We all know that the pregnancy through postpartum transition is hard on our bodies. But there’s something that can make this time even more difficult: a hormonal imbalance.
If you or someone you’re close with has been diagnosed with a condition like PCOS or hypothyroidism, chances are you’re familiar with what these conditions are. A hormonal imbalance, to put it simply, is when there is a miscommunication between our different endocrine glands.
Pollie’s research indicates that 20M women in the US alone have a reproductive hormonal imbalance, and you can add millions more on to that when you consider thyroid disorders. Still, roughly half of these conditions go undiagnosed due to lack of awareness.
Our endocrine system is an important regulator for our body, and when something is chronically “off” it can lead to many of the serious health issues listed above. It can also complicate pregnancies and make postpartum transitions more difficult.
Today we will be taking a look at how hormonal imbalances can impact pregnancy and postpartum, as well as what steps you can take to take your health back into your own hands if you have a hormonal health disorder.
PCOS is an ovulatory disorder that impacts an estimated 10% of women. Common symptoms of PCOS include irregular cycles, weight and blood sugar issues, male-pattern hair loss, irregular hair growth, and more.
PCOS can be characterized by fulfilling 2 of 3 of Rotterdam’s criteria:
- Hyperandrogenism (i.e., high levels of male hormones)
- Anovulatory cycles (i.e., not ovulating regularly)
- Polycystic ovaries (i.e.., ovaries have a ring of follicles, or eggs that failed to ovulate, surrounding them).
If you’ve been diagnosed with PCOS, chances are that your doctor (or Dr. Google) cited several health risks associated with this disorder: increased risk of diabetes, heart disease, estrogen-dominant cancers, and mental health disorders.
One driving factor behind PCOS health risks, and a hallmark of the disorder itself, is insulin-resistance. OVer 60% of women with PCOS are also insulin-resistant, meaning that their body does not effectively use sugar for energy. Insulin is a hormone released by our pancreas that helps convert blood glucose into energy for our muscles, and insulin-resistant bodies must overproduce insulin. This both overworks the pancreas and over time leads to chronically high blood sugar, putting women at risk for diabetes.
Perhaps the most widely-known risk associated with PCOS is infertility. In fact, this condition is the leading cause behind conception struggles (although contrary to rumors, getting pregnant if you have PCOS is still possible – so still practice protected sex if you are not looking to start a family!). It can be difficult to receive a PCOS diagnosis – carefully-timed bloodwork and an internal ultrasound are required – and for this reason many women do not learn that they have PCOS until they start trying to conceive.
PCOS is not all doom and gloom. Many mild to moderate cases can be managed entirely with lifestyle modifications like diet and exercise. Even the most severe cases can be managed, either through lifestyle changes or medication. However, this condition is lifelong, so it is important to find a regimen that fits your goals and lifestyle so that your change is sustainable.
Endometriosis, or “endo,” is an inflammatory, autoimmune, and hormonal disorder in which a woman’s endometrial cells (e.g., cells from our endometrium, or uterus lining) grow in places they shouldn’t grow, most commonly around the ovaries, fallopian tubes, and tissue lining the pelvis. Symptoms of endo include heavy and painful periods, pain with intercourse, urination, and bowel movements, bloating or nausea, other GI issues, and excessive bleeding during menstruation.
Since endo most commonly displays in the pelvic region, it can also lead to infertility: approximately one-third to one-half of women with endometriosis may have trouble conceiving. The reason behind this is commonly due to blockages of endometrial cells where there should not be blockages (e.g., if your fallopian tubes have misplaced tissue growing, your body may have trouble releasing an egg).
However, endometriosis can show up anywhere: the intestines (leading to the above GI issues), the bladder and rectum (causing pain while using the bathroom), and even places as far away from our reproductive organs as our lungs – although fortunately, this is rare.
While the true cause of endometriosis is still unknown, there is evidence that it is rooted in inflammatory and autoimmune issues. There is also a high correlation with estrogen dominance, which is when our body produces too much estrogen relative to progesterone (more on this later!).
Like PCOS, endometriosis can also be managed. Below are some common techniques for managing pain and preventing endometriosis from advancing:
- Lifestyle: For some, sticking to an anti-inflammatory diet, minimizing stress, and using natural pain relief is enough to keep symptoms manageable.
- Hormonal therapy: Hormonal birth control can also be a helpful way to decrease pain, since the pill keeps our body from ovulating and we therefore do not build up new endometrial cells each month. However, this is more of a “band-aid” fix and does not address the root cause.
- Surgery: Although more invasive than other tactics, surgery always remains an option. There are two main types of surgery for endometriosis: conservative surgery, which removes as much of the endometrial tissue as possible while preserving your reproductive organs, and a hysterectomy, where a surgeon will remove your uterus and possible your cervix and ovaries.
The Impact of Hormones on Maternal Health
Despite rumors, it is possible to get pregnant with hormonal health issues like PCOS and endometriosis. And fortunately, there is growing educational content about these problems specifically. But what about if you have PCOS or endo and have managed to get pregnant, or have recently given birth? Are there risks (or benefits!) you should be keeping an eye out for? Absolutely.
Next we will take a look at maternal health issues associated with both PCOS and endometriosis, and explaining why each condition leaves women at a heightened chance of these risks.
Hormonal imbalances can leave you prone to a different pregnancy experience than the average woman.
PCOS oftentimes leaves women at a higher likelihood of having an at-risk pregnancy, although this depends on the severity: PCOS is a spectrum disorder, and minor cases are less risky than severe cases. That said, the following are important to be aware of for all women with PCOS:
- Luteal phase defect and miscarriages: Women with PCOS are at 3x higher risk of miscarriage. This is largely due to something called “luteal phase defect” which is oftentimes seen in women with PCOS in addition to thyroid and prolactin disorders. Luteal phase defect is when your luteal phase (i.e., the two weeks in between ovulation and your period) is shorter than normal because your body does not secrete enough progesterone. Adequate levels of progesterone are needed for proper uterine lining development, and when the luteal phase is too short and your body is not producing enough progesterone, women may experience implantation issues as well as early miscarriages.
- To minimize for this risk, you can track your progesterone levels before conceiving and during your pregnancy. A test like Proov is a great place to start: their at-home progesterone testing kit lets you know how effective your ovulation is and can offer a window into your progesterone status. Bringing this to your OBGYN is a good way to begin this conversation, and you can more trackly track your luteal phase with dried urine tests and bloodwork under the care of a qualified specialist. A provider may prescribe a progesterone cream, or other supplementation, if it’s found that you do have a luteal phase defect. There are also certain foods you can eat to help boost progesterone levels.
- Insulin resistance and gestational diabetes: PCOS also leaves women at a higher risk for gestational diabetes, particularly for the majority of cysters who are insulin resistant. Gestational diabetes can cause a larger-than-normal fetus that requires a cesarean section delivery and also lead to low blood sugar and breathing trouble for newborn babies. That said, gestational diabetes is treatable and when controlled, it should not cause issues for mom nor baby.
- To minimize risk for gestational diabetes, you should keep track of your blood sugar before and during pregnancy, particularly if you already know that you have insulin-resistant PCOS. You can work with your doctor to determine what your target blood sugar levels.
- High blood pressure and preterm birth: Women with PCOS are at an increased risk of high blood pressure and subsequently more likely to develop a condition called preeclampsia. Preeclampsia is a sudden increase in blood pressure after the 20th week of pregnancy that can result in liver and kidney damage, and the most effective treatment is delivery. This often means a preterm birth and cesarean section.
- High blood pressure before pregnancy and gestational hypertension both can increase risk for preeclampsia. Eating a healthy diet that’s low in sodium, drinking at least 8 glasses of water per day, maintaining light activity, and practicing stress management techniques are all ways to keep blood pressure in control. In some cases, your provider may choose to put you on medication until you are far enough along to deliver safely.
Endometriosis also has some pregnancy risks, although it is important to note that many of the pain-related symptoms with the disorder oftentimes disappear during pregnancy. This is largely due to the fact that our monthly cycles, most often during menstruation, cause cyclical pain with endo. Since pregnancy halts our period and our cycle, many women actually find that their symptoms improve! Talk about an unexpected benefit.
That said, there are several risks associated with endometriosis and pregnancy:
- Estrogen dominance and miscarriage: There is also a connection between endometriosis and luteal phase defect, As mentioned earlier, a common hormonal imbalance component seen with endometriosis is estrogen dominance, which is associated with a luteal phase defect. This, along with other issues caused by chronic inflammation, means that women with endometriosis are at a higher risk for miscarriage.
- The same tips for monitoring progesterone for PCOS hold true here: track your hormone levels before and after conceiving, and work with a qualified specialist who can help you supplement if necessary.
- Increased pain: Okay, okay, we just discussed how pregnancy can alleviate symptoms for some women with endo. However, this is a very individualized disorder and no woman’s body will respond the same way. For some women with endo, pregnancy will cause pain to worsen depending on where their cell growths are – if they are located on tissue that will be moving and expanding during your pregnancy, you may still experience pain.
- Like pre-pregnancy endometriosis, pain is hard to manage. But, an anti-inflammatory lifestyle (i.e., foods, exercise, and other techniques that work for you) can help keep this at bay.
- Preterm birth: Studies show that endometriosis leaves women at a 1.5x higher chance of preterm birth, which opens doors for complications for both mom and baby.
- If you are experiencing signs of early labor like contractions, changes in vaginal discharge, and pelvic pressure, see your doctor. In many cases, preterm birth can be stopped with medication so that your baby has more time to develop.
Clearly, hormonal imbalances can complicate pregnancies. The same is true for postpartum, although more so from a discomfort standpoint than a “risk” perspective. For example, women with endometriosis whose pain went away during pregnancy will likely find it returns, and women with PCOS may find more intense hormonal changes that come along with breastfeeding.
One particularly important item to be aware of postpartum is mental health. Both PCOS and endometriosis increase the risk of anxiety and depression, and this can put women at a higher likelihood of developing postpartum depression.
Being aware of these factors is important, particularly during the postpartum period when women and their families are experiencing a high degree of change. Knowledge is empowering, especially during a time like this, and educating yourself with a program like Gravida or working with a specialist if you are experiencing more intense issues are both excellent places to start.
Taking back control
Much like the longer-term risks associated with hormonal health issues, you can manage your body and symptoms to minimize adverse effects during and after pregnancy.
Giving birth is a hormonal rollercoaster for even the more balanced of bodies. If your baseline is imbalanced, you’ll likely need a bit more support.
This is a great time to consider working with a hormonal health specialist. Based on what your goals are, you may want to consider the following specialists:
- Naturopathic doctor: Naturopathic doctors, otherwise known as NDs, sit at the intersection of Eastern and Western medicine. If you are looking to combine the rigor of a MD with the holistic approach of functional medicine, a naturopathic doctor may be for you. They will take a “whole body” approach to re-balancing your body, and you can expect a fair amount of labs and more 1-1 time than with a conventional practitioner when working with this type of provider. You can learn more about NDs here.
- Nutritionist: Nutrition specialists are food-focused. Diet is important when it comes to our hormones, and personalization is key: some bodies may react well to a higher carb, plant-based diet, while others may need a paleo or keto lifestyle to thrive. Keeping tabs on diet during pregnancy and postpartum is important, particularly for bodies whose hormones are more sensitive and prone to imbalance. It is important to note that when it comes to nutritionists, credentials matter: this is not a regulated title, and some providers may have received more schooling than others. This often has a direct relationship with provider scope (e.g., ability to prescribe medication and labs) as well as appointment price. You can read more about the different types of nutrition credentials and what they mean here.
- Health coach: More so than other specialists, health coaches will do as their name implies – coach! Their role is to help you come up with short, mid, and long-term goals, as well as routines, to help make tangible changes. Many coaches will also have experience in nutrition and fitness, and their work tends to be more lifestyle-centric than other types of providers.
In conclusion, while hormonal imbalances can make pregnancy and postpartum more difficult than for the general population, these conditions and risks are manageable. Being aware that you have a condition like PCOS or endometriosis is the first step to taking control, and there are gradations of support that you can pursue to re-balance your body.
Learn more about hormonal health and connect with a health coach over at Pollie!