PCOS & Fertility Awareness: The Theories

(A previous blog post talks about the background of PCOS and a future blog post talks about the options with PCOS.)

PCOS affects about 1 in 10 women in the US. And some would say that there are actually 5 different “types” of PCOS and therefore it’s important to have tests done to find out “where” the PCOS is starting. Is it starting in the brain? in the pancreas? in the adrenals? in the ovaries?

  1. Traditional PCOS: anovulatory, increased androgens, no insulin resistance
  2. Endocrine Syndrome X: anovulatory, increased androgens, insulin resistance or type 2 diabetes
  3. Non-traditional PCOS: anovulatory, normal androgens, obese, insulin resistant or type 2 diabetes
  4. Non-traditional PCOS: ovulatory, increased androgens, mild insulin resistance
  5. Idiopathic Hirsutism: ovulatory, increased androgens, no insulin resistance

Lara Briden, an Evolutionary Biologist and Naturopath Doctor, posits these 4 types of PCOS:

  1. Insulin-Resistant PCOS
  2. Post-Pill (or Pill-induced) PCOS
  3. Inflammatory PCOS
  4. Hidden-cause PCOS (like thyroid disease, a vegetarian diet leading to deficiencies, artificial sweeteners, and others)

And what causes PCOS? From my understanding, there are 3 main theories as to the causes of PCOS:

  1.  Genetics... thanks Mom. And each time I hear that something is “genetic,” I like to take a moment to consider if there’s a possibility that a repeating pattern is being learned and absorbed by the new generation via epigenetics... just a thought... take it or leave it.
  2.  Hormonal Imbalance... there’s miscommunication happening between the hypothalamus, pituitary gland, and ovaries (called the hypothalamic-pituitary-ovarian axis... and sometimes the miscommunication is between the hypothalamus, pituitary gland, and adrenal glands called the hypothalamic-pituitary-adrenal axis). They use hormones to talk to each other and for some reason with PCOS they're not communicating in the ideal amounts like they're supposed to do.
  3. Insulin Resistance... imbalances with insulin and androgens (like testosterone, DHEAS, etc.). One of insulin's jobs is that it can cause the liver to decrease making a molecule called sex-hormone binding globulin (SHBG). Therefore, if there’s too much insulin, it may cause too little SHBG, and too little SHBG may result in excess free testosterone.

Now there's debate about Hormonal Imbalance (#2) being the side-effect of the actual problem of Insulin Resistance (#3)... or... that Insulin Resistance (#3) being the side-effect of the actual problem of Hormonal Imbalance (#2). There are lots of experts trying to figure this one out so thankfully we don't have to! 

As a Holistic Reproductive Health Practitioner, I educate my clients to follow the best plan for them... and that might be to go down a (sometimes long) path of diagnosis with their health care provider so that the underlying problem is ultimately addressed. (There's more about holistic options here.)

When a woman with PCOS and/or irregular cycles charts them using the Fertility Awareness Method, then she has a better idea of what's going on with her body and reproductive health. She can give definitive answers to questions about how long her cycle is, how many days her periods last, what each period is like (especially if they differ), if she's ovulating or not, and if any interventions are making changes. (This is called using the menstrual cycle as a vital sign!) And if blood tests need to be done at certain points in her cycle (like 1 week after ovulation), she'll know if it should be around Day 21 like "everyone else" or (say) Day 63 if she ovulated later and will have a very long cycle.

Whether a woman with PCOS wants to avoid pregnancy, achieve pregnancy, or simply know when to expect her period, charting her cycle can give lots of really good information and make the process a little less frustrating.

Just got my period today... day 53. *sigh* My whole life is just spent waiting for my period.
— Gigi*, Pennsylvania, USA (*not her real name)

Don't forget to check out my posts about the background of PCOS and the options with PCOS.

Colleen Flowers Fertility Awareness Online

Colleen Flowers is a Holistic Reproductive Health Practitioner who loves teaching individuals and couples about their bodies from a natural and holistic perspective using the Fertility Awareness Method... to avoid pregnancy naturally, to increase their chances of conceiving, and to better understand their bodies! See what others have to say or contact her and subscribe to her newsletter. Like what you see? Then book an online consult with her and/or purchase a package for more in-depth coaching.

PCOS & Fertility Awareness: The Background

Many sources claim that women with irregular cycles shouldn't use a Fertility Awareness Method to chart their cycle, which is true if they’re using a statistical method like the Standard Days Method. But if a woman with irregular cycles uses an observational method like the Sympto-Thermal Method of Fertility Awareness, she’ll still be able to answer the question at the end of every day, “Am I fertile? Yes or No?” (Here’s more about statistical methods and observational methods of Fertility Awareness.)

Even as someone who has studied reproductive health quite a bit, I think trying to completely understand PCOS can be a little confusing (and that’s because the health care community still doesn’t completely understand it).

Here’s a YouTube video to help explain it. Feel free to start at 2:20 or 3:05:

This 3D medical animation describes PCOS, polycystic ovary (ovarian) syndrome. The animation begins with the normal anatomy and physiology of the ovaries, including the effects of certain hormones on the ovaries during the menstrual cycle.

Here’s Wikipedia’s explanation and here are the many terms for PCOS:

  • PCOS - polycystic ovarian (ovary) syndrome
  • PCO - polycystic ovaries
  • PCOD - polycystic ovarian disease
  • AAE - anovulatory androgen excess
  • HA - hyperandrogenic anovulation
  • Stein-Leventhal syndrome

PCOS usually refers to the “syndrome” of polycystic ovaries. Syndrome just means that this is a condition distinguished by a set of related symptoms. The most common include:

  • Irregular menstrual periods (ie, longer than 35 days, absent for 4 months, etc.)
  • Weight issues (often around the waist)
  • Excess or unwanted body or facial hair (hirsutism)
  • Thinning hair on the head
  • Skin problems (skin tags, darkening skin and acne)
  • Infertility

PCO usually means that the ovaries have multiple cysts on them but other symptoms listed above may be absent.

PCOD is the term used by Dr. Thomas Hilgers in his book The NaProTECHNOLOGY Revolution: Unleashing the Power in a Woman’s Cycle. He suggests various treatments such as using progesterone supplementation, medications, and surgery. Here is a list of NaPro providers: www.FertilityCare.org (And just so you know, the book and these providers come from a Catholic perspective.)

AAE is the term used by Dr. Jerilynn Prior who founded the Centre for Menstrual Cycle and Ovulation Research (CeMCOR). She has a lot of good information on her website about AAE (the term she uses for PCOS) and progesterone supplementation.

I've written other blog posts that talk about the theories surrounding PCOS and the options with PCOS.

Colleen Flowers PCOS Fertility Awareness Online

Colleen Flowers is a Holistic Reproductive Health Practitioner who loves teaching individuals and couples about their bodies from a natural and holistic perspective using the Fertility Awareness Method... to avoid pregnancy naturally, to increase their chances of conceiving, and to better understand their bodies! See what others have to say or contact her and subscribe to her newsletter. Like what you see? Then book an online consult with her and/or purchase a package for more in-depth coaching.

Lots & Lots of Fertility Awareness-Based Methods (FABMs)...

There are lots of Fertility Awareness-Based Methods (FABMs)... and keeping track of all of them can be confusing sometimes! So here’s some help to understand it...

Fertility Awareness simply means being aware that some days in a woman’s cycle are infertile (intercourse on those days will not lead to a pregnancy) and some days in a woman’s cycle are fertile (intercourse on those days may lead to a pregnancy). *Newsflash - A woman is not fertile every day of her cycle.* So then how these days of fertility and infertility are determined varies by each method. When I meet with individuals and couples, I explain that Fertility Awareness-Based Methods fall into 2 categories: Statistical Methods and Observational Methods. I teach a method found in the latter of these 2 categories; it’s called the Sympto-Thermal Method (STM).

Statistical Methods rely on past information to predict future fertility interpretation; this includes the Standard Days Method (SDM) and Lactational Amenorrhea Method (LAM).

  • Many are familiar with the Rhythm Method and this is where a woman looks at her past cycle/fertility information to predict or calculate her future cycle/fertility information. A standardized and evidence-based version of this is called the Standard Days Method (SDM) and many women use CycleBeads to answer the question at the end of each day, “Am I fertile? Yes or No?” Today’s answer is based on what happened in the past. Cycles must always be between 26 and 32 days; as soon as a cycle varies from this, SDM is no longer recommended. These methods are often call Calendar Methods because they look at the number day of the cycle (or the day on the calendar). Lots and lots of apps use these mathematical calculations to predict when a woman will and will not be fertile... granted, they're better than nothing but I do not recommend apps like that.
  • LAM (or Ecological Breastfeeding) may be used when all 3 of these guidelines are true for a postpartum mama: she is exclusively (or nearly-exclusively) breastfeeding throughout the day and night, her baby is less than 6 months old, and her period (or other bleeding) has not occurred. Again, it uses past information (studies done on other women) to predict her future cycle/fertility information. The answer to the question, “Am I fertile? Yes or No?” is determined by these 3 guidelines. (As an educator, I don’t recommend this method to my clients who want to avoid pregnancy while postpartum and/or breastfeeding.)

Observational Methods rely on daily observations to determine today’s fertility interpretation: this includes Mucus-Only Methods, Temperature-Only Methods, Sympto-Thermal Methods (STM), and Sympto-Hormonal Methods (SHM). When a woman keeps track of the changes in her cervical fluid, and/or the changes in her morning temperature, and/or the changes in her urinary hormones, and/or other fertility signs, then she can answer the question, “Am I fertile? Yes or No?” each day. She doesn’t look at past data to determine future fertility... she observes her fertility each day.

  • Common Mucus-Only Methods include Billings Ovulation Method (BOM - may include religious teachings), Creighton Model System (CrMS - may include religious teachings), and the TwoDay Method. Many postpartum and/or breastfeeding women use this method in addition to a secondary fertility sign (like the position of her cervix).
  • Common Temperature-Only Methods include devices such as Lady-Comp and Baby-Comp.
  • Common Sympto-Thermal Methods (tracking cervical fluid and morning temperature) include methods taught by the Couple-to-Couple League (CCL - may include religious teachings), explained in the books Taking Charge of Your Fertility by Toni Weschler and Garden of Fertility by Katie Singer, taught by the Justisse Method, and used by the myriad of apps that keep track of this information as well as sometimes use the Statistical (or Calendar) information discussed earlier. This is the method I teach... and it can be adjusted to accommodate postpartum/breastfeeding mamas, those who work night shifts, and women who have irregular cycles.
  • Common Sympto-Hormonal Methods include the Marquette Method (MM - may include religious teachings) and devices such as OvuSense and OvaCUE (but not all of these are recommended for those wanting to avoid pregnancy).

Now... there are also the differences between the terms Natural Family Planning (NFP) and the Fertility Awareness Method (FAM)... which is covered in this blog post.

There isn't a “best” method. There’s definitely a “best method for you” or “best method for this phase of life,” but not one of these methods is the “best” method of Fertility Awareness. It depends on how it fits in with your life, what intention you’re using it for, what effectiveness rates you want, and lots of other things. Also, using Fertility Awareness to achieve a pregnancy or avoid a pregnancy isn't the best choice for certain women and couples and that’s why there are lots and lots of other options out there.

So... have you used these methods of Fertility Awareness in your life?

When and where and why and how?

Christmas in July!

As a Fertility Awareness Educator, there's going to be some things that get me pretty excited that the average person may not totally understand.

Let me start at the very beginning...

Remember at the end of February 2014 when I was interviewed for the documentary Miscontraceptions by Cassie Wilson? (...which is now Cassie Moriarty... congrats Cassie!!!) Well, she's taking the short film around to festivals and I got to see it... she and her crew did an AMAZING job!!! (Think I'm exaggerating? It won the Tracy Awards for Best Writing, Best Director, AND Best Picture at Montana State University.) Not only did I love it, but younger women and older women and dudes liked it and laughed and thought it was really well done (and they're only in college... watch out world!)

When I watched the film, I was enthralled with the Sex Health Educator located in Bozeman, Montana that they also interviewed... Laura Mentch. I stalked ...I mean... I found her information on the internet and sent her an email saying I thought she did a great job and would love to meet her... she emailed back (yippee!) and said she was swinging through Denver in a few weeks. So we made plans and met for tea.


Laura is smart, passionate, and kind... I loved spending time with her and look forward to seeing her again soon. Because she's phasing out of teaching Fertility Awareness and doing more work around Cystic Fibrosis education, she asked if I would like the FA resources she's collected over the years. Would I like them? I would LOVE them!!!

That's when a lovely package arrived in the mail...

Hmmm... does this box contain "crack"???

Hmmm... does this box contain "crack"???

Yes! For a Fertility Awareness Educator!!!

Yes! For a Fertility Awareness Educator!!!

So I opened it up to find out what goodies Laura has saved throughout the years and sent to me. Lots of books and reading material about all things related to Fertility Awareness...

Merry Christmas to me on a hot day in July!

Merry Christmas to me on a hot day in July!

What was my favorite item? A book entitled The Modern Method of Birth Control which was published in 1935. Yes, it's about the out-dated Rhythm Method, but it was an important step toward the highly effective modern methods of Fertility Awareness. It's like having a piece of Fertility Awareness history!

There's even a nifty plastic calendar-wheel!

There's even a nifty plastic calendar-wheel!

So... thank you, Cassie, for making this documentary that connected me to Laura. And thank you, Laura, for entrusting me with your quasi-museum of FA material and helping to light my torch as a next-generation Fertility Awareness Educator.

If you want to know more about using Fertility Awareness to avoid pregnancy naturally, increase your chances of conceiving, or simply better-understand your body... keep perusing this website and see if a class or one-on-one consult is the next best step for you.

Do you have any "artifacts" of Fertility Awareness?