PCOS and Cycle Irregularities: Recognising the Signs Your Body is Sending

PCOS is one of the most common endocrine disorders affecting women of reproductive age, yet many struggle for years with unexplained cycle irregularities before receiving answers. What if understanding your body's menstrual signals could transform years of confusion into clarity, frustration into empowerment, and silence into advocacy?

Understanding PCOS: More Than Just "Difficult Periods"

What Your Cycles Are Telling You

Key menstrual irregularities in PCOS:

• Oligomenorrhea: Cycles longer than 35 days or fewer than 8 cycles per year

• Amenorrhea: Complete absence of periods for 3+ months

• Anovulation: Cycles without ovulation (affects 85-90% of women with oligomenorrhea)

• Heavy, prolonged bleeding: When periods do occur, they may be unusually heavy

The fertility connection: PCOS causes 90-95% of anovulatory infertility cases (Sirmans & Pate, 2014), affecting 40% of women with PCOS. This makes cycle charting particularly valuable for women with PCOS, as it can reveal whether ovulation is actually occurring even when periods seem regular, helping distinguish between true menstrual cycles and anovulatory bleeding episodes.

Getting a Diagnosis

PCOS is typically diagnosed using the Rotterdam criteria, which requires two of three features: irregular or absent periods, clinical or biochemical signs of elevated androgens, and polycystic ovaries visible on ultrasound. However, other conditions with similar symptoms must first be ruled out, including thyroid disorders, prolactin abnormalities, and adrenal conditions. The diagnostic process often involves blood tests to measure hormone levels, an ultrasound to examine ovary structure, and a detailed medical history focusing on menstrual patterns and symptoms.

The Complete Picture

Clinical signs of PCOS extend far beyond irregular periods. Hirsutism, or excess hair growth in male-pattern areas like the face, chest, and back, affects up to 70% of women with PCOS and represents one of the most distressing symptoms for many women. Acne affects 15-30% of adult women with PCOS and often persists beyond typical teenage years, appearing on the face, chest, and back areas where androgen receptors are concentrated. Male-pattern baldness or hair thinning at the temples and crown can also occur, representing another manifestation of androgen excess that can significantly impact self-esteem and quality of life.

Beyond these visible signs, biochemical markers tell a crucial story about hormonal imbalances in PCOS. Elevated testosterone levels represent the hallmark of PCOS, with both total and free testosterone often exceeding normal ranges. Free testosterone is particularly important because it represents the biologically active form of the hormone that directly affects tissues. Sex hormone-binding globulin (SHBG) levels are typically reduced in PCOS, which means more testosterone remains "free" and active in the bloodstream rather than being bound and inactive. The free androgen index, calculated from total testosterone and SHBG levels, provides a more accurate picture of androgen activity than testosterone alone. Dehydroepiandrosterone sulfate (DHEAS), produced by the adrenal glands, may also be elevated, particularly in adrenal-type PCOS.

Metabolic disruption forms another crucial component of PCOS. Insulin resistance affects 50-70% of women with PCOS, occurring independently of body weight, which means even lean women can experience this metabolic dysfunction. This insulin resistance creates a cascade of hormonal problems, as high insulin levels directly stimulate the ovaries to produce more testosterone whilst simultaneously reducing the liver's production of SHBG. Weight gain, particularly around the midsection creating an "apple shape," reflects this underlying insulin resistance and often proves frustratingly difficult to address through conventional diet and exercise approaches. Many women report feeling like their bodies don't respond normally to healthy lifestyle changes, which reflects the underlying hormonal and metabolic disruption rather than lack of willpower or effort.

The Four Types of PCOS

Dr. Lara Briden identifies four distinct types of PCOS, each requiring different approaches:

1. Insulin-Resistant PCOS (70% of cases)

• Driven by insulin resistance and high insulin levels

• Often presents with apple-shaped weight gain

• Requires sugar elimination and insulin-sensitising treatments

2. Post-Pill PCOS

• Develops after stopping hormonal birth control

• Usually temporary

• Treatment focuses on supporting natural hormone recovery

3. Inflammatory PCOS

• Driven by chronic inflammation

• Often accompanies digestive issues, fatigue, joint pain

• Requires anti-inflammatory diet

4. Adrenal PCOS (10% of cases)

• Driven by elevated stress hormones (DHEAS)

• Requires stress management and adrenal support

Evidence-Based Lifestyle Management

The Exercise That Works

Any form of regular exercise can help improve insulin resistance in PCOS, making it one of the most accessible and effective treatments available. Whether it's walking, swimming, cycling, strength training, or dance, consistent physical activity helps your muscles use glucose more effectively and reduces insulin levels. The key is finding movement you enjoy and can maintain long-term, with research showing that combining exercise with dietary changes produces better results than either approach alone.

The Anti-Inflammatory Diet

PCOS is fundamentally an inflammatory condition, which means your food choices can either fuel the fire or help calm the storm. Focus on including omega-3 rich fish like salmon and sardines, which provide essential fatty acids that reduce inflammation throughout your body. Leafy greens and non-starchy vegetables supply antioxidants and fibre whilst keeping blood sugar stable, whilst whole grains with low glycemic impact provide sustained energy without triggering insulin spikes. High-fibre foods are particularly important as they slow down digestion and reduce insulin resistance by minimising blood sugar fluctuations.

On the flip side, refined carbohydrates like white bread, pastries, and sugary snacks cause inflammation and worsen insulin resistance, creating the exact opposite effect you want to achieve. Processed foods and added sugars should be minimised as they often contain hidden inflammatory ingredients and blood sugar disruptors. Many women benefit from identifying their personal inflammatory triggers through an elimination approach, removing common culprits like gluten, dairy, or specific additives for a few weeks to see if symptoms improve.

The Sugar Connection

For many women with insulin-resistant PCOS, eliminating sugar represents the most powerful intervention available. Each time you consume something sweet, insulin levels spike, which directly stimulates your ovaries to produce more testosterone whilst reducing the proteins that keep hormones balanced. This creates a vicious cycle where sugar consumption worsens PCOS symptoms like weight gain, acne, and unwanted hair growth. To break free from this cycle, start by eliminating obvious sources like desserts, soft drinks, and fruit juices, then gradually identify hidden sugars in processed foods by reading ingredient labels. Focus on eating satisfying meals with protein, healthy fats, and complex carbohydrates to reduce cravings, and remember that whole fruits in moderation are generally acceptable due to their fibre content which slows sugar absorption. Many women find that their sugar cravings disappear entirely within a week of elimination, making this challenging but transformative change more manageable than expected.

Your Cycle as a Diagnostic Tool

Tracking your menstrual cycle and symptoms transforms you from someone with vague complaints into an informed advocate with concrete data. By recording cycle length, bleeding patterns, energy levels, mood changes, and physical symptoms like skin changes or hair growth, you create a comprehensive picture of your hormonal health that no single doctor's appointment can capture. Fertility awareness charting takes this further by tracking basal body temperature and cervical mucus changes, which can reveal whether you're actually ovulating—a crucial distinction since many women with PCOS have bleeding without ovulation. These temperature patterns also show hormonal fluctuations and provide real-time feedback on whether treatments are working, giving you powerful evidence to share with healthcare providers who might otherwise dismiss your concerns.

From Recognition to Transformation

Your Action Plan

1. Start comprehensive tracking - Document cycles, symptoms, and patterns

2. Identify your PCOS type - Understanding drives targeted treatment

3. Implement evidence-based lifestyle changes - Focus on anti-inflammatory approaches

4. Advocate for appropriate care - Use your data to communicate effectively with healthcare providers

The Ripple Effect

Every woman who recognises her PCOS symptoms and advocates for proper care contributes to breaking down barriers for the next generation. Your voice matters in creating a world where:

• Menstrual irregularities are investigated properly

• Women aren't told their symptoms are "just stress"

• PCOS is understood as a complex metabolic condition

• Healthcare providers receive better hormonal health education

Moving Forward with Confidence

PCOS may be common, but it doesn't have to control your life. By recognising the warning signs, understanding the underlying mechanisms, and advocating for appropriate care, you're not just managing symptoms—you're reclaiming your power.

Your menstrual cycle has been trying to tell you something important. Now you have the knowledge to listen, understand, and act. Your story of recognition doesn't just transform your life—it creates waves of change that reach far beyond yourself.

This content is for informational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider before making health-related decisions.

Sources:

• Bozdag, G., et al. (2016). The prevalence and phenotypic features of polycystic ovary syndrome. Human Reproduction, 31(12), 2841-2855.

• Sirmans, S. M., & Pate, K. A. (2014). Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clinical Epidemiology, 6, 1-13.

• Cowan, S., et al. (2023). Lifestyle management in polycystic ovary syndrome – beyond diet and physical activity. BMC Endocrine Disorders, 23(1), 14.

• Dr. Lara Briden's "Period Repair Manual"