Written by Tarina Mosley
PCOS stands for polycystic ovary syndrome and can affect menstruators of all shapes and ages. PCOS is becoming an increasingly common condition affecting anywhere from 5% to 10% of folks in their reproductive years. This article will outline the hormones involved in PCOS, common symptoms, fertility charting with PCOS and the steps to diagnosis.
What hormones are associated with PCOS?
Within a typical cycle there are four major hormones: FSH (follicle stimulating hormone), LH (luteinising hormone), estrogen, and progesterone. Within a standard cycle, we can expect the rise and fall of these hormones corresponding to the appropriate phase. When PCOS is at play, these hormones do not follow the typical pattern. Let's learn how these hormones are impacted.
The first hormone that typically is elevated is LH – this is the hormone responsible for triggering an egg to be released around ovulation. In PCOS, LH is often elevated consistently versus surging around the time of ovulation – which is what we would expect in a standard cycle.
Due to LH elevation, androgen production is stimulated. Androgens are hormones dominant in males, and testosterone is one of the main androgens. It can be detected in small amount in menstruators, but with the condition of PCOS this hormone is significantly increased.
The final commonly impacted hormone is FSH: this hormone is typically lower than would be expected. FSH is responsible for stimulating and developing the follicles (eggs), in preparation for ovulation.
The combination of these hormones and their imbalances can contribute to poor egg development. Ultimately, it usually leads to an inability to ovulate (or infrequent ovulation) in the condition of PCOS.
What are some of the common symptoms?
There are some common identifiers of PCOS. That said, folks can have any variation of these symptoms.
While not an exhaustive list, some of the common symptoms include:
- Irregular periods and/or no period
- Infertility or difficulty achieving a pregnancy
- Weight gain
- Thinning hair
- Hirsutism (excessive hair growth that is typically present on the chest, back, and/or face)
- Polycystic ovaries (ultrasound)
- Insulin resistance
Higher body mass index (BMI) is commonly associated with PCOS, but is not always a factor. Indeed PCOS is identified in those people with a normal BMI.
It's important to remember symptoms aren't the root cause of PCOS. After all - they're showing you something is wrong, not what is actually wrong. While symptoms help us find the cause of the PCOS, treating symptoms doesn't actually treat PCOS - it's like putting a Band-Aid on a bruise.
How can you start investigations if you suspect PCOS?
If you aren't sure yet if you have PCOS, but you think it may be impairing your cycle health, there are a few ways you can go about doing some digging on your own.
Fertility Awareness Based Method Charting
My number one tip for folks who believe they may have PCOS and/or believe they have been misdiagnosed by a provider is to begin charting their cycles with a fertility awareness-based method (FABM). This will provide you with invaluable information about the length of your cycle, when you typically ovulate (if you ovulate), and so much more.
One of the most common distinguishing factors on a chart with PCOS is anovulatory (not ovulating) and/or delayed ovulation. In fact, you may have a 'regular' period but in fact not be ovulating at all. If you have been trying to conceive, this may be worth investigating.
Another common identifier of the condition visible in a chart is constant cervical mucus secretion. This is due to the hormone imbalance at play, and it's not uncommon in someone with PCOS to have a lengthy period of cervical mucus observations (as opposed to observed dryness).
Not all FABMs are compatible with PCOS cycles. For example, due to elevated LH, methods incorporating ovulation test strips (which detect LH) would often not be ideal, as they may consistently detect falsely elevated results on the test. This isn't the case for everyone, but be aware of the possibility if you have PCOS.
In cases of PCOS, I typically recommend a symptothermal method of fertility awareness, incorporating cervical mucus observations with basal body temperature (BBT). For thos who are wishing to chart in this manner, I would highly suggest using the Tempdrop device. This will make your BBT observations a breeze, with accurate and consistent results! I always recommend folks work with an instructor when they are serious about learning a method, no matter their family planning intentions. Especially if you have been struggling to conceive, I would highly recommend working with an instructor who is well-versed in PCOS and charting.
Getting a diagnosis from a provider
Now that you have the charting information, and you believe it supports the theory of PCOS, I would take this information to your provider: naturopath, general practitioner, midwife, or otherwise. Typically testing begins with a basic blood hormone panel. This can give clues as to whether hormone levels are abnormal and can assist in diagnosis.
Another useful tool can be an ultrasound of your ovaries. It is common to visualize polycystic ovaries via ultrasound in PCOS - although it should be noted isolated polycystic ovaries cannot be used as a sole diagnosis for the condition. Polycystic ovaries can occur in a variety of reproductive system abnormalities, not limited to PCOS.
Getting an official diagnosis of PCOS is useful because it will help you understand the next steps, and it will be easier to get your providers all on the same page.
Although it is difficult not to feel discouraged especially if you have been trying to conceive for some time, there are treatment and holistic options available to improve the condition and increase your chances of conception (if this is the goal).
For any intention family planning, I would highly recommend learning a FABM with a certified instructor to track your cycles and navigate the phases of fertility and infertility within your cycle. PCOS can be frustrating and difficult to chart with as a new charter because of the irregularity it causes. Finding an instructor who understands the complexity of the issue you're facing will help you have a smoother road through charting. Even without regular cycles it is possibly to apply the fertility awareness-based method and avoid use of hormonal contraceptives when this is your goal!
Tarina Mosley is a certified fertility awareness educator through the FEMM institute and a registered midwife. She first discovered fertility awareness after experiencing a multitude of side effects from the Mirena IUD. Soon after, she herself received instruction - became obsessed with the method and sought education.
She has a passion for providing clients with comprehensive and individualized instruction based on informed choice. She has a keen interest in working with those who are trying to conceive, particularly those with PCOS.
She is based out of Alberta, Canada but provides instruction to clients all over the world. You can purchase Tempdrop at a discount through her unique link. You can also find her website www.fertilityfreedom.net or follow her Instagram account @fertilityfreedom.