PCOS and Preconception: What Every Woman Deserves to Know Before Trying to Conceive

You were never meant to feel this confused about your body.

Maybe you’ve been told you have PCOS, but were given little more than a diagnosis and a dismissive plan: lose weight, go back on the pill, come back later.

Maybe you’ve come off birth control and feel like your cycle disappeared.

Maybe you're sensing that something feels off - unwanted hair growth, irregular periods.

This is more common than you think. And yet your experience is still deeply personal.

Polycystic Ovary Syndrome affects 1 in 10 women, and while it can impact fertility, it doesn’t define your future. With the right understanding, support, and compassion, you can begin to work with your body - not against it - and prepare for pregnancy in a way that feels clear, grounded, and deeply aligned.

Let’s explore what’s really going on - and how you can reconnect with your hormones, restore balance, and prepare for pregnancy in a way that honors you fully.

What Is PCOS?

Polycystic Ovary Syndrome is not just one condition, but a hormonal imbalance that shows up in a variety of ways. Some of the most common symptoms include:

• Irregular or absent menstrual cycles

• Acne or oily skin

• Weight gain or difficulty losing weight

• Unwanted facial or body hair (hirsutism)

• Infertility or difficulty ovulating

• The appearance of many small follicles (not true cysts) on the ovaries

PCOS is also linked with increased insulin resistance, inflammation, and higher levels of androgens (male-type hormones like testosterone and DHEAS). And while these symptoms impact fertility, they also affect your overall health, including your risk of developing type 2 diabetes, cardiovascular disease, and mood disorders like anxiety or depression.

How PCOS Affects Fertility

The most significant fertility issue with PCOS is irregular or absent ovulation. Without consistent ovulation, it’s much harder (or sometimes impossible) to time conception.

High levels of insulin, a key player in the most common form of PCOS, cause the ovaries to produce more testosterone. This hormonal environment disrupts the delicate cycle that allows follicles to mature and release an egg. In simple terms, your body may try to ovulate, but the process gets interrupted, and the follicle just… stalls.

This means you might have long gaps between periods, or not bleed at all unless triggered by medication or synthetic hormones. And if you don’t ovulate, you can’t conceive.

The 4 Types of PCOS You Need to Know About

Understanding why you have PCOS is key to getting the right treatment. Over my 17 years of clinical practice, I’ve seen that the most effective path to pregnancy starts with identifying your root cause. There’s no one-size-fits-all plan, and you deserve more than guesswork.

Let’s look at the four main types:

1. Insulin-Resistant PCOS (Most Common)

This is the most prevalent form of PCOS. Elevated insulin tells the ovaries to pump out more testosterone, which interferes with ovulation.

You might have this type if:

• You experience sugar cravings, fatigue after meals, or difficulty losing weight

• You’ve been told your fasting glucose is "normal," but no one has tested your fasting insulin or HOMA-IR

• You have dark patches on your skin (acanthosis nigricans) or stubborn belly weight

Pro tip: Ask your provider for a fasting insulin test. Optimal fasting insulin should be 20 - 50 pmol/L, not just within the "normal" range of 20 - 180 pmol/L.

2. Post-Pill PCOS

This type develops in some women after stopping hormonal birth control. The pill suppresses ovulation, and while cycles typically return within a few months, some women remain anovulatory or have elevated LH (luteinizing hormone), which mimics PCOS.

You might have this type if:

• Your cycles were normal before the pill

• You now have long, irregular cycles after stopping

• Your labs show a high LH:FSH ratio (typically >2:1)

Post-pill PCOS usually improves with time and targeted support for the brain-ovary connection, nutrient replenishment, and gentle hormone balancing.

3. Inflammatory PCOS

Chronic inflammation can disrupt hormone signaling and ovulation.

Signs of inflammation-driven PCOS include:

• Joint pain, skin issues, or gut discomfort

• Elevated CRP or other inflammatory markers

• Fatigue that doesn't improve with rest

Common triggers include food sensitivities, environmental toxins, blood sugar swings, or high stress. Supporting gut health, reducing toxins, and calming inflammation can help regulate cycles naturally.

4. Adrenal PCOS

In this type, the adrenal glands (not the ovaries) are the primary source of excess androgens—specifically DHEAS.

You might have this type if:

• Your testosterone and insulin are normal

• DHEAS is elevated on bloodwork

• You’ve been under chronic stress or had past trauma

Adrenal PCOS accounts for about 10% of cases. Treatment focuses on nervous system regulation, adrenal support, and gentle hormone balancing—not blood sugar or ovarian function alone.

A Patient Story: Sarah’s Path to Pregnancy

Sarah was 33 when she came to me. She had been off the pill for a year and hadn’t had a single period. Her doctor diagnosed her with PCOS and told her to try losing weight and come back in six months. “I felt completely dismissed,” she told me. “I wanted to get pregnant, but no one could explain why my body wasn’t working the way it should.” Through a full preconception workup working with Dr. Jessica we discovered that Sarah had post-pill PCOS with signs of inflammation and nutrient depletion. She wasn’t insulin resistant, but her LH:FSH ratio was elevated, and her B12 and zinc were low. We worked on cycle tracking, gut healing, restoring nutrients, and reducing inflammation. Within 10 weeks, her first natural period returned. Three cycles later, she ovulated and conceived.

Now she’s holding a healthy baby girl.

Supporting Fertility With a PCOS Diagnosis

There is hope - and there are real, science-backed steps you can take right now.

Here are some of the most effective preconception strategies I use with my patients:

✅ Cycle tracking: Even irregular cycles can show signs of ovulation. Learning how to chart your basal body temperature and cervical fluid helps you tune into your body and stop relying on apps alone.

✅ Targeted lab testing: A full hormone panel (including fasting insulin, testosterone, DHEAS, LH, FSH, TSH, prolactin) plus nutrient testing (like vitamin D, B12, and ferritin) paints a complete picture.

✅ Blood sugar support: For insulin-resistant PCOS, simple changes like eating protein with every meal, reducing refined carbs, and walking after meals can make a big impact.

✅ Nervous system regulation: Chronic stress makes hormonal balance nearly impossible. Practices like breathwork, somatic tracking, and nervous system-safe movement can reset the adrenals.

✅ Supplements with purpose: Depending on your root cause, supplements like inositol, NAC, magnesium, or zinc can be game changers—but only when matched to your specific needs.

You Don’t Have to Wait for Infertility to Be Diagnosed

One of the hardest things I hear from women is, “My doctor said to wait and come back in a year.”

But you already know: Waiting without answers isn’t care - it’s delay. And your body deserves more than delay. It deserves attention, clarity, and support right now.

Even if your cycles are irregular. Even if you’re unsure when you’ll try. Supporting your hormones today is a powerful way to align with the future you want.

If you’ve been diagnosed with PCOS - or suspect something is off - this is your invitation to explore a different way forward.

Inside My Preconception Plan, we look deeper. We personalize care. We restore trust in your body.

Let’s begin with a free Preconception Clarity Call. It’s not about rushing. It’s about reconnecting—with your body, your goals, and a plan that actually supports both.

Book My Call Now