How to track ovulation with PCOS

With PCOS, high levels of androgens (male-type hormones) and unmanaged insulin resistance can disrupt your monthly cycle of ovulation and periods. This means that your periods may be irregular or stop altogether.

An irregular and unpredictable menstrual cycle is one of the most common and frustrating symptoms of PCOS. However, tracking your menstrual cycle is a powerful way to understand your body and it can help you to better manage your symptoms.

In this blog post, we’ll explore what happens during ovulation, the relationship between PCOS and ovulation, how tracking your cycle can help, and the different methods of ovulation tracking.

What happens during ovulation?

Your ovaries contain a number of follicles, which contain eggs. Ovulation is part of the menstrual cycle when there's a spike in luteinizing hormone (LH) levels, which triggers the release of the most mature egg from the ovary. The egg then moves along a fallopian tube towards your uterus (1).

This process is a key part of the menstrual cycle and typically occurs about midway through the cycle, around day 14 in a 28-day cycle (although women with PCOS tend to ovulate later) to be fertilised with sperm. If the egg has not been fertilised, it is re-absorbed by the body, the hormone levels drop, and the womb lining is shed, which results in the start of your next period.

How does PCOS affect ovulation?

Hormonal imbalances seen in PCOS (high testosterone and elevated baseline LH levels), can disrupt the maturation of the follicles. The follicles don’t grow or release eggs every month, leading to missed ovulation or delayed cycles. Instead, the follicles remain on your ovaries and can look like lots of cysts on a scan. This is why PCOS is called polycystic (meaning ‘many cysts’) ovary syndrome (2).

What are the benefits of tracking your cycle if you have PCOS?

If you have PCOS, you can get a better sense of your cycles and whether or not ovulation is happening regularly by tracking your cycle.

Tracking ovulation can provide several benefits:

• Understand when you’re most likely ovulating: Tracking ovulation can give you a benchmark to help you understand where you may be in your cycle. You may even discover that you’re likely not ovulating at all, which is important to discuss with your doctor and/or specialist.

• Getting to know your body: Learning about your body’s patterns and what’s normal for your cycle so you can identify changes. Changes in the timing or symptoms that come with your cycle can indicate whether hormone levels are balancing with lifestyle changes or treatments (3).

• Improved chances of conception: Knowing when ovulation occurs can help you time intercourse during your fertile window.

• Better treatment planning: Keeping a record of your cycle (using an app or other recording tool) can be helpful information to share with your doctor and/or specialist. They can use that information to help better manage your symptoms with the most appropriate treatment plan.

How to track ovulation with PCOS

The starting point for all ovulation tracking is to monitor your menstrual cycle. Whether it’s regular or irregular, knowing the pattern by keeping a record can help.

During ovulation, some people may experience breast tenderness, a mild ache, cramp or pain in one side of the lower abdomen (where the ovary is releasing the egg) and bloating. The symptoms can vary, and it’s not a reliable way of predicting ovulation, but noting your symptoms might help to get to know your cycle better.

The symptoms of PCOS can also vary from person to person. Therefore, some of the following methods might work better for your body than others, and you might need to experiment with several ways until you find what works for you.

Here are the main ways that you can try to track and predict ovulation:

• Cycle-tracking apps can help you to establish a record of the timing and length of your cycle. Some apps can make predictions about when your next period or ovulation is likely to come. However, if you have irregular or very long cycles, an app might not be able to predict ovulation.

• Ovulation predictor kits (available from chemists) work by identifying the level of LH in your urine. Since LH levels surge between 24 and 48 hours before ovulation, tracking LH is one of the best predictors for when you’re likely to ovulate. However, one of the characteristics of PCOS is consistently higher than average LH levels. Therefore, some kits may give false ‘positives’ even when you are not about to ovulate. Fertility experts recommend that with PCOS, you should aim to use a kit which has a threshold well above your baseline to increase the chances of accuracy.

• Cervical mucus monitoring: Your cervical mucus changes in consistency throughout your menstrual cycle. Around ovulation, it becomes clear, slippery, and stretchy, similar to raw egg whites. Monitoring these changes can help you to track ovulation.

• Basal Body Temperature (BBT) Monitoring: Ovulation causes a slight increase in BBT due to the rise in progesterone following the release of an egg. BBT tracking involves measuring your body’s temperature every morning (at the same time) before getting out of bed, to help you to understand if ovulation has occurred.

Lifestyle Changes to Support Ovulation

Beyond tracking ovulation, dietary and lifestyle modifications play significant roles in regulating insulin levels and restoring hormonal balance, which may lead to more regular ovulation. I’ll be exploring these in greater depth in my next blog article!

Key takeaways

Ovulation tracking with PCOS presents challenges, but it is still achievable with the right methods and patience. Tools such as advanced OPKs, BBT monitoring and cervical mucus observation can help you to better understand your cycles and help to predict ovulation. Whether you’re trying to conceive or simply want to better understand your body, ovulation tracking with PCOS is a powerful tool for managing your reproductive health.

 References

1. NHS (2023) Periods and fertility in the menstrual cycle. Accessed at: https://www.nhs.uk/conditions/periods/fertility-in-the-menstrual-cycle/

2. Tommys (2024) PCOS and fertility: everything you need to know. Accessed: https://www.tommys.org/pregnancy-information/planning-a-pregnancy/fertility-and-causes-of-infertility/pcos-and-fertility-everything-you-need-know#pcosovulation

3. Wright, H (2010). The PCOS Diet Plan. Ten Speed Press.