Polycystic Ovary Syndrome (PCOS) is a common condition that affects women when they are still in their reproductive age. The hormonal condition can cause elevated androgen levels, cysts in the ovaries, acne, excess hair growth, weight gain, and fertility issues. It can also cause irregular periods, which is quite common in women with PCOS. However, irregular periods may not always be a sign of PCOS. Women may have PCOS with regular periods as well, making it challenging to diagnose it. But does it mean having PCOS with a regular menstrual cycle is a good thing for fertility?

What is PCOS?

Polycystic ovary syndrome or PCOS is a condition in which a woman's ovaries produce an abnormal amount of androgens, which are male sex hormones present in women in small amounts. "The word 'polycystic' refers to the appearance of the ovaries on ultrasound, often, but not always, enlarged and containing multiple small follicles. These are actually immature follicles that have not matured," explains gynaecologist Dr Jyoti Bali. Approximately 8 to 13 percent of women in the reproductive stage across the globe are affected by PCOS, according to the World Health Organization.

PCOS may be due to hormonal imbalance. Image courtesy: Shutterstock

The exact cause of PCOS is still unknown, but it may be connected to the following factors:

1. Insulin resistance

Many women with PCOS have insulin resistance, meaning their bodies have trouble using insulin effectively, leading to higher insulin levels. "This can increase androgen production, and cause disruption in ovulation," says the expert.

2. Hormonal imbalance

When the levels of androgens become high, they can interfere with the normal function of the ovaries. This can lead to irregular ovulation or anovulation (lack of ovulation).

3. Genetics

PCOS tends to run in families, which suggests a genetic component. So, if your mother, sister or someone in the family has PCOS, your risk of developing it may be higher.

How does PCOS affect periods?

Irregular periods, which means the ovaries don't regularly release eggs, is a common sign of PCOS, as per the UK's National Health Service. Women with PCOS may experience:

• Oligomenorrhea or infrequent periods, where cycles may go beyond 35 days.
• Amenorrhea or absence of periods for several months or more.
• When periods do occur, they may be unusually heavy or prolonged due to the thickened uterine lining.

"These menstrual irregularities are primarily due to the hormonal imbalances that disrupt the regular ovulation process," says Dr Bali.

Can you have PCOS with regular periods?

It may come as a surprise, but not all women with PCOS experience irregular periods. During a study published in the Fertility and Sterility journal, about 74 percent of women with excess amounts of androgens reported normal menstruation even though they were diagnosed with PCOS. Another study published in the Human Reproduction journal found that participants of 30 years and older who had PCOS gained regular menstrual cycles as they grew older.

Some women with PCOS have regular menstrual cycles because PCOS presents differently in different women. "In some cases, the hormonal imbalances may not be severe enough to disrupt the menstrual cycle, or the woman may be ovulating regularly despite having PCOS," says Dr Bali.

How to diagnose PCOS if you have regular periods?

Diagnosing PCOS in women with regular periods requires a more nuanced approach. Doctors will typically look for other PCOS symptoms such as:

• Elevated androgens, which can be identified through blood tests or physical symptoms like hirsutism (excess hair growth), acne, or hair thinning.
• Ovarian ultrasound may help to find out if multiple small follicles are present in the ovaries.
• Insulin resistance
• Weight gain, and difficulty losing weight

These may all point toward PCOS. A comprehensive evaluation, including a detailed medical history and hormonal assessment, is essential for an accurate diagnosis.

PCOS with a regular menstrual cycle and fertility

Having regular menstrual cycles with PCOS can be a positive sign for fertility. "Regular cycles often indicate that ovulation is occurring, which is crucial for natural conception. However, even with regular periods, some women with PCOS may still face fertility challenges," says the expert. This may be due to factors like egg quality or other hormonal imbalances.

PCOS with regular periods is possible. Image courtesy: Freepik

It is important to note that regular periods don’t entirely rule out fertility issues associated with PCOS, so women should seek guidance from a fertility specialist if they have concerns.

How to manage PCOS?

Managing PCOS is all about lifestyle changes and medical treatments. Here's what to do -

1. Lifestyle modifications

A balanced diet, which means consuming whole grains, lean proteins, vegetables, fruits and healthy fats can help manage weight and insulin levels. "Regularly engaging in physical activity can help to manage your weight, and improve insulin sensitivity," says Dr Bali.

2. Medications

Birth control pills are not just to prevent unwanted pregnancy, but also to regulate menstrual cycles and reduce androgen levels. Metformin may also help women with PCOS. Metformin can be taken by adults with PCOS for weight loss, and insulin resistance, according to research published by the European Journal of Endocrinology. "For women trying to conceive, medications like clomiphene or letrozole may be prescribed to stimulate ovulation," says Dr Bali.

3. Monitoring

Even though you take your medicines, eat healthy and workout, regular check-ups are important. Monitoring of symptoms and hormonal levels is crucial for managing PCOS effectively.

PCOS is a condition that affects women in different ways, so the symptoms may vary. Understanding the symptoms of PCOS, especially in cases where women have regular periods, is essential for accurate diagnosis and effective management.

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