If you have Polycystic Ovarian Syndrome (PCOS) - a condition caused by an imbalance of reproductive hormones - your ovulation may vary from cycle to cycle even if you have regular periods with a relatively constant number of cycle days in between. For some, those periods may be much more irregular. PCOS is one of the most common causes of infertility in women, and in fact, the condition impacts about 1 in 10 women.  

Despite this high occurrence, women still have trouble receiving a proper diagnosis and are unfamiliar with the condition itself and how it can affect fertility. The good news is that it is a treatable condition and there are a number of steps that can be taken if you are trying to conceive. We know you have a lot of questions about PCOS, so we want to help clear up any confusion! 

You Asked About PCOS, Dr. Alison Gottschalk Answered! 

As a Hormone and PCOS Fertility Naturopathic Doctor, Dr. Alison Gottschalk helps women correct hormone imbalances naturally and prepare for future pregnancies. She frequently gets asked about PCOS and finds it concerning that there is such little information out there. To learn more about this all too common condition, we recently connected with Dr. Gottschalk to answer questions about PCOS from those in the fertility community in an Instagram Live. Check out what she had to say below!

I think I have PCOS. How do I bring this up with my doctor?

In an ideal world, you should be able to go see your doctor and talk about more sensitive topics but also leave confident knowing that your health concerns will be explored further. Unfortunately, we know that that’s not the case for all women. Some women do receive a little bit of pushback from their doctors. The bottom line is just to say, “I’m suspecting PCOS. Can we get some blood work done?”

Do PCOS sufferers generally ovulate later, or can you ovulate early?

In most cases, we typically see a delay in ovulation. You don’t necessarily have to have a delay in ovulation to have PCOS. But let’s just say, hypothetically speaking, in the ‘textbook’ cycle you would ovulate around day 14. In most cases, sometimes we can see up to day 18 if not further for women who have PCOS. And this is where it becomes important in terms of tracking to see when you’re ovulating. 

The doctor says my ovaries are presenting as polycystic. What does that mean for my eggs?

Women who have PCOS are more likely to show cysts on their ovaries on ultrasound. We know that you don’t need to have cysts on your ovaries on ultrasound to have PCOS, but some women do. Women with PCOS are more susceptible to changes in egg quality, so we want to be supporting you by making sure that egg quality is good. When we see cysts on your ovaries, we want to figure out why this is happening and why there is a stall in your ovulatory process. More often than not, women with PCOS need support with egg quality, so we want to incorporate some sort of antioxidant support.

There are different variations for why we see cysts. What’s interesting is that the cysts we see on ultrasound in PCOS aren’t actually cysts. What we’re seeing is really a reflection of the ovulatory process.

How do you know if you have endometriosis as well as PCOS?

Endometriosis is commonly associated with a lot of pelvic pain and heavy periods, whereas with PCOS you shouldn’t be experiencing that level of pelvic pain. So we tend to see heavier, painful periods and more of those estrogen dominant symptoms, like feeling nauseous at certain points of your cycle or getting migraine headaches, with endometriosis.

I would say certainly, if you haven’t already, go see your doctor for an assessment. Endometriosis can be discovered through a laparoscopy, but certainly get an ultrasound done if you’re experiencing a lot of pelvic pain.

Is there a way to fix high free testosterone and low sex hormone-binding globulin (SHBG)?

Elevated testosterone is the main staple with PCOS. Usually women with elevated testosterone experience symptoms like cystic acne around their jawline, hair loss as well as hair growth, and irregular cycles. You can experience symptoms or you can also experience biomarkers on your bloodwork. Typically, when we see symptoms of high testosterone, it’s because not enough free testosterone is being bound to enzymes like SHBG. What binders like SHBG do is tag onto testosterone and make it not available to cause symptoms. So what we want to do is make sure enough of it is bound up and not just running freely in your body and causing those bothersome symptoms. We do that by assessing things such as insulin resistance.

What is your advice for someone with diminished ovarian reserve (DOR) and can OvuSense help at all?

You can certainly conceive with DOR, but you may need more egg quality support. You want to be sure that the eggs you do have are of good quality, so we want to look at, for example, various different supplements that you might want to be taking. OvuSense can help because it allows you to see your fertile window so that you can increase your chance of success. The OvuCore would probably be best for DOR over OvuFirst.

Have any of your patients used OvuSense to conceive?

I see a variety of different ways in which we can track cycles with ovulation. I’m a big fan of tracking core temperature because it is an easy way women can assess themselves at home and outside of a doctor’s appointment. The more ways in which we can tune into what our bodies are telling us, the better things will be. So if you’re not overwhelmed by tracking, I’m a big fan of that.

I haven’t ovulated according to my sensor, but I’m still getting regular periods. I’m just wondering what could be wrong.

The two don’t necessarily have to match up: You can have regular periods but not be ovulating. And just because you are having a period that does not infer that you are in fact ovulating. Sometimes we need to do a further investigation to figure out why that’s not happening by looking at those key issues we see with PCOS, like testosterone, insulin, and inflammation. We’ll want to check which of those are elevated for you and as a possible reason for why there is that stall in the ovulatory process.

How OvuSense Can Help with PCOS

If you’re living with PCOS, know that you are not alone! There are lifestyle and dietary changes you can make as well as invest in technologies that can help during your TTC journey. Fertility tracking, with devices like OvuSense, can be done in the comfort of your own home. The OvuSense OvuCore sensor might be right for you if you have been trying to conceive for a while or you know you may have an issue like PCOS. OvuCore is a completely unique patented sensor technology designed to measure continuous Core Body Temperature (cCBT) while you sleep, giving you the best possible understanding of the fluctuations in progesterone that occur during your cycle.

For more hormone and fertility advice, follow Dr. Alison Gottschalk on Instagram (@dr.alisongottsnd). She also runs a 12 Week Natural PCOS Solutions program, which can be viewed here.

Some answers have been edited for clarity, but you can watch the full Instagram Live here.