From the Guidelines
After successfully having children through IVF with PCOS, it is crucial to continue managing your PCOS symptoms and health risks even after completing your family, as this condition is lifelong and increases the risk of developing type 2 diabetes, heart disease, and endometrial cancer. Schedule regular follow-ups with your healthcare provider to monitor hormone levels, insulin resistance, and metabolic health. Lifestyle modifications remain essential, including maintaining a healthy weight through regular exercise (aim for 150 minutes weekly of moderate activity) and following a balanced diet low in refined carbohydrates, as recommended by the international evidence-based guideline for the assessment and management of PCOS 1.
Key Recommendations
- Regular physical activity, such as 10,000 steps daily, including activities of daily living and 30 minutes of structured physical activity, is ideal 1.
- A balanced diet with realistic goals, such as a 5% to 10% weight loss in those with excess weight, can yield significant clinical improvements 1.
- Medications like metformin (500-2000mg daily) can help with insulin resistance, while hormonal contraceptives like combined oral contraceptives can regulate periods and reduce androgen levels if you're not seeking further pregnancies.
- Regular screening for associated conditions, including diabetes (annual HbA1c testing), cardiovascular risk factors, and endometrial health, is vital.
Ongoing Management
Ongoing management of PCOS is essential to reduce the risk of associated conditions, and your specific treatment plan should be personalized with your healthcare provider based on your symptoms, health goals, and risk factors 1. Psychological factors, such as anxiety and depressive symptoms, body image concerns, and disordered eating, need consideration and management to optimize engagement and adherence to lifestyle interventions 1.
Lifestyle Interventions
Lifestyle interventions, including diet, exercise, and behavioral strategies, should be recommended in all those with PCOS and excess weight, for reductions in weight, central obesity, and insulin resistance 1. Self-monitoring, including with fitness tracking devices and technologies, can be used as an adjunct to support and promote active lifestyles and minimize sedentary behaviors 1.
Healthcare Provider Role
Health professionals should be aware that women with PCOS have a higher prevalence of weight gain and obesity, presenting significant concerns for women, impacting on health and emotional well-being, with a clear need for prevention 1. They should offer regular monitoring for weight changes and excess weight, and provide respectful and considerate assessment, taking into account related stigma, negative body image, and/or low self-esteem 1.
From the Research
Management of PCOS after IVF
- Women with PCOS who have had children via IVF should continue to manage their condition to reduce the risk of associated diseases such as cardiovascular disease and type 2 diabetes 2.
- Lifestyle modification (LSM) is considered the first-line treatment for PCOS, regardless of fertility status, and may include weight loss, exercise, and dietary changes 2.
- Metformin may be used to improve insulin sensitivity and reduce the risk of metabolic complications, but its use should be individualized and monitored by a healthcare provider 3, 4, 5, 6.
Metformin Therapy
- Metformin has been shown to decrease serum lipids, androgen, and insulin levels, and induce ovulation and regular menstrual cycles in women with PCOS 4.
- The optimal dosage and duration of metformin therapy in women with PCOS who achieve pregnancy are not well established and require further research 6.
- Metformin may be continued during pregnancy, but its use should be carefully monitored by a healthcare provider to minimize potential risks 5, 6.