Can You Have PCOS With Regular Periods?

Polycystic ovary syndrome (PCOS) is a common endocrine disorder and a leading cause of female infertility.

The condition is usually diagnosed based on the following three criteria:¹

• Irregular, infrequent, or absent periods

• High androgen levels (androgens, like testosterone, are male sex hormones)

• Enlarged ovaries that contain multiple cysts (fluid-filled sacs)

PCOS diagnosis is dependent on observing two out of three criteria. This means you don’t have to have irregular, infrequent, or absent periods to be diagnosed with the condition. If you have high androgen levels and enlarged ovaries with cysts, you can be diagnosed with PCOS even if your menstrual cycle is regular.

Having PCOS with regular periods may present challenges when it comes to diagnosis. It may take longer for you to receive your diagnosis. You might not be diagnosed with PCOS until you try to become pregnant and experience fertility difficulties (another PCOS symptom).

If you notice other PCOS symptoms, despite having a regular cycle, it’s a good idea to speak to your doctor. They can recommend treatments to help ease your symptoms.

How does PCOS affect your periods?

PCOS is characterized by reduced fertility, elevated androgen levels, and multiple small cysts on the ovaries. These small cysts represent eggs that did not properly develop.

Having irregular periods (oligomenorrhea) is a common symptom of the condition. This is typically defined as a cycle time of 35 days or more in adults and 40 days or more in adolescents.²

Irregular periods are common in adolescents, particularly in the first few years after menarche (the first menstrual period). Teens often don’t settle into their adult cycle for about 2–3 years after starting their periods. Having irregular menstrual cycles during this time doesn’t necessarily signify a medical issue.³

In addition, having irregular periods is not a universal PCOS symptom. Some people with PCOS actually have a relatively regular menstrual cycle.

Furthermore, those with irregular periods don’t always experience few or no periods. Some people with PCOS actually have periods more often than average, with a cycle of 21 days or less.⁴

Why does PCOS affect the menstrual cycle?

Two hormones produced in the pituitary gland are involved in regulating the length of the menstrual cycle: follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

People with PCOS have too much LH and too little FSH. This causes eggs to develop improperly, and often, these abnormal eggs are not released from the ovaries.⁵

After ovulation, progesterone is normally released from a structure called the corpus luteum. This forms from the remains of a follicle after the egg inside it has been released. The corpus luteum won’t form if you don’t ovulate.

The progesterone released by the corpus luteum causes the uterus to build up a thicker lining. Later, when the corpus luteum stops making progesterone, the drop in progesterone levels triggers menstruation.

Because people with PCOS don’t ovulate, they may not form a corpus luteum. This means that the signal that causes the uterus to build up a lining and then shed it will not occur. You won’t have a period without this.

Many people with PCOS do menstruate, although their cycle may not be regular. The amount of menstrual flow may also be altered: it may be lighter than normal, heavier than normal, or highly variable.⁶

Other PCOS symptoms

Diagnosing PCOS can be challenging. Studies indicate that more than half of all people with PCOS are not diagnosed.⁷

Your doctor may not consider PCOS as a possible diagnosis if you have regular periods. This could make it harder for you to get the right diagnosis that explains your other symptoms.

However, you will likely have other PCOS symptoms, including the following:

• Acne and oily skin

• Male pattern hair loss

• Excess hair growth (this usually affects the chin, upper lip, upper arm, chest, back, abdomen, thigh, and buttocks)

These are all signs of increased androgen levels.

Not everyone with PCOS experiences the same symptoms. Testing for androgen levels is an important part of diagnosis. Your doctor may also look for cysts on your ovaries by carrying out an ultrasound.

Why do some people have PCOS with regular periods?

There are a few reasons why you might have regular periods and PCOS:

• Hormonal imbalances

• Oral hormonal contraceptives

• Aging

The hormonal imbalances of PCOS are highly variable. Some people with PCOS have regular periods, but this doesn’t necessarily mean that they are ovulating. The high levels of androgens in the blood can interfere with ovulation, even though menstrual periods are still occurring.

Having regular periods with PCOS can also be explained by the contraceptive pill. This is a very common birth control method, and it can also be prescribed as a PCOS treatment.

Bleeding will generally occur every month in people using the pill. Although this resembles a period, it’s not truly a period. Instead, this is known as “withdrawal bleeding,” and it occurs every month when the hormone dose is lowered.

If you have PCOS and you are using the pill, you might assume you’re having periods. However, you’re only experiencing bleeding triggered by the pill cycles.

Aging generally causes periods to become more regular in people with PCOS. People who have PCOS may find that they develop more regular periods as they get older.⁸

What does having PCOS with a regular cycle mean for fertility?

You can have periods even if you’re not ovulating. Some people with PCOS have regular periods, but they may not be ovulating every cycle. Or, they may not be ovulating at all.

Some people with PCOS who have regular periods don’t find out about their condition until they’re trying to get pregnant. When they have trouble conceiving, they may seek a medical evaluation that reveals they have PCOS.

If you have PCOS with a regular cycle, you may or may not experience infertility. About 70–80% of all women with PCOS experience infertility.⁹

How is PCOS treated?

PCOS cannot be cured, but you can manage the symptoms in several ways. Even if you have regular periods and don’t plan to become pregnant, following your doctor’s recommendations is important if you are diagnosed.

PCOS does not just affect your reproductive health. It is also linked to an increased risk for developing type 2 diabetes, heart disease, stroke, and high blood pressure. Most people with PCOS have insulin resistance, meaning their bodies cannot use insulin effectively. Insulin resistance can lead to diabetes when left untreated.¹⁰

Oral hormonal contraceptives are a common treatment for people with PCOS who are not currently trying to get pregnant. These medications can help restore your hormonal balance. They also have the effect of making periods more predictable. Even if your periods are regular, going on the pill can result in a lighter flow.

If you are trying to get pregnant, the first line of treatment is usually lifestyle changes. Losing weight could help restore your hormonal balance and allow you to get pregnant naturally.

When lifestyle changes aren’t enough, treatment may include the following:

• The diabetes drug metformin. This drug helps sensitize your body to insulin, and it can help you lose weight and encourage ovulation. It may also help your periods become more regular if they are irregular.

• Fertility drugs, such as clomiphene citrate and letrozole. These medications help encourage ovulation.

• When the above measures aren’t enough, additional options include injectable FSH or a minor surgical procedure called ovarian drilling.

Many people with PCOS can successfully get pregnant, naturally or with medical treatment. However, the risk of pregnancy complications is increased in people with PCOS. Complications include high blood pressure during pregnancy, gestational diabetes, and miscarriage.¹¹

Lifestyle changes that help manage PCOS

PCOS is linked to being overweight. People who are overweight are more likely to have PCOS, and extra weight can worsen the symptoms. At the same time, PCOS can cause weight gain. This can lead to a vicious cycle, where PCOS causes a person to gain more weight, which worsens their condition.

Although this situation can feel frustrating, it’s important to take control of your health and try to make changes that help you lose weight. If you’re overweight and have PCOS, losing even a small amount of weight can significantly improve your symptoms and increase your chances of getting pregnant.¹²

It’s best to work on sustainable lifestyle changes that you can continue following in the long term. Crash dieting is not healthy or sustainable. It’s a good idea to ask your doctor for a referral to a nutritionist who can work with you to establish a healthy diet that will not feel overly restrictive.

Increased physical activity can also help, both for losing weight and improving your overall health.

The lowdown

While most people with PCOS experience menstrual irregularities or absent menstruation, it is a myth that all do. It’s possible to have PCOS and regular periods. However, this doesn’t necessarily mean you are ovulating every cycle. PCOS can still lead to infertility, even if you have regular periods.

Speak to your doctor about your PCOS symptoms, even if you have regular periods. For people with PCOS, lifestyle changes and/or treatments may help increase your chances of becoming pregnant. Treating PCOS also helps to reduce your risk of serious health conditions, like type 2 diabetes.