Irregular Periods – Management & Treatment
What are irregular periods?
Although some women with PCOS have regular periods, high levels of androgens (also known as ‘male-type hormones’) and too much insulin in their bodies can disrupt the monthly cycle of ovulation and menstruation of many women with PCOS.
If you have PCOS, your periods might be irregular, or stop altogether. The average menstrual cycle is 28 days – with one ovulation when an egg is released – but anywhere between 21 and 35 days is considered normal.
An ‘irregular’ period cycle is defined as either:
eight or fewer menstrual cycles per year
menstrual cycles shorter than 21 days
menstrual cycles longer than 35 days; or, for young women within three years of starting periods, longer than 45 days.
For adolescents, ‘irregular periods’ means:
periods have not started by the age of 15
more than a year after periods have started, menstrual cycles are longer than 90 days
between one and three years since periods started, cycles are shorter than 21 days or longer than 45 days.
As menstrual cycles lengthen, ovulation can stop entirely (called anovulation) or occur only occasionally. Some women with PCOS also experience heavier or lighter bleeding during their menstrual cycle.
Regular periods help to prevent excess thickening of the lining of the uterus (womb). Not having regular periods can lead to abnormal cells building up inside the womb.
It is important you have at least four cycles a year to avoid a build-up that might include abnormal cells. If you have fewer than four periods a year, discuss this with your doctor.
A healthy lifestyle has been shown to be the most effective approach to managing PCOS successfully and reducing the severity of symptoms. A healthy lifestyle includes eating a balanced and nutritious diet, maintaining a healthy weight, being as active as possible, and minimising harmful habits such as smoking and excessive drinking.
Evidence shows that women with PCOS who are overweight can experience significant improvement in their PCOS symptoms when they lose a small amount of excess weight. A weight loss of 5-10% of body weight can improve menstrual regularity.
A dietitian can help you find a diet that works best for you and support you to achieve your long-term goals. For more information on healthy diets, see Food, eating & PCOS.
Changing your lifestyle can be challenging. It is important to know that there is help available to support you in making changes you can maintain.
Over 70% of women with PCOS in Australia use natural and complementary therapies to improve one or more aspects of their health. Get more information on how natural therapies can help manage insulin resistance and menstrual cycles.
Some women will need medication and lifestyle changes to make the periods regular. Your doctor can prescribe hormonal contraception for this. These medications include:
a combined oral contraceptive pill (‘the pill’)
progesterone, which stimulates the uterus and induces bleeding
vaginal contraceptive rings
intra-uterine devices containing progesterone.
It is important to discuss the options with your doctor and work together to choose the method of hormonal contraception that is right for you.
How they work
The oestrogen and progesterone in hormonal contraception act to override the body’s control of the menstrual cycle and ovulation. The oral contraceptive pill works by ‘switching off the ovaries’. This means that when a woman takes the contraceptive pill, her production of hormones such as testosterone is greatly reduced.
The oral contraceptive pill (‘the pill’) reduces ovarian production of testosterone and other androgens. It also increases the body’s production of sex hormone binding globulin (SHBG). This reduces the activity of testosterone and reduces the symptoms of male-hormone or androgen excess.
Oral contraceptives can worsen insulin resistance and slightly increase the risk of type 2 diabetes in very obese women with PCOS. In general, most oral contraceptives have similar effects on androgen excess.