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Managing PCOS through 1st Trimester Challenges

If you’re reading this I hope that means you’re now pregnant…YAY! Or maybe you’re just curious on how to navigate some of these types of challenges for PCOS. Either way, I hope you find this helpful!

The 1st trimester is filled with so many emotions…

  • Excitement that you were finally able to conceive despite all the barriers put up by PCOS
  • Fear that you could miscarry or lose the baby at any time
  • Anticipation of the future and what that holds for you, your pregnancy, and your new addition to the family
  • Relief knowing that it IS possible for your body to conceive a child
I look back on my 1st trimester with the same fondness I feel about previous relationships with ex-boyfriends…grateful for all that I learned, but happy that it’s over lol. 

There are a lot of different symptoms that women experience during the 1st trimester, such as tender breasts, headaches, mood swings, nausea, morning sickness, fatigue, food cravings or aversions, constipation, and heartburn to name a few. I’m going to highlight areas that I specifically experienced or that pose a challenge when managing PCOS. When you read this, I think it’s important to note that every trimester and pregnancy for that matter looks different on every woman. We all experience pregnancy side effects in different ways, just like we all experience PCOS symptoms differently. Keep in mind, what worked for me may not work for you. 

Nausea and Morning Sickness

My husband-“What’s for dinner honey?” Me-“Dry Rice Chex…again.”

This sweet little side effect of the 1st trimester was by far my least favorite and I think it’s fair to say most women would agree. I hate feeling nauseous, but I hate the act of vomiting even more. In general, I experienced about 3-4 weeks of nausea and intermittent vomiting. My nausea generally lasted all day, which made getting anything done rather difficult. But considering it only lasted about 3-4 weeks out of the 12 week trimester, I feel pretty lucky. Some women experience this the whole 1st trimester and in severe cases, all throughout their pregnancy. 

Why this can happen: The production of HCG (human chorionic gonadotropin), extra estrogen causing quesiness, and stress causing a physical reaction in the body.

Tips for managing: Eat when you are hungry, drink between meals and not with food, acupressure bracelets, keep ready-to-eat healthy snacks (i.e. yogurt, trail mix, beef jerky, roasted chickpeas, cauliflower puffs) on hand at all times, and utilize teas or foods with lemon, ginger, peppermint or red raspberry leaf. 

PCOS-related concerns: The biggest challenge here for me was 1) consuming my normal complex carbohydrates with a fat or protein for optimal blood sugar control and 2) letting go of the fact that I may not be eating my normal PCOS-friendly foods, such as smoothies (still can’t really) or roasted vegetables, as often. Once I let go of the idea of being the perfect pregnant woman with PCOS, I decided to focus my attention more towards just getting nutrition in in any form possible, whether that be from good ol’ fortified Rice Chex or a bagel with cream cheese. Do the best you can here. Again, some nutrition is better than none at all. And forcing “healthy” food down that doesn’t sound good just for the sake of trying to follow a PCOS-friendly diet may backfire and induce more vomiting. I learned this the hard way at least more than once. Listen to what your body is asking for and do your best to give it just that.

Food Cravings and Aversions

I personally did not really experience any food cravings my first trimester. On the other hand, I did experience food aversions to meat and roasted vegetables for about 3-4 weeks during my 1st trimester. I normally love roasted broccoli and cauliflower but the smell of it alone made me quesy. Food cravings and aversions are a common side effect during the 1st trimester, but they can often persist throughout your pregnancy. Depending on how you handle these aversions, they can also lead to longer term aversions beyond pregnancy. However, most if not all food aversions subside after pregnancy. 

Why this can happen: the increase in HCG (human chorionic gonadotropin), placental growth, and shifts in hormone levels are what is believed to be the cause of these cravings or aversions. 

Tips for managing: Listen to your body and get creative! If you can’t handle meat, but know you need protein then try getting more protein from vegetarian sources such as beans, nuts, soy, or seeds. Try different textures or temperatures of the foods you know you need. For example, roasted carrots and veggies didn’t go so well for me, but eating them raw and cold went down much better. Also throwing some spinach, fruits, or other veggies in a smoothie can help with getting these nutrients using different methods. 

PCOS-related concerns: Sometimes these food aversions or cravings can lead us to eating foods that may or may not fall into a healthy PCOS diet. The best thing you can do here is listen to your body and give it what it wants. If that’s frozen yogurt on the regular then do your best to do so in moderation, watch portion sizes, or add fruit instead of chocolate chips as your topping for some added nutritional benefit. The best advice I can give is try to practice the 80/20 rule with a little more leeway. These food cravings/aversions are likely not to last forever and forcing yourself to eat things that don’t sound good can result in a longer term aversion beyond pregnancy which may be more detrimental than just avoiding for this period of time. Again, get creative here!

Should I stop certain supplements?

Just to be on the safe side, you’ll want to run all your supplements and medications by your OBGYN when you get pregnant. For me, I stopped my CBD oil and herbal supplements, such as aloe vera and elderberry. I did however continue my Ovasitol, NAC, probiotic, vitamin D, and fish oil after running them by my OBGYN. The main supplements you’ll want to be careful of are herbal supplements. While they can be very helpful in managing your PCOS on a regular basis, they often don’t have a ton of evidence to support their use during pregnancy. Here are a few that are not recommended during pregnancy: excess vitamin A, vitamin E, saw palmetto, black cohosh, roman chamomile, and goldenseal. A few that are allowed include: red raspberry leaf, ginger root, peppermint leaf, slippery elm bark, and oats and oat straw. For more information regarding what herbal supplements may or may not be considered safe, read more here

Bottom line: Do your research on the safety of the herbs you wish to continue during your pregnancy, be careful of what route of administration was considered safe in the supporting research, and always run it by your physician regardless. Safety of herbs ranges drastically depending on what resource you use. I don’t know about you, but it took me long enough to get pregnant so I wasn’t about to chance it with my herbal supplements.


The struggle of fatigue was REAL for me for about 3-4 weeks. I am lucky enough to work from home so I was able to adjust my schedule as needed, but even when I did sit down to try and work, I often ended up leaning back in my work chair just wondering if I was ever going to feel motivated again lol. This also usually passes by the second trimester, but may circle back around in the 3rd trimester. 

Why this happens: An increase in the hormone, progesterone, relaxes the muscles and body, which may contribute to fatigue and lack of energy.

Tips to manage: Doing your best to eat a well-balanced diet can help here, adjusting your schedule as your lifestyle allows,  mild physical activity can help give off endorphins for some increased energy levels, and allowing yourself time for rest (even in small amounts) during the day or afternoon. 

PCOS-related concerns: The biggest PCOS-related concerns I experienced related to fatigue during my first trimester was my limited energy for doing the things that I normally do, such as preparing healthy meals and snacks in addition to participating in my regular physical activity. In these instances, I was fortunate enough to have a husband who picked up the slack and helped out with meal preparation. Being savvy here and using some produce that is already pre-cut or partially prepared can help. Also sticking to PCOS-friendly shelf stable snacks that are easy to grab-and-go and that don’t require a lot of extra preparation is helpful during these times of fatigue. In terms of exercise, allow yourself some grace and adjust as needed. Adjusting to lower intensity exercises like yoga or mild resistance training can seem more attainable instead of high intensity or regular cardio. For me, I stopped doing my heavy lifting and just focused on a goal of exercise at least 3 times per week for 30 minutes. This was much less than I was used to doing, but once I gave myself permission to do this, I was relieved and felt better. This is what worked for me so adjust your exercise based on what you feel your body needs.

Nutrients to focus on (if you can!)

  • Folate: this nutrient is essential for preventing neural tube defects and proper brain and spinal cord development. Food sources: fortified cereals, leafy greens, citrus fruits, beans, and peas.
  • Iron: helps in the production of healthy red blood cells and oxygen delivery to both you and your baby’s tissues. Food sources: red meat, poultry, fish, leafy greens, beans, and fortified cereals.
  • Protein: protein requirements continue to increase throughout the trimesters of pregnancy to ensure proper growth of the fetus. Food sources: meat, poultry, dairy, fish, legumes, nuts, seeds, and soy.
  • Calcium: calcium is important for building strong bones and healthy circulatory and nervous systems. Food sources: dairy, broccoli, kale, spinach, and fortified cereals. 
  • Vitamin D: essential in building strong bones. It’s also one of those vitamins that we are often lacking in PCOS. Food sources: fatty fish, eggs, and fortified foods, such as milk and orange juice.
At the end of the day, if getting your prenatal vitamin in is the only thing you can manage based on how crappy you are feeling, that is A-OK. Sometimes getting my prenatal vitamin in was about as much as I could focus on or stomach during certain days of my 1st trimester. 


OOOooooo poop talk. Everyone’s favorite. Well at least it’s mine 😉 Dietitians love poop talk. I’m going to be real with you. Constipation since being pregnant is something I struggled with in my 1st trimester and continues to be an ongoing issue even in the 2nd trimester…oh the joys. Between taking a probiotic, regular exercise, and managing my fiber and water intake, I’ve been able to manage this fairly well for the most part. 

Why this can happen: the hormone, progesterone, is a muscle-relaxant and as a result, can slow your digestive system down during pregnancy. 

Tips to managing: Increase fiber intake WITH water intake. You shouldn’t do one without the other. Increase your fiber using fruits, vegetables, seeds, and whole grains. My favorite go-to is adding ground flaxseed to my breakfast oatmeal with fruit. Regular exercise or movement of any kind can promote regular bowel movements. Taking a probiotic can also help.

PCOS-related concerns: Even without being pregnant, it’s important for cysters to be having at least one bowel movement a day in order to detoxify your estrogen properly. Making this happen using your diet and lifestyle just becomes even more evident if you experience constipation with pregnancy.

Worry about Miscarriage

While it’s true that women with PCOS are about 3x more likely to have miscarriages, I think it’s important to remember what we can and can’t control. Due to this increased risk, my husband and I decided to wait to tell family and friends until at least 10 weeks. We also didn’t share on social media until we confirmed our baby was healthy in our 20-week ultrasound. How you approach this is a personal decision. Personally, I’m so grateful we waited to share. It gave me some piece of mind knowing that my risk had decreased significantly by the time most of our family and friends knew. But that’s not to say it was easy keeping this secret! I come from a big family and my sisters/mom definitely sniffed it out (lol), but I denied and tried to keep to myself as much as possible during this time. 

Allowing the fear of miscarriage to completely destroy the excitement of the 1st trimester is just not healthy in my opinion. Close to 50% of miscarriages occur due to chromosomal abnormalities AKA you’ll never really know why it happened if it does. Focus on what you can control: your diet (nausea aside of course), exercise or movement, reducing environmental toxins as much as possible, and taking care of your mental health.

Mental Health Tips & Reminders

Always keep in mind that every pregnancy is different! You may experience something totally different from the next cyster. Avoiding the comparison trap is so important! You have to listen to what YOUR body needs and adjust your diet and lifestyle intuitively.

This nausea, fatigue, and food aversions will pass! For most women, many of these symptoms pass after the 1st trimester. I know when you’re feeling awful, it can be hard to comprehend that you WILL feel better at some point, but trust me it does get better!

You’re only one person. No matter what you’re doing to help manage both your PCOS and 1st trimester symptoms, you’re doing great! Remind yourself of this often. And the fact that you’re reading this means you’re ahead of the game already. 

If you’re feeling anxious or stressed during your 1st trimester, try to incorporate stress-reducing activities such as yoga, meditation, positive affirmations, gratitude journal, talking a bath, reading a good book, or even starting a pregnancy journal! Any of these activities, in addition to good quality sleep, can do wonders for our mental health. Don’t forget to make it a priority!

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