PCOS with Regular Periods: Symptoms, Diagnosis and Treatment

PCOS which was known until recently as PCOD, is Polycystic Ovarian Syndrome affecting millions of women all over the world. This syndrome can be understood as hormone dys regulation causing issues with fertility and regular periods. However, you can have regular menstrual cycle while still be suffering with PCOS presenting other symptoms. As the name suggests, in PCOS, there are multiple cysts on either ovaries.

There is a criterion that Gynecologists take into account while diagnosing someone with PCOS

Irregular periods: PCOS is generally diagnosed early in life when menstruation begins. In most cases, periods should be regular following the first full year after getting the first period or menarche. 

If this is not the case, your Gynecologist may suspect PCOS and order some scans.

Excess body hair: Presence of excess hair on body especially on the chest, back and face in women may indicate high androgens in blood stream. This is usually an indicator for PCOS in young women.

Oily skin and scalp: The hormone disruption leads to excess production of sebum in women on face and scalp causing cystic acne and thinning of hair.

Infertility: If PCOS is not diagnosed early, often infertility issues leads to diagnosing the presence of cysts on ovaries.

Based on this one can understand that although period dys regulation is a common factor in people with PCOS, there are several other criteria that may be present to indicate PCOS and warrant further examination. 

Usually two out three things are looked for, hormone abnormalities, irregular periods and radiographic investigation showing enlarged ovaries that contain multiple cysts to diagnose Polycystic Ovarian Syndrome. Understanding these other factors is necessary or the diagnosis becomes challenging.

How do some people have regular periods even after PCOS is diagnosed?

There could be several factors:

• Even with PCOS, the hormonal imbalance is variable. It may not be necessarily causing dys regulation of the hormone to effect the menstrual cycle but may present with other kinds of symptoms leading to insulin resistance or causing excessive facial hair. One thing to note is that even with regular periods, ovulation may not be regular. 
• Another factor that is to be considered is that being on oral contraceptive medication, can regulate periods even if they were not prescribed for regulating periods.
• Also with aging there is some Regularization of periods. As one passes through multiple cycles, PCOS may be persistent but menstruation can follow a 28 to 30 day cycle.

If I have regular periods does it mean that I have no issues with fertility? 

If you have regular periods with PCOS, this does not indicate or mean that there are no underlying infertility issues. 

People with PCOS who have regular periods may not even be diagnosed until they are trying to conceive. 

In most cases, PCOS does lead to some or the other fertility issues which can be managed with medical intervention.

PCOS treatment

• For a proper treatment plan, an accurate diagnosis is necessary. Understanding the different ways that PCOS can present itself thus becomes important.
• PCOS cannot be cured and the cysts on the ovaries do not go away by themselves.
• Having PCOS is linked to higher risk for getting diabetes, heart disease, and high blood pressure. Having PCOS inadvertently leads to having high insulin resistance where body cannot effectively use insulin. 
• Understanding the consequences of PCOS can help motivate an individual to make healthy lifestyle choices. This is the first line of treatment. 
• Following a healthy eating pattern with regular exercise can maintain the insulin levels without having high peaks that may further exacerbate the problems.
• A prescription of Oral hormonal contraceptives is also common for people with PCOS. 
• For acute weight gain and pre diabetes, metformin is also prescribed. 
• When these treatment options do not yield satisfactory results, surgery is performed to extract cyst contents. 

Summary

PCOS as the name indicates, is a syndrome. The symptoms vary and are presented differently in different individuals. It is true that in most people, hormone irregularities that are a consequence of having cysts on the ovaries can lead to irregular periods. However, this is simply not true for every case. Even with regular periods, taking necessary steps to reverse other associated symptoms should be a priority. Loosing weight with PCOS can be challenging but is necessary. For people who are trying to conceive, get a hormone panel and ultrasound to look for PCOS can improve chances of fertility. Taking PCOS seriously and following the protocol as suggested by a gynecologist can prevent serious health outcomes like Diabetes or heart disease. Another important thing to understand and consider is stress regulation. When you become stressed, the organs that release androgens, produce excess of them. Regulating stress with techniques like meditation, yoga, and psychiatric counselling can be beneficial.