Can you have PCOS with regular periods: A deep look into the mechanism of menstrual irregularity in polycystic women

In a nutshell:

Menstrual irregularity has long been known as one of the primary symptoms of polycystic ovary syndrome (PCOS) due to the hormonal nature of this disorder. Indeed, women with PCOS often report irregular periods caused by hormonal imbalances, irregular ovulation, and insulin resistance. Still, can you have PCOS and have regular periods? - Yes, it’s possible and quite common to retain regular periods while also having polycystic ovaries.

PCOS is a hormonal disorder that’s typically linked to menstrual irregularity by default. Indeed, causing hormonal imbalances, PCOS can bring irregular periods as one of its primary symptoms. But can you have PCOS with regular periods?

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Understanding PCOS and its impact on female health

Can you have PCOS and have regular periods? - In order to answer this common question, it’s important to gain a better understanding of the syndrome itself and the mechanics of cycle irregularity in women diagnosed with it.

So what is PCOS, in the first place? It is a polycystic ovary syndrome - a common hormonal condition that affects women of childbearing age and can start as early as your first period. Although it affects roughly 8-13% of women in the world (with up to 70% undiagnosed cases), the real causes of PCOS are still unknown. What we know about this syndrome though is that it causes female ovaries to develop a large number of fluid-filled sacs (cysts) on their surface. These cysts hinder the normal work of ovaries, causing them to produce too many androgens (male hormones) and lead to a range of symptoms, such as:

• Menstrual irregularity
• Enlarged ovaries with cysts
• Excess hair growth
• Hair loss
• Acne
• Weight gain
• Infertility

3 factors behind menstrual irregularity in PCOS

As you can see, irregular cycles are the primary symptoms of PCOS. The question is how the mechanism of this irregularity works in practice.

To answer this question, let’s look at the top three factors contributing to irregular periods in women with PCOS:

Hormonal Imbalance

Being a hormonal disorder, PCOS hinders the balance of key hormones in your body. Typically, this syndrome makes your ovaries produce unusually high levels of androgens (male hormones, such as testosterone).

As a result, the rest of crucial reproductive hormones, such as estrogen and progesterone, become imbalanced. Your progesterone levels don’t rise at the end of the cycle as they are supposed to and don’t trigger uterine contractions, which means that you don’t go on your periods.

Egg release disruption

In the middle of the cycle, a healthy woman is supposed to release a mature egg from its ovaries to allow conception. The egg is getting mature and released from the sacs in your ovaries. In PCOS, your ovaries have these sacs filled with liquid and underdeveloped, which means they are often unable to release an egg.

When you don’t ovulate and there is no egg to be fertilized, this disrupts the normal work of your cycle. As a result, you technically can’t menstruate if there is no ovulation.

Insulin resistance and metabolic problems

In addition to hormonal imbalances and unpredictable ovulation, PCOS is also known to affect females’ metabolic health. Namely, women with PCOS have been shown to have an inappropriate reaction to insulin in their tissues, which led to frequent occurrence of insulin resistance in women with this syndrome.

Such metabolic problems can further disrupt hormonal balance and fertility. That is, insulin resistance also contributes to menstrual irregularity.

Additional circumstances contributing to menstrual irregularity

Although hormonal imbalances, ovulation disruption, and insulin resistance problems might be found in all women with PCOS, this doesn’t mean that every female with this diagnosis will experience problems with her cycle. Moreover, there are no two identical cases of PCOS, meaning that the nature, prominence, and severity of cycle irregularity can vary greatly from one woman to another.

There are three additional factors that can affect your condition:

• Severity of PCOS symptoms. Whether we’re talking about a hormonal imbalance or insulin resistance, the impact they have on your cycle greatly depends on their severity.
• Treatment. Birth control pills intake and the presence of other PCOS management treatments can also determine cycle regularity.
• Lifestyle and environment. Lastly, nearly all symptoms of PCOS are sensitive to your lifestyle habits and environmental factors. That is, the nutritional value of your diet, your activity levels, and stress susceptibility can all affect your cycle.

Can you have regular periods with PCOS?

Given the hormonal nature of this condition and its impact on the female reproductive system, menstrual irregularity is often considered a by-default attribute of PCOS, which makes the question “Can you have PCOS with regular periods” one of the most common ones in women diagnosed with this syndrome.

Now, this might surprise you but the short answer to this question is “yes.” Although irregular periods are among the most common PCOS symptoms, they may not always be a prominent symptom. This phenomenon was first discovered in 1963 by Goldzieher and colleagues - a study on 1,079 patients has shown that 12% of females diagnosed with PCOS actually had normal periods.

Further studies of this phenomenon have also confirmed it. Namely, a study by Lobo and Carmina has found a 15% prevalence of regular menstruation in PCOS women and a study by Balen et al. has revealed an even higher prevalence of 25%.

These and many other studies confirm the same thing - yes, you can have PCOS but regular periods.

Challenges in diagnosis of Polycystic Ovary Syndrome

Although they help us understand the true nature of this syndrome, the studies that confirm that you can have PCOS but regular periods only uncover the tip of the iceberg. All of them have been run on females who are already diagnosed with PCOS and revealed a fairly high prevalence of regular menstruation in them. Now, given this fact and that we assume up to 70% of PCOS cases in the world remain undiagnosed, can you imagine the real number of women with hidden PCOS who don’t realize their diagnosis because their menses are totally fine?

The common myth of the inevitability of menstrual irregularities in PCOS creates one of the biggest challenges in diagnosing this syndrome.

According to the general medical guidelines, healthcare providers are recommended that the diagnosis of PCOS in adolescents requires a well-defined cycle irregularity. And this is what creates controversies in individual diagnostic criteria. Since healthy females and women with PCOS can have naturally varying cycle lengths and period regularities, this often leads to misdiagnosis or underdiagnosis of PCOS.

This leads us to a few important things we need to incorporate in the near future:

1. A more comprehensive education about PCOS and its varied presentations in females. Raising more awareness about this condition can help more women consider an individual diagnosis regardless of cycle regularity but rather due to a combination of symptoms.
2. A more all-rounded diagnostic criteria. Today, PCOS is still tightly associated with irregular menses, meaning that a woman who has regular cycles typically can’t be diagnosed with this syndrome. By integrating deeper and more personalized diagnosis criteria, we can help eliminate the commonness of PCOS misdiagnosis or underdiagnosis and allow more timely and appropriate treatment for more females affected by this syndrome.

Final verdict

So can you have regular periods with PCOS? - As you now know, the answer is “yes.” Polycystic ovary syndrome is known as a hormonal disorder, which affects the female reproductive health. It can cause menstrual irregularities by causing three underlying problems:

• Hormonal imbalance
• Ovulation disruption
• Insulin resistance

All these issues are often associated with PCOS and can lead to irregular periods. However, it’s important to remember that there are other factors that also affect cycle regularity, such as the severity of PCOS symptoms, treatment, and lifestyle factors. Due to these reasons, it’s technically possible to have PCOS but regular periods. In fact, it is rather common, which makes it harder to diagnose PCOS in some women.