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?

The normal menstrual cycle is regulated by two hormones, progesterone and estrogen, which are made by the ovaries. Every month, these hormones cause the endometrium (innermost layer of the uterus) 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 ceases to get fertilized, the egg disintegrates and pregnancy does not occur. Following this cycle, the levels of the hormones-estrogen and progesterone decrease triggering the uterus to shed/breakaway its lining, leading to bleeding, which is called the menstrual period. In most women, this cycle lasts about 28 days but cycles that are shorter or longer by 7 days are considered normal.

Polycystic Ovarian Syndrome Irregular Periods

Irregular Periods is the most common characteristic of PCOS. Examples include prolonged menstrual intervals exceeding 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?

A patient with PCOS can experience irregularities in or complete cessation of the menstrual cycle. The average menstrual cycle lasts for 28 days, with cycles extending or shortened by 7 days considered normal. However, irregular menstrual cycles are said to occur, if any of these criteria are met:

  • Eight or less menstrual cycles per year
  • Menstrual cycles exceeding 35 days
  • Occurrence of either heaver or scantier bleeding than normal

How does PCOS cause irregular periods

We have already seen that Polycystic Ovarian Syndrome can cause irregular period but what exactly leads to this condition?

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. Abnormally higher levels of androgens can interfere with your menstrual cycle to the level of inhibiting ovulation (egg release). Thus, inhibition of egg release ceases the subsequent stages of the menstrual cycle, causing disruption in hormonal levels and overall interruption in the normal cycle, leading to cessation of menstrual bleeding.

Keep in mind that this symptom can manifest 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 put you at an increased risk of cancer of the uterus-commonly known as 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 prevent this abnormal built-up of 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 machinery, the pain usually subsides with pain killers and sufficient rest.  However in few women with PCOS, often periods and cramps can be truly debilitating. This in medical terms is called as secondary dysmenorrhea.

Without any doubt these symptoms can be distressing and challenging, but there are strategies to deal with it and maintain a decent quality of life. Follow your doctor’s advice and know which treatment might work best for you if you are experiencing any of these symptoms.

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