Usefulness of the Sympto-Thermal Method with Standardized Cervical Mucus Assessment (InVivo Method) for Evaluating the Monthly Cycle in Women with Polycystic Ovary Syndrome (PCOS)
Stachowska A,Kicińska AM,Kotulak-Chrząszcz A,Babińska A
Published May 29, 2024Healthcare (Basel, Switzerland)
Stachowska, A., Kicińska, A. M., Kotulak-Chrząszcz, A., & Babińska, A. (2024). Usefulness of the Sympto-Thermal Method with Standardized Cervical Mucus Assessment (InVivo Method) for Evaluating the Monthly Cycle in Women with Polycystic Ovary Syndrome (PCOS). Healthcare (Basel, Switzerland). https://doi.org/10.3390/healthcare12111108
Stachowska A, Kicińska AM, Kotulak-Chrząszcz A, Babińska A. Usefulness of the Sympto-Thermal Method with Standardized Cervical Mucus Assessment (InVivo Method) for Evaluating the Monthly Cycle in Women with Polycystic Ovary Syndrome (PCOS). Healthcare (Basel, Switzerland). 2024. doi:10.3390/healthcare12111108
Stachowska, Aneta, et al. "Usefulness of the Sympto-Thermal Method with Standardized Cervical Mucus Assessment (InVivo Method) for Evaluating the Monthly Cycle in Women with Polycystic Ovary Syndrome (PCOS)." Healthcare (Basel, Switzerland), 2024.
PCOS cycle charts show longer menstruation and more mucus peaks
Women with PCOS had longer menstruation and more cervical mucus peaks than healthy women on InVivo cycle charts. The study in Gdańsk compared 108 cycle cards from 18 women with PCOS, also named PMOS (Polyendocrine Metabolic Ovarian Syndrome), and 14 healthy women.
Key Findings
Menstruation lasted 7 days in the PCOS group and 6 days in the control group (p = 0.000814), counting bleeding, spotting and dirtying days. Bleeding alone lasted 4 days in both groups.
Women with PCOS recorded a median of 2 mucus peaks in the first phase of the cycle against 1 in healthy women (p = 0.040747).
Follicular phase by basal body temperature: 18.5 days with PCOS, 16.5 in controls (p = 0.156058). Quartiles were 16.5 to 23.5 days with PCOS and 15 to 19 in controls.
Luteal phase length was 12.5 days with PCOS and 13 days in controls (p = 0.883427). Cycle length was 33 days and 30 days (p = 0.339053).
In 32 pairs of mucus images from 10 women, clear, stretchy, wet mucus crystallized normally in both groups. Springy, gummy, papular, creamy or discolored mucus showed indeterminate, hard-to-assess crystallization.
Interpretation
The study is an observational comparison of cycle charts from 32 women aged 20 to 32 with no previous pregnancy. Certified instructors taught every woman the InVivo sympto-thermal method, and each woman photographed her mucus and compared it with a pictorial dictionary. Menstruation length and mucus peaks differed significantly between groups. Follicular phase, luteal phase and cycle length did not. The authors name the small study groups as a limitation. They read the extra mucus peaks as suggesting abnormal follicle maturation with PCOS, and say InVivo charting can be an important supplement to a patient's history.
RRM Context
Major professional societies describe the menstrual cycle as a vital sign. Fertility awareness charting records that sign day by day. InVivo cards add bleeding days, mucus peaks and the temperature shift, each tied to a phase of the cycle. Evaluating the ovulatory pattern directly is where a cause-based approach to cycle disorders starts. The authors report that photographing mucus against a pictorial dictionary minimized the possibility of error in how women noted mucus.
Our editorial summary of this paper, not the article's abstract.
Abstract
(1) Background: FABMs (fertility awareness-based methods) are methods that rely on the observation of clinical signs related to fertility found in women, the so-called fertility bioindicators. They can be a valuable tool for diagnosing monthly cycle disorders and infertility, for example, among patients with PCOS (polycystic ovary syndrome). Until now, it has been difficult for women with PCOS to use FABM, due to the difficulty of describing fertility bioindicators and their disorders due to the biology of the syndrome. The new InVivo sympto-thermal method with standardized cervical mucus assessment may provide a valuable diagnostic and therapeutic tool for observing the monthly cycle in this group of women. (2) Methods: The monthly cycle was evaluated in a group of 32 women of reproductive age. A total of 108 monthly cycle observation cards were analyzed: 35 monthly cycle cards were collected from 18 women with PCOS, and 73 monthly cycle cards collected from 14 healthy women. In addition, 32 pairs of macroscopic and microscopic images were evaluated: 17 pairs from the study group (four subjects) and 15 pairs from women in the control group (six subjects). (3) Results: We showed that in the group of patients with PCOS, menstruation was longer (p = 0.000814), the number of mucus peaks was statistically higher (p = 0.040747), and the interquartile range (IQR) of the duration of the follicular phase (calculated according to the BBT) was significantly higher (8 days) compared to women in the control group. We also observed that among all the women studied, the microscopic image of cervical mucus correlated with the cycle phase described in the observation card, as determined by reference to the BBT chart, provided that it showed the correct features. (4) Conclusions: Systematic maintenance of monthly cycle observation charts using the InVivo method can be an important supplement to the medical history, as it allows for a thorough assessment of, among others, the timing of monthly bleeding, cervical mucus symptoms, BBT changes, and the duration of the follicular and luteal phases among both healthy and PCOS women.
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