PCOS and Ovulation Tests: Can They Help Track Your Cycle?

Ovulation in people with PCOS is notoriously difficult to track due to them commonly experiencing irregular or no menstrual cycles. In fact, around 80% of those with PCOS suffer from anovulatory infertility (1); infertility caused by a lack of ovulation. Saying that, even if getting pregnant isn’t your goal at the moment, having a regular menstrual cycle is a sign of a healthy reproductive system and irregular periods may be part of your PCOS symptom profile. So if you are struggling with an irregular menstrual cycle and wondering how you can optimise it then read on, as this blog will look at how ovulation tracking and testing can be useful tools you might want in your tool box.

What is ovulation?

So, what is ovulation? Simply put, ovulation is the release of an egg from the ovaries into the fallopian tubes and then to the uterus. If the egg has been fertilised then it will try to implant into the uterine wall, otherwise it will be lost in your period when your uterine wall is shed. Ovulation is stimulated by various hormones, predominantly luteinising hormone (LH), an increase in which leads to the release of an egg. This occurs around day 14 in an ‘average’ cycle, however this is only true for around 10% of people (so not really average at all!), and for most it will vary between day 12-16 or even longer, including for those with PCOS. (2)

How does PCOS affect ovulation?

In PCOS, hormones such as LH and progesterone (also involved in stimulating ovulation) are at elevated levels throughout the menstrual cycle. This means stimulating ovulation is more difficult or infrequent, and also leads to irregular periods.

Why should we track ovulation?

There are many benefits to tracking ovulation, these include; 

• It may help increase your chances of pregnancy. 

• Gaining more insight and understanding of your cycle and put you on the road to a healthy reproductive system. 

• You may spot changes in your ‘norm’ earlier. 

• You will have more accurate data to share with your doctor/health care provider, who can then more accurately advise you and give more personalised medical or nutrition advice to support regulating ovulation

• A greater sense of freedom and control.

How do I know if I am ovulating?

So we know ovulation usually occurs around day 12-16 days after menstruation,  however, PCOS can decrease or increase the frequency of your cycle, so tracking ovulation proves to be difficult. Common symptoms associated with ovulation include ‘breast tenderness, bloating and mild tummy pain’. (3) These symptoms will vary between individuals and so relying on symptoms alone to detect ovulation is not a reliable method which is where hormone ovulation testing kits may be helpful.

How to track ovulation using ovulation tests?

You may be thinking, well is there another way to know when I’m ovulating? Ovulation tests, sometimes also called ovulation predictor kits (OPKs) are another method to track ovulation. Using ovulation tests is similar to pregnancy tests; you simply follow the instructions (pee on a stick!) and wait for your results. 

So how do they actually work ? Around halfway through the cycle, ovulation occurs and a dramatic increase in LH (alongside progesterone, oestrogen & FSH)  is observed. Ovulation tests work by detecting this increase in LH & a positive result indicates you’re ovulating. However, as hormonal changes in the menstrual cycle differ greatly in those with PCOS; rather than seeing dramatic increases during the different stages, hormone levels tend to be high for the duration of the cycle so accuracy of results may be affected.

Can PCOS affect results of testing kits?

Ovulation tests are not always accurate, especially if you have PCOS for a number of reasons:

1.  As hormones such as LH are already in an elevated state, ‘false positive’ results may be obtained. (4)

2. If you have an irregular cycle it can be really difficult deciding when to use them. This can be incredibly frustrating and also wasteful if you continuously receive inaccurate results, thus most individuals give up easily and can potentially miss detecting when ovulation occurs.

Alternative methods to track ovulation.

Although hormone ovulation tests may not be the most suitable option, don’t worry, as they are not the only method used to track ovulation. There are easier methods that may prove to be more accurate and don’t require you to purchase single-use tests (bonus sustainability points!).....

• Basal Body Temperature: also known as BBT, usually increases by between 0.22 to 0.56 C when ovulating. (4) So measuring your temperature when at home, at the same time each day, ideally when you first wake up, and noticing any increases in temperature may indicate ovulation.

• Cervical Mucus: the consistency of your cervical mucus usually changes when you’re about to ovulate and becomes quite ‘slippery and wet’, and it often described as having a similar consistency to egg white. (4) This is the easiest and most reliable method to track your ovulation, especially for those with a PCOS diagnosis. It requires no equipment e.g. thermometers or hormone tests and can be carried out at home with ease.

How to optimise ovulation?

Your doctor may recommend medications or hormonal contraceptives e.g. clomiphene (clomid), letrozole (femara) & gonadotropins, but these may not work for everyone.

Changes to diet and lifestyle factors can be extremely helpful in regulating ovulation. For example, reducing alcohol intake, incorporating wholegrains and fibre into your diet and regular exercise. 

A recent study reviewing the evidence found that certain foods can have a positive influence over ovulation; these include (5); 

• low glycaemic index carbohydrates (GI)

• plant-based proteins

• monounsaturated & polyunsaturated fatty acids

• vitamin D. 

When consuming a low GI diet, ovulation occurred in 24.6% of women which was significantly higher than the 7.4% occurrence observed in women who consumed traditional diets. (6)

Furthermore, another study found that swapping animal proteins for plant based proteins could reduce the risk of anovulatory infertility. (7) 

The Bottom Line

So are hormone ovulation tests a reliable method for tracking ovulation? As we have discussed, although ovulation tests can be a good method to track ovulation in those with a normal menstrual cycle, they are not always the easiest or most reliable method for those with PCOS due to the risk of inaccurate results. Other methods such as BBT and measuring cervical mucus can be easier to carry out and provide more accurate indications of ovulation. Tracking ovulation, by whichever method works for you, can be extremely helpful in managing your PCOS, and making changes to your diet could improve the ovulatory cycle, so if you are struggling with irregular menstrual cycles and are not sure if you are ovulating regularly, then it might be worth getting some personalised advice from your women's health dietitian. 

If you would like 1-1 support with your PCOS, get in touch to book a free discovery call.

References:

1. The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance

2. The timing of the “fertile window” in the menstrual cycle: day specific estimates from a prospective study

3. Periods and fertility in the menstrual cycle

4. Ovulation tracking - Improve Conception Chances!

5. The Influence of Diet on Ovulation Disorders in Women—A Narrative Review

6. Effect of a low glycemic diet in patients with polycystic ovary syndrome and anovulation - a randomized controlled trial

7. Protein intake and ovulatory infertility