PCOS can cause various menstrual irregularities, from skipped or prolonged cycles to light or heavy bleeding. However, some women with PCOS have regular periods. By understanding the hormonal impacts of PCOS and exploring lifestyle or medical treatments, women can better regulate their cycles and improve overall health.
Understanding PCOS and Menstrual Cycle Irregularities
Polycystic ovary syndrome (PCOS) affects approximately 8% to 13% of reproductive-age women, with irregular menstrual cycles being one of its most prominent symptoms.[1] Understanding how this complex hormonal disorder influences your menstrual cycle is crucial for developing effective management strategies and optimizing your reproductive health.
What is Polycystic Ovary Syndrome (PCOS)?
While PCOS typically emerges during puberty, it can develop at various points throughout a woman's reproductive years. The condition's symptoms often fluctuate in intensity over time, creating a dynamic pattern that requires ongoing attention and management throughout a woman's life.
Definition and Overview
Think of hormones as your body's messaging network, orchestrating vital processes through carefully coordinated signals that keep everything running smoothly. When this delicate balance gets disrupted, as happens with PCOS, various body functions can be thrown off track.
In women with PCOS, higher levels of androgens (male sex hormones) create a hormonal imbalance that especially affects reproductive function. This excess of androgens can interfere with normal ovarian function, often leading to irregular or missing ovulation, problems with egg development, and as a result, unpredictable menstrual cycles.
Common symptoms
Common symptoms of PCOS include:
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Irregular or absence of periods
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Excess hair growth on the face and body, a condition known as hirsutism
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Weight gain
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Acne
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Oily skin
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Fertility Issues
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Cysts on the ovaries
Women with PCOS may have one or more of these symptoms but not necessarily all of them.
Can You Have PCOS with Regular Periods?
It is possible to have regular periods even with PCOS. One key symptom of PCOS is increased levels of androgen hormones. One study found that 74% of women with high levels of these hormones and regular periods did have PCOS.[2] For most with PCOS, though, irregular periods are common.
Causes of Irregular Periods
While PCOS is one of the most common causes of irregular menstruation, it's important to recognize that various other medical conditions, hormonal imbalances, and lifestyle factors can affect menstrual regularity.
Hormonal Imbalances
The menstrual cycle relies on hormones working together like a well-choreographed dance, but PCOS can throw off this delicate rhythm by creating hormonal imbalances that often lead to irregular cycles.
Estrogen plays a key role by triggering both ovulation—when a mature egg is released into the fallopian tube—and the thickening of the uterine lining, while progesterone later signals the body to start menstruation by breaking down this lining. When PCOS disrupts these hormonal signals, it can interfere with each step of this carefully coordinated process.
Conditions that cause an imbalance in hormones can lead to an irregular period. These imbalances can be caused by:
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PCOS
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Endometriosis
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Premature ovarian insufficiency
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Thyroid dysfunction
Non-PCOS-Related Causes
Lifestyle can also impact menstruation. Stress, for example, triggers the release of cortisol, the hormone responsible for the "fight or flight" mechanism. Cortisol can interfere with the body's production of key reproductive hormones like estrogen and progesterone, which are essential in regulating periods.
Other lifestyle issues that might impact your menstrual cycle include:
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Extreme weight fluctuations: Being underweight or overweight can impact hormone levels.
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Excessive exercise: Over-exercising can disrupt hormone balance; an irregular menstrual cycle is often an issue for female athletes who train constantly.
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Diet: High sugar levels can trigger the release of androgen hormones and create an imbalance. So, eating or drinking sugary foods can have an impact.
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Sleep disorders: Poor sleep can significantly affect hormone production.
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Smoking: Shown to shorten periods and can lead to infertility.
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Chronic stress: High cortisol levels from ongoing stress can significantly disrupt your menstrual cycle by interfering with reproductive hormone production and throwing off your body's natural hormone balance.
Managing your weight, improving your diet, and getting plenty of sleep may be all it takes to regulate your periods. If your menstrual cycle fails to improve after making these changes, there could be a deeper root cause.
To help identify whether your menstrual irregularities might be related to PCOS, take the PCOS Symptoms Quiz, developed by Dr. Thais Aliabadi.
How PCOS Causes Irregular Periods
PCOS causes the production of excessive male hormones. These elevated levels impact follicle maturation and ovulation, which can result in the release of an immature egg or no egg at all.
PCOS can also cause the formation of cysts on the ovaries. These cysts can make it impossible for an egg to pass from the ovary to the fallopian tube.
Women with PCOS may experience long, very heavy periods, too. This is due to the uneven thickening of the uterine lining. Cramping can be painful when this happens. Some will have spotting between periods as well, which can make it seem like you are having another period or spotting due to pregnancy.
PCOS and Menstrual Cycle Variations
Having PCOS doesn't necessarily mean you miss periods. Each woman can experience a different PCOS cycle length.
Irregular periods: Skipping, Long, or Short cycles
The average menstrual cycle is 28 days. A woman with PCOS might experience cycles that last 35 days or more, making it challenging to anticipate periods or ovulation. The cycles can be shorter, too. They may occur every 15 days instead of 28 or be absent altogether.
Light or Heavy Periods with PCOS
A 2018 study indicates up to 90% of women with longer-than-normal periods also have PCOS.[3] Their menstrual cycles averaged longer than 35 days. This can lead to a buildup of the uterine lining and heavy, painful periods.
Women diagnosed with PCOS can also have short cycles. They may average menstrual cycles that last 26 days instead of the standard 28. The short lifespan of the uterine lining can make periods very light or even nonexistent.
Can PCOS Cause Prolonged Bleeding or Absence of Periods?
A primary symptom of PCOS is irregular menstrual cycles due to hormone imbalances. As a result, periods can be heavier than normal. This is due to the extra thick uterine lining caused by a longer menstrual cycle.
Missed periods are also common. The woman might not ovulate, so the uterine lining never sheds.
The Connection Between PCOS and Hormone Regulation
PCOS disrupts hormone levels through increased production of androgens (male hormones such as testosterone), leading to an imbalance that affects multiple bodily systems. All women produce a small amount of testosterone but women with PCOS have higher levels than normal.
Most will also have increased levels of luteinizing hormone (LH). LH stimulates ovulation, but high levels can have an abnormal effect.
PCOS can reduce the production of the sex hormone-binding globulin (SHBG), as well. This hormone binds to testosterone to reduce its effect. Lower levels of SHBG mean higher testosterone.
It is unclear why these hormone imbalances occur. One hypothesis is that there is a problem with the ovaries that produce these hormones. Another suggests the issue exists in the pituitary gland in the brain. This "master" gland regulates all hormone production.
Diagnosing PCOS in Women With Regular and Irregular Periods
No single test can diagnose PCOS. Instead, doctors use diagnostic criteria to make the diagnosis. This means a patient must meet at least two established criteria before the physician can give a PCOS diagnosis.
PCOS with Regular or Normal Cycles
Not all women with PCOS experience irregular menstrual cycles, which is why healthcare providers rely on multiple diagnostic criteria rather than any single symptom. It's important to note that having regular bleeding patterns doesn't necessarily indicate normal ovulation is occurring.
Hormonal medications, particularly birth control methods like pills, patches, shots, IUDs, and vaginal rings, can create artificial cycle regularity in women with PCOS by helping to balance hormone levels. However, the bleeding experienced while using hormonal contraceptives is actually withdrawal bleeding rather than a true menstrual period, which can sometimes lead to confusion about cycle regularity.
Other medications may also help regulate menstrual cycles in women with PCOS. For example, metformin, commonly prescribed for type 2 diabetes, can help establish regular periods by addressing insulin resistance—a condition that can trigger excess androgen production. Similarly, weight management can play a crucial role in cycle regulation by improving insulin sensitivity and helping to restore hormonal balance.
Age-related changes can also influence cycle regularity, regardless of PCOS status. As women age and their ovarian reserve naturally decreases, some may experience more regular cycles, though this doesn't necessarily indicate an improvement in PCOS symptoms or overall hormonal balance.
Key Diagnostic Criteria
Given that some women with PCOS experience regular menstrual cycles, healthcare providers rely on specific diagnostic criteria to accurately identify the condition. To diagnose PCOS, medical professionals evaluate patients based on three key criteria, with at least two needing to be present for a definitive diagnosis:
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Irregular or infrequent periods: This would indicate irregular ovulation, which can be a symptom of PCOS.
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High levels of androgen or male hormones: A blood test can show high testosterone levels, for example, highlighting hormonal imbalances.
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Cysts on the ovaries: Polycystic ovaries can be seen through imaging tests such as ultrasound, CT, or MRI scans.
For a diagnosis of PCOS, the patient must meet at least two of these criteria. So, even with a regular menstrual cycle, a patient may fit the other two criteria and receive a PCOS diagnosis. To assist in her diagnostic process, Dr. Thais Aliabadi developed Ovii's comprehensive PCOS Symptoms Quiz, which she uses as an initial assessment tool with her patients. While this validated questionnaire is not diagnostic on its own, completing it before your consultation can help streamline the evaluation process and provide a structured framework for discussing your specific symptoms and concerns with your healthcare provider.
The Role of Hormonal and Physical Symptoms in Diagnosis
Diagnosis will likely begin with a physical exam. The doctor may look for symptoms that could point to PCOS, such as facial hair and acne.
They may order an ultrasound to check for poor development of ovarian follicles. These tiny sacs secrete hormones and release eggs into the fallopian tubes. The hormonal imbalance associated with PCOS can prevent the follicles from maturing.
The diagnosis will also require blood tests to measure hormone levels. The doctor will look for high levels of androgen hormones like testosterone and increased insulin levels in the blood
Managing PCOS and Regulating Menstrual Cycles
Your doctor may recommend a multi-tiered approach to managing your PCOS and regulating menstrual cycles, including medication, natural approaches, and lifestyle changes.
How to Regulate Periods Naturally with PCOS
Your best natural approach to regulating your periods focuses on exercise, diet, and herbal remedies.
Studies indicate that doing yoga five to six times a week can help manage your periods. A 2013 study published in the International Journal of Alternative and Complementary Medicine found that 35 to 40 minutes of yoga a day, at least five days a week could lower hormone levels that lead to irregular periods.[4]
Yoga also helps improve your physical fitness and reduce stress. Being overweight and stressed can both contribute to irregular menstrual cycles.
Evidence shows that adding a little spice to your life is also beneficial. Both ginger and cinnamon may help regulate periods. You can add them to foods or take them as supplements. Some other natural remedies to regulate your periods include:
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Inositol: A form of sugar alcohol that has been shown to improve ovulation and help regulate menstrual cycles.
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Vitamin D: Supports reproductive health and helps maintain regular menstrual cycles. Deficiencies in vitamin D have been linked to irregular periods.
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Magnesium: Works in multiple ways to support menstrual health by both regulating cycles and reducing cortisol levels, which can help stabilize periods.
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Curcumin: Helps reduce cortisol (the stress hormone), which can contribute to more regular menstrual cycles. Sourced from Turmeric.
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Polyphenols: Natural compounds that help lower cortisol levels, potentially supporting more regular periods by reducing stress-related cycle disruptions. Found in acai, elderberries, and pomegranate.
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Apple cider vinegar: Studies show that as little as 15 grams of apple vinegar daily could impact ovulation. [5]
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Pineapple: Contains a natural enzyme, bromelain, that is said to soften the uterine lining. That could promote more manageable and stable periods.
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Ashwagandha: Helps control the release of stress hormones and chronic inflammation.
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Basil: May impact insulin resistance and help manage weight.
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Fennel: Supports ovarian health and helps relieve period pain.
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Fenugreek: Can improve insulin resistance and promote regular menstrual cycles.
These natural approaches can work in combination with medication and lifestyle changes. However, check with your doctor if you take medication before taking dietary supplements.
Medical Treatments: Birth Control, Norethindrone, and Progesterone
Healthcare providers often recommend hormonal birth control as a primary treatment for menstrual irregularity in PCOS patients. The most common formulations combine estrogen and progestin to help decrease androgen production, and these medications are available in various forms including pills, patches, vaginal rings, and hormone-based IUDs to accommodate different preferences and needs.
Alternative options include progestin-only medications like norethindrone, which can be effective for some patients who cannot take estrogen-containing contraceptives, such as those who experience migraines. Consuming estrogen-containing contraceptives in this instance can increase risks of a stroke.[6] It's important to consult with your healthcare provider when deciding your preferred birth control option.
Additionally, progesterone therapy may be prescribed either as a short-term treatment for amenorrhea (absence of periods) or as a longer-term solution for cycle regulation, with treatment plans typically tailored to individual patient needs and responses.
Lifestyle Changes for Better Cycle Control
Most care plans involve lifestyle changes, too. Weight management is a critical component in treating PCOS. Your physician will suggest a balanced diet with plenty of vegetables and fruits. Cutting back on sugary snacks and processed foods is also recommended to help balance hormones.
Aim for moderate-intensity exercise, such as a brisk walk. Avoid over-exercising, as this can disrupt hormone balance.
Practice good sleep hygiene to ensure you get up to nine hours a night. Reduce caffeine to promote good sleep, and set a regular schedule for going to bed and getting up.
PCOS, Fertility, and Pregnancy
Having PCOS can make getting pregnant more challenging due to irregular ovulation patterns, but it's not impossible. Many women with PCOS successfully conceive and have healthy pregnancies, either naturally or with help from fertility treatments.
Tips for Getting Pregnant with PCOS and Irregular Periods
If you want to get pregnant and you have PCOS with irregular periods, you'll want to have a plan in place. It may start with you making some lifestyle changes to help manage the condition.
Ideally, any woman looking to have a successful pregnancy will want to maintain a healthy weight. Even small amounts of weight loss can increase your chances of conceiving.
Whether you need to lose weight or not, follow a healthy, balanced diet and exercise plan. Eat plenty of lean protein, vegetables, and fruits. Avoid processed meals, sugar, baked goods, and unhealthy fats. Stick with moderate exercise, such as a brisk walk or yoga at least 3 times per week.
Talk to your doctor about checking and managing your blood sugar levels. Excess insulin in the blood can impact ovulation. A medication such as metformin may be necessary to help manage insulin resistance and lower levels.
Monitor your ovulations. You can do this manually with a calendar, or with the help of period and ovulation tracking apps. This can help you determine the most fertile days of your cycle, allowing you to try and get pregnant on the days that offer the highest chance of success.
If you have been diagnosed with PCOS and have continued difficulty conceiving, consider seeing a fertility specialist. They will work with you to manage your condition and increase your chances of having a successful pregnancy. They may also suggest assisted reproduction treatments such as fertility drugs or IVF to increase your chances.
Risks and Solutions for Women with PCOS Trying to Conceive
Women with PCOS have an increased risk of complications both when trying to conceive and during a pregnancy. Irregular menstrual cycles and absent ovulation are one of the hallmark symptoms of PCOS.
Many women with PCOS also have insulin resistance. High insulin levels in the blood can stimulate the overproduction of androgen hormones such as testosterone. That will likely lead to irregular ovulation.
Women who get pregnant face some challenges, too, such as:
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Gestational diabetes
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Preeclampsia
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Miscarriage
Pay attention to your weight when trying to conceive and after you become pregnant. Manage your diet and get moderate exercise multiple times per week.
Managing stress levels is another crucial factor, as stress hormones can contribute to insulin resistance and further hormonal imbalances. While lifestyle modifications are important, working with your healthcare provider to explore medication options is often essential for managing PCOS symptoms and regulating menstrual cycles. Common medical treatments for PCOS include:
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Clomiphene citrate (Clomid): Can stimulate ovulation
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Metformin: Helps reduce insulin resistance, which can enhance ovulation
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Letrozole (Femara): Induces ovulation
Your fertility specialist may suggest lifestyle changes, medication, and assisted reproduction to improve your odds of pregnancy. Typical forms of assisted reproduction include fertility drugs, intrauterine insemination (IUI), and in vitro fertilization (IVF).
Managing Irregular Periods: Your Path Forward
Understanding the connection between PCOS and irregular menstrual cycles is an important step in taking control of your reproductive health. While irregular periods can be frustrating and concerning, various treatment options are available to help regulate your cycle and manage PCOS symptoms effectively. Through a combination of medical interventions, lifestyle modifications, and regular monitoring with healthcare providers, many women successfully manage their menstrual irregularities and maintain their overall well-being.
Remember that every woman's experience with PCOS and irregular periods is unique, and finding the right treatment approach may take time. Don't hesitate to discuss your concerns and symptoms with your healthcare provider, as they can help develop a personalized management plan that addresses your specific needs. With proper care and support, you can work toward achieving more regular cycles and better hormonal balance while maintaining hope for your reproductive goals.