS, you may have lower levels of  progesterone and low progesterone is linked to decreased milk supply, as well as elevated androgens. Increased androgens interfere with prolactin (the main hormone driving milk production) receptors, causing a decrease in milk production. 

Another potential major impact on milk supply is increased insulin levels. Females who are impacted with insulin resistance are more likely to have lower milk production (3). And, as you likely know by now, at least 70% of people with PCOS experience insulin resistance! You can read more about the connection between PCOS and insulin resistance here.

Tips for breastfeeding with PCOS?

So, what can you do if you are having trouble breastfeeding with PCOS? Below are some tips to keep in mind that may help ease breastfeeding complications.

• Maintain balanced blood sugar: Talk with your provider to see if they recommend you continue taking Metformin or inositol, as both can be safe while breastfeeding.
• Keep in mind nutrition: Include a protein, complex carbohydrate, fat, and colorful veggies for every meal. Eating enough when you are breastfeeding is important because our body requires extra energy to produce its milk supply during this time period. 
• Listen to hunger cues: Speaking of eating enough, make sure you are feeding your body nourishing foods regularly throughout the course of the day. Feeling hungrier is expected during this period, so make sure you are eating every several hours and include balanced snacks throughout the day. Check out our meal guides in our app for meal and snack ideas!
• Try herbal teas: Different herbal teas have been shown to help with milk flow or production. Herbs like nettle, fenugreek, blessed thistle, stinging nettle, goat's rue, moringa, and milk thistle may be helpful. As always, check with your provider before including any of these (4).
• Consider assessing hormone levels: Since PCOS increases the possibility of lower prolactin levels and higher testosterone levels, assessing hormone levels can determine what exactly is causing lower milk production.
• Reach out to a lactation consultant: If it is accessible to you, a lactation consultant can teach you early breast massages, compression, and latching techniques. La Leche League also has great resources.
• Don’t forget to breastfeed and/or pump in regular intervals to keep supply and demand up!

How can you manage PCOS symptoms after pregnancy?

Keep stress levels in mind

Being a new mother is exciting and fulfilling, but it is by no means easy. With so many responsibilities you may forget to take care of yourself, but in order to have the energy to care for your baby, you have to also be taken care of. 

Stress is often a catalyst for PCOS and can worsen symptoms, so finding moments to incorporate self-care is key. Your self-care routine may look a little different than before, but try to use nourishment as self care as a start. Use mindfulness to check-in with yourself and take brief moments to do some breath-work throughout the day. 

Find time to rest

In addition to finding effective stress management tools, make time to rest and avoid trying to take on everything by yourself. Sleep and recovery plays a significant role in managing stress, which helps keep inflammation and PCOS symptoms at bay. 

We know prioritizing rest isn’t always easy, but keep communication open with friends and family and don’t be afraid to ask for help. You can also bring in a trusted source to give you and your partner a couple of hours of quiet time. 

Learn more about how PCOS affects sleep here.

Nutrition and diet

We mentioned the importance of nutrition and balanced blood sugar for milk supply, but eating a nutrient-dense diet is also going to help build enough energy for both you and your baby. During times of stress, especially during pregnancy and postpartum, minerals can get easily depleted. You can increase mineral intake through “mineral mocktails.” Try mixing 6 oz coconut water, 3 oz orange juice, ¼ tsp cream of tartar, and a sprinkle of natural sea salt to replenish your minerals. You can also add collagen or whole fat coconut milk if you are concerned about blood sugar. 

Be sure to also speak with your provider for additional ways to incorporate minerals into your diet, as well as any multivitamins or supplements they recommend.

Exercise and movement

There is no need to jump back into exercise quickly, so go slow and find what works best with your body! Take note of what your body needs and what movement feels good for you.

For many, working with a pelvic floor physical therapist is a good starting place to get back into movement. When your body feels ready, you can also start with simple pelvic floor and core exercises to incorporate gentle movement back into the day. Other options can include taking the baby out for walks to get out of the house for some fresh air and sunlight. 

Slowly work on strength and endurance before doing any intense exercises  and stay open with your provider if you are having new or heightened symptoms. 

Does PCOS go away after pregnancy?

It is a common misconception that PCOS goes away after pregnancy. However, having a baby does not mean your condition disappears. It’s important that you pay attention to any symptoms that may reemerge. Continue to assess lab markers and your PCOS management strategies (including nutrition sleep, stress levels, and movement,) which may change after pregnancy. Note that these changes are completely normal! 

If you have any questions about how to manage your PCOS post-pregnancy, reach out to your care team or work with your provider to determine if specific medications or supplements are necessary.

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References

1. ACOG Practice Bulletin No. 108: Polycystic ovary syndrome. (2009). Obstetrics and gynecology, 114(4), 936. https://doi.org/10.1097/AOG.0b013e3181bd12cb
2. Alur-Gupta, S., Boland, M. R., Barnhart, K. T., Sammel, M. D., & Dokras, A. (2021). Postpartum complications increased in women with polycystic ovary syndrome. American journal of obstetrics and gynecology, 224(3), 280.e1–280.e13. https://doi.org/10.1016/j.ajog.2020.08.048
3. Lemay, D. G., Ballard, O. A., Hughes, M. A., Morrow, A. L., Horseman, N. D., & Nommsen-Rivers, L. A. (2013). RNA sequencing of the human milk fat layer transcriptome reveals distinct gene expression profiles at three stages of lactation. PLoS ONE, 8(7). https://doi.org/10.1371/journal.pone.0067531 
4. Turkyılmaz, C., Onal, E., Hirfanoglu, I. M., Turan, O., Koç, E., Ergenekon, E., & Atalay, Y. (2011). The effect of galactagogue herbal tea on breast milk production and short-term catch-up of birth weight in the first week of life. Journal of alternative and complementary medicine (New York, N.Y.), 17(2), 139–142. https://doi.org/10.1089/acm.2010.0090

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