New Research Finds 3 Unique PCOS Cycles. What Does That Mean for You? [Podcast] - PCOS Diva
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New Research Finds 3 Unique PCOS Cycles. What Does That Mean for You? [Podcast]

PCOS Podcast No 138 Kate Davies - New Research - 3 Cycles“I’m passionate about teaching women to really understand their cycles, understand their fertility, understand when they’re ovulating, because we know that research shows that fertility awareness knowledge can reduce your time to conception considerably.”

 – Kate Davies, RN, BSc(Hons), FP Cert, Expert Fertility Nurse Consultant and Coach

Being a PCOS Diva is centered upon empowering yourself with information so that you can take better control of your PCOS. That information can come from many sources, but there’s no better information than the data that your cycles (or lack thereof) give you every month. Cycle tracking is how I discovered I had PCOS and it’s an excellent way to track fertility as well as diet, supplement, and lifestyle changes.

But it is not always simple to track your cycle with PCOS. Most predictor kits don’t work for us. In fact, many PCOS patients are told by their doctors that they’re not ovulating. Very often that is untrue. PCOS cycles are simply different. New research indicates that there are 3 cycles unique to women with PCOS.

Listen in or read the transcript as our expert guest, Kate Davies, discusses:

  • Fertility monitors
  • Types of menstrual cycles and what they mean
  • How to best communicate about your cycle with your doctor
  • Natural interventions to help women with PCOS ovulate

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Complete Transcript:

Amy:

Today’s podcast guest is Kate Davies. She’s a returning guest to the PCOS Diva Podcast and I will post our previous episode in the show notes. She is an independent fertility nurse consultant and IVF coach. She’s also the cohost of a fantastic podcast called The Fertility Podcast, and Kate uses her platform to help break the silence surrounding infertility and promote positive and accurate fertility messages and information. So, welcome to the PCOS Diva Podcast again, Kate.

Kate Davies:

Thank you, Amy. It’s lovely to be here. Thanks for having me.

Amy:

So listeners know that being a PCOS Diva is about empowering yourself with information so that you can take better control of your PCOS. And honestly, Kate, I think you and I agree that there’s no better information than the data that your cycles give you every month. Oh, go ahead.

Kate Davies:

Yeah, no, absolutely. It’s something I’m really, really passionate about. I’m passionate about teaching women to really understand their cycles, understand their fertility, understand when they’re ovulating, because we know that research shows that fertility awareness knowledge can reduce your time to conception considerably. And I think it’s something that we’re kind of not taught in school are we? We’re taught in school to avoid getting pregnant. We’re not taught this really amazing information about our bodies that actually mother nature has given us. And I think it’s something that can be so empowering for women to learn. And I know when I learned about it, I thought, why did I not know this sooner? And I think that’s exactly how we both feel, don’t we, about the importance of empowering women on their cycles?

Amy:

Oh, and I’ve shared this with women on the podcast, that it was really the way that I discovered I had PCOS was through charting my cycles. I realized that I had these really long anovulatory cycles. And it’s kind of a mystery for a lot of women on how to go about charting and go about figuring out the patterns. I just wanted to draw attention to some blog post articles. I will put them in the show notes, that you graciously wrote for us a while back about different ovulation predictor kits and different ways of charting your cycles. But I think you and I are both in agreement that really, for women with PCOS who kind of have, like I just mentioned these long periods of anovulation and it’s difficult to track your cycles.

The OvuSense Fertility Monitor is really my favorite and the one that I recommend to my clients with PCOS and who have irregular cycles. And, I know we’ve had this conversation before about OvuSense and I was wondering if you could just let people know what you think about it and why do you think it’s good for women with PCOS?

Kate Davies:

Yeah, sure, absolutely. I came across OvuSense about six years ago, five, six years ago, and I was immediately interested in it because I thought this is what I teach my patients with basal body temperature recording, but it gives so much more accuracy and convenience. And I think those are the two things that are so important. And as you mentioned for women with PCOS who have long cycles, if you’re taking your temperature through BBT every morning, it can be really difficult to keep going with that the whole time. And also the accuracy is so important and women need something that is going to give them that accuracy and also, I think with the importance with PCOS is there’s nothing better than for a woman to find out that she is ovulating.

Because as you know, so many women are told that they’re not ovulating by their medical practitioners and often that’s down to inaccurate timing of the progesterone test, for example. But actually once they start getting empowered by their cycles and whilst they might have really long cycles, the majority of women are ovulating, some clearly aren’t, but the majority are. And to have that information and knowledge is so powerful. And I think the reason why OvuSense to me was just the best option, compared to BBT and to other methods such as using skin temperature methods, or OPKs, looking at luteinizing hormone, is that those just aren’t accurate for a lot of women. Whereas, the core body temperature is the most accurate measurement of your temperature for fertility.

And with OvuSense, as I know a lot of your ladies in the audience already know, is a vaginal sensor that is worn in the vagina overnight. Now sometimes when I first say that to ladies, they’re like, “What? You want me to put that where?” But actually, once they start using it, they’re like, “Oh, yeah, it’s just like a tampon.” And if used correctly, just like a tampon, you don’t feel it. So it’s really comfortable, it’s really well tolerated, and it takes all these measurements at five-minute intervals overnight. So, really convenient. You don’t have to worry about taking the temperature first thing in the morning and any kind of environmental room temperature disturbances that might happen from that. Or certainly, if you already have a child, not having to worry about having to have a disturbed night’s sleep, doesn’t matter with OvuSense. It’s there, it’s doing its magic and you don’t have to worry about it.

And also, just the information that it gives is obviously that great deal of accuracy with the five-minute interval measurements and showing those temperature fluctuations and the temperature cycle, and exactly what happens with ovulation and the biphasic curve is just great to look at. And again, really empowering. So it’s definitely the method that I prefer overall.

Amy:

So, yesterday I had a couple Discover Call client sessions, and we were talking about cycles and it was really interesting because a couple of these ladies were starting to take different supplements like Ovasitol. And they were noticing that they were having some interesting breakthrough bleeding in their cycle. One woman’s cycle was shorter. And I feel like Ovasitol is one of those supplements that can really shake up your menstrual cycle, but you’re not really sure what’s happening. But I feel like combining that with a fertility tracking method, like OvuSense, just really helps you with the data to figure out what is going on. And I was wondering if you could talk about using fertility tracking like that to, I guess, hack your menstrual cycle.

Kate Davies:

Yeah, absolutely. I mean, I think that’s the beauty of it. It gives you so much information. So for example, you can pick up things like an early ovulation. You can pick up important PCOS or late ovulation. You’re going to picking up an anovulation, so a monophasic chart, rather than a biphasic chart that has the two phases. Importantly, and this is what I see an awful lot of, is short luteal phase. And to me, I don’t know about you, but to me, the luteal phase is one of the most important phases of the menstrual cycle because that’s the time when the endometrium, the lining of the womb, is getting really ready to, and I like to think of it as a little comfy duvet, to getting already plump and just like a lovely duvet, that’s going to allow the fertilized embryo to nestle into this lovely endometrium. And if that luteal phase is too short, then clearly that’s not going to create that beautiful environment. So picking up a short luteal phase is vitally important.

Other things as well, that you can pick up are a slow rise, a slow temperature rise, which you love to see with women with PCOS. So rather than a sharp rise over a 24-hour period, you can see this slow rise that takes a few days to kind of get elevated. So there’s certainly lots of cycle patterns that you can pick up using OvuSense that will give you a bit of an insight into what’s going on with your fertility.

Amy:

And I think that it’s a good tool to sort of see if lifestyle intervention is working, because you can kind of see that in your cycle, if you’re changing your diet, your lifestyle, adding certain supplements.

Kate Davies:

Yes.

Amy:

You can see the actual data, using that OvuSense system.

Kate Davies:

Yeah, you absolutely can, and I think that’s what I love about it is that I might start seeing a lady who’s using OvuSense and might suggest some dietary changes, particularly with PCOS, or use of Inositol, and then you can really monitor that improvement for a woman that previously may have had a really long cycle to that cycle becoming less lengthy and a better quality of ovulation. And equally, women who might be having medications throughout their cycle, prescribed medication, like ovulation reduction, then you’re able to see the success of ovulation induction, which again is critical for women that perhaps wasn’t ovulating previously when she’s taking Clomid or Letrozole, that you can actually start to see an ovulation, you can really show the benefits of the treatment. And again, we have ladies that are perhaps going through IUI or IVF who want to, again, really monitor what’s happening with their cycle during that treatment phase.

Amy:

Yeah. I think what, and really why I want to get the message out to PCOS Divas is that it really puts so much control into your hands. I know, gosh, my oldest now just turned 20, so this is a long time ago that I was going through monitored Clomid cycles and having to go into the doctor’s office for an ultrasound or to see if I had ovulated where you could really, do your Clomid cycle. And you can really see in real time what’s happening with your hormones and your ovulation through the OvuSense system.

Kate Davies:

Yeah, yeah. Really empowering, isn’t it? Really empowering. And my oldest is 18 and I wish that I had this information back then. It would have been a lot simpler.

Amy:

Yeah, yeah.

Kate Davies:

Yeah, it’s a shame, yeah.

Amy:

So, the other thing that I wanted to share with everyone is that I got my hands on a research paper that OvuSense presented at this past year’s ASRM, which is a big conference of reproductive endocrinologists here in the US and I thought it was really fascinating because I think I’ve been a fan of OvuSense since they started and I really understood the power of this tool. But OvuSense has been collecting cycles from women with PCOS who had been using the product over the last several years, and they have started to see different patterns that are unique to women with PCOS. And I feel like you could probably do a better job of explaining those, than I can, and I just thought that you could share that with us.

Kate Davies:

Yeah, sure, absolutely. Yes, OvuSense started a study in 2019, basically analyzing the cycle data from a huge amount of users and they combined it with this questionnaire. And the questionnaire was asking about a previous kind of PCOS histories and looking at whether they have PCOS, looking at whether they had a recurrent miscarriage, that type of thing. And this paper actually is also being presented to ESCRH, which is the European Society of Reproductive Health next week. It’s our ESCRH week next week, so it’s an exciting time, definitely. And the study kind of identified three new cycle patterns. So, I’ve already mentioned about the early ovulation, the ovulation, and the ones that we know of, but these are brand new ones that OvuSense have seen.

And the first one is what’s called crash to baseline, and that’s where the temperature starts high in the early part of the cycle and falls before ovulation. And the second one is a false start and that’s showing where the temperature rises in the middle of the cycle and might rise a number of times, actually, but no ovulation takes place until eventually that the ovulation takes place later in the cycle. And I see that really frequently, and I also see it in combination with when women notice this temperature rise, they also notice an increase in cervical mucus, which then the temperature drops, and the cervical mucus disappears and then it comes back again a few days later. And I tend to see actually typically two or three rises before ovulation then occurs. But that’s just anecdotal from what I see, from looking at charts and charts every day in and day out.

Amy:

Yeah, and that particular false start pattern, is that sort of suggesting an initial LH surge?

Kate Davies:

Yes. Well, possibly. I mean, obviously, OvuSense isn’t looking at LH. It’s looking at progesterone, but it’s certainly showing that there was a rise in progesterone. Now whether that was initially from some LH surge that then started that, then obviously OvuSense isn’t looking for that, but it’s certainly noticing that rise in progesterone, but it just doesn’t come to anything.

Amy:

Okay, mm-hmm (affirmative).

Kate Davies:

And then the third one is something called crash after ovulation. That’s where the temperature falls directly after ovulation. And I think what these three patterns tell us, in terms of fertility and how they’re not a diagnostic tool in themselves, but they can absolutely assist in diagnosing, and what they’ve found is that these have been, as the research has linked these patterns with the previously known diagnosis of the participants in the study, they have noticed that the crash to baseline, so the first one I mentioned, is highly associated with PCOS, and particularly with regular cycles. So these women are women that actually may well go undiagnosed or may take years to get a diagnosis because they know something is wrong, but actually they’re not perhaps fitting into all the Rotterdam criteria to get a diagnosis.

So that’s quite an interesting one. The false start is also more highly associated with PCOS, as we mentioned. And then I think the one that I’m finding absolutely fascinating, and I think there is so much information here and so much potential interest in this one, is that the final one, which was the crash after ovulation, seems to be associated with women who have had one or more previous miscarriage. And so it’s showing that actually that could potentially be a miscarriage risk. So we’re showing that fall in temperature, which could then be diagnostic or helping diagnosing that miscarriage risk. So I think that’s fascinating. They’re all fascinating. But for me, I think the third one is great because there’s so much that we just don’t know about miscarriage, so I’m so pleased to have that.

Amy:

Yeah. So I wanted to just draw listeners to their attention, to a podcast that I did with Dr. Poppy Daniels a while back on progesterone and we talk about progesterone supplementation in early pregnancy to kind of help women that have this … I’m making assumptions here, but have this type of cycle pattern because there’s a lot of women that can’t support their pregnancies, because they’re not making enough progesterone and the progesterone’s not rising. So I’m wondering, I’m just inferring, I guess, that these women that have this crash after ovulation potentially could need progesterone supplementation, early in pregnancy.

Kate Davies:

Absolutely.

Amy:

Yeah.

Kate Davies:

Yeah, absolutely. And I think what’s really interesting is I don’t quite know your situation in the US, but in the UK we’ve always been quite, not particularly keen to prescribe progesterone for luteal phase support. It’s not recognized in our NICE guidelines, and so there’s always been a bit of a barrier there. But there’s been some recent research and I think there’s more coming out as well, that is showing that actually progesterone support to women who particularly have had recurrent miscarriage, is so important. So I’m hoping in the UK, we’re going to start seeing some changes to that. I don’t know, you tell me Amy, how likely is it that women can get hold of progesterone if they’re concerned?

Amy:

Yeah. You know, right now you have to really fight for it and find … You know, if you can look for a doctor who’s been trained in NaPro technology, they use natural progesterone in their practices and Dr. Poppy Daniels was talking about that as well, and I, for a while was seeing a NaPro specialist. They’re trained through … I think it’s the Pope John Paul Institute. And you’re probably familiar with the Creighton Model of natural family planning?

Kate Davies:

Yeah, yeah I am.

Amy:

So they’re associated with that, but they could certainly help you with a defect like this, the crash after ovulation and make sure you’re on the right supplement protocol. I don’t know if most traditionally trained OB-GYNs would do that. I am hearing from a lot of Divas that they are getting pushback on that. So you really have to go armed to your doctor with this kind of data. And I’m just wondering if you could give women some tips on how to do that. You know, if you have an OvuSense monitor, if you’re tracking like this and you see these cycle patterns, can you maybe give us some tips on how to communicate this with our doctor?

Kate Davies:

Yeah, well, I think traditionally is it’s always been quite difficult to start these discussions about temperature recording with the medical profession, because it fell out of favor many, many years ago, and it’s something that I think that it’s always been quite difficult for some. In my experience, some of my patients will try and talk to their consultants about it, and they’re like, “No, I’m not interested in that.” However, as more and more women are turning to tech, it’s something that the medical profession are having to start listening to. And certainly there does seem to be more of a willingness and understanding, especially in the younger medical doctors coming through that, do you have perhaps a bit more of a knowledge of that, they actually might have personal knowledge of it or their partner might be using it. So I think that is definitely going to change.

With regards to OvuSense, is OvuSense is just bringing out and just about to launch OvuSense Pro, which is actually designed to use with your professional. And it’s going to hopefully make it a lot easier and also give an awful lot of information to the professional about their cycles and what this data is telling them. I think a lot of it is, you know, you and I understand it, and a lot of other people understand it, but sometimes if you’re not using it all the time, then they might not necessarily be familiar with what the temperatures are saying and what the cycle pattern is saying. So this OvuSense Pro can now actually show all these cycle pattern patterns that are now analyzed in the new clinician portal so the doctor will have an opportunity to look at the cycles and look back over the history of the OvuSense users patterns as well, to be able to see what’s going on, and that will help them then to understand what further tests might be needed.

And, as we talked about earlier, they can really help to track the effect of medications. And I think particularly for the medical profession ovulation induction, that would be really useful for them to be able to see and actually ovulation induction at the moment, you might have a scan to check for ovulation, you might have a progesterone test to check for ovulation, but all of those cost money, and actually what’s more cost effective than having an OvuSense to tell you that you’ve ovulated and to tell a professional that you’ve ovulated. So, hopefully, this will be a thing that professionals will really take on board and women will be able to use the OvuSense Pro with their professional to get so much more information.

Amy:

Yeah. That would be fantastic. And then it would be great to even have a database at some point, like what doctors are using the OvuSense Pro so that you can go in and have a conversation on the same page with your doctor.

Kate Davies:

Yeah, absolutely. Yeah, that would be the ideal.

Amy:

So for listeners that are … I’m just going to pick your brain here since I have you on the podcast.

Kate Davies:

Sure.

Amy:

You know, so many women with PCOS have struggled with ovulating. What are your favorite natural interventions to help women with PCOS ovulate?

Kate Davies:

Okay, well definitely the first one has to be nutrition. You know, lifestyle is just huge. The international guidelines for the assessment management and treatment of PCOS really clearly states that the first line management is lifestyle. So clearly, nutrition. Obviously, if a woman with PCOS, and not all, clearly, but obviously, if a woman with PCOS is carrying a little extra weight, then losing some weight can be really helpful. And it can mean that they spontaneously ovulate if they lose a percentage of their body weight, so that can be really useful. Exercise is again so important, especially for insulin resistance, using some muscle strengthening exercise is vitally important and can really help in the mix of everything.

And I suppose my third thing is do supplementation, particularly Inositol, omega threes, as well as have the normal ones, like vitamin D and folate or folic acid, depending on your preference. And I think those are my three top areas that I think are very important and I would suggest to all of my patients.

Amy:

Yeah, I think that there’s no really magic pill. Even Clomid and Letrozole, you really need to be working in combination with these lifestyle factors.

Kate Davies:

Absolutely.

Amy:

So, can you tell us about your Fertility Podcast and what you talk about on there?

Kate Davies:

Yeah. Well, I’d love to say it’s mine, but it’s absolutely not. So The Fertility Podcast was started five years ago by Natalie Silverman, who is a broadcaster and that’s her background. She worked in radio and then she started her podcast when she initially was going through … I think she was successfully pregnant after having IVF. And that was, I guess, her desire to start talking about fertility. And then I’ve been asking for number of years, I’ve talked to her about PCOS on her podcast. And then this time last year, I went to London to do some radio interviews and just loved sitting like I’m sitting now and me with my cans on ears, my microphone in front of me, and I just thought, “I love this, and I want to do more.”

Kate Davies:

And I think Natalie and I had been chatting over a few weeks before that and I said … I think I sent her a message on the train on the way home and said, “You know, I just loved it. I really feel like I want to do more with this. What can I do?” And she said, “Oh, it’s funny you’re kind of thinking about that, because I was thinking along the same lines. I’d love to get somebody in to cohost with me,” and that’s where it started. So Natalie always says that she’s kind of the patient voice and I am the science voice. I wouldn’t ever go as far as to say I’m the science voice, but I definitely bring kind of a clinician edge, as well as the professional edge to it.

And we about all sorts. We have done some great interviews today. We talked about gut health, actually, and PCOS today and that’s coming up soon. We’ve been talking to another lady with PCOS. For some reason today it’s all been about PCOS and it wouldn’t necessarily normally be. We’ve just interviewed an amazing journalist who brought out a podcast just at the beginning of the year called The Immaculate Deception, which is … I don’t know if you remember hearing about it, but there was a doctor, she’s a doctor in the Netherlands called Jan Karbaat, who it is believed fathered, I think getting on for a hundred, maybe even more children with his own sperm, when he should have been using donor sperm or a woman’s partner’s sperm.

Amy:

Oh, my Lord.

Kate Davies:

I know, awful. Absolutely awful, but a fascinating podcast. So we interviewed her so that’s coming out soon. So we talk about everything, A to Z on fertility, basically.

Amy:

Well, I definitely recommend checking it out. And then also, Kate, tell us where we can find your blog and more information about your practice.

Kate Davies:

Yes, certainly. So my practice is called Your Fertility Journey, so you can find it just by Googling Your Fertility Journey and you can find lots of information on there about PCOS. You can also find information about me and what I do. And yeah, there’s lots of information, so feel free to head over and take a look. I’m also on Instagram as well on Your Fertility Journey on Instagram. I’d love anyone of anyone to join me on there. Love it.

Amy:

Well, and I just want to thank you for all of your great content that you’ve shared over the years with us at PCOS Diva and we are going to link to some of that great content, especially around cycle tracking and ovulation predictors because you’ve done some great work to help drive our awareness. So thank you so much.

Kate Davies:

Oh, you’re welcome. It’s an absolute pleasure. Thank you for having me again today.

Amy:

And thank you everyone for listening and I look forward to being with you again very soon. Bye-bye.

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