Trying to Avoid with PCOS

One of the most frequent questions regarding charting to avoid a pregnancy, besides “Does it work?” is “What if you have irregular cycles?” The short answer is that since a woman keeps track on a day-by-day basis, she is able to accurately identify her potentially fertile times, even if they don’t come regularly. But charting is a personal business, so rather than talking about the science and data, I would like to share my experience with irregular cycles and trying to avoid pregnancy using the fertility awareness method.
Since puberty, I have never been able to know for sure what day my period was coming and I have tended to cycle every 5-6 weeks instead of every 4. The very first time I charted my cycle, I didn’t even ovulate. I’ve also had a couple of cycles that were so long that my body started bleeding shortly before I ovulated, because it simply couldn’t maintain my uterine lining while it was waiting for my ovaries to ovulate. While there are several hormonal and metabolic problems that can cause irregular cycles, I was eventually diagnosed with Polycystic Ovarian Syndrome (PCOS), which means my ovaries are under-responsive to the typical hormonal cycle, instead producing excessive amounts of estrogen and testosterone and often making cysts on the ovaries from “trying” multiple times a cycle to stimulate egg production.
Charting helped me to visualize these hormonal changes, because estrogen not only matures eggs in the ovary, but it also causes the cervix to make cervical fluid (CF) in preparation for facilitating sperm entry at the time of ovulation. For most women, CF first appears 5-7 days before ovulation, but on my charts it was often a lot longer between when my fluid first appeared and when my temperatures showed ovulation. This fluid pattern, for example, shows 10 days from the first day I had CF until my last day of CF on cycle day 21, which on this chart corresponded to ovulation based on temperatures (not shown).

Other times my CF would begin to show very fertile fluid as if ovulation were approaching, only to “back off” so to speak, and return again later. My husband and I used to humorously call this “gearing up” or “gearing down” as we waited to see if my temperatures would confirm ovulation after I experienced a fertile fluid pattern. The Fertility Awareness Method is based on the understanding that CF is the indicator of impending ovulation, so having several extra days of fluid present meant that we had more days than the average couple that we had to avoid unprotected intercourse, since we had to assume each time that the presence of fluid could lead to ovulation.
This chart shows an example of a false “gear-up” followed by an actual ovulation. I found that it was very important for me to take my temperatures consistently, because only then could I know if my fluid pattern was because of ovulation or because of my ovaries’ extra hormones trying and failing to produce an egg.

While obviously we had frustrations trying to avoid an egg that never seemed to come predictably, these frustrations were mostly due to our commitment to following the rules correctly, not because they were hard to understand. We often had long periods where we had to assume fertility before ovulation finally happened. I also learned that my body was very, very susceptible to stress, and that even the littlest things could delay my ovulation by a week or more. It is definitely difficult to *think* that you are approaching ovulation, only for your temperature to stay low and your body to have to try again later.
But I can honestly say that charting was the best thing decision that my husband and I ever made in regards to family planning. It was so empowering to be able to see what my body was doing, even when it did something different every month. There was no guess-work involved in interpreting the signs, and my husband and I always knew what we had to do, even if couldn’t see into the future and predict when ovulation would happen. It was also a huge advantage that once I did ovulate, I knew how many days later I would get my period, and I stopped being taken by surprise. I also could see that I didn’t have a “normal” looking cycle, and could be confident that we weren’t putting anything into my body that could make it even harder to conceive later on.
Although our days of trying to avoid a pregnancy are long behind us, I am so glad we chose Fertility Awareness instead of any other form of family planning. It is not only effective, but also teaches a woman and her spouse about health in such detail; none of our other choices even came close to this. Charting is especially important to me, since I now know that there is an underlying problem that causes my cycles to be abnormal, and charting helped me to see and work with the problem before a doctor ever recognized it and put a name to it. If we need to avoid pregnancy again in the future, this will definitely be our method of choice, most especially because my cycles are irregular.