Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder that affects people of reproductive age assigned female at birth. One major symptom of PCOS is the lack of or irregular ovulation, the process by which a mature egg is released from the ovary.
In this article, we will delve into the relationship between PCOS and ovulation, discussing what PCOS is, the significance of ovulation, the potential impact of PCOS on ovulation, methods for tracking ovulation in individuals with PCOS, signs of ovulation, and the best ovulation tests for PCOS.
What is PCOS?
Polycystic Ovary Syndrome is a hormonal disorder characterised by symptoms such as irregular periods, oily skin, acne, excessive hair growth, hair loss on the head and fertility issues. The exact cause of PCOS is still not fully understood, but genetics, environmental impacts and lifestyle factors are believed to be involved.
PCOS cannot be cured but symptoms can be managed to improve wellbeing and quality of life.
What is ovulation?
Ovulation is a critical phase in a person’s menstrual cycle. It is the process during which a mature egg is released from the ovary and made available for fertilisation. For people with a “regular” 28-day cycle, the average day for releasing an egg is day 14 of the cycle i.e. 2 weeks before the period starts again. If someone has a 35-day cycle, for example, ovulation occurs on approximately day 21.
The day the egg is released (i.e. ovulation occurs) is the time when one is most fertile. If fertilisation occurs, the egg will implant itself in the uterus, resulting in pregnancy. Ovulation is regulated by various hormones, primarily luteinising hormone (LH) and follicle-stimulating hormone (FSH).
If you have PCOS do you ovulate?
Individuals with PCOS may experience irregular ovulation or anovulation (lack of ovulation). The hormonal imbalances in PCOS, particularly the excess of androgens, can disrupt the normal ovulation process. This may result in the ovaries producing immature eggs that don’t fully mature or get released.
Tracking ovulation with PCOS
Because of the increased risk of irregular or lack of ovulation in people with PCOS, if you are trying to conceive then tracking your cycle and ovulation is essential. There are several methods available, including tracking temperature, tracking signs of ovulation, LH ovulation kits, progesterone ovulation testing and ultrasound testing.
Tracking temperature
Tracking your temperature can be an effective way to track ovulation. This is because progesterone raises body temperature by about 0.5 – 1.0 degrees Celcius (approximately 32.9 – 33.8°F) during ovulation. This method of tracking requires you to be precise, accurate and consistent with your tracking – and not everyone’s temperature raises by this amount. There are more reliable ways to track ovulation, as we will explore below.
Tracking signs of ovulation
Recognising signs of ovulation can help people with PCOS better predict their fertile window. Some common signs of ovulation include pain, changes in cervical mucus, bloating and breast tenderness.
- Pain – some people can feel it when they ovulate. When the follicle bursts from the fluid-filled follicle a characteristic discomfort can occur. This is also known as Mittelschmerz pelvic cramping.
- Changes in cervical mucus – cervical mucus changes during our cycle. At the time of ovulation, you may note that your discharge will become wet, stretchy and slippery. It is often thought of as looking like raw egg whites.
- Bloating – you may notice bloating during ovulation. An increase in the levels of oestrogen may contribute to bloating.
- Breast tenderness – you may feel pain or tenderness in your breast tissue during ovulation. The breasts may feel lumpy and dense, but symptoms tend to disappear as soon as ovulation is complete.
Signs of ovulation are subjective so your signs of ovulation may differ from someone else. It may be worth noting down your symptoms using an app like Clue period tracker or in a notebook.
LH ovulation kits
Home ovulation test kits detect LH (luteinizing hormone) levels in the urine. LH in the blood reaches a sharp peak just before ovulation and some LH is excreted in urine. Digital ovulation kits also often check oestrogen levels to try and determine the ovulation date.
But in most people with PCOS, LH levels are already raised. This will mean that you may get false positives during testing. If you choose to use LH testing kits you may find it more helpful to measure your LH levels the week after your period to get your baseline LH levels. If you receive a positive result then you will know that your LH levels are likely to be elevated and LH ovulation kits are unlikely to be suitable for you.
Progesterone ovulation testing
Progesterone levels one week after ovulation are at their peak. Therefore, testing for progesterone levels on approximately day 21 in those with a “normal” cycle can help to show ovulation has taken place. Values greater than 25 nmol/L indicate ovulation. This test is only reliable if your cycle is regular. This means it is likely to be less helpful for those with PCOS.
Ultrasound testing
If you are undergoing fertility support then you may undergo ultrasound testing to track ovulation. These occur every few days to watch the ovary as the follicles develop. Once the follicles reach approximately 10mm they grow at approximately 2mm per day quite reliably. Once they have reached 20mm approximately then ovulation occurs.
Best ovulation tests for PCOS
Given the potential challenges of irregular ovulation in PCOS, we understand why you would want to track your ovulation. But unfortunately, ovulation tests for PCOS are unreliable.
As mentioned, this is because levels of LH and oestrogen are often already elevated in people with PCOS, and progesterone testing only tends to work for those with regular cycles. It may be helpful to combine a few efforts to track your ovulation i.e. tracking your symptoms and body temperature. But it is important to note that it is unlikely that you will be able to get a reliable result from these types of ovulation tests and tracking methods.
We recommend consulting with your healthcare professional to seek further support for fertility and conception support.
Key takeaways: PCOS and ovulation
PCOS is a hormonal disorder that can lead to irregular periods, hormonal imbalances, and fertility issues. PCOS can lead to irregular ovulation or anovulation due to hormonal imbalances. Tracking ovulation can be done through various methods, such as temperature tracking, symptom observation, LH urine tests, progesterone ovulation tests, and ultrasound monitoring. Tracking your ovulation as someone with PCOS can be difficult because of the hormonal imbalance seen in those with PCOS. If you are facing challenges with your conception journey, speak to a healthcare professional for further support.
