I was diagnosed with PCOS 4 years ago. I have not had a menstrual cycle nor ovulated in almost 5 years, due to PCOS. I am obese by standards, but have lost 28 lbs in the last 6 months. For these past 6 months, I have been working on my feet 12 hours a day, 5-6 days a week. About 6 weeks ago, I started spotting moderately (enough for a liner, not a pad) and this lasted approx. 4 days. Two weeks went by and I spotted again. This time, hardly anything was on the pad, but every time I would wipe after using the bathroom, the toilet paper would be pinkish red for approx. 3 days. Almost three weeks later, I started spotting yet again. In the mornings, I spot onto the liner. But in the afternoons and evenings, it is pinkish red toilet paper again. This has been going on for 2-3 days off for 1 day, back on for 2-3 days and so forth. Currently, I am on day 3 of this last type of spotting.

What could this strange spotting be caused by? Since I don't ovulate or menstrate, I have no way of knowing if I were to begin to ovulate; should I be concerned for pregnancy? Does a HPT work accurately on women with this form of PCOS given the hormone levels?