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Navigating Fertility With PCOS And Hashimoto's Disease

Learn what a joint Hashimoto’s and PCOS diagnosis may mean for your family formation journey.
Navigating Fertility With PCOS And Hashimoto's Disease
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Polycystic ovary syndrome (PCOS) and Hashimoto's disease are two of the most common endocrine disorders seen in people who menstruate. And there is a correlation between the two: Hashimoto's is 3-4x more common in people with PCOS than those without it! 


Hormone-related issues can cause many problematic symptoms, but one of the most severe implications is challenges with fertility. This is no exception for those who struggle with both Hashimoto's disease and PCOS.


Ahead, the experts at Pollie explore what a joint Hashimoto's and PCOS diagnosis may mean for your family formation journey.


In this article:

What is it like having both Hashimoto's and PCOS?

Hashimoto's and PCOS share many characteristics despite their completely different etiologies. Before we discuss what these conditions look like together, let's take a moment to define what they each are individually.

Hashimoto's disease

Hashimoto's thyroiditis is a common thyroid disorder. Hashimoto's is an autoimmune disease that mistakenly causes one's body to attack healthy thyroid cells. In the case of Hashimoto's, the immune system attacks healthy thyroid tissue. Over time, this can lead to damage that prevents our thyroid from producing enough thyroid hormones, thus causing us to enter a state of hypothyroidism. 


Diagnosing Hashimoto's requires looking for the presence of thyroid peroxidase antibody, or TPO antibodies. Paloma Health's at-home thyroid blood test can help identify whether your symptoms may be due to Hashimoto's.

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Hashimoto's disease progresses over time, and you may not initially notice signs or symptoms of the disease. Eventually, Hashimoto's can lead to hypothyroidism which can result in symptoms. 


Common symptoms of hypothyroidism include:

  • Fatigue
  • Cold intolerance
  • Constipation
  • Dry skin
  • Weight gain or difficulty with weight loss
  • Puffy face
  • Hoarseness
  • Muscle weakness
  • Elevated blood cholesterol level
  • Muscle aches, tenderness, or stiffness
  • Joint pain, stiffness, or swelling
  • Heavy or irregular menstrual periods
  • Thinning hair
  • Slowed heart rate
  • Depression
  • Impaired memory
  • Infertility
  • Goiter (enlarged thyroid gland)


If left undiagnosed or untreated in cases that progress to hypothyroidism, Hashimoto's disease can lead to serious health risks such as heart attack, gallstones, and peripheral neuropathy. 

Polycystic ovary syndrome (PCOS)

PCOS is a common hormonal imbalance that impacts at least 10% of people that menstruate. This syndrome is characterized by fulfilling two of the three Rotterdam criteria:

  • Anovulation or irregular ovulation - Patient-reported irregular cycles
  • High androgens, or male hormones - Diagnosed with blood work.
  • Polycystic ovaries - Diagnosed by a transvaginal ultrasound that indicates an abnormally high number of follicles, or immature eggs, surrounding at least one ovary

While PCOS always comes along with imbalanced sex hormones, it can also be a metabolic disorder for many. Research shows that 70 - 90% of PCOS patients are also insulin resistant, leading to more severe symptoms due to a vicious cycle between insulin resistance and hyperandrogenism. It can also significantly increase the risk for developing conditions like diabetes down the line. 

One of the most tell-tale symptoms of PCOS is irregular menstrual periods. Other symptoms include excessive facial hair growth, hair thinning, acne and skin discoloration, blood sugar imbalance (and subsequent energy spikes and crashes), stubborn weight gain, brain fog, and mood disorders.  

Hashimoto's and PCOS together

As mentioned above, people with PCOS are more likely to have Hashimoto's and vice versa. While often assumed as their own subgroups, thyroid hormones and reproductive hormones are closely intertwined. 

As you have likely picked up, there is considerable overlap in symptoms between these conditions relating to symptoms like fatigue, weight gain, hair loss, and irregular menstrual cycles. Some examples of ways these two conditions can further throw off hormone balance when they occur together include:

  • Polycystic ovariesAs mentioned, this is a key aspect of meeting the criteria for PCOS for many people. It is more challenging to ovulate if you have PCOS because of high androgen levels. Ovaries often present polycystic because immature follicles continue to collect rather than be released for successful ovulation. Hashimoto's can make this more intense if one has progressed to hypothyroidism. Hypothyroidism can result in high levels of a hormone called prolactin and thus stop ovulation. This hormone is produced for breastfeeding and signals to our body that it is not ready for a new baby. So, having PCOS and Hashimoto's may mean you have even more follicles on one or both of your ovaries.
  • LH-FSH ratio: Although not required for a PCOS or Hashimoto's diagnosis, the luteinizing hormone (LH) and follicle-stimulating hormone (FSH) can be indicators of both conditions. If your LH-FSH ratio is high, it can signal either PCOS or Hashimoto's. Having both conditions can increase it even further. 
  • Obesity: Hashimoto's and PCOS can both lead to weight gain alone. Suppose one has an underactive thyroid from Hashimoto's and insulin-resistant PCOS. In that case, the effects of having a "slow metabolism" may be even more prevalent. 

One of the more common severe implications of these conditions—and particularly comorbid cases—is infertility. While it may be harder to conceive with these conditions, it is certainly not impossible. 

Optimizing fertility and fetal health with PCOS and Hashimoto's

If you have PCOS and Hashimoto's, it is essential to know that these diagnoses are not a fertility death sentence. In most cases, pregnancy is possible! It may just take some tweaking and a longer amount of time to get there than for someone who does not struggle with hormone or autoimmune issues.

People with Hashimoto's and PCOS have hormonal imbalances that interfere with the growth and release of eggs from their ovaries required for successful and predictable ovulation. Since ovulation is necessary for pregnancy, it will likely be more difficult to conceive if not ovulating consistently. If you are trying to start a family or think you want to have children in the future, proactively learning what your reproductive hormone status is (and what your specific ovulation barriers are) is an excellent first step.

An under-discussed topic with hormone issues and family planning is pregnancy itself. Since fertility struggles are so prevalent, the emphasis is often on conception itself. Still, it is important to be aware of ways to monitor your pregnancy. The risks of both diagnoses are similar, such as difficulty conceiving, gestational diabetes, preeclampsia, miscarriages, cesarean deliveries, and premature birth.

However, like conception, pregnancy risk can be mitigated by monitoring your lab values and knowing what to look out for. 

You can increase your chances of becoming pregnant and maintaining a healthy pregnancy with PCOS and Hashimoto's through various treatment options. The following are just a few of the available options:

Lifestyle changes

Regular exercise and a balanced diet may help regulate your menstrual cycle. If you have PCOS and Hashimoto's, focusing on minimizing inflammation is a must. You can do this through a combination of diet, exercise, and stress management. Taking a personalized approach to reducing your body's inflammation with a program like Pollie is most helpful.


Myo-inositol is a supplement that can be particularly helpful for insulin-resistant PCOS. It has shown to be as effective as drugs like metformin, and it also comes with little to no side effects for most people. An iodine supplement may also be helpful for Hashimoto's that is accompanied by hypothyroidism to maintain proper levels of beta-hCG, which is needed for a healthy pregnancy.


Suppose other causes of infertility have been ruled out. In that case, your health care provider may prescribe medicine to help you ovulate, such as clomiphene. Clomiphene has been shown to increase the chances of getting pregnant by six times in women with PCOS than those who do not take it. Women who do not respond to clomiphene may also be prescribed metformin if they are insulin resistant or have high blood sugar, as metabolic issues have been shown to have negative impacts on ovulation. Those suffering from hypothyroidism caused by Hashimoto's are usually prescribed thyroid hormone replacement medication, which has been shown to increase anti-Müllerian hormone (AMH) levels. 

Hormone therapy

Women with PCOS who aren't responding to medications such as Metformin and Clomiphene can take gonadotropins and hCG. Hormone therapy is also a helpful treatment avenue to combat Hashimoto's since a normal thyroid level is necessary for regular menstrual cycles and ovulation. The proper thyroid hormone replacement dosage may help you conceive by regulating your period. There is a link between low progesterone and PCOS and Hashimoto's, leading to implantation difficulties once a sperm fertilizes an egg and early miscarriage. Getting your progesterone tested to know if you should be supplementing after ovulation is important for PCOS and Hashimoto's. 

Infertility treatment

Some women may not respond to either lifestyle changes or medications. Fertility treatments like intrauterine insemination (IUI) and in-vitro fertilization (IVF) may help increase the chance of women getting pregnant. Infertility treatment can be costly and is often not covered by insurance. Still, more and more employers are offering these services as an employee benefit if self-pay is not an option for you.

Know your body

Tracking your cycle and how symptoms change throughout the month is a helpful way to understand what works for you versus what does not. Suppose you are not yet trying to conceive. In that case, a PCOS-specific app like Pollie (or a general period tracking app) is a helpful tool for monitoring your hormonal health status. Being aware of your body's changes during pregnancy is also important, and there are many tracking resources available for this.

Be sure to talk with your physician before making changes to your lifestyle, supplements, or medication. While it seems simple, starting a new diet or taking a new supplement can be powerful. It is important to ensure that it will not interfere negatively with existing treatments. 

A note from Pollie

While having a joint PCOS and Hashimoto's diagnosis can be overwhelming when thinking about fertility, it does not need to be. Getting the proper support for labs, specialists, and treatment is an incredibly helpful way to get your PCOS and Hashimoto's symptoms in control, regulate your hormones, and begin your fertility journey.  


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