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Hi there, Today we have Daisy Larwood-Knights sharing her PMOS diagnosis and the push for her to get pregnant straight away. I know her story will resonate with a lot of you - partly because I hear it echoed in the DMs constantly, and partly because she articulates something really important about what it means to navigate PCOS when the healthcare system has let you down. Daisy was diagnosed in her teens, dismissed by multiple doctors, gaslit about her own diagnosis, pressured about her fertility, and eventually forced to become an expert in her own condition because nobody else would do the work. So I asked her to walk us through it. In her words. Here’s what she shared. Disclaimer: We are all unique in our own ways, so this information is for educational purposes only. This shouldn’t be viewed as medical advice at any point. Please further consult your healthcare provider about your health needs. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.thepcosnewsletter.com/subscribe

Hello everyone, Today I bring you Angela Grassi | PCOS, Honestly , a Registered Dietitian Nutritionist (RDN) and founder and CEO of the PCOS Nutrition Center. Angela recently shared that she has been taking GLP-1s to help her PCOS and perimenopause symptoms, and I couldn’t pass on the opportunity to chat about these medications with a dietitian who has been working in this space for over 26 years. This conversation is for those who have heard about GLP-1 medications and aren’t sure what to make of them, whether they’re curious or quietly wondering if they might be an option. GLP-1 medications are everywhere right now, and women with PCOS are increasingly taking them or thinking about them. This conversation cuts through the noise and gets into what these medications actually do, who they might help, what the risks are, and where the research still needs to catch up. PS: Angela takes them herself, and her experience was not what she expected. We cover: * What GLP-1 medications are and how they work * How they apply specifically to PMOS * Angela’s personal experience taking them * Nutrient deficiencies and muscle loss, the risks we aren’t talking about enough * The stigma around taking them (and the stigma around weight) * The connection between body image, eating disorders, and GLP-1s * What the future of GLP-1s in PMOS might look like Disclaimer: We are all unique in our own ways, so this information is for educational purposes only. In my communications, I summarise research data and bring my experience. This shouldn’t be viewed as medical advice at any point. Please further consult your healthcare provider about your health needs. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.thepcosnewsletter.com/subscribe

Hi there, Have you ever considered egg freezing? Today I am bringing you Tatyana, who froze her eggs because she wanted to have control over her fertility. In this podcast, we go through why she did it, what nobody told her about the process, and what she’d do differently. What is egg freezing actually like — the decision, the process, and what happens after? Disclaimer: We are all unique in our own ways, so this information is for educational purposes only. This issue reflects one person’s personal experience and is not medical or clinical guidance. This shouldn’t be viewed as medical advice at any point. Please further consult your healthcare provider about your health needs. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.thepcosnewsletter.com/subscribe

Today I bring you a lovely conversation with Registered Dietitian Tara | PCOS Journal about a well-known myth: “Losing weight is the only way to manage PCOS.” If you’ve ever sat in a doctor’s office with PCOS, you’ve likely heard some version of this. At least I did. In this episode, we go through: * Is weight loss necessary for PCOS management? * The type of fat that is problematic for PCOS * The psychological impact of wanting to lose weight This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.thepcosnewsletter.com/subscribe

Today, I bring you Olivia Palmer, a Registered Nutritionist and Health Psychologist. Olivia has worked with thousands of women in health and weight loss settings, and she reached a very clear conclusion: We need to stop telling people that they need to lose weight to be healthy This conversation is for those who don’t want their worth measured by a number on a scale and who know they deserve care beyond their weight. Women with PCOS are told to lose weight at pretty much every appointment they go to, so this conversation is a valuable exploration of biology, psychology, public health systems, culture, and, unfortunately, stigma. We are detaching the equation of Weight = Health. We cover: * The problem with “lose weight” as a prescription * Should weight be ignored completely? * The importance of addressing the underlying biology * Why does healthcare continue to focus so heavily on weight? * The role of behaviour change in health * What should women do when they hear “lose weight” This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.thepcosnewsletter.com/subscribe

Today I bring you a lovely conversation with Registered Dietitian Tara | PCOS Journal about HIIT workouts and how they impact PCOS. Among PTs and fitness influencers, HIIT is praised as the ultimate solution for weight loss. Short bursts. Maximum burn. Efficient and powerful. On the other side, women with PCOS are told that HIIT is “too stressful,” that it spikes cortisol, that it ruins hormones, and that we should avoid it altogether. As usual, the truth sits somewhere in between. In this episode, we go through: * HIIT and cortisol - is it true that it messes with your hormones? * Should HIIT be off-limits? * What type of exercise is best for PCOS? This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.thepcosnewsletter.com/subscribe

Hello everyone, Today, I bring you the lovely Julie Duffy Dillon from PCOS Health with Intuitive Eating. I absolutely loved this conversation with Julie, and I think you will too. Julie is a Registered Dietitian who spent over 25 years helping women with PCOS heal their relationship with food and find peace within their bodies. Her book Find your food voice can be found here. Over these years, she kept seeing the same pattern: women with PCOS being harmed by the very advice that was meant to “fix” them. Not because PCOS causes eating disorders directly, but because of how early restriction starts for so many of us. Being told, often in adolescence, that we are “too big” or that we must lose weight to control our hormones does something subtle but powerful. It teaches us that our bodies cannot be trusted. Personally, this is my mission in the work I do: help women connect to their bodies, even when PCOS is present, which is why this specific conversation was so special to me. In this episode, we cover: * What is intuitive eating? * Is intuitive eating suitable for someone with PCOS? * How did we lose the connection to our body? * What are some baby steps we can take to start intuitive eating? * What does “good” look like? This episode can be listened to on all major platforms, including Spotify, Apple and YouTube. If you prefer reading, I have summarised it below. I share snippets from our conversation and short-form content on Instagram. Follow us there: What is intuitive eating? Julie described intuitive eating as a non-diet framework for learning how to live with food. Not to control it. Not to master it. Not to optimise it to perfection. But to live with it. At its core, it means making peace with food and giving yourself unconditional permission to eat. You are allowed to eat. You are allowed to decide what you do with your body. Intuitive eating is often simplified to “eat whatever you want.” In practice, it relies heavily on hunger and fullness cues—and not everyone feels them clearly. Especially not women with PCOS. Especially not women who have dieted for years. If hunger cues are unreliable, we don’t abandon structure entirely. We can use other signals. The clock. Fatigue. Mood. Cravings. Fatigue and cravings, in particular, are strong signals in PCOS. They are not character flaws. They are not weaknesses. They are data. She mentioned something interesting from her clinical work: when someone could not stop eating cereal or peanut butter, it was often a sign they weren’t eating enough overall. The body was looking for quick carbohydrates and micronutrients. It was not a discipline issue. It was survival. Do we focus on eating enough, or eating “better”? Julie always starts with enough. If the body is not getting enough total energy, it stays in a state of deprivation. In that state, it cannot regulate properly. It cannot stabilise blood sugar effectively. It cannot be repaired, and most importantly, it can’t eat intuitively because it’s always fighting. Trying to optimise food composition while under-eating is like trying to design the perfect house while the foundation is cracking. She has worked with many women who had both PCOS and anorexia, more than the literature often suggests, and she saw repeatedly that once energy intake stabilised, several things improved before any micronutrient optimisation was introduced: sleep, focus, emotional regulation, and overall energy. Only when the body feels safe does it allow you to think clearly enough to refine composition. And this connects to something we discussed — the “overhaul” phase. That moment after diagnosis when fear drives you to change everything at once. Cut everything. Count everything. Fix everything. Fear does not create sustainable behaviour change. It creates short bursts of control followed by burnout. When the panic fades, meaningful work can begin. How much of the disconnection with our bodies is PCOS, and how much is dieting? PCOS does bring physiological differences — fatigue, cravings, altered insulin signalling. But Julie was very clear that diet culture amplifies the disconnection. We live in a world where we are told how we should look, how we should eat, and that our bodies are projects to manage. Over time, external noise becomes louder than internal signals. Many women with PCOS have also been traumatised in medical settings. Repeated weight-centred conversations create shame and hypervigilance. Trauma increases stress. Stress worsens inflammation and insulin resistance. The cycle feeds itself. When fear is used as motivation — whether for heart disease, diabetes risk, or PCOS — it does not last. It may create compliance temporarily, but not stability. Grace works better than panic. What are some of the baby steps to make with intuitive eating? If intuitive eating feels abstract or even slightly frustrating, the baby steps are far less dramatic than we imagine. It does not start with throwing away all structure or suddenly “trusting yourself.” It often starts with something much more grounded: eating consistently. Three meals a day. Not skipping lunch even if you are “not that hungry.” Noticing when fatigue or irritability might actually mean you need food. It can look like adding rather than removing — adding protein to a meal, adding a snack before you get overly hungry, adding awareness to why you are reaching for something. It is also about gently observing without judgement. Instead of asking, “Why did I eat that?” asking, “What was I needing in that moment?” Hunger, comfort, stimulation, rest? Intuitive eating begins with curiosity, not control. And over time, that curiosity becomes trust. What does “good” look like? Before making changes, list the PCOS symptoms that are actually disrupting your life. Not what you think should bother you. Not what social media emphasises. What genuinely affects your day-to-day. Is it fatigue?Cravings?Irregular cycles?Sleep? Those become your markers. “Good” does not mean perfection. It means those symptoms are becoming less intrusive. Labs can help, but they are not the only measure. For some women, medical environments are triggering, and that must be taken seriously. Symptom relief, sleep quality, energy stability — these matter. Why have we lost connection to our bodies? Our grandparents did not track macros. They ate what was available. They ate when they were hungry. There was no calorie ledger on the wall. Modern life is different. Food is engineered. Messaging is constant. We override hunger with rules. Interestingly, Julie mentioned that connection often becomes easier when we are caring for someone else, for example, during pregnancy. When responsibility extends beyond ourselves, we tune in more carefully. There is research supporting this. But she also said something important: we deserve nourishment whether we are growing a baby or not. Connection should not be conditional. A closing thought You can add many tools to manage PCOS, but you also deserve grace. If something is not working, it does not mean you failed. It may just mean you do not yet have the right tools, and that is a very different starting point than blame. You can follow Julie on her own Substack below: See you Sunday, Francesca This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.thepcosnewsletter.com/subscribe

Hello everyone, Today I bring you a lovely conversation with Registered Dietitian Tara | PCOS Journal on the role of the contraceptive pill in managing PCOS and the importance of the cycle beyond pregnancy. Tara and I share many of the same principles for managing PCOS, and our conversations are always filled with passion, inspiration, and insights. We got so frustrated about the misinformation shared online about PCOS that this will be a 3-part series where we debunk and discuss some of the most common things we see on social media about PCOS. Today, we discuss the pill. We walk through: * The issues we have with the “just take the pill” approach * How the pill works * When it’s appropriate to take it * Why having a natural cycle is important beyond contraception This episode can be listened to on all major platforms, including Spotify, Apple and YouTube. If you prefer reading, I have summarised it below. The pill & the illusion of “fixing” PCOS When most women are diagnosed with PCOS, the first thing they’re offered is the contraceptive pill. At least that was my experience. The main issues I had, and I am seeing, is that it is often done without much explanation. Not because doctors are careless, but because it’s the standard first-line treatment. It regulates periods, reduces androgens, improves acne, and creates predictable cycles. On paper, it looks like it’s solving the problem. However, the pill doesn’t “fix” PCOS. It doesn’t restore ovulation. It doesn’t address insulin resistance. It doesn’t correct the underlying metabolic drivers. What it does is suppress the communication between your brain and your ovaries. Instead of your body producing its own cyclical hormones, you’re given synthetic ones in a steady, controlled dose. Your natural rhythm is paused. For some women, that pause can be relief. If you’re dealing with acne, irregular period, emotional overwhelm, or simply need contraception, the pill can be a helpful tool. There is no shame in using medication. The issue isn’t the pill itself. The issue is when women aren’t told what it’s actually doing, and that is something we have a bit of an issue with. It’s the false illusion that this will fix everything, which is not true. How the pill works In a natural cycle, there’s constant communication between your brain and your ovaries. Hormones rise and fall. Estrogen builds. Ovulation happens. Progesterone rises. Then everything resets and begins again. When we take the combined oral contraceptive pill, that communication is suppressed. Instead of your brain and ovaries leading the process, synthetic hormones take over. They flatten the fluctuations. Ovulation is paused. The “bleed” you get each month isn’t a true menstrual period; it’s a withdrawal bleed triggered by the hormone drop in the pill cycle. So, in PCOS, it gives the illusion of a cycle, and it does help manage some of our most annoying symptoms: * Increases sex hormone binding globulin (SHBG), which binds free testosterone. * Lowers circulating androgens. * Reduces acne and excess hair growth. * Creates predictable cycle patterns. The issue is that the underlying drivers have not been addressed, so once women come off it, PCOS returns. I have a more in-depth article on the mechanism behind the combined oral pill here: What happens when we come off Many women assume that after a few years on the pill, their PCOS will be “sorted”, that the break gave their bodies time to recalibrate. But PCOS is a syndrome. It’s a complex condition influenced by genetics, metabolism, and environment. When you remove the pill, your original physiology returns. Sometimes symptoms come back stronger.Sometimes they look different.Sometimes they were masked for years. And if no one explained that beforehand, it can feel quite a shock. A cycle is important beyond just pregnancy The other issues we have with being on the pill for a very long time are that it assumes that our cycles and hormones produced naturally are not important for other aspects of our lives. That is not true. Estrogen supports: * Bone density * Cardiovascular health * Brain function Progesterone supports: * Mood stability * Sleep quality * Nervous system regulation These functions only touch the tip of the iceberg. Our bodies are highly intelligent machines that have not been designed for any single use. In PCOS, restoring ovulation isn’t just about getting pregnant. It’s a barometer. It tells you insulin resistance is improving. It tells you the hormonal communication loop is functioning better, and it allows your hormones to do their thing in other parts of your body. When you suppress that loop, you lose a piece of feedback. That doesn’t automatically mean it’s wrong, but it does mean something important is different. Tara shared something really powerful - she only truly experienced a natural cycle consistently in her 40s. For much of her life, she was either on hormonal contraception, pregnant, or breastfeeding. When she finally lived with a regular, natural cycle, she started noticing patterns: * Libido rising before ovulation * Cervical mucus shifting. * Mood softening before bleeding. * Energy surges in the follicular phase. She described it as if she'd discovered a hidden rhythm she’d never been taught to listen to. However, we should NOT demonise it Two truths can exist simultaneously. Hormonal contraception has given women enormous autonomy. It has reduced unplanned pregnancies. It has allowed educational and career freedom. And at the same time, it suppresses a complex hormonal system that affects more than reproduction. If you take it, take it consciously. If you need it, use it without shame. But understand: * It manages symptoms. * It does not cure PCOS. * It pauses your natural cycle. * It doesn’t replace lifestyle and metabolic work if those are relevant. And perhaps most importantly, have a plan. Are you using it short-term for symptom relief?For contraception?While you stabilise something else in your life? That’s very different from assuming it has resolved the condition. Our conclusion Women deserve an explanation. Not just prescriptions. PCOS is complex. It requires time, nuance, and often a multidisciplinary approach. So the real message isn’t “Don’t take the pill” but know what you’re choosing, what is does and have a plan on how to come off it once you want to. See you Sunday, Francesca This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.thepcosnewsletter.com/subscribe

Having PCOS makes it hard to understand what is going on with our body. The unpredictability. The irregular cycles. The “Am I ovulating?” The constant second-guessing. In this episode of The PCOS Podcast, I sat down with Kate, Vice President of Medical for Women’s Health at Ultrahuman. With over 30 years of experience across gynaecology, menopause and fertility, she now works at the intersection of clinical medicine and health technology. We go through Ultrahumans' cycle-tracking algorithm (the only medical device-grade algorithm for temperature tracking), how it helps women with PCOS and the impact it can have on your health. If you are considering investing in a ring to help you track your cycle and ovulation alongside your other markers, I would recommend listening to this episode. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.thepcosnewsletter.com/subscribe

Hello everyone, I am so excited to bring you Georgia Kohlhoff as deep dive into the metabolism of women with PCOS. Georgia has recently co-authored a research paper that was wanted to answer the burning question of: Do women with PCOS have a slower metabolism? Georgia is a Registered Nutritionist and Trainee Counsellor & Psychotherapist and works in fat loss and PCOS. You can find her here on Substack at Flourishing Health or on Instagram. For anyone interested in the paper itself, you can find the abstract here. It’s still going through peer review, but should be fully out soon. This episode is available on Apple and Spotify. If you prefer reading, I have summarised the conversation down below. In this conversation we go through: * Why was answering this question important to you? * Do women with PCOS have slower metabolism? * How is metabolism defined in research? * What was the methodology of this research paper? * If metabolism is not to blame, what makes it challenging for women with PCOS to lose weight? * What surprised you in this research? This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.thepcosnewsletter.com/subscribe

Hello everyone, Today I have the pleasure of introducing you to Dr Lily Kruse, a cardiac surgeon with a Yale medical degree and a deep passion for prevention. A deep conversation that will show you how to take care of your heart early so we can live a long, fulfilling life. We answer: * What are the differences between men and women in CVD? * Women are twice as likely to die of a heart attack compared to man. Why is that? * What symptoms should I take seriously as a women? * How does each hormonal stage in a women’s life impact our CVD risk? * How can I protect my cardiovascular health? * What is your view on PCOS in relation to CVD? This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.thepcosnewsletter.com/subscribe

Hello everyone, Here we are! 2026 has officially started! You know I like to talk a lot about behaviour change in January, and this year I am bringing you an interview with Dr Rosie Webster, the person who first taught me about behaviour change in 2021.PS: The videos I upload here are available as podcasts on Spotify, Apple Podcasts or on YouTube. If you prefer reading, I have summarised the conversation below. If you have PCOS and feel stuck in cycles of motivation, burnout, and starting over, this episode is for you. We break down why common advice doesn’t work, why weight loss is such a frustrating goal, and how behavioural science can help you build habits that actually support your hormones, health, and long-term life. You’ll leave with a clearer way to think about habits, health, and January resets and a framework you can actually apply to your own life. We answer the following: * Why does motivation fade so quickly when we try to change our habits, especially around weight and lifestyle? * Why doesn’t “just trying harder” work when it comes to weight loss and behaviour change? * How should someone approach lifestyle change in a way that’s realistic and sustainable, rather than all-or-nothing? * What role do our environment and daily context play in why weight-related changes feel so hard to stick to? * Why does focusing on weight loss often backfire, and what should people focus on instead? * How can someone use a fresh start (like January) to actually set up changes that last long term? Rosie has a PhD in Health Psychology and is a behavioural science consultant and health coach, specialising in how people make and sustain health behaviour change. The perfect person to speak to in January, as we are considering making changes to our lifestyle for PCOS. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.thepcosnewsletter.com/subscribe

Hello everyone, Today, I bring you another PCOS story from Dr Laura. She was sent home at 18 years old with a diagnosis of menopause, instead of PCOS and no answers. Dr Laura hosts her own PCOS podcast, Triggered by Testosterone, where she speaks openly about PCOS, hormones, mental health, and the realities of managing this condition in everyday life. Laura holds a PhD in Management Studies, where her work focuses on women’s health in the workplace and how organisations can better support women living with chronic and hormonal conditions. Her academic research is profoundly shaped by her own experience navigating PCOS. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.thepcosnewsletter.com/subscribe

Hello everyone, Caroline’s 10 years learning regarding her fertility and PCOS were so touching. Listening to her has made me feel angry, hopeful and determined. Sharing these insights will help so many women avoid the pain of having to try for 3 years before conceiving. This episode is also dear to me because it showcases how tools such as ovulation trackers, knowledge and advocating for yourself can help women navigate this challenging time that some of us have to go through. Weather you are just starting your conceiving journey, have been in it for a while or want to know what tools to use once the times comes, this episode is for you. Ultrahuman gifted me their product for review; this interview is part of that collaboration. Caroline goes through her realisation that she had a short luteal phase using the OvuSense vaginal temperature tracker and how she had to fight for ovulation medication due to her weight. A story of resilience, perseverance and love. Caroline is part of the Ultrahuman team, who have recently acquired viO HealthTech company who produces the OvuSense temperature trackers. She left her job at a police department to join this team because of how much she believes in advocating for women with PCOS. The Ultrahuman team has a 30% discount on their ring who has an advanced temperature tracking module. I don’t gain any monetary value from sharing this. Have a good Sunday, Francesca This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.thepcosnewsletter.com/subscribe

Hello everyone, This article was quite hard to write and film emotionally. For anyone who wishes to become a mother, the thought of managing to get pregnant and losing it is terrifying. I have added one more episode to the series. So far we have gone through: * Episode 1: PCOS and fertility - how do I know how much time I have left? * Episode 2: How can I prepare my body for pregnancy? * Episode 3: The other side of the coin -> checking your partner’s fertility and optimising for a family * Episode 4: Finding ovulation when your cycles are irregular * Episode 5: The risk of miscarriage I know numerous women who have gone through miscarriages and then went on to have healthy babies later down the line, or women who needed assistance. The reason why I think it’s important to talk about it is because it normalises it. 90% of miscarriages in the first trimester are down to chromosomal problems - so it’s not your fault if it happens. Many women blame themselves for it, but it’s a natural phenomenon. Of course, we are emotionally intelligent animals, so it’s hard to stay purely in the facts, but understanding the odds is helpful. Approximately 25% of women experience a miscarriage in their lifetime, so that’s 1 in 4 who will have to go through this unpleasant experience. I have been very close to two of my friends’ miscarriages and their experience, which, while painful, normalised it. Here are the numbers for women without PCOS and those with PCOS. ❤️ This content is for our paid subscribers. A lot of work and research goes into writing these articles. Consider becoming a paid subscriber to get the most scientifically-backed PCOS information and learn to control your PCOS. Women without PCOS There is a book that provides in-depth details about the data we have on popular pregnancy myths. It’s called Expecting Better by Emily Oster. I can see that she was a very anxious mom-to-be and found a lot of comfort in understanding risk percentages and delving deeply into the data. If you are seen at week 6, and everything looks good, these are the % of pregnancies that are lost afterwards. Starting at 11% in week 6 and going down to 2% in week 11. A very sharp decrease. Other sources, such as the Tommys, a charity dedicated to pregnancy and babies, report the following numbers: early miscarriages happen to 10-20 in 100 (10 to 20%) of pregnancies. That’s almost 1 in 5. Second-trimester miscarriages happen in 3-4% of pregnancies. The numbers differ according to the source. As you can imagine, it’s pretty hard to estimate, as some of the miscarriages can go unnoticed when they happen. Some studies even put the risk at week 3 at 30%. The risk of losing your pregnancy goes down as time passes and the little cells become a fetus. Women with PCOS It will come as no shock to you that we have a higher chance of miscarriage. With this condition, you can pretty much assume that we have an increased risk of every disease under the sun. It does show the wide range of implications of hormones on our bodies. A paper on pregnancy in women with PCOS puts our first-trimester miscarriage rate between 30 to 50%. It is pretty challenging to determine, so most of these figures come from studies where some form of assistance was provided. For example, treatment with ovulation-inducing agents such as clomiphene or letrozole is associated with a higher incidence of miscarriage compared to the naturally conceiving population. It is not known the rate of miscarriage for those who conceived naturally. I guess that it depends heavily on how well-controlled your PCOS is. Why? 1. Increased LH An increase in LH characterises PCOS. High LH can: * Prematurely trigger oocyte maturation → poorer quality eggs. * Impair corpus luteum function → insufficient progesterone support for early pregnancy - progesterone is needed for the endometrium to develop and be stable where the embryo implants What can I do? Before conceiving, it would be ideal to undergo a test to determine your baseline LH levels. Elevated LH is primarily genetic; however, there is evidence that insulin can increase LH secretion - so taking care of your insulin levels MIGHT*** help. Might*** - with three *** because it’s very hard to prevent miscarriages or be sure of what the issues are - the things that I suggest are in no way saying - if you do this, you won’t have a miscarriage. As we saw at the beginning of this article, most of it’s chromosomal - we are just trying to understand if the percentage increase compared to women without PCOS might be due to PCOS-specific things. I am a control freak - so if there are things that I can try, I will do them even though they might not necessarily have an effect. 2. Elevated androgens Elevated free/total testosterone ratios were found to be predictive of early pregnancy loss in two different studies. The authors speculated that high androgen levels antagonise estrogen, which may affect endometrial development and implantation. The endometrium is incredibly important for the embryo to implant and find its cosy home for the next 9 months. What can I do? Similarly, testing your testosterone levels beforehand is probably a good idea. It’s all about understanding your baseline and giving yourself 3-12 months prep time. We discuss how to prepare for pregnancy at length in our second episode. 4. Plasminogen activator inhibitor-1 (PAI-1) High plasminogen activator inhibitor-1(PAI-1) activity is associated with recurrent pregnancy loss in women with unexplained recurrent miscarriages. It has also been found to be significantly higher in women with PCOS. PAI-1 inhibits fibrinolysis - the body’s ability to dissolve clots. Tiny clots can form in the blood vessels that feed the placenta (the organ that supplies the baby with oxygen and nutrients). These clots block the blood flow, so the placenta doesn’t get enough circulation. Without proper blood supply, the placenta can’t support the baby → leading to pregnancy loss. What can I do? There is a study which documented improved pregnancy outcomes with metformin in overweight women with PCOS and correlated it to significantly reduced PAI-1 activity levels resulting from treatment. This is an option. Metformin will come up later in the article. 5. Insulin Resistance You knew this one was coming. This one has multiple implications: * Alters oocyte quality and maturation. * Interferes with glucose uptake in the endometrium → poor energy support for implantation. * Exposure to excess glucose can turn on a “self-destruct switch” ( apoptosis) * Suppresses GLUT4 expression in endometrial cells, reducing glucose transport. * Reduces glycodelin & IGFBP-1 (proteins crucial for implantation and maternal immune tolerance). What can I do? Allowing yourself time to adjust your diet before trying to conceive is important. Metformin can also be your friend in these instances, together with Inositol, a low-GI diet and muscle building. 6. Endometrial Dysfunction Even beyond hormones and insulin resistance, women with PCOS may show: * Reduced β3 integrins → cell adhesion molecules needed for embryo attachment. * Reduced glycodelin → supports placental development and immune modulation * Reduced IGFBP-1 - regulates fetal growth and implantation Can I do anything to prevent a miscarriage? There is a retrospective review where 65 women with PCOS who continued metformin during pregnancy had a much lower rate of first-trimester loss (8.8%) compared to 31 women who did not take it (41.9%). Among those with a history of miscarriage, the protective effect was even more substantial (11.1% vs. 58.3%). These findings suggest that metformin use in pregnancy may significantly reduce early pregnancy loss in women with PCOS. There is a current research study ongoing, called the LOCIS Trial, which is due to be published later this year. The LOCI trial will generate robust evidence on whether continuing metformin treatment throughout the 1st trimester can reduce the risk of miscarriage for approximately 1,800 women with PCOS. I would discuss this with your doctor and consider taking Metformin for a while before you start conceiving and throughout your first trimester. Lifestyle and weight management are universally recommended and provide broader health and fertility benefits. Looking after our PCOS markers is essential. Supplementation with Vitamin D, Omega-3, and Folate is also very important. A good prenatal multivitamin can help. If you need specialised support, don’t hesitate to contact me at [email protected] This concludes our fertility series. I will create a lot more pregnancy content later on. I hope this has offered you a window into what you need to know about this chapter in our lives. See you next Sunday, Francesca This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.thepcosnewsletter.com/subscribe