Polycystic ovary syndrome signs and symptoms often begin soon after a woman first begins having periods (menarche). In some cases, PCOS develops later during the reproductive years, for instance, in response to substantial weight gain.
What is a normal menstrual cycle?
It is important to first understand the normal menstrual cycle. The normal menstrual cycle is regulated by two hormones, progesterone and estrogen, which are made by the ovaries. Each month these hormones cause the endometrium to grow in preparation for a possible pregnancy. About 12-14 days before the start of a period, an egg is released from the ovary. This is called ovulation. The egg travels down the fallopian tubes where it can be fertilized by sperm. If it is not and pregnancy does not occur, the levels of hormones decrease and signal the uterus to shed its lining. This shedding is the menstrual period. In most women, this cycle lasts about 28 days but cycles that are 7 days shorter or longer are considered normal.
Polycystic Ovarian Syndrome Irregular Periods
Irregular Periods is the most common characteristic of PCOS. Examples include menstrual intervals longer than 35 days; fewer than eight menstrual cycles a year; failure to menstruate for four months or longer; and prolonged periods that may be scant or heavy.
Although some women with PCOS have regular periods, high levels of androgens (‘male’ hormones) and excess insulin can disrupt the monthly cycle of ovulation and menstruation.
What is an irregular period in PCOS?
If you have PCOS, your periods may be ‘irregular’ or stop altogether. The average menstrual cycle is 28 days with one ovulation when eggs are released, but anywhere between 21 and 35 days is considered ‘normal’. An ‘irregular’ period cycle is defined as either:
- Eight or less menstrual cycles per year
- Menstrual cycles longer than 35 days
- Some women with PCOS also experience heavier or lighter bleeding during their menstrual cycle
How does PCOS cause irregular periods
We have already seen that Polycsytic Ovarian Syndrome can cause irregular period but what exactly is the cause? Let’s take a look.
Here’s how PCOS affects your menstrual cycle: every month a follicle matures and gets released by your ovaries to be fertilized. But because of the hormonal imbalance seen in PCOS (typically higher levels of androgens like testosterone and high levels of luteinizing hormone), the follicle doesn’t mature or get released. Instead of being released, the follicle (often miscalled a cyst) stays in the ovaries where it can be seen on an ultrasound. High levels of circulating androgens such as testosterone interfere with your menstrual cycle and can prevent ovulation. Without ovulation and the hormonal events that lead up to it, your uterus does not have the stimulation it needs to shed its lining.
Keep in mind that this symptom can be experienced in different ways. Some with PCOS can have regular periods every 28 days, others have periods every 30 to 40 days, and still others don’t have periods at all. While this is a “normal” symptom of PCOS, it is one that needs to be addressed, especially if you are getting fewer than eight or nine periods each year.
Why is it important to regularize your Periods in PCOS?
When you don’t have a regular period, not only can it affect your fertility but it can increase your risk of developing endometrial cancer.
Regular periods help to prevent excess thickening of the lining of the uterus (womb). Long gaps between periods can lead to abnormal cells building up inside the womb. It is important you have at least four cycles per year to avoid a build up that may include abnormal cells.
Heavy bleeding during periods and Pain: Treatment and Management
Women experience cramps during a typical menstrual cycle and this is termed as dysmenorrhea. In women with normal hormonal work-up, the pain usually subsides with pain killers and a good nap. However in few women with PCOS, often periods and cramps can be truly debilitating. This in medical terms is called as secondary dysmenorrhea.
While all of these symptoms can be incredibly painful and challenging, there are ways to manage them and maintain a good quality of life. If you’ve experienced any of these symptoms yourself, be sure to talk to your doctor about the best treatment options for you.