Are you on the Right Birth Control Pill? What is Your Hoogland Score?


Photography W. Scifres
Women might want to know their Hoogland score, because it would give you a hint as to whether or not you are protected against getting pregnant when using birth control pills (OCP). One of the main ways to detect effectiveness of birth control and cycle control is to measure how little one ovulates, medically termed "ovarian suppression." There is an official, gyno endorsed, way to measure ovarian suppression during OCP use: it is cored on 6 features of possible egg development: 1. no evidence of any ovarian activity on ultrasound, 2. potential activity on ultrasound, 3. non-active follicle like structures, 5) luteinized unruptured follicle and 6 ) ovulation . Other factors contribute to how successful the ovarian suppression is.  Measuring estrogen levels, and thickness of the lining of the uterus called the endometrium, and measuring progesterone for evidence of ovulation can all contribute towards making a diagnosis of ovulation. We use the cut off of about 8 mm for the size of a small follicle (fluid filled area of the ovary that may contain an egg) but it’s more likely that those that are over 10 mm will progress to ovulate whether you are on the birth control pill or not. Of course ovulation is a complex matter. Anyone undergoing fertility treatment cycles will tell you, eggs don’t always release from the ovary on schedule. So Hoogland scores aside, the ultrasound picture is not necessarily the whole story. A woman typically must have an LH  (hormone of ovulation) surge from the pituitary gland in order to ovulate. That surge follows rapidly on the heals of a ripe egg within a ripe small cyst (follicle) in a natural cycle, but the hormones in birth control pills will prevent that surge fairly reliably, causing the follicle to collapse and shrink without releasing it’s egg. That’s what that 5th point in the score is talking about, a follicle that has become lutenized without rupturing. The more days a month you take your pills, the lower your Hoogland score is likely to be. The more hormone you have in your pills the lower the score is likely to be.If you knew your Hoogland score, then you would know you really can count on your birth control pills (which you can count on well over 95% of the time!).

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