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.