How does PCOS affect ovulation and ovulation testing?
Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that is common among women in their reproductive years and is well known mainly for its link to infertility. Today we’re going to delve deeper into PCOS - what exactly it is, what are the symptoms, how it can impact how someone ovulates and tracks their cycle.
What Exactly is PCOS?
Irregular, no period or prolonged menstrual cycle
Excessive hair growth - usually on the face, chest, back or buttocks
Unexplained weight gain
Male pattern baldness (ie thinning hair, hair loss from the head)
Oily skin or acne
Difficulty getting pregnant
It’s important to note that difficulty getting pregnant is one of the symptoms of PCOS. Not all people who have or experience symptoms of PCOS will have difficulty getting pregnant. Having one symptom of PCOS doesn’t mean you will have all symptoms. If you think you have any of these symptoms, start the conversation with your medical provider about what you’re experiencing and how to best care for your body.
How Do I Get PCOS?
The exact reason why some people have PCOS is not known, but doctors and researchers have some ideas.
The irregular hormones that may cause PCOS boil down to a few culprits. Some potential hormonal-related reasons why you may be experiencing PCOS symptoms include raised levels of testosterone, luteinising hormone (LH), or prolactin, or lower levels of sex hormone-binding globulin. The reasons why these hormones change is unknown.
Also, there are correlations between people who have PCOS and other symptoms or diseases. Many women with PCOS are insulin resistant, and insulin resistance is often due to family history or weight gain. Being overweight is associated with PCOS, but the relationship between weight gain and PCOS - i.e. does PCOS cause weight gain or visa versa - is not yet understood. Additionally, women who have a family member with PCOS or type 2 diabetes are more likely to develop PCOS. Weight gain, genetics, type 2 diabetes and insulin resistance are all related - and doctors and researchers are still working to understand exactly how PCOS relates to these other symptoms.
How Does PCOS Impact Ovulation?
The imbalance of hormones caused by PCOS, namely the imbalance of androgens, can inhibit the maturation and release of an egg from the ovary, ultimately disrupting ovulation. The eggs may collect on the ovaries as small, immature follicles commonly known as cysts. If you don’t ovulate, you can’t get pregnant. PCOS is one of the most common causes of infertility for people with vaginas, and people often receive their first PCOS diagnosis while trying to become pregnant.
How Does PCOS Impact Ovulation Testing?
Short answer, it’s possible that PCOS also impacts ovulation testing, but it really depends on the type of test or the method you are using.
The most popular ovulation test that can be easily done at home, is the traditional urine dipsticks (like a Stix ovulation test!). These measure estrogen and LH, since increases of these hormones are clues to ongoing ovulation. Yet, someone with PCOS can have multiple peaks or constant highs of estrogen or LH due to their hormonal imbalance, which can influence the test’s accuracy. Urine dipsticks may still work if you are having regular, monthly periods, meaning you can reasonably expect to ovulate around 14 days after the start of your cycle. But if your periods are irregular it may be hard to know when to take the ovulation test to get an accurate result. Some people may receive constant positive results, which probably means your LH levels are unregulated or constantly high. In this case, the urine dipstick would not provide the best information regarding whether you are ovulating or not.
Another option is the saliva ferning tests. This microscopic saliva test detects higher levels of estrogen, which potentially signifies ovulation. For people with PCOS who may have chronically high or fluctuating levels of estrogen, this test will not be very helpful. (Additionally, the U.S. Food and Drug Administration details many reasons why this test may be inaccurate, for example brushing your teeth or smoking, which impacts people with or without PCOS.)
Beyond hormonal based tests, there are other more hands-on ways for people with PCOS to try to track their ovulation. This includes using a basal body temperature thermometer to check and track your basal body temperature, as well as checking and tracking your cervical mucus or position of your cervix. For those with PCOS and irregular periods, using and noting clues from your body may be the best way to understand what’s going on in your body and adapt your behaviors based on potential ovulation. Reach out to your doctor to learn the best way to track ovulation based on your PCOS symptoms.