Monitor your cycle can be very helpful:
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If you want to get pregnant, it allows you to target your fertility window as accurately as possible and to verify that the phases of your cycle are optimal.
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If you are not using hormonal contraception and do not want children, cycle monitoring methods are a reliable form of contraception when applied properly. According to the government, the symptothermal method (after training by a professional) has a practical effectiveness of 98% vs 91% for contraceptive pills (source)!
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In any case, your cycle and ovulation provide important indications about your hormonal balance and overall health. In fact, for the American College of Obstetricians and Gynecologists, the menstrual cycle actually is a vital sign, just like the others (blood pressure, heart rate, etc.)!
You want to start monitoring your cycle, but with PCOS, you may have long and/or irregular cycles that make monitoring even more difficult.
Don't get discouraged, we’ll give you all the keys to learn how to track your cycle in this article!
Quick reminder about the physiology of menstrual cycles
The theoretical length of a cycle
The first day of your cycle is the first day of your periods (we're talking about real blood flow, not spotting!). Even though periods are the starting point for tracking the cycle, ovulation is the main event! Without it, no periods, no hormonal secretions, and no pregnancy.
In theory, cycles last 28 days. This is the length you learned in biology class, and the one most gynaecologists base their assessments on.
In practice, only 13% of women have a 28-day cycle! Between 21 and 35 days, the cycle is considered normal. It also happens that the duration of the cycle varies from one month to another, without it being a problem.
But when you have PCOS, you often go well beyond these lengths... You quite often only have periods a few times a year.
Cycle phases
- The follicular phase: It extends from the 1st day of menstruation until ovulation. It's the stage during which the ovaries prepare the maturation of follicles, including the dominant follicle that will release the egg.
This phase has the most variable duration; however, it's interesting to spot it as it provides clues about how your body is reacting.
It's worth noting that late ovulation doesn't necessarily impact fertility; the essential thing is for good quality ovulation to occur.
Don’t worry though, I've seen pregnancies starting with ovulation on day 60 or even 100!
The hormones characterising this phase are mainly oestrogen and FSH (follicle-stimulating hormone).
- Ovulation: It occurs at the end of the follicular phase when the LH (luteinizing hormone) peak occurs.
The egg is a very fragile fatty cell; it only survives for 12 hours (maximum 24 hours) after its release.
- The luteal phase: lasting between 12 and 16 days (maximum!), it is characterised by an increase in progesterone levels.
Progesterone allows, among other things, the development of the uterine lining that will host the embryo if fertilisation occurs. It's also responsible for raising your body temperature. "Pro-gest-erone" → "pro-gestation"! It's an essential hormone for initiating and maintaining pregnancy. A luteal phase shorter than 11 days is problematic because it indicates that your progesterone levels are too low, and the embryo won't have time to settle in the endometrium. This could be due to poor-quality ovulation, hormonal imbalance... which needs to be explored with your healthcare professional (gynaecologist, naturopath...).
Caution: All this is ap)plies only if you are not on hormonal contraception! If you are taking the pill (or other methods), your cycle is simply paused, and you cannot make these observations.
The evolution of cervical mucus (Billings method)
What is cervical mucus?
It's a lesser-known term that refers to the "ovulation discharge" that can be observed in your underwear or when you wipe. Cervical mucus is a fluid secreted by your cervix, whose consistency changes throughout the cycle.
It can be confused with vaginal secretions, which are sticky white-cream secretions that "clean" the vagina and prevent infections.
Cervical mucus is not dirty or something to be ashamed of. Quite the contrary, as it is an extremely important part of getting pregnant. Don't be tempted by products or miracle solutions designed to dry up mucus. It's a 100% normal physiological phenomenon that needs to be carefully preserved.
What is cervical mucus used for?
Cervical mucus mostly creates a favourable environment for sperm survival when you're fertile. Since the egg has a very short lifespan, cervical mucus helps keep sperm alive for several days until ovulation occurs. That's why it's better to have intercourse before ovulation and on the day of ovulation, rather than after!
Cervical mucus also plays another role after ovulation. It becomes compact and inhospitable to both protect the cervix from pathogens and preserve a potential pregnancy that is just settling in.
The evolution of cervical mucus throughout the cycle
It changes throughout the cycle, but it's most visible during your fertility window.
Under the influence of oestrogen, mucus becomes increasingly fluid and abundant, providing a sensation of moisture. This is referred to as "mucus quality improvement". Its consistency resembles that of raw egg whites. Ideally, you should be able to stretch it between your fingers for several centimetres without it breaking!
WIth some women, mucus is difficult to monitor because it remains close to the cervix without going down the vagina. This is not an obstacle to fertility, as long as it's here. However, if you never seem to be able to spot it out (neither on toilet paper/underwear, nor by trying to collect it directly from the cervix), it could be a sign of hormonal imbalance and, particularly, a lack of oestrogen. Discuss it with your healthcare professional!
It's possible to spot several episodes of mucus quality improvement during the cycle; each episode corresponds to an attempt at ovulation until your body finally manages to expel a mature egg. This is quite common in women with PCOS, who often have a very long and suboptimal follicular phase.
Ovulation tests: Yes, but...
How do they work?
These are very simple tests that you can easily do at home. They come in the form of strips to be dipped into a small container of urine collected beforehand. Some more expensive models are equipped with a plastic casing and must be used directly under the stream of urine.
They can be purchased over the counter at pharmacies, supermarkets, or even online. If you're unsure about which tests to choose, don't hesitate to seek advice from a midwife or your healthcare professional.
These tests are used to detect LH, the luteinizing hormone that triggers ovulation when it reaches its peak (around 25 to 40 mIU/ml). Once the test is positive, ovulation occurs within 12 to 36 hours (varies among women).
To obtain reliable results, especially if you're just starting out, you should test from the end of your period until ovulation, preferably in the morning and at roughly the same time. Once the test is positive, it can be useful to continue testing for a few days to ensure that the LH levels return to normal.
Are ovulation tests reliable for women with PCOS?
In the majority of cases, unfortunately, ovulation tests are no great help in terms of clarity because PCOS is often characterised by high LH levels. Most of the time, ovulation tests always come out positive and are therefore not interpretable.
It also depends on the tests’ sensitivity. Some manufacturers offer highly sensitive tests that react at 10 mIU/ml, while others react at 30 mIU/ml. You might need to try out different brands to see which one works best for you, or you could also seek guidance from a professional.
When LH levels are normal, ovulation tests can be used reliably, but they require perseverance. Indeed, you need to test diligently every day of your cycle, even when it takes weeks for ovulation to occur! For this reason, we recommend bulk buying ovulation tests strip packs online (for example, on Amazon) rather than at the pharmacy. It will be much cheaper.
Caution: ovulation tests are not 100% reliable as only a temperature chart can confirm that ovulation has occurred!
Taking your temperature (Symptothermal Method)
The symptothermal method is a topic that could be the subject of an entire article!
This method involves charting your basal body temperature throughout your cycle. Basal body temperature is your body's lowest temperature, which is why temperature measurements must be taken in the morning upon waking up, before getting out of bed or moving around. Temperature also varies according to how many hours you slept so it's essential to take it at roughly the same time each day.
For a reliable graph, use a thermometer that can ùeasure to 2 decimal places and do not change the measurement method during the cycle. You can take your temperature rectally, vaginally, or orally... but stick with the same method until the cycle is over!
After taking your temperature, record the result in your cycle tracking app (or on graph paper) and connect the points gradually.
Interpreting the Chart
In the first part of the cycle, the chart is not interpretable: temperatures fluctuate up and down, creating a "yo-yo curve" that doesn't mean much. This is normal as the temperature is low and unstable in the follicular phase.
However, once ovulation has occurred, the chart becomes much clearer: you should observe a temperature rise of approximately +0.3° to +0.5°C, which persists for a minimum of 3 consecutive days. When the egg is released, the corpus luteum begins to secrete progesterone which is the hormone responsible for the body temperature rising thereby creating the best possible conditions for pregnancy.
Data collected through the symptothermal method is of paramount importance for understanding your cycle because it will show exactly when you ovulate and whether your luteal phase (post-ovulatory) is optimal i.e. lasting at least 11 days and having a nice high and persistent plateau! If you notice your chart fluctuating in the second part of the cycle, seek advice from a healthcare professional as this may be the telltale sign of an imbalance between oestrogen and progesterone, or poor-quality ovulation...
For contraceptive purposes, it is strongly advised to seek guidance from a competent professional and not to rely solely on information gathered online. There is a real risk of unintended pregnancy when this method is poorly applied!
Here's an example of a chart showing ovulation and a rise in temperature in the second part of the cycle.
Is the symptothermal method suitable for PCOS?
As we did when it came to ovulation tests, we'll give you a nuanced answer: yes…and no!
Yes, because this method can be used by absolutely all menstruating women who are not using hormonal contraception (in which case, of course, there is no observable cycle).
However, it's important to know that this method is perceived as quite demanding by some women. Taking your temperature every day at the same time is not always easily done in daily life.
To make things easier, some brands are offering very user-friendly thermometers (such as TempDrop with its nighttime armband that automatically calculates your basal temperature and sends it to an app). However, these models often come at a significant cost. Some health insurance plans are starting to reimburse these tools just like other contraceptive methods so don't hesitate to explore this option if you can invest some money!
Temperature-taking can also be anxiety-inducing for women with PCOS as every day charting without seeing any signs of ovulation for weeks can quickly become stressful and discouraging.
If you feel that this approach causes you stress and anxiety then don’t use it! You can also seek guidance and encouragement from a trained professional (such as a midwife or a specialised naturopath) to support you in your journey.
In summary:
It's often challenging to monitor your cycle when you have PCOS because cycles are mostly long and irregular.
Don't get discouraged! At first, it may seem difficult or even impossible to track your cycle, but over time and with careful note-taking (for example, in a cycle tracking app), you'll come to understand the mechanisms behind your cycle better. This understanding is crucial because it allows you to pinpoint your fertility window and have intercourse at the best time if you're trying to get pregnant!
In addition, don't hesitate to seek guidance from a specialised healthcare professional to be able to shorten and better regulate your cycle. Monitoring methods will then become much simpler to implement!
