Irregular periods are often the first sign that something may be different with your hormones, and one of the most common reasons is polycystic ovary syndrome (PCOS). PCOS is a common hormonal condition, and it can be managed well once it is recognised. This guide explains how PCOS can affect your period, which other symptoms to look out for, and when it is time to see a doctor.
What is PCOS?
PCOS is a condition in which the ovaries do not release eggs regularly (ovulation) and the body may make higher than usual levels of hormones called androgens, which are sometimes called "male hormones". It usually becomes noticeable in the late teens or early twenties. The word "polycystic" can be misleading: PCOS does not mean you have a lot of dangerous cysts, but that the ovaries may contain many small follicles, which are fluid-filled sacs in which eggs develop.
How PCOS can affect your period
Because ovulation does not happen regularly, the pattern of your periods changes. You may notice:
- Irregular periods: cycles that are unpredictable, so that you cannot guess when your next period will start.
- Infrequent periods: cycles that are often longer than about 35 days, or fewer than about 8 periods a year.
- Missed periods: some women go for months without a period, or have no periods at all.
- Heavy periods: when a period finally arrives after a long gap, the lining of the womb has had longer to build up, so bleeding can be heavier and last longer, sometimes with clots.
- Spotting or prolonged bleeding: light bleeding between periods, or a period that goes on for many days.
- Lighter periods: some women have very light bleeding.
Some women with PCOS have fairly regular cycles, so a normal period does not completely rule out PCOS.
What about period pain?
PCOS does not usually cause severe period pain on its own. Very painful periods may be caused by other conditions, such as endometriosis, and sometimes a woman can have both. If pain is severe or getting worse, tell your doctor.
Other symptoms of PCOS
- Excess hair growth on the face, chest, back, or tummy (hirsutism)
- Acne and oily skin
- Thinning hair on the scalp, or hair loss at the temples
- Weight gain, or difficulty losing weight, often around the waist
- Darker patches of skin, often at the neck, underarms, or groin
- Tiredness, mood changes, or low mood and anxiety
- Difficulty getting pregnant, because of irregular ovulation
You do not need to have all of these. Symptoms vary a lot from one woman to another.
Could it be something else?
Irregular periods have many possible causes besides PCOS, so you should not diagnose yourself. They include:
- Pregnancy. Always take a pregnancy test first if you have a missed period.
- Thyroid problems
- High levels of the hormone prolactin
- Stress, very low body weight, excessive exercise, or sudden weight change
- Breastfeeding, or stopping hormonal contraception
- Perimenopause, in women in their 40s
In teenagers, periods are often irregular for the first couple of years after they begin, which is normal and does not necessarily mean PCOS.
How is PCOS diagnosed?
Your doctor will ask about your periods and symptoms, check your blood pressure, and may arrange blood tests to look at hormone levels and to rule out other causes. An ultrasound scan may be offered. A diagnosis can usually be made if other causes are ruled out and you have at least 2 of these 3 features:
- Irregular, infrequent, or absent periods
- Signs of high androgen levels, either symptoms such as excess hair and acne, or blood test results
- Polycystic ovaries on an ultrasound scan
Having polycystic-looking ovaries on a scan does not on its own mean you have PCOS, because they are common, especially in young women.
Why does it matter to treat irregular periods?
If you go for a long time without a period, the lining of the womb can become thicker than normal. Over many years, this can increase the risk of problems with the womb lining, which is why doctors may recommend a treatment that brings regular bleeds. PCOS is also linked to insulin resistance, type 2 diabetes, high blood pressure, and raised cholesterol, so regular check-ups are important.
Treatment and management
There is no single cure, but symptoms can be managed. Your doctor will suggest options depending on your symptoms and whether you want to get pregnant. These may include:
- Healthy lifestyle: balanced meals, regular activity, and good sleep. If you are overweight, losing even 5% to 10% of your weight can help to bring back more regular periods.
- Hormonal treatment: such as the combined contraceptive pill, or a course of progestogen, to regulate periods and protect the womb lining.
- Medicines that improve insulin sensitivity, or that treat acne and excess hair, if needed.
- Fertility treatment if you are trying to conceive and are not ovulating.
Never start or stop a hormonal treatment or supplement without medical advice.
PCOS and pregnancy
Many women with PCOS become pregnant, either naturally or with help. It may take longer because ovulation is irregular. If you have been trying for 6 to 12 months without success, or you have very irregular periods, speak to your doctor early. Tracking your cycle and using an ovulation calculator can help, but with PCOS the estimates may be less reliable.
Keep a period diary
Write down the first day of each period, how long it lasted, how heavy it was, and any other symptoms. A few months of notes give your doctor useful information, and you can record it on a calendar or an app.
When to see a doctor
Make an appointment if you have:
- Periods that stop for 3 months or more (and you are not pregnant)
- Cycles that are often longer than 35 days, or very unpredictable
- Heavy bleeding that soaks a pad or tampon every hour for several hours, or periods lasting more than 7 days
- Excess hair growth, acne, or hair thinning that is bothering you
- Difficulty getting pregnant
- Severe pelvic pain
Get urgent medical help for very heavy bleeding with dizziness, fainting, or a racing heart, or for sudden severe pelvic pain.
Frequently asked questions
Can you have PCOS and a regular period?
Yes, some women with PCOS have fairly regular cycles, even if ovulation is not always happening.
Can PCOS cause a period to last a long time?
Yes. After a long gap, a period may be heavy and last longer. See a doctor if bleeding is heavy or lasts more than 7 days.
Is PCOS curable?
It cannot be cured, but symptoms can be managed very effectively with lifestyle changes and treatment.
Do I need a scan to be diagnosed?
Not always. A diagnosis can be made with only 2 of the 3 features, so you may not need an ultrasound.
Does PCOS mean I cannot have a baby?
No. Many women with PCOS conceive, and help is available if it takes longer.
Sources and further reading
- HSE (Ireland), Polycystic ovary syndrome (PCOS): diagnosis
- Royal Berkshire NHS Foundation Trust, Polycystic ovary syndrome (PCOS) patient leaflet
This article is for general education and does not replace advice from your doctor. If you are worried about your periods or your health, contact a healthcare professional. See our Disclaimer.
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