Tracking ovulation with PCOS can be frustrating, but it’s not necessarily impossible!
In this article, we’ll cover everything you need to know about tracking ovulation with PCOS — including how the condition affects your hormone levels, why traditional ovulation predictor kits (OPKs) will be unreliable, and alternative cycle tracking methods that work better for individuals with PCOS.
Understanding PCOS and Ovulation
What Is PCOS (Polycystic Ovary Syndrome)?
Polycystic ovary syndrome (PCOS) is an endocrine condition that disrupts hormone levels and leads to prolonged hormone imbalance. The most common hormonal indicators of PCOS include:
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Elevated androgen levels
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Elevated luteinizing hormone (LH) levels
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Insulin resistance
When hormone levels are out of balance, this can lead to a range of symptoms that interfere with fertility and general health. The most common PCOS symptoms include:
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Bloating
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Heavy menstrual flow
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Irregular periods
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Menstrual cycles shorter than 21 days
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Menstrual cycles longer than 35 days
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Unexpected weight gain
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Increased presence of acne, dark patches, and skin tags
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Excess facial and body hair (hirsutism)
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Male-pattern baldness
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Hypertension
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Mood swings and fatigue
To receive a PCOS diagnosis, an individual must have at least two of the following three symptoms:
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Irregular periods and ovulation and/or absence of periods and ovulation
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Excess androgen levels
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Polycystic ovaries (PCO)
Side Note: Even though the word ‘polycystic’ implies the presence of cysts on the ovaries, the vast majority of PCOS patients don’t actually have any cysts at all. Instead, the term ‘polycystic’ is used to describe ovaries that are enlarged and contain more ovarian follicles than normal. This condition is sometimes referred to as ‘PCO’ or ‘multifollicular ovaries’, and it’s possible to have PCO on its own without PCOS. It’s also possible to have PCOS without PCO.
Confused? Check out our article PCO vs. PCOS: Key Differences, Symptoms, and Impact on Fertility for clarity on the key differences between PCO and PCOS.
How PCOS Affects Ovulation and Fertility
The World Health Organization names PCOS as a leading cause of infertility. Here’s a breakdown of why:
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When hormones are out of balance due to PCOS, the menstrual cycle is disrupted.
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This can cause ovulation to become irregular. It can also cause ovulation to stop altogether.
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Without ovulation, natural conception is not possible.
Hormone imbalance due to PCOS is also associated with insulin resistance, which can lead to weight gain. If BMI is above 19.5, research suggests that the risk of infertility increases by 3% with each unit increase in BMI.
Common Ovulation Patterns in Women with PCOS
Ovulation with PCOS can feel like a mystery. PCOS patients are likely to experience the following two ovulation patterns:
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Anovulation (lack of ovulation) - an egg is not released from the ovaries at any point during the menstrual cycle.
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Oligoovulation (irregular ovulation) - an egg is released from the ovaries during the menstrual cycle, but it may not happen on a regular basis.
If ovulation does not happen regularly or at all, planning a pregnancy without medical assistance is difficult. Without ovulation, natural conception is not possible. If ovulation is irregular, it can be difficult to time sex at the right time each cycle.
PCOS and Ovulation Tests: Why Standard Ovulation Predictor Kits (OPKs) May Not Work
The unpredictability of ovulation with PCOS can make tracking ovulation difficult. Not only that, but individuals with PCOS are also likely to have elevated baseline LH levels. This is why traditional at-home ovulation predictor kits (OPKs) — often advertised as ovulation test kits, ovulation strips, or ovulation sticks — may not work with PCOS.
Let’s break it down.
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In a standard 28-day menstrual cycle, ovulation typically occurs on cycle day 14.
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The primary hormone that initiates ovulation is luteinizing hormone (LH), and it surges approximately 24-36 hours before ovulation.
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Ovulation predictor kits work by measuring LH levels in urine. If LH levels are elevated above a certain threshold, this is a positive ovulation test result that indicates ovulation will happen soon.
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When couples receive a positive result, they know to have sex regularly over the next few days to maximize the chances of conception.
Now let’s think about the impact of PCOS on the menstrual cycle.
To start, if ovulation is irregular, cycles may be much longer or shorter than the standard 28 days. This can make it difficult to know when to start testing with an OPK and ovulation could be missed.
Elevated baseline LH levels with PCOS can also throw a spanner in the works when using OPKs. If LH levels are consistently elevated, it’s possible for an OPK to show a positive result — even if the body hasn’t technically ovulated. It’s also common for individuals with PCOS to have multiple LH peaks within one cycle, which can also lead to false-positive results. These false-positive results can be super frustrating, and they only exacerbate feelings of anxiety, confusion, and disappointment while TTC.
Alternative Ovulation Tracking Methods and Their Effectiveness for PCOS
High Effectiveness: Advanced Fertility Monitors
Similar to OPKs, advanced fertility monitors can also measure LH levels in urine. However, they differ from OPKs because they provide more information beyond a positive or negative result.
For example, with the Mira Monitor and Wands, you can chart your 6-day fertile window, predict ovulation, and confirm exactly when ovulation occurred. In addition to measuring and tracking LH levels at higher hormone ranges compared to OPKs, you can also measure three additional hormones in urine:
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Estrone-3-glucuronide (E3G) – the urine metabolite of estradiol
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Pregnanediol glucuronide (PdG) – the urine metabolite of progesterone
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Follicle-stimulating hormone (FSH)
The best part about Mira is that you can see your exact hormone levels. This is absolutely essential for individuals with PCOS, as it enables you to differentiate smaller LH peaks from your actual LH surge — even if your baseline LH level is high.
When tracked over time in the Mira App, Mira’s powerful AI can learn your cycle, detect even the tiniest of hormone fluctuations, and enable you to more accurately predict ovulation.
To learn more about how Mira can help you get pregnant with PCOS, visit How does Mira work with PCOS?
Moderate Effectiveness: Cervical Mucus Method
In the days leading up to ovulation, it’s common for cervical mucus to increase in volume. It also changes in texture and consistency, often resembling raw egg whites. By tracking these physical changes, individuals can predict their fertile window and plan intercourse accordingly.
Some of the most common cervical mucus methods include:
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The Billings Method
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The Creighton Method
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The 2-Day Method
Some individuals with PCOS may be able to spot these changes and anticipate ovulation. However, it’s important to note that due to hormone imbalance, sometimes individuals with PCOS may have reduced cervical mucus elasticity. This can make it more difficult to use this method for ovulation tracking.
Low Effectiveness: Basal Body Temperature (BBT) Method
The basal body temperature (BBT) method involves tracking your BBT daily using a BBT thermometer to predict ovulation.
BBT is your body’s temperature when it is completely at rest. There is a slight rise in BBT following ovulation. By tracking BBT regularly over time, you may be able to:
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Spot patterns in ovulation timing and
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Confirm when ovulation has occurred
Even in the best of circumstances though, BBT monitoring is not necessarily the most reliable method for tracking ovulation. It can take several cycles to collect enough data for the method to work. And, research suggests that it is prone to inaccuracy. This is because a number of factors can influence BBT — including stress, illness, alcohol consumption, and hormone imbalance.
Tips for Tracking Ovulation with PCOS
Stay Away from OPKs
OPKs are designed to work for regular cycles and are not a good tool to use if you have PCOS. Other tools and methods, such as advanced fertility monitors, cervical mucus tracking, and BBT tracking, will provide you with much more valuable information about your body and hormones.
Always Follow the Instructions
Whether you’re using an advanced fertility monitor (like Mira) or following a specific cervical mucus tracking method, always make sure to follow the instructions very carefully. This will help to ensure your results are as accurate as possible.
Be Consistent
Gathering enough data to make accurate predictions for ovulation can take some time. For the best results, try to be patient and consistent with testing.
Combine Multiple Testing Methods
For even better predictability, it’s worth using multiple ovulation tracking methods at the same time. The more you know about your body, the better-equipped you’ll be at predicting ovulation. You’ll also be better prepared at your next doctor’s appointment.
Know When to See a Doctor
In some cases, natural conception is just not possible with PCOS — no matter how much time and energy you devote to tracking ovulation. If this is you, don’t panic! Speak with your doctor. They can help you navigate the next steps of seeking further fertility treatment.
Pro Tip: You should speak with your doctor if you are under the age of 35 and have been actively TTC for at least one year. If you are over the age of 35, you should speak with a doctor if you have been actively TTC for at least six months.
Natural Ways to Support Ovulation with PCOS
Maintain a Healthy Weight
Individuals with PCOS are at a higher risk of insulin resistance, which can lead to weight gain and reduced fertility. PCOS patients should embrace a diet rich in whole-grains, plenty of fruits and vegetables, and lots of lean proteins. Regular, moderate exercise is also advised, with research suggesting that exercise therapy can help to restore regular periods among PCOS patients.
Nourish Your Body With Supplements
Certain herbs, vitamins, and minerals may help regulate hormones and promote ovulation. Commonly recommended ingredients for PCOS include goji berries, chaste tree berries, and peppermint (all of which can be found in Mira’s own fertility tea). Mira’s PCOS supplements are another great option, as they contain the most effective ratio of Myo and D-Chiro Inositol for restoring ovulation and cycle regularity.
Limit Stress Levels
Research shows that prolonged periods of stress can interfere with an individual’s ability to conceive and maintain a pregnancy. For PCOS patients especially, it’s important to be mindful of stress levels to maximize the chances of conception when ovulation occurs. Although stress is a normal part of life, it’s important to carve out time for stress-reducing activities such as journaling, being creative, exercising, and spending time in nature. You can also try Mira’s expert-backed meditation playlist, which includes six meditation exercises to naturally lower stress levels.
Final Thoughts
At Mira, we want you to feel empowered to learn more about your body, hormones, and fertility. If you found this article helpful, you may also find the following resources on our website helpful as well:
Struggling to juggle it all with PCOS? We would love to support you in our Hormone Health Clinic! Our experienced hormone health practitioners can review your hormone charts, provide guidance on nutrition and supplements, and help you create a practical action plan for getting pregnant with PCOS.
Frequently Asked Questions
Can you still ovulate with PCOS?
Yes, it is still possible to ovulate with PCOS. However, individuals with PCOS may not ovulate on a regular basis. This is why ovulation tracking with PCOS can be a challenge.
What does a typical ovulation test strip's progression look like?
When using LH test strips found in standard ovulation kits (i.e. OPKs), the first test may show a test line that is faint in color. The test line should darken with each new test taken over the next few days. When the test line is at its darkest, this indicates a positive result and ovulation is likely to occur within the next 24-36 hours.
Please note: OPKs are not a reliable tool for PCOS patients.
What is the best PCOS ovulation test?
If you have PCOS, ovulation can be difficult to track. Unfortunately, there is no specific ovulation test designed for individuals with PCOS. The best way to track ovulation is by tracking your exact hormone levels on a regular basis. This can be done with an advanced fertility monitor like Mira.
