PCOS and Infertility Must-Knows Plus Breakfast meal ideas
By Jennifer Cockran, Dietetic Intern
Blog Medically reviewed by Sue-Ellen Anderson-Haynes, MS, RDN, CDCES, LDN, NASM-CPT, Founder of 360Girls&Women®
We are wrapping up PCOS awareness month. Polycystic Ovary syndrome (PCOS) is a whole body disorder that affects ovulation and causes your body to produce too many androgens (masculine hormones such as testosterone). This can cause symptoms such as irregular or missed periods, acne, facial hair growth, thinning hair and weight gain.
Why do some of these these symptoms occur?
Unwanted hair growth (typically around face and chin): excess testosterone caused by overproduction of androgens gets into the oil glands in the skin and causes excess oil production which blocks hair follicles. This can also contribute to acne around the jaw and chin.
Thinning hair: This symptom is also hormone sensitive and occurs when testosterone gets converted into a more potent form called DHT and causes hair follicles to die and fall out.
Increased androgens (male hormones such as testosterone) this is due to a rise in leutilizing hormone (LH). LH is responsible for maintaing your menstrual cycle and helps make estrogen. Rises in this hormone can cause excess facial and body hair and can contribute to irregular periods.
Irregular periods: an increase in testosterone, insulin resistance, chronic inflammation and thyroid imbalances can all contribute to a disruption in ovulation. Irregular periods occur when your period does not come in the typical range of 25-35 days.
The color of your period is a big indicator of a healthy menstrual cycle
Bright red means that the blood is fresh that is shed quickly from the uterus, this is a sign of a healthy cycle
Dark red or brown means that it is older blood that has had time to oxidize
Pink is often caused when menstrual blood is mixed with cervical mucus, if your blood is usually more pink than bright red, have your doctor check you for anemia
Orange may indicate an infection such as bacterial vaginosis
Gray may indicate an infection or miscarriage
Purple can indicate high estrogen levels, speak to your healthcare provider if you normally experience purple colored blood
If you experience abnormal bleeding such as prolonged bleeding of more than 7 days and heavy bleeding (soaking through a tampon or pad every hour for 2-3 hours or passing large blood clots (bigger than a quarter) contact your healthcare provider as this can be a sign of a medical condition.
How does PCOS affect fertility?
PCOS may affect your ability to become pregnant because it causes an imbalance in reproductive hormones. Your ovaries need the correct amount of hormones in order to have a normal and healthy menstrual cycle. These hormones include luteinizing hormone (LH) and follicle stimulating hormones (FSH) which help control the production of estrogen and progesterone and the release of an egg in the ovaries. In women with PCOS, these levels are higher than normal which makes it more difficult to achieve pregnancy because it is affecting your menstrual cycle and whether or not you ovulate.
How do hormonal imbalances contribute to PCOS and infertility?
Insulin: 50-70% of women experience insulin resistance as a result of PCOS. High insulin heightens the risk of pregnancy complications such as developing preeclampsia and gestational diabetes.
Having high insulin levels with PCOS can contribute to infertility in a few ways:
High insulin levels can cause the ovaries to produce more testosterone and less estrogen which can stop ovulation (release of an egg from the ovaries).
High insulin levels can decrease the amount of sex-hormone binding globulin (SHBG) which is produced by the liver, this can lead to more free testosterone in the body, also stopping ovulation.
Insulin resistance can also cause fluctuations in energy, sugar and carbohydrate cravings, brain fog, “hangry” attacks, mood swing and stubborn weight gain.
High stress hormones such as cortisol and adrenaline:
Women with PCOS tend to have higher stress hormones such as cortisol and adrenaline, having high levels of these hormones, the body is unable to use estrogen and progesterone effectively.
High cortisol disrupts the body's process (or feedback mechanism) and leads to an altered production of luteinizing hormone (LH) and follicle stimulating hormone (FSH) which is important for hormonal balance and ovulation.
When these hormones are not balanced, it can lead to disruption in ovulation making it harder to become pregnant.
When cortisol and adrenaline are high, the body dumps glucose into the bloodstream constantly, but since the energy isn’t being properly used, extra glucose causes the body to become less responsive to insulin.
Overtime, the adrenal glands can’t keep up resulting in feelings of being tired and never feeling refreshed.
How do I lower my androgen levels naturally?
Spearmint tea helps to naturally lower androgens
A randomized control study showed that drinking two cups spearmint tea daily for 30 days resulted in lowered blood testosterone levels, improved LH to FSH ratios and reduced abnormal hair growth
Nutrition Considerations for insulin resistance:
Simple changes to meals can reduce sugar cravings, improve energy levels and improve your mood. You may have heard that breakfast is the most important meal of the day, with PCOS it is important to start the day off with a PCOS friendly breakfast to help improve insulin levels throughout the day and to avoid “hangry” attacks and cravings.
The most common breakfast foods include cereal, toast, fruit and instant oatmeal- what do these foods have in common? They are all high in carbohydrates and lower in protein. Eating a high carbohydrate, especially refined carbs which are carbohydrates that are easily digestible such as white bread and causes the body to send out too much insulin at once and a sudden drop in blood sugar can make you feel jittery, hungry, moody or have low energy which can increase cravings in PCOS.
Excess Insulin can also cause the ovaries to produce more androgens which can worsen symptoms. This can affect fertility by preventing the ovaries from releasing an egg during the menstrual cycle and also cause anovulation which is when ovulation does not occur.
Balanced fiber, protein and healthy fat breakfasts, on the other hand, can help keep blood sugars stable so that there isn’t a spike in blood sugar levels.
How to Swap High Carb breakfasts for a PCOS friendly breakfast:
Swap ultra-processed cereal with berries and chia pudding (chia seeds soaked in soy milk) topped with coconut yogurt or other plant-based yogurt.
Swap instant oatmeal with cooked steel cut oatmeal, berries and plant-based yogurt bowl with a handful of nuts (for example walnuts, macadamia).
Add low sugar fruits and enjoy at breakfast. These fruits are not only lower in sugar but also lower on the glycemic index, the glycemic index is used to measure how quickly a food raises blood sugar, these fruits do not raise blood sugar very quickly and are a good option for someone with PCOS.
Ideally aim to eat breakfast within an hour of waking up- studies show this has the best effect on blood sugar and insulin levels throughout the day.
How Plant based foods can improve symptoms. Here are some examples:
Flax seeds: contain lignan that can help reduce 5-alpha reductase which is an enzyme responsible for converting testosterone to potent DHT which causes acne and unwanted hair growth.
Brazil nuts: top source of selenium and naturally supports thyroid and requires sufficient levels to keep thyroid hormones in balance (women with PCOS are 3x more likely to suffer from thyroid disorders) and imbalanced thyroid hormones contribute to worsened PCOS symptoms, irregular ovulation, weight gain, infertility and insulin resistance.
Turmeric: contains anti-inflammatory curcumin and can bring down inflammation in the body and may help improve fasting glucose levels.
Getting pregnant with PCOS
Altered hormone function can cause cycles to be inconsistent- Balancing stress hormones, eating a PCOS friendly diet and addressing insulin sensitivities can contribute to more consistent cycles and lower androgen levels in the body.
Changes to the diet and balancing hormone levels, insulin resistance and thyroid levels can all contribute to healthier fertility.
Personalized nutrition is key when addressing PCOS as each person’s medical history, lifestyle, eating patterns, symptoms, etc vary dramatically.
It is imperative to seek out expert advice when managing a chronic condition. Working with your Primary Care Provider, OBGYN and Women’s Health Dietitian is a good place to start.
To learn more about our individualized holistic nutrition and wellness plan or program book a call.
Blog Medically reviewed by Sue-Ellen Anderson-Haynes, MS, RDN, CDCES, LDN, NASM-CPT, Women's Health Dietitian, Wellness Practitioner, Certified Diabetes Care and Education Specialist, Women's Fitness Specialist Certified Personal Trainer, & Founder - 360Girls&Women®
Sue-Ellen Anderson Haynes, MS, RDN, CDCES, LDN, NASM-CPT, founder of 360Girls&Women® Award Winning and Nationally recognized nutrition and food expert and leading global expert in Gestational Diabetes. "What makes us different?"
360 represents completion. At 360 G+W we provide personalized insight to help girls and women dramatically improve their wellbeing.Our mission is to provide evidence-based information and services to help maximize a woman's complete health through the complete life-cycle - preventing, managing, and reversing certain reproductive and chronic illnesses- using nutrition as the foundation along with other innovative holistic practices. Read more.
References:
Woods, T. (2023). PCOS repair protocol: The complete manual to thriving with polycystic ovary syndrome by uncovering the root cause of your symptoms. Fire publishing.
TEED HJ, Norman RJ, Garad RM. A new evidence based guideline for assessment and management of polycystic ovary syndrome. Med J Aust. 2019;210 (6): 285-285.el.
Fica S, Albu A, Constantin M, Dobri GA. Insulin resistance and fertility in polycystic ovary syndrome. J Med Life. 2008///Oct-Dec; 1 (4): 415-422.
Grant P. Spearmint herbal tea has significant anti-androgen effects in polycystic ovary syndrome. A randomized control trial. Phythoer Res. 2010;24(2): 186-188
Wu C, Wei K, Jiang Z. 5x reductase activity in women with polycystic ovary syndrome: a systematic review and meta-analysis. Reprod Biol Endocrinol 2017;15(1):21-21.
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