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12/10/2021 PCOS AND PREGNANCY Odds are, you know at least one woman around you who has PCOS. It is a common condition effecting women of reproductive age, with prevalence rates approximated to be around 1.4 million in Canada alone. Upon diagnosis, most women’s first question is ‘how will this impact my fertility’? Unfortunately there is no short answer, but the general conscientious is that while PCOS is unlikely to cause infertility, and can certainly make it harder to conceive, and increases risks of secondary complications.
However, the good news is there are numerous ways to improve PCOS to ultimately assist in a woman’s chances of conception and lead a healthy pregnancy if she has PCOS. Let’s learn more about PCOS and how to improve your changes of getting pregnant with it. 3/2/2020 PCOS: Maybe She’s Born With It PCOS is a medical condition that affects hormone levels in women, impacting 5%–20% of women of reproductive age worldwide and characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. Women with PCO end up producing a higher amount of male hormones, like testosterone, and often experiencing resistance to the metabolic hormone, insulin. These imbalances can lead to issues with acne, and missed menstrual periods (impacting fertility), amongst other symptoms. The 2003 Rotterdam criteria are currently the internationally accepted criteria by which PCOS is diagnosed.
However, the pathogenesis of polycystic ovary syndrome (PCOS) is poorly understood. Part of the research conducted on the origination of the disease has shown that the likelihood of PCOS development in women may be determined at birth. Research in primates suggests that excess fetal androgen exposure may predispose the infant to later development of PCOS through alternations in the epigenome (1). If there is an imbalance of hormones from PCOS during pregnancy, then there is an increased likelihood the baby may also develop PCOS if the infant is born female. Additionally, exposure to testosterone prior to pregnancy could lead to PCOS even when women have children later.  Polycystic Ovarian Syndrome (PCOS) is one of the leading medical conditions now impacting women of reproductive age, and can also have substantial impacts on a woman’s physical and emotional well-being. We’ve already covered symptoms and diagnostic testing of PCOS here, but let's dive deeper into one key hormonal disruption that seems to be particularly troublesome for my patient population – hyperandrogenism.
Hyperandrogenism is common in PCOS, often seen as elevated testosterone and DHEA levels on blood work. And while these two hormones are often seen as synonymous when evaluating total androgenic burden, there is a significant difference between the two. Testosterone and DHEA are both classified as androgenic hormones, however some women with PCOS may have elevated testosterone, with normal DHEA levels, and vice versa. You also don't have to have cysts on your ovaries to present with hyperandrogenism (in fact, only about 20% of women with high androgens have cystic ovaries), and cysts on your ovaries don't always mean you’ll have high androgens. Have I lost you yet?  Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal health issues in women, affecting an estimated 1 in 10 women of reproductive age. Many women are first diagnosed when they are having difficulty trying to conceive, but PCOS presents with many other symptoms, like hair loss, acne, hirsutism, and weight gain. These symptoms can affect a woman's health even beyond trying to get pregnant.
What Causes PCOS? The exact cause of Polycystic Ovary Syndrome is unknown, though it is thought that genetics play a major role. PCOS is a complex disorder that presents itself as a group of symptoms resulting from hormonal imbalances -- usually an excess of androgens like testosterone and high levels of insulin. These symptoms include:  If you’ve ever taken birth control pills and discontinued, you may have experiencedsomething known as post-birth control syndrome. It generally arises within the first 6 months of discontinuing, affects women of all ages, and has a wide array of symptoms. The severity is based on several factors, including how long you took the pill, the type of pill (dosage and hormone combination), your age, liver health, bowel regularity, and overall wellbeing.
Some of the more common symptoms one might experience after stopping the pill include acne and losing hair, and for some women it results in an absence of menses returning, known as amenorrhea. Other less common symptoms women may experience include:  If you and your loved one have been trying to conceive a child, but have unfortunately had little success, stress levels are often on the rise for both of you. But for some couples, the stress resulting from the inability to conceive may actually be part of the reason they’re having difficulty getting pregnant. Anew condition called “Pregnancy Stress Syndrome”not only can prevent you from getting pregnant, but also can create problems and complications during the pregnancy, most notably, miscarriages.
What Is Going on Inside My Body When I’m Under Stress? When faced with excessive stress levels, the brain signals the adrenal glands to start producing and releasing more stress hormones, especially adrenalin and cortisol. In other words, your body is initiating your “fight or flight” response in the sympathetic nervous system. Since all hormones talk to each other (that is their job, after all), increased levels of stress hormones within your body often cause an imbalance to other hormone systems. Together, the adrenal glands, pituitary gland, and hypothalamus of the brain, evaluate the level of stress and perceived stressors on your present state, and increase the production of stress hormones to enhance our “survival instincts” during heightened levels of stress. While this can be beneficial occasionally in certain situations, it is when we are in a constant state of “fight or flight,” it is counterproductive to the reproductive system and being able to conceive a child. How Does Stress Prevent Pregnancy? Increased, prolonged levels of stress results in the body’s continual release adrenalin and cortisol, and elevated levels affect the body as follows:
What Can I Do? The first thing you need to do is address and deal with your stress in a healthy manner. Diet First and foremost, a change in dietary eating patterns and developing a daily exercise routine helps immensely. Far too often, our “go-to” foods when overly stressed are those we consider “comfort” foods, which are full of unhealthy fats and contain large amounts of sugar and sodium. Eliminating refined sugar and a processed food reduces the insulin burden on the hormone system, and the livers need to detoxify chemicals. Instead, reach for whole foods, healthy fats like avocado and nuts, and be sure to reach your required daily caloric intake healty fat making up at least 40% of it. Stress Management Others benefit from learning new techniques and methods to reduce stress and relax, like getting regular message therapy, joining a yoga class, or trying acupuncture. I’ve personally seen acupuncture lower FSH levels (a sign of ovarian failure) from 19 down to 9 in a the course of a month. Seek Help Lastly, DON”TGoogle things! The Internet is a never-ending black hole of information, some good, some bad, and some terrible. You’re wasting precious energy adding potentially incorrect information to your already stressed state. This is what your Naturopath is for. Unsure to build a well rounded health team to not only help you manage stressors, but to look at every factor involved that may be reducing your chances of conception, all the while optimizing your chances of success (there’s a LOT you can do to improve sperm & egg quality, ovulation patterns, etc.) As an additional resource, consider a well-rounded book that will provide insight and empowerment, like Taking Charge of Your Fertility, by Toni Weschler MPH. To determine whether your inability to conceive is due to heightened stress levels, I encourage you to consult with a qualified and experienced Naturopathic Doctor who has a focus in hormones and infertility for a detailed and comprehensive examination. To schedule a consultation appointment today, please feel free to contact Dr. Courtney Holmberg at 647-351-7282, or visit www.courtneyholmbergnd.ca for more information.  Polycystic Ovarian Syndrome (PCOS) is a condition that causes significant imbalances to the hormonal system in many women today. One of the biggest concerns with PCOS is that it is widely under-diagnosed. Just in the United States alone, there are approximately 7 million women experiencing symptoms of this condition, yet around half of these women have no idea they have PCOS!
For a long time, the root cause to PCOS was believed to be a result of an overproduction of male hormones, called androgens. In more recent years, research has confirmed PCOS is in fact a condition resulting from desensitization to insulin production within the body, which in turn leads to increased production of these androgenic hormones. In addition, studies on PCOS have revealed those with the condition are at a greater risk for heart disease and diabetes (type 2). Heart disease is the leading killer in women. Even in cases where women were young and fit, yet had PCOS, it was five times more likely they would still develop these risks if they did not seek treatment for their conditions.  There have been several studies and research conducted over the years on the topic of whether depression and taking a birth control pill is related. A very recent study was published this year on the topic, and is making headlines, as some of you may already know. But before discussing some of its findings, it is important to first understand how the pill works, and discuss its efficacy, side effects, and potential risks on your mental and physical wellbeing.
Birth control pills are the most commonly prescribed form of contraception to young females in North America. They contain a variety of different active and inactive ingredients. Among the more common ones are progestin, synthetic progesterone, and estrogen. The pills can contain a combination of these hormones in various dosages, or just consist of a single hormone. Ingesting synthetic hormones alters your body’s natural hormonal balance, levels, and production, ultimately preventing ovulation and subsequent ability to conceive. The estimated probability of pregnancy during the first year of perfect use of the pill is 0.3% if taken at the exact same time every day, and a dose is never missed. However, actual rates of pregnancy with oral contraceptive are more like 9-11% in their first year of use [1]. Furthermore, an estimate 51% of unintended pregnancies happen while using a birth control pill [3], suggesting failure rate is high. Furthermore, as a result of this natural hormone imbalance, it also affects responses within the brain, which causes altered psychological and physical responses. For instance, some of the more common side effects that have been reported from women taking oral contraceptives include:
The University of Copenhagen Study on Depression and Birth Control This recent study contained a large sample population, consisting of 1,061,997 female subjects, who were aged 15 to 34. In addition, none of these women had experienced any form of depression or other psychiatric/psychological problems prior to starting birth control. To help determine the effects of taking oral contraceptives, the researchers monitored whether subjects were diagnoses with depression or started a new antidepressant prescription throughout the study. The study sample was also divided into two groups, where one set of women would take some form of birth control including:
The other group of women would not use female birth control during the study. At the conclusion of the study, researchers compared the number of women who developed depression during the study period in both groups. The findings were as follows [3]:
Relative risks for first time use of antidepressants were as follows:
Based upon these findings, the study concluded there was evidence that birth control use and depression were related. However, future studies conducted at other research facilities have resulted varying findings. For instance, a 2007 study also found an increase in depression from subjects taking birth control, while another one in 2012 did not find a correlation between the two. Natural Alternatives for Birth Control If you are worried about potential risks and side effects of oral contraceptives, there are several natural alternatives available. Forms of hormone free birth control method include:
A conversation I often have with my patients is the use of a hormone free intrauterine device made from copper. While the study did not assess the use of a hormone free intrauterine device, if you have a history of depression, or have previously experienced low moods on a birth control pill, this may be an effective alternative for you. Of course, it comes with its own risks and side effects, so always have a full discussion with your Medical Doctor or Naturopath to find an option that is right for you. For more information about these and other natural alternatives, please feel free to contact Dr. Courtney Holmberg ND at 647.351.7282 or access the online schedule HERE today to arrange a consultation appointment at her naturopathic clinic in Toronto. References:
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