PCOS, Period! PCOS and Your Menstrual Cycle

Typically, women with PCOS do not have normal menstrual cycles unless they are artificially induced by taking oral contraceptives. Because of hormonal changes caused by PCOS many women have irregular or non-existent periods. By learning about a normal menstrual cycle, you may be able to develop a deeper understanding of why women with PCOS do not menstruate.

First and foremost, let’s dispel the myth of the 28-day cycle. Most women experience menstrual cycles that range from anywhere from 22 to 32 days. The menstrual cycle is characterized by changing hormone levels which induce menstruation and ovulation. The goal of each menstrual cycle is to prepare the body for pregnancy. The menstrual cycle can be divided into two phases: the follicular phase and the luteal phase. Menstruation occurs right before the follicular phase, and ovulation occurs between the follicular and luteal phase

FSH stands for Follicle Stimulating Hormone. This is a hormone that stimulates the maturation of 15-20 eggs in each ovary. A follicle produces estrogen and surrounds each egg. Only 1 follicle becomes the largest and releases an egg.

The development of the follicle and release of an egg takes 2 weeks on average. Depending on how long it takes your body to reach the estrogen threshold this range can actually take from 8 to 30 days or more. This first half of the menstrual cycle, the follicular phase, is highly variable between women and even month to month within the same woman. Stress can affect the length of the follicular phase.

When the body reaches the estrogen threshold, those high levels of estrogen trigger ovulation.

When the egg bursts through the ovarian wall it enters into the fallopian tube where it slowly journeys towards the uterus and awaits fertilization by sperm.

The leftover follicle in the ovary releases progesterone and lives from 12 to 16 days. This duration stays relatively the same in any particular woman. Therefore, the second half of the menstrual cycle, the luteal phase (the time between ovulation and the next menstruation), tends to remain consistent in the same woman. The leftover follicle releases progesterone until it dies and menstruation occurs.

Progesterone causes the primary fertility signs to change. If pregnancy occurs, progesterone also performs a host of other actions. If pregnancy does not occur, estrogen and progesterone levels drop off and the growing endometrium, no longer needed to nourish and sustain a fertilized egg, is sloughed off in menstruation.

You can monitor these incredibly complex hormonal patterns throughout your menstrual cycle simply by paying attention to the 3 primary fertility signs: waking temperature, cervical fluid, and cervical position.

“Waking body temperatures” A woman’s body temperature rises within a day or two after ovulation due to increased progesterone. Think of progesterone as the pregnancy hormone which turns up the heat in the oven to help you incubate the baby! Waking temperatures are measured right after you wake up, before engaging in any physical activity whatsoever. The temperature must be taken before any activity to get a true basal body temperature. It should be taken at the same time every day.

“Cervical fluid” refers to the changes that occur in cervical fluid throughout the menstrual cycle. The cervical fluid pattern starts off very dry right after menstruation, and then progresses to being sticky or pasty, then slightly rubbery, then creamy. This is when you would start to consider it as being fertile cervical fluid. However, the most fertile cervical fluid follows and resembles raw egg white. This egg white fertile cervical fluid is very slippery and stretchy. Sometimes it can be tinged with yellow or pink. These changes in cervical fluid are mediated by estrogen, and as estrogen drops off after ovulation you will notice a sudden drying of the cervical fluid.

“Cervical position.” You may already have realized that your cervix changes position. Perhaps you have noticed that sometimes sexual intercourse in certain positions is painful, when other times that same position is not painful. This is because the position of the cervix (the lower part of the uterus, which extends into the vaginal canal) changes throughout the menstrual cycle. The cervix changes in order to facilitate pregnancy. During ovulation the cervix becomes high, soft, open and wet, in order to increase the likelihood that sperm will be able to pass through and reach the awaiting egg in the fallopian tube. During the rest of the cycle, the cervical position is lower, firm, closed, and dry.

Remember, you can learn volumes about your body by paying attention to the subtle changes happening on a monthly basis. If you are a woman with PCOS who has irregular periods you may have learned that during the follicular phase, your body due to increased insulin levels and hormonal imbalance, your body is not releasing the egg from the follicle. Therefore, you are not ovulating. This non ovulatory cycle is responsible for infertility, ovarian cysts, and increased chances or further hormone imbalance. You can benefit from connecting with other women who have PCOS, and by consulting your doctor about options to restore your menstrual cycle.