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My 3rd Trimester: COVID-19, PCOS, and more

My 3rd trimester was filled with so many ups and downs. It sure came at an interesting time. My 3rd trimester started mid-April 2020 when we were knee-deep in our stay-at-home order here in Michigan for COVID-19. The middle of my 3rd trimester was marked by civil unrest and protests breaking out across the country, including in my own backyard, Grand Rapids, over the death of George Floyd. Every OB appointment had a new flavor of the week in terms of COVID requirements, which always kept me on my toes. But sprinkled in there were so many wonderful things too, like finalizing names for Baby B, clients or followers getting pregnant with PCOS, the launch of my new e-book, adjusting to fluctuations in appetite, and feeling big, I mean BIG movements by Baby B in my belly.

COVID-19

I think we are all a little sick of talking about COVID-19, but it has been a serious milestone in both 2020 and my pregnancy. It seemed to have no rhyme or reason in terms of who got sick and how they carried their symptoms, making it quite stressful for a normal person, let alone a 3rd trimester pregnant person. 

I feel incredibly lucky that for the most part, my husband and I, as well as our families were not badly affected by the virus directly or indirectly. My husband and I work from home normally so not much changed there, but it is incredible how different you feel when you can’t even go the 2-3 places you were used to going daily. Or even just how isolated you start feeling from not being able to go to those 2-3 places daily or seeing close family and friends. My OB appointments started to get very interesting. Protocols changed every time I went in for a new appointment and my husband was no longer allowed to accompany me to any appointments. 

Although I felt relatively blessed throughout the whole process, I’d be lying if I said there weren’t times where I thought to myself ‘why this year?!’. A few times where I was at bigger appointments alone, I had a few moments of feeling sorry for myself and wishing my husband was able to be there with me during this new and sometimes anxious experience…both for me and for him. I’m a strong person mentally but sometimes you just want your person there with you, mainly to make sure you don’t forget anything you wanted to ask and catch every piece of information the doctor tells you. As I mentioned before, luckily my family’s health was not directly affected (meaning I think we all have been affected mentally in some capacity, but physically no one in my family has tested positive for COVID) and my husband was able to join me for my last OBGYN appointment before the baby arrives.

Civil Unrest

I was just starting to enter the 2nd half of my 3rd trimester when the riots started breaking out after George Floyd’s death. While I’m not going to use this time to take a political stance, I do want to mention that this certainly brought on some self-reflection on just how advantaged I have been throughout my life. This provided me with an interesting perspective considering I’m also due to bring a child into this world any minute. It made me reflect on how I was raised and what I might want to tweak to help create a human that is priivy to the world around her, understands the value of human life as well as the history of our country, but can also critically think about the information provided by (social) media and be able to come up with her own conclusions. Again, I’d be lying if I said this time in our history has not left me feeling uneasy with my own ignorance at times and just about bringing a child into this world at this time, but without uneasiness there is no growth. I’m going to leave it at that.

Ravenous Appetite and PCOS

I’ve touched on food cravings in my previous pregnancy posts, but I wanted to provide a few tips here. The 3rd trimester definitely left me hungry almost every 2 hours. There were often times that even despite having healthy food and snacks around, I would eat through those healthy foods and wonder ‘what else can I eat?!’. This was a little tricky at times in terms of trying to manage my PCOS and keep my blood sugar balance. 

Here are a few tips to help navigate this time: 

  • Pair your carbs with a protein or fat. This may sound redundant but it’s true! It helps keep your cravings to a minimum and keeps you full for longer
  • Consider inositol supplementation. Always consult your doctor and/or PCOS dietitian before starting any supplement but inositol, specifically myoinositol has been considered safe to use during pregnancy, can help keep your cravings under control, and has been shown to lower risk of gestational diabetes when used in combination with folic acid. Not to mention, it can help keep androgens (or male hormones) within normal levels. 
  • Keep ready-to-eat healthy snacks on-hand as much as possible. Having carrots, cucumbers, and spinach in the fridge is one thing. But having them washed, cut up, and ready-to-eat makes the decision to chose the healthy snack a lot easier. Even if you run out of your healthy snacks faster, all those vitamins, minerals, antioxidants, and fiber help keep both you and baby healthy! 
  • Listen to your cravings more often than you would when you weren’t pregnant. Now that’s not to say you can’t listen to your cravings when you’re not pregnant either, but during pregnancy our hormones are doing crazy things to help bring a healthy baby into the world. So often when you’re craving full-fat ice cream or pickles, your body (and growing belly) might be telling you it needs more salt, iodine, or calcium so LISTEN! Try your best to live a PCOS-friendly lifestyle 80% of the time, eat the food, and move on! 

Postpartum Meal Prep

Postpartum meal prep

 

In my final weeks of pregnancy, I tried my best to prepare a handful of PCOS-friendly meals and snacks to have on-hand to make postpartum life a little easier. Although my husband said he’s happy to cook (he’s a keeper!), I also know that this will be a new journey for both of us and it will be helpful to have some freezer meals and snacks to fall back on if he decides he wants a week off. I find it hard to cook for just two people anyway so cooking extra of some of my favorite go-to meals was not all that difficult for me. Plus, I’m planning on breastfeeding so I know my appetite might be a little larger than normal depending on how that goes. Some of these recipes are mine, but some are also from other fertility-friendly resources which I will link accordingly. For any pregnant mamas out there considering postpartum meal prep, Lily Nichols’ book, Real Food for Pregnancy, and website are great resources for recipes and nutrients to focus on throughout pregnancy and postpartum regardless of whether you have PCOS or not. 

I’m a dietitian and I seriously learned SO much about both prenatal and postpartum nutrition that I didn’t know beforehand by reading Lily Nichols’ book. It is no surprise to me that nutrition plays a HUGE role in postpartum healing and breastfeeding. An important tidbit of information that I found particularly helpful as it pertains to PCOS in her postpartum nutrition chapter was where she discusses carbohydrates. She explains that while it may be tempting to immediately go back to a low carbohydrate diet to help drop the baby weight, the immediate postpartum period is not the time to do so (or at least not until your milk supply is fully established). She states that this type of undereating can negatively impact your milk supply, put you and your baby at risk for dehydration as extra fluids are needed when creating breastmilk, and lead to inadequate electrolyte intake. 

What I made:

  • PCOS-friendly Apple Spiced Granola
  • Pork Carnitas (I followed Lily Nichols’ recipe from Real Food for Pregnancy book-check out her website here)
  • Beef Chili
  • Chicken & Veggie Coconut Curry (recipe from my ebook bonus items, but here is a similar recipe I use)
  • Brownie Protein Bites (recipe from my ebook bonus items)
  • Oatmeal PB Energy Bites
  • Venison and Veggie Egg Muffin Cups
  • Oatmeal Breakfast Bars (I used @fertility.with.pcos recipe from Instagram here)
  • Chicken Enchiladas (here is a similar recipe I use (feel free to sub out black beans for chicken and other veggies you have on hand for the sweet potatoes)-I did both gluten-free and regular tortilla options for me and my husband)

Recommendations for Storage: I’m not going to lie. I was in a pinch and needed to make this food fast so I used the standard disposable aluminum freezer containers. We are all human here. I will adjust for next time and plan accordingly, but here are some lower toxin strategies for freezer food storage:

*Tip: Depending on how many will be eating with you, portion out accordingly. For example, I portioned mine out into 2-4 serving portions for both my husband and I, but if it’s just you or more you’re feeding, you’ll want to modify as needed.

Launch of my Restore Your Fertility E-book!

Restore Your Fertility Ebook

This was definitely a highlight of my 3rd trimester! The launch of my Restore Your Fertility E-book on May 27, 2020 was so fun! It was a labor of love and what I hope to be a great resource for any woman with PCOS trying to get pregnant. I poured information I wish I would have known during my fertility journey, as well as other evidence-based information on how to get synced with your cycle, how to optimize your nutrition for fertility, and how to build a healthy, fertile mindset (a crucial part of any infertility journey!). Not to mention, it provides 2 weeks of PCOS-friendly meals to help get you started. It’s bound to get you one step closer to getting pregnant with PCOS! For more information on the ebook, click here

The day is almost here!

Last but certainly not least, enjoy this time! For me, I fluctuated frequently between excitement and anxiety over what I didn’t know or do yet. Did I read enough books or do I know what the hell I’m doing?! My take? Nope. There will never be enough books to read, videos to watch, recipes to make, or articles to read that will appropriately prepare you for becoming a parent. The most I can do? Allow myself some grace during such a momentous transition in my life. And I encourage you to do the same! I hope you found this helpful! The next time we chat, I will have a baby 🙂 Happy almost 4th of July friends!

-EAB

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Venison and Veggie Egg Muffins

Egg Cups

Venison and Veggie Egg Muffins

Course Breakfast
Servings 18 muffins
Author Liz Bissell

Ingredients

  • 8 venison breakfast sausages, cubed (about 1 1/2 cups)
  • 1 red bell pepper, chopped
  • 1 small head of broccoli, cut into small bite-size pieces
  • 2-3 green onions, sliced
  • 2 cups fresh spinach, chopped
  • 15-16 eggs, more (as needed)
  • ½ milk of choice
  • shredded cheese (optional for topping)
  • salt, pepper, and garlic powder (pinch of each)

Instructions

  1. Preheat oven to 350 degrees. Start by browning your venison sausages in a medium saute pan. Once browned, remove, and set aside.

  2. Add the bell pepper and broccoli with a drizzle of water to the same saute pan. Saute for about 4-5 minutes. You don't want to fully cook here but until both the pepper and broccoli soften slightly. Season with a little salt and pepper.

  3. Whisk together the eggs, milk, salt, pepper, and garlic powder.

  4. Grease a muffin tin using non-stick spray. First fill 3/4 of the muffin cups with your veggies. Next, add in the cubed venison sausage. Then fill the muffin tins with the egg mixture. Top with cheese (optional).

  5. Bake for 20-25 minutes or until a toothpick comes out clean from the middle of the muffin. Let cool for at least 5 minutes before removing. If freezing, place the muffins on a baking sheet and freeze for 20-30 minutes. Then combine in a freezer-friendly container or bag.

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Oatmeal Energy Bites

Oatmeal Energy Bites

Oatmeal Energy Bites

Course Snack
Servings 18 bites
Author Liz Bissell

Ingredients

  • 1⅓ cup old-fashioned oats
  • cup coconut shreds, unsweetened
  • 3 scoops unflavored collagen peptides
  • ¼ cup ground flaxseed
  • cup + 2 tbsp sunflower butter
  • 2 tbsp honey
  • 1 tsp vanilla extract
  • 4 tbsp melted coconut oil
  • ¼ cup mini chocolate chips

Instructions

  1. In a medium mixing bowl, stir together the oats, coconut, collagen peptides, and ground flaxseed.

  2. Add in the sunflower butter, honey, vanilla extract, and coconut oil. Stir until evenly combined. Fold in the mini chocolate chips.

  3. Using a melon scoop or spoon, form into balls. Place on baking sheet and freeze for at least 10 minutes. Place in a bag or container and refrigerate. If freezing, place in freezer-friendly container/bag and freeze.

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The 2nd trimester of pregnancy and PCOS

2nd trimester of pregnancy and PCOS

The second trimester of my pregnancy was full of so many amazing changes! You’re finally potentially in the clear of those crappy first trimester symptoms, such as nausea, vomiting, or food aversions. However, for some these persist throughout pregnancy. Everyone is different…don’t forget that! But as you continue to progress through the second trimester, your risk of miscarriage also continues to decline, which definitely helps ease those concerns from the first trimester.

You’re also starting to show! Yep, turns out there is actually a baby in there! While many of us feel the side effects of having a baby in our bellies in the first trimester, we don’t start seeing changes in our body until the second trimester. For me, this posed some unexpected difficulties, which I’ll dig into more shortly. 

Some other things to look forward to this trimester include your 20-week ultrasound, a glucose tolerance test for gestational diabetes risk, thyroid concerns, and possible food cravings or aversions. Now remember, these are things that stick out in MY pregnancy. Everyone is bound to experience things a little differently.

 

Miscarriage Risk

This is a biggie. Once I entered my second trimester, I felt a sense of relief. However, that didn’t stop me from being extremely happy and excited one minute to feeling terrified of being an exception to the rule, in terms of my miscarriage risk, the next minute. While women with PCOS are more likely to have a miscarriage, rate of miscarriage decreases to 5% after 12 weeks so take a deep breath! There is only so much we can control here. In times of anxiety surrounding miscarriage, I had to remind myself there is no point in causing stress over something I can’t control. If anything, the stress will have more adverse side effects than the risk of miscarriage itself. Here is where trust in your body and utilizing positive affirmations can be very advantageous.

Body Image Changes

While this seems like an obvious one. I struggled here. I’m a dietitian and for the most part, have always had control over how my body looks with my diet and lifestyle. During the initial few weeks of my body changing in the 2nd trimester, I honestly felt “chubby”…just being honest here. I wasn’t feeling the baby yet so I didn’t yet have that connection or bond yet with the baby. My clothes were all starting to fit very tightly, but I wasn’t big enough to fit into maternity clothes. There was about a 2-week time frame here where I really struggled with this transition mentally. 

I finally decided to go out and buy myself some maternity clothes. I felt so much better after! It was like a sign to myself that this WAS real and I was accepting the process for whatever it had in store for me. Pregnancy is a truly amazing thing and sometimes you just have to surrender yourself to it and enjoy the journey! My biggest recommendation during this transition is to allow yourself some grace. Initially I felt guilty about feeling the way I did, but in all honesty I had never experienced anything like it before so I was bound to run into some (minor) roadblocks. Once I got over this hump, I seriously did not look back. My belly continued to grow, I started feeling baby kick (which never gets old!), and had way more energy than I did in my 1st trimester. All things to celebrate!

20-Week Ultrasound

GUYS. This was one of the coolest memories I have from my whole pregnancy. The night before my ultrasound, I thought I felt a tickle of some sort in my belly and I thought, “I wonder…”. Up until that point, I had not felt the baby kick yet or I really couldn’t decipher if it was bowel sounds or baby moving. I was in complete awe when they started the ultrasound and I saw a baby moving in my belly…and I mean moving! She was wiggling around like crazy! It was a complete revelation that there was actually a human being growing inside of me. And the best part? My husbands’ reaction. Watching his face light up when he saw the screen of her little body moving around is a memory I’ll never forget. This is potentially my favorite memory from pregnancy (still TBD as I have 3 weeks left at the moment!).

Glucose Tolerance Test

This is a glucose test that is used to diagnose gestational diabetes during pregnancy. Gestational diabetes can pose several risks to pregnancy including excess birth weight, preterm birth, high blood pressure, stillbirth, and risk of obesity and type 2 diabetes later in life. 

Because of our inherent insulin resistance, women with PCOS are more likely to develop gestational diabetes risk. Therefore, if you know this is something you struggle with, it is beneficial to ask your doctor for this screening earlier in your pregnancy. Normal testing is done at 24-28 weeks, but if you have PCOS, I highly recommend getting tested in the first trimester (or early second trimester) and later in pregnancy again. If your practitioner is not willing to do the glucose tolerance test that early, ask for a hemoglobin A1c minimum so you know where you stand early on. 

This is also why it is still important to do your best with continuing a PCOS-friendly diet and lifestyle during pregnancy. While every woman experiences different challenges during pregnancy, managing your intake of carbohydrates continues to be an important area to focus on during your PCOS pregnancy. Just like when you’re not pregnant, the goal is not to avoid carbs, but to pair them with fat/protein and choose whole grains over refined grains as much as possible. Continued exercise can also be very beneficial here. Although you may need to modify your type of exercise based on your growing belly, continued exercise can help with improving insulin sensitivity, not to mention maintaining healthy weight gain throughout your pregnancy. Shoot for 30 minutes 3x/week minimum in a way the feels good to your body and baby.

Thyroid Concerns

I bring this up because many of us women with PCOS also struggle with thyroid issues. Research has shown that thyroid irregularities are more common among women with PCOS than the healthy population. With that being said, our thyroid hormone needs continue to increase as pregnancy progresses due to our increasing metabolic needs for the developing baby so it’s imperative that your practitioner test your thyroid levels if you have hypothyroidism before pregnancy or have concerns of hypothyroid at any point during your pregnancy. 

Screening and testing is recommended at 4-6 weeks gestation then every 4-6 weeks until 20 weeks gestation, then at 24-28 weeks, and 32-34 weeks. If left untreated, hypothyroid issues in pregnancy can lead to complications, such as miscarriage, preeclampsia, anemia, premature birth, and postpartum hemorrhage. I had mine tested a few different times because I was paying attention to my body and noticed some of my hypothyroid symptoms worsening. Being your own advocate can make a big difference! As a reminder, hypothyroid symptoms may include cold intolerance, low libido, hair loss, excessive fatigue or muscle achiness, dry skin, or feeling depressed.

Food Cravings and Aversions

Fortunately, I did not experience any food aversions during my 2nd trimester so I got lucky! I did however, start to really crave more dairy, something I had been limiting (but not entirely avoiding) prior to pregnancy. Craving dairy in pregnancy is often common due to the iodine content and the increasing iodine needs (about 50%) during pregnancy. So what did I do? I ate the dairy! Listening to your body is SO IMPORTANT during pregnancy (and all the time for that matter). 

When I did crave dairy, I did my best to eat full-fat, quality dairy. Although sometimes it was that full-fat custard ice cream from Culver’s and I wasn’t mad about it! I continued to exercise and also tried to keep these types of indulgences to a minimum. In my opinion, it’s better to eat the food and move on then obsess about it and waste mental space on it, especially if you follow a PCOS-friendly lifestyle normally. Plus, the more you avoid and restrict, the more likely you are to binge on it later. Not too mention, cravings like this can mean something as I mentioned earlier about iodine needs during pregnancy.

2nd trimester pregnancy and PCOS

The 2nd trimester or what my doctor likes to call “the happy trimester” was truly a wonderful experience and I can’t complain. I hope you found this helpful! What questions do you have for me about 2nd trimester challenges and PCOS? Feel free to drop a comment below!

-EAB

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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.

Fatigue

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. 

Constipation

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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Homemade Cashew Milk

Homemade Cashew Milk

Course Drinks
Keyword cashew milk, cashews, homemade
Author Liz Bissell

Ingredients

  • 1 cup raw cashews, soaked
  • ½ tsp sea salt
  • 1 tsp vanilla extract
  • 4 cups water
  • 1 tbsp maple syrup (optional)
  • ¼ tsp cinnamon (optional)

Instructions

  1. Cover the cashews with water and soak for at least 2 hours or overnight.

  2. Drain the cashews. Add the cashews, 4 cups water, sea salt, vanilla extract, maple syrup (optional), and cinnamon (optional) to a blender and blend until smooth.

  3. Add to 3 mason jars or 1 large. Store in refrigerator for up to a week.

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My Journey to Getting Pregnant with PCOS

It took me about 13 months to get pregnant. Compared to many women with PCOS trying to conceive, I feel very fortunate it only took that long. However, if you are in the process of trying to get pregnant, every month or cycle can feel like a lifetime and from my experience, this feeling tends to get worse with time.

I went off birth control right around the time I got married (end of September 2018). I honestly had not thought of my PCOS in a few years and I genuinely hoped I would be the exception to the rule and get pregnant by Christmas that same year. After all, I followed a pretty healthy diet. You know, being a dietitian and all. 

But I was sorely mistaken.

My menstrual cycles became quickly irregular, ranging from 33 to 65 days. This made it very difficult to know when to test for ovulation. Christmas 2018 was a tough time for me. Everyone seemed as though they focused on when I was going to get pregnant, but I think a lot of that pressure was what I built in my own mind. 

That following January, I decided to make my mental health a priority. I realized I was struggling mentally with the challenge of trying to conceive, so I reached out to a licensed therapist for help. This was NOT an easy decision for me. I have always prided myself on being a strong and confident person. I had never really thought of myself as someone that would need “therapy”. But it turned out to be one of the best decisions I made for myself. I would recommend it to anyone, especially any woman with PCOS due to our population being more prone to anxiety or mood disorders anyways.

At that time, I don’t think I quite realized how much I internalized different stressors (both work and personal). I put a lot of pressure on myself to meet certain personal goals, getting pregnant within a defined time frame being one of them. I learned A LOT about myself. For example, I’m a little more type A in certain areas of my life than I may come off externally. I was setting goals for myself that often set me up for disappointment.

Spring started and while I continued to work on my mental health, I finally decided to reach out to an OBGYN to start discussing my fertility treatment options. My OBGYN at the time recommended Provera to help me have more regular periods in combination with Clomid to help stimulate ovulation. I didn’t love the idea of taking pills to help me get pregnant but at that point, I was willing to give it a go. 

I took both Provera and Clomid the first month, but due to scheduling issues I skipped the next couple months. I stopped taking Provera altogether; I just didn’t really see the benefit. Diet-wise, I hadn’t really tried anything different other than increasing my intake of anti-inflammatory foods such as ginger, turmeric, and leafy greens.

July rolled around and a few things were changing in my life. I was turning 30 years old and my job was transitioning into a position I no longer enjoyed. Not to mention, I was still not pregnant. I did some serious self-reflection. I asked myself:

  • “Do I really want to do this job anymore?”
  • “Does this job really fulfill my inner purpose?”
  • “Does this job have the ability to transition into something that is flexible if I get pregnant and start having children?”

After much deliberation and discussion with my husband, I decided to quit my job. It was not an easy decision and I was absolutely terrified! I didn’t quite know what I was going to do but at the end of the day, I was confident in my ability to figure it out.

For the first time in many years I didn’t have a job and wasn’t in school. For a while, I felt pretty off-the-grid, especially since we kicked off my newfound freedom with a boating trip to the Florida Keys with my in-laws. Not too shabby! Although I was terrified of not knowing what I was going to do next with my career, I felt absolutely liberated. Elated might be the better word to explain it. My therapist graduated me stating “you just seem so much happier”. And I couldn’t have agreed more!

For a month or so, I just kind of floated around in my unemployment phase making recipes, blog writing, expanding on ideas I was interested in, or just allowing myself to do things that felt organic to me. As I had more time to look into research related to fertility, it dawned on me that that my long-ago PCOS diagnosis may be affecting my fertility now. Light bulb! 

I started reading research every moment I could, following and learning from helpful dietitians in the PCOS realm and tweaking my diet accordingly as I learned more. I started a gluten and dairy-free diet to determine if I had any intolerance issues. Quite frankly, I didn’t feel much different going gluten and dairy-free. I think that was a testament to the health of my routine diet as it was. I also found a dairy and gluten-free diet to be rather unsustainable long-term. I did notice some acne when I started introducing dairy back into my diet, but I determined how many servings of dairy a day kept my acne in check. When it came to gluten, I really didn’t feel any different. I did however become more aware of the effect that simple carbohydrates had on my energy levels, but that was just a reminder of something I already knew.  

The main focus of my dietary changes turned into what foods to start including MORE, such as omega 3 fatty acid sources, nutrient-dense fruits and vegetables, nuts and seeds, and plant-based proteins. Dietary supplements such as Ovasitol, N-acetylcysteine, a proper prenatal vitamin, probiotic, omega 3-fatty acid, vitamin D, CBD oil, and a B-complex were also started. I based this on my personal dietitian assessment of what my diet and lifestyle needed.  

At the same time as I was starting to make dietary changes, I followed up with my primary care physician who (god bless her) had a hunch that I may have some underlying thyroid issues. She diagnosed me with clinical hypothyroidism and started treating me with thyroid medication based on my symptoms and optimal lab values for fertility. After talking with many cysters and hearing their struggles with diagnosis and treatment with both PCOS and thyroid issues, I feel really lucky that my primary care physician was in-tune to treating the ‘whole person’ for fertility. 

For the following three months, I continued tweaking my diet to promote better management of my PCOS and for optimal fertility. I started addressing my mindset surrounding the month to month roller coaster of emotions each menstrual cycle can have. I started using positive affirmations and actually believing I was going to not only get pregnant, but meet other career and personal goals. In addition, I used Clomid 2 out of those 3 months. 

In addition to these dietary changes and use of Clomid, I started making small changes to reduce both me and my husband’s toxin load. We stopped drinking from plastic water bottles and I started transitioning most of my makeup, skincare, and household products to cleaner products to help reduce our exposure to endocrine disrupters. Low and behold, my cycles became more regular and I got pregnant in November!

I couldn’t believe it! After months of negative pregnancy tests, I had to take at least two more tests before I could believe it was true! After much reflection, this is a testament to addressing the WHOLE BODY when it comes to your health and fertility. In the year (more specifically the 3 months) leading up to my pregnancy, I made some serious life changes when it came to managing my stress better. I developed a healthier mindset and I honed in on specific nutrients and supplements to increase in my diet for optimal fertility. While I believe addressing diet and lifestyle FIRST is the best approach to managing PCOS, I also believe that there is a place for combining functional and conventional medicine. I am proof of that.

What to take from this information?

It’s so easy to obsess over replicating every little thing I did to see if it works for you. I used my nutrition and science background to individualize my nutrition based on my needs. I also worked closely with my primary care physician and OBGYN to combine both conventional and functional medicine. THAT, in my opinion, is the best way to approach PCOS and fertility. This is exactly why I developed my Restore Your Fertility 1:1 coaching program so that I could become a resource (which are often limited for women with PCOS) to cysters so that they can feel empowered to overcome their infertility by using specific diet and lifestyle changes right for THEM. If you’re ready to find out what’s driving your PCOS and start managing your PCOS better so you can get pregnant then apply to my 1:1 coaching program today!

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PCOS-Friendly Shamrock Smoothie

Quarantine 2020 got your St. Patrick’s Day down in the dumps? No problem. I’ve got your back! The quarantine for the Coronavirus is keeping us all closer to home this St. Patrick’s Day, which may prevent you from getting your seasonal shamrock shake from McDonald’s. 

Guess what? This is a blessing in disguise! While yes, McDonald’s Shamrock Shake is delicious and yes, every once in a while, treat yo self! BUT, I researched the nutritional breakdown of these shakes and I’m SHOOK. I can’t go back. These nutrition facts and ingredients cannot be unseen. 

Let me give you a few highlights. For a small size shake, calories 460, saturated fat 8 grams, and sugars 63 grams…you heard correctly 63 grams! God help us. Just for a little reference, our recommended added sugar allowance per day is 25 grams for women (36 for men). Yikes! The only upside is it does offer 10 grams of protein for the small shake. The ingredients in the shake however are chalk full of simple sugars like corn syrup or high fructose corn syrup and artificial coloring/additives like sodium benzoate, yellow 5, and blue 1. 

These types of simple sugars and artificial ingredients wreak havoc on our hormones. While we are all cooped up, why not try making my PCOS and hormone-friendly shamrock smoothie (or shake) recipe? It provides a good source of protein, healthy fats, and vitamins/minerals to help keep your blood sugar balanced, hormones happy, and taste buds doing the jig this St. Patrick’s Day! Enjoy!

PCOS-Friendly Shamrock Smoothie

Course Drinks, Snack
Keyword shake, smoothie
Servings 1 smoothie
Author Liz Bissell

Ingredients

  • ½ frozen banana
  • ½ avocado
  • Small handful fresh spinach (or frozen)
  • ¼ tsp mint extract (more as needed or if you don't have any fresh mint leaves)
  • ¼ tsp vanilla extract
  • 8 fresh mint leaves (ok to eliminate if not available)
  • 1 scoop unflavored collagen peptides
  • 1-3 drops stevia/monkfruit sweetener
  • 4 ice cubes
  • cup full fat DF milk (regular milk also works here- I used unsweetened soy milk)
  • pinch pink sea salt

Instructions

  1. Combine and blend in a blender until smooth. Top with cocoa nibs, chocolate chips, fresh mint leaves, or whipped topping. Serve immediately.

Recipe Notes

If you want to make this recipe into more of a dessert shake option, eliminate the ice cubes and stevia/monkfruit, add 1 scoop DF mint chocolate chip or vanilla ice cream and decrease milk to 1/3 cup. 

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Spirulina Blueberry Banana Smoothie

Spirulina Blueberry Banana Smoothie

Course Drinks
Keyword smoothie, spirulina
Servings 1 smoothie

Ingredients

  • 1 frozen banana
  • cup frozen blueberries
  • Handful of kale (spinach would work here too)
  • 2-3 tsp agave nectar
  • ½ tsp spirulina powder
  • ½ cup coconut water
  • 2 tbsp coconut cream
  • 1 scoop collagen peptides (I use unflavored Vital Protein)

Instructions

  1. Blend all ingredients until smooth. Top with unsweetened shredded coconut and fresh blueberries (optional). Serve immediately.

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Why Clean Beauty is the Sexiest Beauty

I was first introduced to clean beauty about 2 years ago by my sister-in-law. Before that time, I really had no idea about the potentially dangerous substances in my everyday skincare and makeup. I’ve never been a girly girl. I grew up as an athlete wearing minimal makeup. For years, I only used Oil of Olay lotion, mascara, concealer on blemishes if needed, and a little bit of blush type of gal. Plain Jane, no shame! I never thought too hard on my choices of makeup, especially when I was a broke college student. My makeup and skincare product choices generally came down to what was the cheapest at the local drugstore. And despite my ongoing breakouts and terribly dry and flaky skin, I continued this regimen for years. 

But when I started to hear more and learn more about some of the scary ingredients in my makeup and skincare, I started to rethink my choices. As I neared my late 20s, I also started to think about what my skin might look like if I continued down the current trajectory in 10 or 20 years. I started to ask myself “are these poor quality products REALLY helping my skin?” Or in other words, are they even worth the $5-10 I spend every other month or so to potentially further harm my skin? Hint, hint: no!

My initial impression of clean beauty was that it MUST be expensive. Better quality products means $$$$ and I began to wonder if I could even afford using “cleaner” beauty products. Short answer? Yes. I (and YOU!) am worth the few extra bucks to have better skin, not to mention just better overall health. In reality, the clean beauty movement is spreading. There are more and more products coming out all the time. And from what I’ve learned, you can spend an arm and a leg on clean beauty products or you can spend middle of the road or even relatively the same as what you were paying for your crap products before. The cost truly varies but I think it’s fair to say you can satisfy any budget and still use clean beauty products.

Let’s talk about a few ingredients of concern in beauty or skin products:

  • Parabens: Often used to prevent growth of bacteria or mold. Found most commonly in shampoo, face cleanser, body wash, body lotion, and foundation. 
  • Phthalates: Used to make products more pliable or help fragrances stick to skin. Most commonly found in synthetic frangrance, nail polish, hairspray, and plastic containers.
  • Polyethylene glycol (PEG): Most often used in cosmetics as thickeners, solvents, softeners, and moisture-carriers. Often found in creams, sunscreen, and shampoo.
  • Retinyl Palmitate: This ingredient uses palmitic acid and retinol (vitamin A), which when combined with sunlight has been found to cause skin lesions and photosensitization.
  • Synthetic Fragrances: Synthetic fragrances are often manufactured using any 3,000+ chemical ingredients. Some of which include hormone disrupters and allergens. Most fragrance companies don’t have to list the specific chemicals used in the fragrance because it may expose their trade secrets, which is why these chemicals aren’t listed on the label. Found in most cosmetics that have any specific scent.
  • Triclosan: an antimicrobial agent often used in toothpaste, body wash, hand sanitizers, or soaps.

So what's so concerning about these ingredients?

Many of these ingredients have been shown to disrupt the endocrine system and wreak havoc on your hormones long-term. And this list is not all-inclusive…yikes! Endocrine disrupters like the ones listed above have shown to interfere with hormones, such as the thyroid, estrogen, testosterone, and insulin. Hormone disrupters can make you more susceptible to gaining weight by affecting the appetite, metabolism, and encouraging fat cells to grow and multiply. Some of them have also been linked to infertility, early puberty, attention deficit disorders, insulin resistance, cardiovascular disease, liver disease, and cancer. Um, no thank you! 

This is why I started to slowly transition over to clean beauty products. I hate wasting so I try to use up what I have on hand first and as I start to run out, I incorporate new clean beauty products into my skincare or makeup routine. My top two favorite clean skincare lines at the moment include Beautycounter and Cocokind, but I plan on continuing to try new products as needed. 

I’ve noticed less is more when it comes to my skin. Simple ingredients actually fare better for my skin. Overall, I’ve had better all-over hydration and fewer breakouts since changing over to clean skincare products. For that reason alone, I highly recommend trialing out a few clean products, especially if it could also mean less effects on your hormones and overall better health.

Remember small changes make BIG IMPACT long term so start small and don’t feel overwhelmed. These things take time. I think it’s fair to say we as women can feel very attached to our skin care routine and get nervous when thinking about rocking the boat.  Start with swapping out one or two products and build from there. Utilize resources like the Environmental Working Group’s Skin Deep Database to help guide you in your choices. This database ranks over 80,000 products and can help guide you on which products are safest. Now I want to hear from you! What are some of your favorite clean beauty products? Comment below!