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Sasha Pieterse, an actress best known for her starring role in 'Pretty Little Liars', has been candid about her experience with PCOS. When the actress was just 17, she navigated some noticeable side effects of the condition — and she did so while very much existing in the public eye. Her story illustrates so many things about the experience of living with PCOS, especially when it comes to all the unknowns associated with the condition.
Like so many people who live with PCOS, Pieterse struggled with the symptoms of the disease before securing a diagnosis. After all, PCOS is notoriously complicated to identify, diagnose, and, as a result, treat.
"I never had a regular period ever and I was just always told by gynecologists that I was just young. Like, ‘Don't worry, it'll regulate,' ” Pieterse shared during an appearance on The Squeeze podcast. “When I turned, it was probably around 15-16, that I started noticing a difference in just my metabolism in general. At 17, I gained 70 lbs. in the year, for no reason. There was no explanation for it. It was the most frustrating experience and disheartening because no matter what I did, no matter how well I behaved, no matter how great I treated my body, things were actually getting worse rather than better, it was very very confusing.”
She was finally diagnosed after visiting over 15 gynecologists.
But while many people worry about conceiving after a PCOS diagnosis, as the condition has clearly been associated with fertility challenges, Pieterse revealed she got pregnant with her son, Hendrix, on the first try, which she refers to as a “pleasant surprise”.
Then, Pieterse had another happy surprise. “Miraculously, Hendrix regulated my hormones. It happens in a very small percentage of women, but essentially my PCOS is dormant,” Pieterse said. “I have regular periods for the first time in my life.”
Pieterse is right — PCOS can’t be cured, but it can be dormant.
“PCOS can indeed exhibit periods of dormancy when hormone levels achieve a state of balance. [People with PCOS] may experience phases where PCOS symptoms are minimal or absent,” says Ian Waldman, MD, a reproductive endocrinologist at CCRM Fertility. “During these times, hormonal imbalances that contribute to irregular menstrual cycles, hair growth, acne, and other manifestations of PCOS might be temporarily mitigated.”
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It’s not just pregnancy that can do this. Managing the condition with hormone therapies or weight loss can also lead to periods of dormancy with PCOS, as can natural hormonal fluctuations.
Is it typical for PCOS to become dormant after pregnancy?
One of the most frustrating things about PCOS is how unpredictable it can be. As Pieterse’s story suggests, people with PCOS may experience infertility…or they may not. They may exhibit all the textbook symptoms of the disease (which can include irregular periods, hirsutism, and ovarian cysts, according to Mayo Clinic)…or they may not. And PCOS may become dormant after giving birth…or it may not.
“During pregnancy, the elevated levels of estrogen and progesterone often counterbalance the higher androgen levels seen in PCOS, leading to an improvement or temporary disappearance of PCOS symptoms,” says Dr. Waldman. “After giving birth, a woman's hormone levels undergo significant changes, including those associated with PCOS. As time passes from the immediate postpartum period, hormone levels will typically normalize, and most women will notice a return of their PCOS symptoms.”
“As the symptoms of PCOS present on a spectrum it is not uncommon for those with PCOS to experience fluctuations throughout their life,” he continues. “The hormonal changes during pregnancy typically provide a temporary respite rather than a permanent change in the underlying hormonal imbalances associated with PCOS.”
For some people, pregnancy can make PCOS symptoms worse.
There’s really no way of predicting how pregnancy will affect each person’s PCOS symptoms or levels.
“Some women might experience an exacerbation of symptoms, while others might observe milder symptoms,” says Dr. Waldman. “The return to pre-pregnancy hormonal levels often means a recurrence of PCOS symptoms. Factors such as breastfeeding, postpartum weight changes, and individual variation contribute to how PCOS may affect someone after pregnancy. It’s important to remember the symptoms of PCOS can present on a spectrum. Not every person with PCOS will have the same symptoms in the same way and each individual can have times of more or less symptoms.”
Management is key
Pieterse mentions that the dormancy of her PCOS isn’t just because she delivered her baby — she also actively works to manage the condition (the keto diet is hugely instrumental in this, she shares). Experts cosign that idea.
“Women with PCOS need to be managing their condition actively. One pregnancy does not dictate a dormant state or guaranteed fertility in the future,” says Lora Shahine, MD, a reproductive endocrinologist.
“PCOS is a hormonal condition, and while hormones change drastically over a pregnancy, having a successful pregnancy does not necessarily mean an individual will no longer experience symptoms associated with the condition postpartum,” Dr. Shahine adds. “While every individual is different, it is important for women to speak with their healthcare providers once they are postpartum to support the management of returning PCOS symptoms.”
The bottom line: Everyone is different when it comes to PCOS.
“Pregnancy's impact on PCOS is complex and varies from person to person,” says Dr. Waldman. “The elevated estrogen and progesterone levels during pregnancy often mitigate androgen-related PCOS symptoms, offering temporary relief. However, pregnancy doesn't alter the fundamental hormonal and metabolic imbalances underlying PCOS. It's important for individuals with PCOS to consult with healthcare professionals specializing in the condition to navigate the various phases of reproductive years, pregnancy, and postpartum effectively.”
Zara Hanawalt is a freelance journalist and mom of twins. She's written for outlets like Parents, Marie Claire, Elle, Cosmopolitan, Motherly, and many others. In her (admittedly limited!) free time, she enjoys cooking, reading, trying new restaurants, and traveling with her family.