PCOS: The Hidden Enemy to Fertility

Sleeping woman holding journalIn my practice, I see many women who are dealing with mental health issues related to reproduction, including fertility challenges. It is interesting to me that 1 in 10 women struggle with polycystic ovarian syndrome (PCOS).

Just what is PCOS? The symptoms are complex and the cause not always clear. What is known is that PCOS is an endocrine disorder (pertaining to hormones) thought to be of genetic origin and also influenced by insulin resistance. An increase in androgens (male hormones) results in hirsutism (excessive facial hair) or hair loss (male pattern balding), absence of menstrual cycles, weight gain, high blood pressure, acne, difficulty losing weight, insulin resistance, depression, mood swings (think: perpetual PMS), and sometimes ovarian cysts for women with PCOS. Also, 40% of women with PCOS have a thyroid condition. Fifty-percent of women with PCOS have diabetes (and the percentage is higher with those with “just insulin resistance”). Clearly, the delicate orchestra of hormones fires out-of-whack in a woman dealing with PCOS, and if she is trying to conceive a baby, then she has some significant hurdles to leap to accomplish her goal.

The good news for women managing PCOS is that holistic interventions exist that can help influence fertility and assist her to prime her body to be in optimal condition for a potentially natural conception. In addition, many women have benefited from conventional medicine interventions resulting in conception and full-term pregnancy as well.

Although it is beyond the scope of this article to go in depth on medical interventions, I wanted to a list a few helpful suggestions that are widely reported to be beneficial:

  • Try a weight loss program (exercise 30 mins/day to boost metabolism—women with PCOS have “slow” metabolisms) and also incorporate healthy diet (many diets are suggested in resources below)….please consult with your endocrinologist before making any health-related changes.
  • Practice stress reduction through yoga, deep breathing, exercise, journaling, and psychotherapy.
  • Absolutely eliminate smoking, alcohol, and caffeine from the diet.
  • Acupuncture and Chinese medicine (herbs) have shown some benefit in reducing symptoms of PCOS and assisting with fertility (again, research with your health practitioner the best course of action).
  • Join an online forum for women who are challenged with PCOS (see resources below).
  • Always seek out the advice of your medical practitioner. In some cases, women may elect to try conventional medicine to lower insulin resistance and also improve the odds of ovulation through conventional medications such as metformin and Clomid (clomiphene).
  • Seek the support and comfort of a perinatal/women’s reproductive mental health psychotherapist.

Helpful websites/resources to support women as they journey through PCOS are:

  • soulcysters.net – online community with great links to medical studies, interventions, online support, books, resources
  • pcosupport.org – helpful information, online community for women with PCOS, medical/conventional/holistic interventions, resources
  • pcoschallenge.com – online community, forum, diet suggestions, radio, support forum for women.
  • postpartum.net – (PSI) for women who are experiencing perinatal depression/anxiety; co-coordinators provide names of trained perinatal practitioners who can help clients with reproductive mental health challenges.

As a perinatal psychotherapist, I am involved in linking resources and coordinating treatment with my client’s health-care team. I also provide unconditional, positive support emotionally to my clients who clearly have a physical condition that influences mood. My approach to treatment, although eclectic, is always strength-focused and client-centered. I spend a lot of time focusing on self-care and stress reduction, as well as empowering my clients to make health-conscious decisions for their lives. I blend cognitive-behavioral and interpersonal techniques to help women who are struggling with PCOS and hoping to become pregnant.

We also know that women who have had fertility challenges are more at risk for perinatal depression. Therefore, it is imperative to monitor such clients for symptoms and arm our clients with screening, information, and support throughout their pregnancies on through the first year postpartum (see my previous articles on perinatal depression and anxiety at GoodTherapy.org). Women with PCOS are also at increased risk for pregnancy-related complications including miscarriage, gestational diabetes, and premature delivery resulting in increased NICU (neonatal intensive care unit) stays. All of these potential complications can obviously seriously affect the client’s psychological well-being and place a client at a heightened risk for perinatal depression and anxiety.

In addition, I also provide a safe space for my clients to explore their fears and the sense of anger that their body has betrayed them. Holding the hope that a woman can reclaim her health through holistic (and conventional) interventions is so helpful for clients. In many cases, I have been privileged to learn of my clients’ pregnancies and subsequent healthy deliveries. I am honored to help my clients psychologically through the road to fertility, conception, delivery, and beyond. This work is truly gratifying and moving.


© Copyright 2012 GoodTherapy.org. All rights reserved. Permission to publish granted by Andrea Schneider, LCSW, Postpartum Depression Topic Expert Contributor

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • Leave a Comment
  • Andrea Schneider

    September 7th, 2012 at 1:12 PM

    additional very important resource for perinatal depression/anxiety:
    Postpartum Support International
    postpartum. net

  • Adam

    September 7th, 2012 at 1:36 PM

    I can understand how this must feel.Anxiety or another problem creating problems in conceiving and then that in turn causes more anxiety and anger, thereby increasing the reasons! It truly is great to have these solutions to this menacing problem!

  • Samantha

    September 7th, 2012 at 2:33 PM

    You don’t know how happy I was to stumble across this article because I have just recently been diagnosed myself with PCOS.
    For a long time I have tried to get pregnent and nothing was working. I have struggles with my weight, fertility, and have always been relatively hairy for a female. My OB Gyn said that these are tell tell signs of PCOS if he has ever seen them, and testing confirmed what he thought.
    I may still struggle with getting pregnant so I am thinkin about adoption instead, but it is nice at least to know what’s causing all of this and thatnks for some suggestions as to how I can attack this and hopefully get some of my symptoms under control.

  • Genevieve

    September 8th, 2012 at 5:18 AM

    How is it that as a female, and no spring chicken mind you, that I have never heard of PCOS? You would think that if this is an illness that causes such disruption to a woman’s health then it would receive a lot more attention than it does. That or either I have been living under a rock for the past 50 years. When I see issues like this come up it makes me thankful that more attention is now being paid to women’s health than perhaps we saw in the past, but given that this is the first I have ever read about it it also shows that there is far more to be done in the realm that concerns the overall health and well being of women. Our issues have been hidden and overshadowed in the past by issues that more relate to the health of men. This is our time to speak up and demand t hat just as much attention and research be done to advance the betterment of our gender!

  • Lori

    September 9th, 2012 at 5:20 AM

    Like so many other women I had never thought about this too much either until it happened directly to someone I knew.

    Only then did i learn how PCOS could breakdown a women’s efforts of fertility and could leave her feeling so hopeless about having a child.

  • nel

    September 9th, 2012 at 1:42 PM

    “many women have benefited from conventional medicine interventions resulting in conception and full-term pregnancy as well.”

    I do not know much about PCOS but what is the conventional medicine that is referred here?Hormonal meds?Wouldn’t that mess things up for the women taking them?!

  • Andrea Schneider

    September 9th, 2012 at 6:47 PM

    Glad this article can bring some awareness to folks who have not heard about PCOS. @Nel–in terms of conventional medicine, I would recommend you research some of the websites I listed at the bottom of the article. As it is out of my scope as a therapist to discuss medical interventions specifically. I do know that many women have been helped with conventional and alternative treatments to treat the condition. My article focuses on the emotional support component for women. :)A

  • Kimmie

    September 10th, 2012 at 10:48 AM

    Is this something that most female doctors should be aware of and testing for? Or do you have to see some sort of specialist to determine if you show the risk factors for PCOS? I just have never heard of any testing being done for this but maybe it’s because they only start looking for it if there are increasing problems lack a seeming lack of fertility and an inability to conceive.

  • Andrea Schneider

    September 10th, 2012 at 12:26 PM

    @Kimmie…yes, a reproductive endocrinologist can test and work with you on a diagnosis. The first place to start is with an Obstetrician/Gynecologist who can then refer your for further consultation. Diagnosis usually involves looking at hormone levels in blood, ultrasound of ovaries, and looking at evidence of other symptoms

  • Jeremy

    September 10th, 2012 at 3:32 PM

    Question: why more depression in PCOS patients?
    Shouldn’t they be happy that they were able to get pregnant and sustain the pregnancy?

  • Andrea

    September 10th, 2012 at 4:20 PM

    @Jeremy–women with PCOS are more likely to have complicated pregnancies resulting NICU stays and other challenges. Women with PCOS tend to have more mood instability due to hormonal fluctuations, which also correlates with the hormonal changes during pregnancy, childbirth and breast-feeding. Mind and body are intricately and delicately connected. Thanks for your question, Jeremy. A.;)

  • Andrea Schneider

    September 10th, 2012 at 6:04 PM

    @Jeremy–Studies show that there is more depression in PCOS patients because of the hormonal imbalance contributing to mood swings, and the potential for a complicated pregnancy and childbirth, not to mention the emotional ups and downs of infertility that affect mood health. Mind and body are intricately linked.

  • zara

    September 11th, 2012 at 12:43 PM

    I have always been ncurios as to whether or not this could run in families.
    I have one sister who has had such a hard time getting pregnant, she is actually thinking about adopting now, whcih I am glad for because she has struggled for so many years with this.
    But my other sisters and I have not had a difficult time at all with having children, as we have eight between the 3 of us!
    So is there something that we could look back on to see if she could/should have done differently, or have you found this to just be kind of like random bad luck for some women?

  • Andrea

    September 11th, 2012 at 2:32 PM

    @Zara—If your sister is having fertility challenges, should she wish to pursue some guidance, she should work with her Obstetrician/Gynecologist for a referral to a Reproductive Endocrinologist who can help diagnose the exact cause of the challenge and then help her with possible interventions (both holistic and conventional). PCOS is definitely a condition the average person knows nothing about, but if she suspects she has PCOS, a qualified doctor can help her..

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