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PCOS and Periods: What’s Different and What to Know

Polycystic Ovary Syndrome, or PCOS, is one of the most common hormonal conditions affecting people of reproductive age. Despite its name, you don’t need to have cysts on your ovaries to have PCOS. Instead, it’s defined by a combination of symptoms, often including irregular or absent periods.


If you’ve been diagnosed with PCOS, or suspect you might have it, understanding how it affects your menstrual cycle can help you make more informed choices about your health and wellbeing.


What Is PCOS?


PCOS is a hormonal condition that affects how the ovaries function. The main features include:


  • Irregular or absent periods

  • High levels of androgens (often referred to as “male hormones,” like testosterone)

  • Polycystic ovaries (ovaries that appear enlarged with many small follicles)


You only need to meet two out of three of these criteria to be diagnosed with PCOS. The condition can affect menstrual health, fertility, metabolism, skin, and even mood.



How PCOS Affects Your Periods


1. Irregular Cycles


One of the most common signs of PCOS is infrequent or unpredictable periods. Some people may have a period every few months, while others might not bleed at all for long stretches. This happens because PCOS often prevents ovulation, the release of an egg each month, which is necessary for a regular menstrual cycle.


2. Heavier or Lighter Bleeding


When periods do happen, they can sometimes be heavier than usual due to a thickened uterine lining. In other cases, the flow may be lighter or just spotting. Everyone’s experience is slightly different.


3. Longer Cycles


A typical menstrual cycle is about 21 to 35 days. With PCOS, cycles are often much longer — sometimes 40, 50, or even more days apart. That doesn’t just make periods unpredictable, it can also affect fertility and long-term health.


4. Missed Periods or No Periods at All


Some people with PCOS go several months — or longer — without a period. This is known as amenorrhea. Regularly missing periods can increase the risk of developing endometrial hyperplasia (a thickened uterine lining), which should be monitored.


5. Spotting Between Periods


Some may experience light spotting between cycles, especially when hormones fluctuate or if a period is trying to start but ovulation hasn’t occurred. This isn’t always a cause for concern but should be discussed with a GP if it’s frequent or unusual.



Why These Changes Happen


PCOS is linked to hormonal imbalance, especially involving:

  • Low or irregular ovulation

  • Increased androgens (which can also cause acne, excess hair, or hair thinning)

  • Insulin resistance, which can affect energy levels, weight, and blood sugar control


These hormonal shifts disrupt the normal rhythm of the menstrual cycle. Ovulation may be delayed, skipped, or inconsistent, which affects when or whether a period arrives.


When to Talk to a GP


It’s important to speak with a healthcare provider if you notice:

  • Periods that are consistently more than 35 days apart

  • Long stretches (months) without bleeding

  • Very heavy or prolonged periods

  • Difficulty managing weight, skin changes, or excess hair growth

  • Concerns about fertility or planning for the future


A diagnosis is usually made through a combination of blood tests, medical history, and a pelvic ultrasound.


Managing Period Symptoms with PCOS


The treatment approach depends on your symptoms, goals, and whether or not you’re trying to conceive. Here are some common strategies:


1. Regulating Periods

  • Combined contraceptive pill: Helps regulate cycles, lower androgen levels, and protect the uterine lining

  • Progesterone therapy: Used intermittently to trigger a period if you're not ovulating regularly

  • Hormonal IUDs: Can reduce bleeding and protect the womb lining, though they may not make periods more regular


2. Managing Hormone Imbalance

  • Anti-androgen medications: May help with acne or excess hair growth

  • Metformin: Commonly used in PCOS to improve insulin sensitivity and support ovulation in some cases


3. Lifestyle Support

  • Balanced eating: Focus on steady blood sugar levels through whole foods and regular meals

  • Movement: Regular physical activity (even light) can help with insulin sensitivity and mood

  • Sleep and stress: Prioritising rest and reducing stress can support hormonal balance

  • Cycle tracking: Keeping a log of bleeding days, symptoms, and mood can help spot patterns and guide treatment.



Fertility and Periods with PCOS


Not ovulating regularly doesn’t mean you can’t get pregnant — but it might take longer or require additional support. Many people with PCOS conceive naturally, while others may benefit from ovulation-stimulating medications or fertility treatments. If you’re thinking about fertility now or in the future, speak with your GP or a fertility specialist.


In Summary


PCOS affects everyone a little differently, but irregular or absent periods are one of the most common signs. Understanding how hormonal imbalances influence your cycle can help you feel more informed and empowered to manage your symptoms.


There’s no one-size-fits-all solution, but with the right information and support, including medical care, lifestyle changes, and tracking your own patterns, you can take steps to feel more in control of your cycle and your health.

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