PCOS and Miscarriage Risk: Why It Happens and What You Can Do to Support a Healthy Pregnancy

Understanding the Connection Between PCOS and Miscarriages

If you have PCOS and you’re trying to conceive, or you’ve experienced pregnancy loss it can feel incredibly unfair.

Many women with PCOS already carry a level of fertility fear. They’ve been told their cycles are “too irregular,” ovulation is “unpredictable,” or pregnancy may require medication. So when miscarriage enters the picture, it can add another layer of anxiety and overwhelm.

First, I want you to know this:

PCOS does not mean you will miscarry. And it does not mean you can’t have a healthy pregnancy.

But research does show there can be an increased risk of miscarriage in women with PCOS, particularly when underlying drivers like insulin resistance, inflammation and hormone imbalance are not addressed.

Negative Pregnancy Test

What Is PCOS and How Does It Affect Fertility?

PCOS (Polycystic Ovary Syndrome) is a hormonal and metabolic condition, not just a reproductive one.

It’s often linked with:

• irregular cycles and ovulation disruption

• insulin resistance

• androgen excess

• inflammation

• nutrient depletion over time

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This can affect fertility because predictable ovulation is required for conception, and metabolic health plays a major role in egg quality and pregnancy outcomes.

Women with PCOS often experience:

• irregular or absent periods

• difficulty identifying ovulation

• weight changes or stubborn weight loss resistance

• fatigue and cravings

• increased risk of metabolic complications (including gestational diabetes)

Why Does PCOS Increase Miscarriage Risk?

Miscarriage is complex and can happen for many reasons, even in women with no known health concerns.

But in PCOS, several factors may increase risk.

1) Insulin Resistance and Blood Sugar Dysregulation

This is one of the biggest drivers I look at clinically.

High insulin levels can affect:

• endometrial receptivity (how well the embryo implants)

• inflammation

• hormone signalling

• placental development

Even women with PCOS who are not classified as overweight can have insulin resistance — which is why proper metabolic testing matters.

2) Hormonal Imbalance (Including Low Progesterone Patterns)

If ovulation is irregular, progesterone can be low or inconsistent.

Progesterone is crucial because it supports:

• thickening and maintaining the uterine lining

• early pregnancy stability

• immune tolerance for implantation

This doesn’t mean progesterone is always the cause, but it can be a factor in some women, particularly with irregular cycles and short luteal phases.

3) Egg Quality and Ovulation Disruption

In PCOS, ovulation may be inconsistent and egg maturation may be impacted by:

• elevated insulin

• inflammation

• oxidative stress

• nutrient depletion

• 
  

Poor egg quality increases the likelihood of chromosomal abnormalities, which is the most common cause of early miscarriage.

This is why improving egg quality in the months before conception is so valuable.

4) Chronic Inflammation

Inflammation is a major fertility barrier and is commonly elevated in PCOS.

I

nflammation can impact:

• implantation

• placental development

• immune function

• blood flow to the uterus

When I support women preconception, reducing inflammation is often one of the biggest priorities.

5) Coagulation / Clotting Factors (In Specific Cases)

Not every woman with PCOS has clotting risk, but in some cases (especially recurrent pregnancy loss), investigation for clotting disorders may be warranted.

Impaired blood flow to the placenta can contribute to miscarriage risk, which is why deeper testing is sometimes required.

Early Symptoms to Watch For

If you are pregnant and experience any of the following, seek medical advice promptly:

• vaginal bleeding or spotting

• cramping or pelvic pain

• sudden loss of pregnancy symptoms

• feeling faint, dizzy or unwell

However, it’s also important to know: spotting and cramping does not always mean miscarriage, many women experience spotting and pain and go on to have healthy pregnancies.

The key is getting checked early.

How to Reduce Miscarriage Risk With PCOS (What Actually Helps)

This is where I want you to feel empowered.

Because even though you can’t control everything in pregnancy, there are clear steps that improve outcomes, especially when started before conception.

1) Improve insulin sensitivity (preconception priority)

The goal is stable blood sugar and lower insulin output.

This often includes:

• protein-focused meals

• balanced carbohydrates (not extreme restriction)

• strength training + walking

• reducing refined sugars

• personalised nutrition plans

In some cases, medication such as metformin may be recommended — and this should always be guided by your doctor.

2) Reduce inflammation

Reducing inflammation improves:

• egg quality

• implantation environment

• hormonal signalling

• pregnancy resilience

This can involve:

• anti-inflammatory wholefood nutrition

• gut support

• omega-3 intake

• sleep and nervous system regulation

• reducing toxic burden where relevant

• 
  

3) Support ovulation and progesterone patterns

If cycles are irregular or luteal phase is short, supporting ovulation becomes crucial.

Support may include:

• cycle tracking education

• ovulation confirmation

• targeted nutrition and herbs

• personalised supplementation

• collaboration with your GP or fertility specialist if progesterone support is required

4) Address nutrients (because pregnancy is demanding)

Common nutrients to assess and correct preconception:

• iron + ferritin

• vitamin D

• B12 and folate

• zinc

• iodine and selenium (case dependent)

Nutrient depletion can contribute to fatigue, hormonal dysfunction and pregnancy complications.

5) Get personalised medical monitoring

Women with PCOS benefit from early pregnancy support and monitoring.

Depending on your history, this can include:

• early ultrasounds

• hormone monitoring

• blood sugar support

• miscarriage risk investigations if you have a history of loss

When to Seek Further Investigation

If you have experienced:

• recurrent miscarriage (2 or more losses)

• long periods of trying without conception

• irregular ovulation with PCOS

• additional symptoms suggesting endometriosis or thyroid dysfunction

then deeper investigation is important.

There is always more to explore — and you deserve that support.

Final Thoughts

Miscarriage is heartbreaking, and if you’ve experienced it, you deserve support that goes beyond “these things happen.”

Yes, PCOS can increase miscarriage risk, but it’s often linked to drivers that can be improved with the right approach.

The most empowering thing you can do is focus on preparation:

• insulin sensitivity

• inflammation reduction

• ovulation support

• nutrient optimisation

• nervous system support

• 
  

This is how we build a stronger foundation for pregnancy.

If you have PCOS and you’re feeling fear around pregnancy loss, fertility, or trying to conceive, I can help you create a supportive plan moving forward.

Book a FREE Naturopathic PCOS Assessment Call and we’ll map out what may be increasing your risk, what testing and investigation should be prioritised, and the most supportive steps to improve hormonal balance, reduce inflammation and support a healthy pregnancy.