Research
Complete Guide to PCOS and Pregnancy
Learn how to manage PCOS for a healthy pregnancy with lifestyle changes, medical treatments, and essential prenatal care strategies.
June 7, 2025
·
17
Learn how to manage PCOS for a healthy pregnancy with lifestyle changes, medical treatments, and essential prenatal care strategies.
PCOS doesn’t mean you can’t get pregnant. With the right approach, many women with PCOS can conceive and have a healthy pregnancy. Here’s what you need to know:
Quick Fertility Treatment Comparison:
| Medication | Use | Effectiveness | Cost (Generic/Brand) |
|---|---|---|---|
| Clomiphene | Induces ovulation | 75–80% ovulation rate, 22% conception/cycle | $52 / $128 |
| Letrozole | Induces ovulation | 27.5% live birth rate | $340 (brand only) |
| Metformin | Supports insulin sensitivity | Lower effectiveness alone for fertility | $73 / $107 |
Takeaway: PCOS is manageable with the right combination of lifestyle changes, medical treatments, and consistent prenatal care. Start by talking to your doctor about your goals and creating a plan tailored to you.
PCOS can make conceiving more challenging, but with focused lifestyle changes, medical options, and preconception planning, you can improve your chances.
Diet and exercise are often the first steps in managing PCOS, particularly because insulin resistance affects 35–80% of women with this condition. These adjustments can have a meaningful impact. For instance, one study found that following an anti-inflammatory diet for three months led to a 7% body weight loss, with 63% of participants experiencing a return to regular menstrual cycles.
Even modest weight loss - just 5–10% of your body weight - can help restore ovulation. This is especially relevant since women with PCOS tend to gain more weight over time compared to others, with studies showing an average increase of about 2.6 kg over a decade.
Focus on eating whole, anti-inflammatory foods while cutting back on processed sugars and simple carbs. A low-carb diet can help stabilize blood sugar levels, as complex carbs release energy gradually, unlike simple carbs that cause spikes.
Exercise is another key piece of the puzzle. Regular physical activity can regulate hormones and lower testosterone levels. Aim for at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous activity per week, along with strength training twice a week. Activities like walking, running, swimming, cycling, or hiking are great options. High-intensity interval training (HIIT) can boost cardiovascular health, while strength training improves insulin sensitivity. Mind-body exercises such as yoga, Tai Chi, or Pilates can also help manage stress, which often worsens PCOS symptoms.
Simple daily habits like cooking at home, staying hydrated, and reducing sedentary time can also make a difference. Start small - add one or two healthy options to each meal rather than overhauling your routine all at once.
If lifestyle changes alone aren’t enough, medical treatments can provide additional support.
When lifestyle adjustments don’t yield results, medical treatments can address anovulation, which affects 70–80% of women with PCOS.
The first step is often oral medications. Clomiphene citrate (Clomid) is a common choice, inducing ovulation in 75–80% of women with PCOS and achieving a conception rate of around 22% per cycle. The generic version costs about $52 per treatment cycle, while the brand version costs approximately $128.
Letrozole (Femara) is another option and has shown better outcomes than clomiphene. Studies report live birth rates of 27.5% with letrozole compared to 19.1% with clomiphene. Although letrozole is pricier, costing around $340 for the brand version, many fertility specialists now prefer it as the first-line treatment.
Metformin, an insulin-sensitizing drug, can also be used alone or alongside clomiphene. It’s often prescribed off-label to manage PCOS symptoms and support fertility. Generic metformin costs about $73, while the brand version (Glucophage) is around $107. However, metformin alone is generally less effective than clomiphene for improving ovulation, pregnancy, and live birth rates, particularly in women with a BMI over 30.
| Medication | Primary Use | Effectiveness | Cost (Generic/Brand) |
|---|---|---|---|
| Clomiphene | Infertility | 75–80% ovulation rate, 22% conception per cycle | $52 / $128 |
| Letrozole | Infertility | 27.5% live birth rate | $340 (brand only) |
| Metformin | Multiple PCOS symptoms | Lower effectiveness alone for fertility | $73 / $107 |
If oral medications don’t work, second-line treatments include gonadotropin injections or laparoscopic ovarian drilling (LOD). LOD can restore ovulation in up to 80% of cases. For more complex cases, in vitro fertilization (IVF) may be recommended as a third-line treatment, with pregnancy rates as high as 50% per cycle, especially for younger women.
Throughout treatment, your healthcare provider will monitor your progress with ultrasound scans to assess ovarian response and endometrial thickness. It’s also essential to rule out other causes of infertility before starting PCOS-specific treatments.
Combining lifestyle changes and medical treatments with preconception planning can help prepare your body for pregnancy. A preconception health check is a vital step in optimizing your fertility.
"As for all women, being in the best possible health before trying for a baby increases the chance of pregnancy and gives the baby the best start in life."
- Sara Holton, Deakin University and Karin Hammarberg, Monash University
Key preconception assessments include checking blood sugar levels and measuring weight and BMI with your doctor. These evaluations allow your healthcare team to create a personalized plan tailored to your needs.
Healthy lifestyle habits are equally important. Maintain a healthy weight, avoid smoking, limit alcohol, eat a balanced diet, exercise regularly, and get enough sleep.
Timing sex during your "fertile window" - the five days before and including ovulation - can also increase your chances of conceiving. Use an ovulation calendar or app to track your cycle.
Preconception is the perfect time to establish healthy eating and exercise routines. These steps not only improve fertility but also set the stage for a healthy pregnancy.
When you're pregnant and managing PCOS, the focus shifts to closely monitoring your health and symptoms. While PCOS can bring unique challenges, staying proactive with your care and maintaining regular communication with your healthcare provider can help ensure a safe and healthy pregnancy.
Pregnancy hormones, like estrogen and progesterone, can significantly influence PCOS symptoms. For some women, these hormonal surges may mask certain symptoms, while others remain noticeable. The way these changes manifest varies from person to person.
One tricky aspect is that early pregnancy signs - such as missed periods, fatigue, bloating, and mood swings - can overlap with common PCOS symptoms, especially for those with irregular menstrual cycles. This overlap can make it harder to distinguish between the two.
In the first trimester, some women may notice shifts in blood sugar levels due to pregnancy hormones affecting insulin sensitivity. As pregnancy progresses, monitoring blood sugar becomes even more important, as women with PCOS are two to four times more likely to develop gestational diabetes. This condition can affect up to 40-50% of pregnancies in women with PCOS. These hormonal changes often require a review and adjustment of medications.
Adjusting medications during pregnancy is a key part of managing PCOS. Some medications may be safe to continue, while others need to be stopped immediately. Always consult your doctor before making any changes.
Always work closely with your healthcare provider to weigh the benefits and risks of any medication. Never start or stop treatment without professional advice.
With the changes in symptoms and the increased risks associated with PCOS, consistent prenatal care becomes even more critical. Your healthcare provider may recommend more frequent visits to monitor your health and catch potential issues early.
"Pregnancy‐related risk profile should ideally be assessed for modifiable risk factors (e.g., lifestyle and weight management) at preconception in women with PCOS."
– Mahnaz Bahri Khomami, Helena J Teede, Anju E Joham, Lisa J Moran, Terhi T Piltonen, Jacqueline A Boyle
Through regular checkups, specialized testing, and personalized care plans, your healthcare team will help you navigate the unique challenges of PCOS during pregnancy.
Maintaining a healthy diet and lifestyle is especially important during a PCOS pregnancy. Smart nutrition choices can help regulate blood sugar, support your baby's growth, and lower the risk of complications. Pairing these dietary changes with safe exercise and stress management creates a solid foundation for a healthy pregnancy. As you transition from preconception strategies to pregnancy care, focusing on these areas becomes even more critical.
Nutritional needs shift during pregnancy, especially for women with PCOS, who face higher risks of miscarriage and gestational diabetes. Research shows that women with PCOS who stick to a balanced diet are three times more likely to experience a healthy pregnancy.
To stabilize blood sugar, aim to eat every 3–4 hours and include a mix of fiber, healthy fats, and protein in your meals and snacks. Swap out refined carbs for slow-digesting, fiber-rich options like whole grains, beans, lentils, starchy vegetables, and whole fruits. These foods provide steady energy and help reduce insulin resistance, a common issue for women with PCOS.
Protein is a key player in your baby's development. Incorporate lean protein sources such as poultry, fish, eggs, dairy, legumes, or tofu into your diet. For omega-3 fatty acids, which support fetal brain development and reduce inflammation, aim for two to three servings of low-mercury fish like salmon or sardines each week.
Healthy fats are another important part of the equation. Add foods like avocados, nuts, seeds, and olive oil to your meals. Don’t forget key nutrients like folic acid (found in leafy greens, legumes, and fortified cereals) to help prevent neural tube defects. Calcium and choline are also essential, so include dairy, eggs, and fortified foods in your diet. A prenatal multivitamin can help fill any gaps.
Simple swaps can make a big difference. Replace sugary drinks with fruit-infused water, snack on fruit paired with peanut butter, and opt for whole-grain bread or pasta instead of white versions. Fill half your plate with non-starchy vegetables and try using beans as a protein source a few times a week. Keep caffeine under 200 milligrams daily and cut back on sugary snacks and processed foods.
A balanced diet works best when combined with regular, safe physical activity. Exercise during pregnancy not only improves overall well-being but also helps manage PCOS symptoms and control weight gain.
Follow general guidelines by aiming for at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic exercise weekly. Add muscle-strengthening exercises twice a week on non-consecutive days. Low-impact activities like walking, swimming, and prenatal yoga are excellent choices. Swimming is particularly beneficial since it provides a full-body workout while reducing strain on your joints.
Exercise also helps regulate PCOS by improving free androgen levels and reducing hyperinsulinemia. However, safety is key - avoid activities in extreme heat, contact sports, high altitudes, or scuba diving. Listen to your body and stop if you feel dizzy, experience chest pain, or notice any unusual symptoms.
If you’re new to exercise, start small with short walks or gentle stretches and gradually increase intensity as your fitness improves. If you’re already active, you can often continue your routine with adjustments as needed. Professional guidance from a clinical exercise physiologist can help tailor a plan to address both pregnancy and PCOS needs. A 2023 study even highlighted that high-intensity interval training over three months reduced depression and anxiety levels in participants.
Emotional health is just as important as physical health during pregnancy, particularly for women managing PCOS. Studies show that women with PCOS are more likely to experience depression and anxiety than those without the condition. Chronic stress can worsen PCOS symptoms by triggering excess androgen production through overstimulation of the adrenal glands.
"Managing stress and regulating emotions are crucial for maintaining overall quality of life, supporting our relationships, physical health, and mental clarity." - clairemacenutrition.com
Mindfulness practices like meditation, deep breathing, and progressive muscle relaxation can help ease stress and anxiety. Getting 7–9 hours of sleep each night is also essential for hormone balance and overall health. Yoga is another great option, offering both stress relief and gentle physical activity that’s safe during pregnancy.
Maintaining regular eating patterns can also create a sense of routine and stability, reducing stress. A recent trial found that following the MIND diet - a blend of the Mediterranean and DASH diets - led to lower levels of depression and anxiety after just eight weeks. Checking in with your emotions daily and practicing self-compassion can help you manage feelings before they become overwhelming.
Professional support can make a big difference too. A 2023 study revealed that women with PCOS who participated in eight sessions of cognitive behavioral therapy reported significant reductions in anxiety and depression compared to those who didn’t receive counseling.
Building on earlier strategies for fertility and prenatal care, keeping a close eye on your health is crucial when managing PCOS during pregnancy. PCOS can increase the likelihood of gestational diabetes, high blood pressure, and preterm birth. Regular screenings and working closely with your healthcare team can help identify potential issues early, keeping both you and your baby in good health.
Pregnancy with PCOS often involves more frequent monitoring compared to standard prenatal care. One of the most important tests is the glucose tolerance test for gestational diabetes. Because of your higher risk, you’ll need a 75-gram oral glucose tolerance test (OGTT) early in pregnancy - within the first 20 weeks - and again between 24–28 weeks. Blood pressure checks are also critical, and your initial appointment should include measurements of height, weight, and BMI to establish a baseline for tracking weight gain throughout pregnancy. Mental health evaluations for anxiety and depression are equally important, as women with PCOS face higher psychological risks.
"In the absence of evidence of benefit for strategies specific to women with PCOS, the international evidence‐based guidelines for the assessment and management of PCOS recommend screening, optimizing, and monitoring risk profile in women with PCOS (at preconception, during and postpregnancy) consistent with the recommendations for the general population."
Frequent ultrasounds and fetal growth checks are also necessary to monitor your baby’s development and catch any potential concerns early. These assessments, combined with open communication with your healthcare team, are key to managing PCOS during pregnancy.
Managing PCOS during pregnancy requires a coordinated approach with a focus on your individual needs. Your obstetrician will oversee care, monitoring fetal growth and keeping an eye out for complications like preeclampsia or preterm labor. If needed, an endocrinologist can help manage insulin resistance, adjust medications such as metformin, and track hormone levels. Be sure to attend regular prenatal check-ups to monitor your blood pressure and your baby’s development. Don’t hesitate to share any concerns or symptoms with your healthcare providers.
"The treatment plan is tailored around your health goals and is individualized to you."
This personalized care ensures your team can adapt their recommendations based on your specific symptoms, pregnancy progress, and overall health.
In addition to medical care, small daily habits can make a big difference in managing PCOS during pregnancy. If advised by your doctor, monitoring your blood sugar can help you understand how your diet and activities impact glucose levels.
Weight management is another important element. Depending on your pre-pregnancy BMI, here are the general guidelines for healthy weight gain during pregnancy:
| Pre-pregnancy BMI Category | Recommended Weight Gain |
|---|---|
| Underweight (<18.5) | 28–40 lbs |
| Normal (18.5–24.9) | 25–35 lbs |
| Overweight (25.0–29.9) | 15–25 lbs |
| Obese (≥30.0) | 11–20 lbs |
Sticking to consistent meal timing, such as eating every three to four hours with three meals and two to three snacks, can help stabilize blood sugar. Regular physical activity - like a 20–30 minute walk, swimming, prenatal yoga, or stationary cycling - can boost energy and support healthy weight gain.
Incorporate stress management techniques like meditation, deep breathing, or gentle yoga to help keep stress hormones in check. Also, aim for seven to nine hours of quality sleep each night by maintaining a consistent bedtime routine and creating a relaxing sleep environment.
"It will significantly decrease pregnancy risks associated with PCOS, including miscarriage and diabetes, and will decrease the long-term risk of type 2 diabetes, high blood pressure and heart disease." – Victoria Fewell, MD, OBGYN with Banner – University Medicine
Dr. Fewell’s insight highlights how these everyday habits can lay the groundwork for a healthier pregnancy and long-term wellbeing for both you and your baby.
Managing PCOS during pregnancy requires understanding your unique needs, committing to lifestyle adjustments, and collaborating closely with your healthcare team. These steps lay the groundwork for effectively navigating the challenges that PCOS can present during pregnancy.
One of the most impactful strategies is weight management, which plays a consistent role throughout the journey. Alongside this, focusing on a balanced diet filled with whole, fiber-rich foods and incorporating regular exercise supports both fertility and overall pregnancy health. These elements serve as cornerstones of your care plan.
Open and honest communication with your healthcare team is equally important. Dr. Keisha Callins, MD, MPH, emphasizes this point:
"Understanding PCOS is really about understanding why your body works the way it does and allows you to have an honest conversation with your physician or medical provider about how to achieve your personal goals throughout the different phases of your life."
Your healthcare providers will guide you through the additional monitoring often needed during pregnancy. This might include early glucose tolerance tests, frequent blood pressure checks, and regular assessments of fetal growth.
Mental health is another critical area to prioritize. Women with PCOS face a higher risk of anxiety and depression, making it essential to incorporate stress management techniques, maintain healthy sleep habits, and seek professional support when necessary.
Since PCOS affects everyone differently, personalized care is crucial. What works for one person may not work for another, so staying adaptable and working closely with your healthcare team to fine-tune your treatment plan is key. These strategies, combined with consistent medical care, create a comprehensive approach to achieving pregnancy success with PCOS.
Making a few changes to your daily routine can have a big impact on fertility for those managing PCOS. Here's what to focus on:
These lifestyle tweaks can make a meaningful difference in fertility and set the stage for a healthier pregnancy journey with PCOS.
Managing PCOS symptoms during pregnancy requires a blend of medical attention and mindful lifestyle choices. Regular visits to your healthcare provider are crucial for keeping an eye on potential issues like gestational diabetes or preeclampsia. If gestational diabetes does develop, treatments such as insulin therapy might be necessary to keep blood sugar levels steady.
In addition to medical care, focusing on a balanced diet and staying physically active can make a big difference. Incorporate lean proteins, whole grains, and plenty of vegetables into your meals. Pair this with moderate, regular exercise to help manage insulin resistance and lower potential risks. By staying engaged with your healthcare team and making thoughtful lifestyle choices, you can support a healthier pregnancy while addressing PCOS symptoms effectively.
If you’re navigating PCOS and planning for pregnancy, having an open dialogue with your doctor is key. Start by sharing details about your symptoms, such as irregular periods or other health issues that could affect your fertility. Providing your medical history can also help pinpoint any potential challenges.
Discuss possible fertility treatments, including ovulation-inducing medications or Metformin, which might increase your chances of conceiving. It’s also worth exploring lifestyle adjustments like improving your diet, staying active, and managing your weight - these changes can support both your fertility and overall health.
Your doctor may recommend a preconception health check to assess your overall health and identify any risks. This could involve monitoring hormone levels or performing tests like ultrasounds to better understand your ovarian function. Taking these steps can give you a clearer path forward and help you feel more confident as you work toward your pregnancy goals.
