Why is my ovulation all over the place?

Ovulation and Fertility Challenges in PCOS Explained

Often when I speak to women in the clinic for the first time, they come with feelings of having been dismissed. Many are told to “just lose weight” or are left with little explanation as to why their cycles are so unpredictable. And when it comes to fertility, the confusion and worry can be overwhelming. This blog takes a look at how PCOS affects ovulation and fertility, looking at the signs you may not be ovulating, and also evidence-based ways to support your body naturally. Whether you are looking to have a baby or not, regularly ovulating is super important for you health. Read on to find out why.

What is ovulation and why does it matter in PCOS?

Ovulation is the point in the menstrual cycle when an ovary releases a mature egg. In a typical cycle, this happens once a month, around the middle of the cycle. In PCOS, hormonal imbalances mean ovulation can often be irregular or absent entirely.

Ovulation matters not just for conception but for overall health. And this is key. Regular ovulation supports progesterone production, balances oestrogen, and plays a role in bone, heart, and uterine health. When ovulation is disrupted, many of these systems can be affected too.

How PCOS affects ovulation

PCOS is characterised by higher levels of insulin and androgens (male hormones like testosterone). Elevated insulin drives the ovaries to produce more androgens, which then interfere with normal follicle development. Instead of one follicle maturing and releasing an egg, several small follicles remain underdeveloped, which can lead to missed or irregular ovulation.

This is why cycles may be long, unpredictable, or sometimes appear regular but without ovulation actually taking place (anovulatory cycles).

Signs you may not be ovulating regularly

Are you wondering if this might be you? Clues that ovulation may be inconsistent include:

• Cycles that are longer than 35 days
• Periods that come unpredictably or are missed altogether
• Negative results on ovulation predictor kits (although these can often be unreliable in PCOS due to elevated LH)
• Lack of noticeable changes in cervical mucus or basal body temperature

Some women also bleed monthly without ovulation — highlighting just how confusing PCOS cycles can be without deeper investigation.

Fertility treatments vs lifestyle approaches

Medical options such as ovulation induction or assisted reproductive technology can be effective and are appropriate for many women with PCOS. Alongside these, nutrition and lifestyle changes are strongly recommended in the current guidelines as first-line therapy to support fertility. These are not quick fixes, but consistent approaches that create a better environment for ovulation to happen. And again – even if you’re not looking to have a baby right now (or ever!) regular ovulation should be considered a vital sign – it’s important for your health.

Balancing blood sugar

Insulin resistance is common in PCOS and disrupts ovulation by raising androgen levels. Stabilising blood sugar helps to reduce these effects. Research shows that balanced meals combining protein, healthy fats, and fibre-rich carbohydrates improve insulin sensitivity and ovulation frequency.

Some small changes you can include are:

• Always pairing carbohydrates with protein (e.g. apple with nut butter)
• Choosing pulses over refined carbs (e.g. swapping rice for lentils)
• Avoiding sugary drinks and choosing water or herbal teas instead
• Eating three good meals per day, and trying to avoid snackign

Key nutrients for ovulation

Certain nutrients have shown particular benefit in PCOS and fertility research:

• Myo-inositol: may improve insulin sensitivity and has been shown in trials to restore more regular ovulation.
• Vitamin D: often lower in women with PCOS; adequate levels are associated with better cycle regulation and fertility outcomes.
• Omega-3 fatty acids: support lower inflammation and may reduce androgen levels.
• Magnesium and zinc: both play important roles in insulin action, ovarian function, and egg development.

Food sources matter — oily fish, nuts, seeds, legumes, and green leafy vegetables all contribute these nutrients in a natural form.

Stress and fertility in PCOS

High stress levels can disrupt the delicate hormonal signalling needed for ovulation. Cortisol interferes with the hypothalamic–pituitary–ovarian axis and can also worsen insulin resistance and inflammation.

Mind–body approaches such as yoga, mindfulness, gentle walking, or breathwork have been shown to lower stress in women with PCOS and are linked with improved cycle regularity. Building daily practices to calm the nervous system is just as important as food and supplements.

Movement and exercise

Exercise improves insulin sensitivity, lowers androgens, and supports ovulation. Both aerobic activity (such as brisk walking or cycling) and resistance training (such as weights or bodyweight exercises) are effective.

Research shows that even modest increases in activity improve metabolic and reproductive outcomes in PCOS. Consistency matters more than intensity, and over-exercising can sometimes have the opposite effect. Aiming for regular, enjoyable movement is the best approach.

Sleep and circadian health

Poor sleep is increasingly recognised as a hidden driver of hormonal imbalance. And women with PCOS have been seen to have higher rates of sleep disturbance. Annoyingly, insufficient sleep worsens insulin resistance, inflammation, and stress hormones – so it’s a vicious cycle. 

Prioritising good sleep hygiene: a consistent bedtime, minimising screens in the evening, and creating a dark, cool sleep environment, can support more regular ovulation. Screening for sleep apnoea is also important where symptoms suggest it. Check with your GP or healthcare provider.

Gut health and inflammation

The gut microbiome is closely linked with both immune and hormonal health. Research shows women with PCOS often have less microbial diversity, which may contribute to inflammation and insulin resistance.

Supporting the gut through fibre diversity (vegetables, nuts, seeds, pulses), prebiotic foods (onion, garlic, asparagus), and fermented foods where tolerated may help reduce systemic inflammation and support ovulation.

Reducing endocrine disruptor exposure

Environmental chemicals such as BPA and phthalates can mimic or interfere with hormone signalling. Research suggests they may worsen symptoms in PCOS.

Practical steps include avoiding microwaving food in plastic, choosing glass or stainless-steel water bottles, and reducing use of fragranced personal care products where possible. These small changes may help reduce the overall hormonal burden.

Alcohol, smoking and ovulation

Both alcohol and smoking are linked with reduced fertility outcomes. Excess alcohol can disrupt cycles and ovulation, while smoking contributes to oxidative stress and poorer egg quality. Minimising or avoiding these is an important but often overlooked step for reproductive health in PCOS.

Anti-inflammatory dietary patterns

Low-grade inflammation is a recognised driver of PCOS symptoms. Diets rich in antioxidants and omega-3 fats, and lower in ultra-processed foods, support a more balanced inflammatory state.

The Mediterranean diet, with its emphasis on vegetables, legumes, fish, olive oil, and nuts, has been shown to reduce inflammation and improve metabolic and reproductive outcomes.

When to seek support

If you’ve been trying to conceive for over a year (or six months if you’re over 35), fertility investigations are recommended. But you don’t have to wait until then. If your cycles feel confusing, or if you’ve felt dismissed by healthcare professionals, getting evidence-based support sooner can make the process less overwhelming and give you practical steps forward.

Whether you’re hoping to conceive now or in the future, there are clear, evidence-backed ways to create better conditions for ovulation. And you don’t have to figure it out alone.  Why not get in touch and book a free call? We’d love to talk further with you.

PCOS Symptoms

Polycystic Ovary Syndrome (PCOS) affects an estimated 1 in 10 women in the UK, making it one of the most common hormone-related conditions in women of reproductive age. Worldwide, it is thought to affect more than 100 million women.

The name “PCOS” can be misleading, as not everyone with PCOS has cysts on their ovaries. In fact, around 20% of women without PCOS have cysts, while about 30% of women with PCOS do not.

So, what is it?
PCOS is often described as a complex endocrine condition involving hormonal and inflammatory factors that may disrupt the development of ovarian follicles. This can affect ovulation and menstrual cycles, and may be linked with changes in weight, skin health, fertility, and mood.

Research also suggests that women with PCOS may have a higher risk of developing metabolic complications, such as insulin resistance, type 2 diabetes, altered cholesterol, and cardiovascular risk factors.

Some of the more common symptoms of PCOS include:

Irregular or absent periods
PCOS can disrupt ovulation, sometimes leading to irregular, infrequent, or absent periods. Hormonal changes, particularly higher androgen levels, may contribute to this.

Heavy or painful periods
When ovulation is irregular or absent, the endometrial lining may build up over time. This can result in heavier bleeding when periods do occur. Hormonal imbalances, such as altered oestrogen and androgen levels, may also contribute.

“Cysts” on the ovaries
In PCOS, hormone signalling that supports egg release (ovulation) can be disrupted. Follicles may remain underdeveloped, which can appear as “cysts” on an ultrasound. These are not true cysts but immature follicles.

Acne or oily skin
Higher androgen levels can increase sebum (oil) production in the skin, sometimes leading to clogged pores and acne. PCOS-related acne often appears on androgen-sensitive areas such as the jawline, chest, or back.

Hirsutism (unwanted hair growth)
Androgens can stimulate hair follicles, leading to thicker, darker hair in areas such as the face, chest, or abdomen.

Hair thinning or loss
Some women with PCOS experience hair loss from the scalp, often in a pattern similar to male hair loss. This is linked to follicle sensitivity to dihydrotestosterone (DHT), a potent form of testosterone.

Weight changes
Insulin resistance, common in PCOS, can make it harder for cells to respond to insulin effectively. This may lead to higher circulating insulin levels, which can increase appetite, promote fat storage, and make weight loss more difficult.

Mood changes
Low mood, anxiety, and irritability are commonly reported in PCOS. Hormonal influences, inflammation, and insulin resistance may all play a role, alongside the psychological impact of other symptoms such as acne, hirsutism, or fertility challenges.

Long-term health risks
Research indicates that women with PCOS may have an increased risk of developing type 2 diabetes, cardiovascular concerns, and stroke. This is thought to be linked to factors such as insulin resistance, inflammation, and weight.

The positive news

While PCOS can feel overwhelming, research suggests that nutrition and lifestyle approaches may support symptom management and overall wellbeing.

If you’d like to explore how nutrition and lifestyle changes could support you, you’re welcome to book a free call.

Please note: we do not diagnose or treat PCOS. Nutrition and lifestyle support can complement medical care, but diagnosis and treatment should always be discussed with your GP.

How do I know if I have PCOS for sure?

If you suspect you may have PCOS, the most important step is to speak with your GP. PCOS is what’s called a diagnosis of exclusion – this means other conditions need to be ruled out first. Only a healthcare professional can make the diagnosis, so it’s important to get checked rather than relying on self-assessment.

Things to reflect on before seeing your GP

While you cannot diagnose PCOS yourself, thinking about your symptoms can help you prepare for the appointment. For example:

• If you’re not on hormonal contraception, are your periods irregular or sometimes absent?
• Do you experience excess hair growth on your face or body, or persistent acne?
• Have you noticed recent weight changes that don’t seem linked to diet or lifestyle?
• Do other women in your family have a PCOS diagnosis?

If you answered “yes” to some of these questions, it may be worth discussing them with your GP.

Keeping a symptoms diary

Before your appointment, it can be useful to keep a record of your symptoms. This can help you and your GP look for patterns. You might want to note:

• Period dates, cycle length, and how heavy or light they are
• Whether ovulation is absent (if you’re tracking with ovulation kits or trying to conceive)
• Weight changes
• Excess hair growth (face, chest, stomach, thighs, etc.)
• Thinning hair on the head
• Acne or oily skin
• Skin changes such as tags or dark, velvety patches (known as acanthosis nigricans)
• Mood changes, anxiety, low mood, or worsening PMS
• Fertility challenges or recurrent miscarriage
• Fatigue or low energy

What guidelines say about diagnosis

According to current NICE guidance:

In adults (over 20 years old), a diagnosis of PCOS may be considered if two out of the following three are present, once other causes have been ruled out:

• Signs of high androgen levels (either clinical or shown in blood tests)
• Ovulatory dysfunction (irregular or absent periods)
• Polycystic ovarian appearance on ultrasound

Or, put more simply:

• A blood test showing raised androgens
• Irregular or absent periods
• Multiple “cysts” on ovaries visible on ultrasound

In adolescents (under 20 years old), diagnosis is based on hormone levels and irregular or absent periods. Ultrasound is not usually recommended at this stage, as it is not considered reliable for diagnosis in younger women.

Adolescents with some PCOS features, but who do not meet the full diagnostic criteria, may be considered at increased risk. Guidelines suggest reassessment at or before full reproductive maturity (approximately eight years after the first period).

Depending on your age and symptoms, your GP may recommend blood tests and/or an ultrasound scan as part of the diagnostic process.

Important note
Nutrition and lifestyle approaches can support general wellbeing if you have PCOS symptoms, but they cannot replace medical diagnosis or treatment. Always seek advice from your GP if you are concerned about your symptoms.

What is PCOS?

Polycystic Ovary Syndrome (PCOS) affects an estimated 1 in 10 women in the UK, making it one of the most common hormone-related conditions in women of reproductive age and a leading cause of ovulatory infertility. Worldwide, it’s thought to affect over 100 million women.

The name “PCOS” can be misleading. It’s actually a collection of symptoms that may have different underlying drivers – and not everyone with PCOS has cysts on their ovaries. In fact, around 20% of women without PCOS have cysts, while about 30% of women with PCOS do not.

So, what is it?
PCOS is often described as a complex endocrine condition involving hormonal and inflammatory changes that can disrupt the development of ovarian follicles. This can lead to delayed or absent ovulation, resulting in irregular or missed periods. In practice, PCOS may affect menstrual cycles, weight regulation, fertility, and other aspects of health.

Research suggests women with PCOS may also have a higher risk of metabolic complications such as insulin resistance, type 2 diabetes, altered cholesterol (dyslipidaemia), and potentially cardiovascular concerns.

Some of the more common symptoms of PCOS include:

• Insulin resistance
• Elevated androgens (or ‘male hormones’)
• Mid-cycle or ovulatory pain
• Acne or oily skin
• Unwanted hair growth on the face or body (hirsutism)
• Male-pattern hair thinning or hair loss
• Unwanted weight gain or difficulty losing weight
• Mood changes such as low mood, anxiety or irritability
• Sleep issues, including sleep apnoea

What are androgens?

Androgens are hormones such as testosterone, androstenedione, and dehydroepiandrosterone (DHEA). It’s normal to have some androgens – they support mood, libido, and bone health.

In PCOS, higher-than-average androgen levels (hyperandrogenism) are common. This is linked with difficulties ovulating, irregular periods, weight changes, unwanted hair growth, and acne. Hyperandrogenism is therefore considered both a clinical feature and a contributing factor in PCOS.

Factors which may contribute to PCOS

Family history

• PCOS can run in families. If a close female relative has PCOS, your likelihood of developing it may be higher.
• Genes may increase susceptibility, while environment and lifestyle may influence how strongly these genes are expressed.

Insulin and blood sugar balance

• High insulin levels may reduce sex hormone-binding globulin (SHBG), leaving more free testosterone available and contributing to symptoms.
• Insulin can also stimulate the ovaries and pituitary gland, influencing androgen production.
• Diets high in sugar and refined carbohydrates, combined with other factors such as stress, smoking, alcohol, sleep deprivation, some medications, and environmental exposures, may contribute to insulin resistance over time.

Inflammation

• Chronic low-grade inflammation is common in PCOS and may influence ovarian function and androgen production.
• Visceral fat (fat stored around the abdomen) can secrete inflammatory molecules, which in turn may worsen insulin resistance, creating a cycle that fuels symptoms.
• Lifestyle factors such as smoking, alcohol, ultra-processed foods, and chronic stress can add to overall inflammatory load.
• Gut health, infections, autoimmune activity, and food intolerances may also play a role in some cases.

Adrenal androgens and stress

• The adrenal glands produce stress hormones and some androgens. In PCOS, adrenal androgens may account for 20–30% of the elevated hormone levels seen.
• Ongoing stress may therefore play a role in symptom expression, even in women who are not insulin resistant or do not have ovarian cysts.
• Research suggests cortisol regulation may be altered in PCOS, potentially contributing to changes in weight, appetite, menstrual cycles, and immunity.

Exposure to endocrine-disrupting chemicals

• Certain environmental chemicals, sometimes called xenoestrogens (such as BPA in plastics), may mimic or interfere with hormone activity.
• Studies suggest they may contribute to insulin resistance, inflammation, and hormone imbalance, although more research is needed.

Post-pill hormone changes

• Some people notice PCOS-like symptoms after stopping the contraceptive pill. This does not mean the pill causes PCOS, but rather that hormonal shifts can temporarily mimic or unmask symptoms. PCOS itself is a longer-term condition with complex causes.

In reality, PCOS is often the result of a combination of these factors, with different drivers in different individuals.

Next steps

If you’d like to learn more about PCOS and explore nutrition and lifestyle approaches that may support your symptoms, you’re welcome to book a free call here.

Please note: we do not diagnose or treat PCOS. Nutrition and lifestyle support can complement medical care, but it is important to consult your GP for diagnosis, medical advice, and management.

Why do we get acne with PCOS?

In a UK-based study, over 50% of women with PCOS reported experiencing acne, and highlighting its effect on their overall wellbeing. This compares to only 21% of British women without PCOS stating that they suffer with acne.

If you have PCOS, this might not be coming as much of a surprise to you! So, why do we women with PCOS suffer more with our skin than the average British woman?

This comes down to our hormone balance again. PCOS is an endocrine (hormonal) condition, and we see that most women with PCOS have higher androgen (or ‘male’ hormone) levels than women without PCOS.   

The higher androgen levels in PCOS can stimulate overproduction of sebum in the skin which can clog pores causing spots to form. Additionally, the low-grade inflammation consistent with PCOS can make the acne worse and more painful, sometimes turning into cystic acne, the type of acne that causes deep, painful bumps. It also tends to flare up when stress is involved, or around the time of our periods. 

PCOS-related acne is often found in areas of the body that are more androgen-sensitive, such as around the jawline, chin, chest, and back. This is because these areas have a higher density of androgen receptors, which respond to the higher levels of androgens more intensely. This leads to excess sebum production, as well as increased keratin production in the skin, which can clog pores and foster acne. The back and chest are particularly rich in oil glands, hence why those areas can be especially problematic.

The good news is that any of the dietary changes you make with your PCOS to help reduce androgens will then, in turn, help reduce the prevalence of acne that you’re suffering with.

Check out my blog about how to eat healthily for your skin. And, if you’d like to chat further, why not book a call? One of our one-to-one targeted programmes could be right for you.

PCOS and Fertility

Polycystic Ovarian Syndrome (PCOS) is a complex condition that often casts a shadow over the dream of parenthood for many women. Amidst the myriad of symptoms and challenges, fertility struggles stand as a significant concern for those with PCOS. 

PCOS can bring about a range of symptoms, including irregular periods, elevated androgen levels, and ovarian cysts. Fertility struggles, often intertwined with these symptoms, can present a profound emotional toll on individuals and couples. 

The Link PCOS between and Fertility

The intricate interplay between PCOS and fertility involves a complex dance of hormones, ovulation, and reproductive health. Here are some of the factors:

• Ovulatory Disruptions: One of the defining features of PCOS is irregular or absent ovulation, a key factor in fertility. Hormonal imbalances can hinder the release of mature eggs, impacting the chances of conception.
• Insulin Resistance: Many individuals with PCOS experience insulin resistance, which can lead to elevated insulin levels. This, in turn, can stimulate the ovaries to produce excess androgens, further disrupting ovulation.
• Hormonal Imbalances: Elevated androgens and other hormonal irregularities can create an environment less conducive to successful conception and pregnancy.
• Anovulatory Cycles: Anovulation, the absence of ovulation, can lead to irregular menstrual cycles and difficulty in predicting fertile windows.
• Egg Quality: PCOS-related hormonal imbalances can potentially impact egg quality, affecting the chances of successful fertilization.

Managing PCOS for Improved Fertility Chances

Strategies aimed at addressing the unique challenges of PCOS-related fertility struggles can make a significant difference:

• Ovulation Tracking: Monitoring menstrual cycles and using ovulation prediction tools can help identify fertile periods and maximize chances of conception.
• Hormone-Friendly Diet: Opt for a balanced diet rich in nutrients that support hormonal balance and fertility, such as whole foods, healthy fats, and antioxidants.
• Regular Exercise: Engaging in regular physical activity can help manage insulin resistance, support hormonal equilibrium, and enhance fertility.
• Stress Management: Prioritize stress-reduction techniques to mitigate hormonal fluctuations and support a conducive reproductive environment.
• Professional Guidance: Consult with healthcare providers experienced in fertility and PCOS management for personalised recommendations, such as our team of Registered Nutritional Therapists.

Hope on the Horizon

While the road to fertility for individuals with PCOS may present challenges, it's important to remember that hope is far from lost. Understanding the complexities of the connection between PCOS and fertility helps us to take proactive steps toward achieving our parenthood goals. 

By addressing hormonal imbalances, adopting a healthy lifestyle, and seeking professional guidance, those of us navigating PCOS-related fertility struggles can move closer to our dream. 

If you’d like to discuss this further, why not book in a call with us to discuss further? Here’s the link to book a call.