Even when your doctor isn’t sure what’s going on

Your periods are irregular. You have hair in places you wish you didn’t. You’ve gained weight, and you’re not sure why. If you’ve been trying to conceive, it’s been tough because you can’t predict when you’re going to ovulate—or if you’re going to ovulate—each month.

If this sounds familiar, you may have a condition called polycystic ovarian syndrome (PCOS). But how do you know?

Charting Can Clue You and Your Doctor In

Though an estimated 10 percent of women have PCOS, the majority of women visit at least three health care providers before being properly diagnosed. It can be confusing because the symptoms—acne, irregular periods, hirsutism (excessive hair growth on the face, chest, abdomen, or upper thighs), weight gain, and infertility—aren’t exclusive to PCOS and are often attributed to stress or an unhealthy lifestyle instead.

Christina Robinson, APN and FertilityCare Practitioner, explains that charting can offer more helpful clues. Robinson teaches the Creighton Model, one of several fertility awareness-based methods (FABM) in which a woman tracks and charts her cervical mucus as a marker of her daily fertility or infertility. (It’s not as gross as it may sound.)

While there are many different ways a chart may appear for a woman with PCOS (including a normal chart!), several distinct patterns are often present.

  • Long cycles: A normal cycle length is twenty-one to thirty-five days; the majority of women with PCOS have cycles that last longer (about thirty-five to sixty days), which indicates that ovulation is either not occurring or is occurring irregularly. Some women go months between periods. The majority of the time this is due to PCOS, though other causes include thyroid disease, elevation of prolactin (a hormone mainly used to make milk after childbirth), and stress.
  • Irregular bleeding patterns: Women who go months between cycles may notice several days of brown bleeding or spotting in between real periods. The uterine lining becomes thicker than normal when monthly menstruation doesn’t happen. If the lining gets too thick, it becomes unstable and starts to shed small amounts, which results in spotting. There are other possible causes of irregular bleeding, but “irregular” in non-PCOS cases typically means heavier flow than usual or bleeding between periods that still occur at regular intervals.
  • Prolonged cervical mucus production: Once trained in Creighton Model charting, women with PCOS often see extended periods of cervical mucus, which is produced by the cervix in response to rising levels of estrogen as the ovary prepares for ovulation. The mucus’s purpose is to aid in conception, helping sperm make their way to the egg. Usually, women notice three to eight days of mucus during this phase of the cycle. PCOS triggers prolonged, fluctuating levels of estrogen, instead of a shorter steady rise in this hormone—thus, more mucus over a much longer period of time.

Robinson recommends that if you observe these patterns (whether or not you're charting), you should see your gynecologist for an evaluation. If you’re getting your period less frequently than every two months, it could be a serious condition, so make that appointment even sooner.

What Happens Next?

At your visit, next steps will likely include a blood test to check hormone levels and an ultrasound to see if your ovaries appear polycystic. “Polycystic” refers to the multiple small, fluid-filled sacs that can form in the ovary when an egg is not released on a regular basis. These cysts can cause hormonal imbalances, which are responsible for the mental and physical symptoms of PCOS, and can eventually lead to diabetes and heart disease.

Charting Helps Diagnose, Monitor, and Treat PCOS

While most women are prescribed hormonal birth control as treatment, the pill doesn’t actually solve the problem. If and when these women go off the pill, often with the goal of conceiving, they typically face the same challenges with ovulation they did previously.

There's no cure for PCOS and the treatment options are limited. Sometimes lifestyle changes—achieving a healthy BMI through wholesome nutrition and regular exercise, taking vitamins (especially D and multis), and getting quality sleep—are enough to mitigate PCOS symptoms and get your body to work normally. If making lifestyle changes isn't enough to manage the symptoms, a doctor may prescribe Metformin (typically used by patients with diabetes) to lower blood glucose and insulin levels, Clomid to induce ovulation, or drugs like spironolacton that lower androgen levels to reduce unwanted hair growth. It's important to note that these drugs aren't FDA-approved for PCOS treatment, but many doctors do prescribe them. If you're prescribed one of these drugs, it's important to ask your doctor why you're taking it and whether it is benefitting you. Researchers are studying the effectiveness of natural treatments like cinnamon, vitamin D, and B complex vitamins, but the findings are still in development.

In any case, Robinson says, “Charting your cycles is a great tool for monitoring any changes happening from cycle to cycle while you are making lifestyle changes or starting treatment to address your PCOS.” As an example, she cites studies showing how overweight women with PCOS who are able to lose 5 to 10 percent of their body weight begin to ovulate more regularly, which leads to more normal length cycles and often a resolution of irregular bleeding.

In her experience, Robinson shares, “Seeing these improvements in your chart will help to confirm that what you’re doing is working and help motivate you to continue with these lifestyle changes or treatment.”

Unlike with a pill, don’t expect changes to happen overnight. But don’t give up on healing your PCOS or educating the women in your life on how charting can help them, too. Robinson’s advice? “Finding someone who is trained to teach the [charting] method you’ve chosen will be the most helpful thing you can do in learning to use it effectively.”