My cycles are very irregular. Do I have polycystic ovary syndrome?

It’s ovulation that makes the menstrual cycle regular. The cycle is irregular or the period stops when ovulation is seldom or doesn’t occur at all. Polycystic ovary syndrome (PCOS) is the most common ovulation disorder. It affects 8 to 13% of reproductive-aged women. PCOS is a heterogeneous syndrome, and its features range from mild to severe. The diagnosis is based on specific criteria that have been updated in a recent international guideline*:

1. Irregular menstrual cycles
• Adult women: < 21 days or > 45 days or < 8 cycles per year
• Adolescent: < 21 days or > 45 days and/or no period (primary amenorrhea by age 15.
• > 90 days for any one cycle and/or

2. Signs of elevated male hormones (hyperandrogenism)
• Excess of body and facial hair (hirsutism)
• Acne (in adolescent: severe acne only)
• Progressive hair loss (alopecia)
• Elevated male hormones in the blood and/or

3. Polycystic ovarian morphology on transvaginal ultrasound
• Presence of >20 follicles per ovary (the famous “cysts” that are in fact the structures containing the eggs). This criterium should not be used <8 years after menarche, the ovaries of adolescent and young women being particularly rich in follicles.

PCOS is diagnosed if at least 2 out of 3 criteria are present.

In addition to ovulatory dysfunction, women with PCOS are at increased risk of cardiovascular disease and diabetes. Most of them also suffer of excess body weight or obesity, which are promoted by the hormonal imbalance, and further increase the risk of metabolic disorders.

Can PCOS be treated?
Yes. Unless you want to get pregnant, the best treatment is a birth control pill. It will reduce the hormonal imbalance. Metformin, an insulin sensitizer, helps with weight loss and reduces metabolic problems. If you want to get pregnant, an ovulation induction medication will be prescribed. Healthy lifestyle and weight control will reduce risk factors and are advisable in any case.

If it’s not PCOS, what can cause an irregular menstrual cycle?
A significant stress, physical or psychological, as it is the case in anorexia or highly competitive athletes. If being overweight has become a society concern, we see more and more often young women following restrictive diets, with the idea of “eating healthy” or to meet the obsession of thinness carried by the medias. In this case, the lack of fatty tissue and the unbalanced energy expenditure promote the arrest of the menses. Less common causes are hyperprolactinemia and premature ovarian insufficiency.

The reproductive medicine specialist can prescribe the appropriate tests to establish the diagnosis, and propose the most appropriate treatment.

*International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018.