In cases of Polycystic Ovary Syndrome (PCOS), the most common signs that alert women are irregular cycles or the complete absence of menstruation. If you’re reading this, it's likely these symptoms have led you to seek help.
Whether it’s after stopping hormonal contraception or during puberty, you’ve soon realised that not having your periods isn’t quite right. You might have found it convenient at first because periods aren’t always comfortable, but if you’re here, you’re probably hoping to restore everything to its proper state—and most importantly, to have your period every month.
Why don't you have your periods with PCOS?
To get straight to the point, you’re not having your periods because you’re not ovulating. While the explanation is straightforward, it warrants further detail so you can understand what steps you might take to regain your periods with PCOS.
Absence of periods: causes to rule out
PCOS is not the only condition that can cause the cessation of menstruation. Essential or primary amenorrhea refers to the absence of periods at puberty, while secondary amenorrhea refers to the onset of periods followed by their disappearance.
Here, we’ll focus on causes that might lead to secondary amenorrhea and which are worth ruling out before addressing your PCOS symptoms.
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Hypothalamic Dysfunction: The hypothalamus, the command centre for your hormones, might not function properly due to stress, intense activity (such as high-level sports), poor nutrition (eating disorders), or mental health issues (depression).
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Primary Ovarian Insufficiency: Premature menopause.
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Pituitary Dysfunction: Caused by head trauma, elevated prolactin levels, or a pituitary adenoma.
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Thyroid Dysfunction: Both hyperthyroidism and hypothyroidism.
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Use of Certain Medications: Such as antidepressants and antipsychotics.
To rule out these causes and conduct the necessary tests, we recommend consulting a healthcare professional.
Hyperandrogenism and its effects on the menstrual cycle
Ovulation disturbances can have various origins, but in the case of PCOS, they are generally linked to hyperandrogenism. Hyperandrogenism occurs when your body produces excessive amounts of androgens, also known as “male” hormones. Testosterone is an androgen, but others include androstenedione and DHEAS.
This excess of androgens leads to the following symptoms:
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Long or irregular cycles;
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Absence of periods;
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Inflammatory acne;
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Hirsutism (excessive hair growth);
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Androgenic alopecia (hair loss);
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Polycystic ovaries;
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Insulin resistance.
It’s important to note that androgens are naturally produced by your ovaries and adrenal glands (small glands above the kidneys), but PCOS exacerbates their production. There are three main reasons for this:
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Insulin resistance and/or hyperglycemia caused by PCOS, which stimulates androgen production.
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Chronic low-grade inflammation induced by excessive androgens, insulin resistance, and/or hyperglycaemia.
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Elevated LH levels related to the overproduction of androgens, which perpetuates the hormonal imbalance.
These three factors disrupt your menstrual cycle and frequently inhibit ovulation, leading to long, irregular cycles or a complete absence of periods.
Additional factors that can exacerbate this existing imbalance include stress, which can stimulate adrenal glands and increase androgen production, and factors such as diet, smoking, alcohol, high-intensity exercise, and lack of sleep, which can further intensify chronic low-grade inflammation and insulin resistance.
The absence of ovulation: a major event in the menstrual cycle
Ovulation is crucial as it determines the production of your hormones (oestrogens and progesterone), making it the major event of the menstrual cycle. Without ovulation, your hormonal balance is disrupted. You won’t produce progesterone, which is essential for mental health, sleep, skin, muscle, and bone health.
For ovulation to occur, the following conditions must be met:
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Produce sufficient oestrogens.
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Maintain a balanced FSH/LH ratio: LH triggers ovulation; if it’s significantly higher than FSH, it will inhibit ovulation.
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Have balanced hormonal levels : including androgens, blood sugar, progesterone, thyroid hormones, and prolactin.
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Protect your body from “survival mode” that may be triggered by intense physical or psychological stress. This “survival mode” helps your body avoid potential pregnancy, which requires substantial energy, by limiting sex hormone production. For example, women experiencing war or famine often stop menstruating. Nowadays, stress, alcohol, lack of sleep, inadequate nutrition, or overtraining can activate this “survival mode.”
How to stimulate ovulation?
As you’ve gathered, many factors can disrupt your ovulation, but the good news is there are numerous solutions to help get it back on track. However, the solutions we’ll discuss focus on lifestyle adjustments and should not replace medical intervention. We advise consulting a healthcare professional, particularly in cases of prolonged amenorrhea (> 6 months). Our suggestions can complement and optimise your medical care.
Lifestyle and PCOS: Where to start?
Many are unsure where to begin when it comes to altering lifestyle habits to improve PCOS symptoms. We suggest considering the following questions to assess and potentially identify areas for improvement. The goal is to review and identify what can be changed to enhance your quality of life.
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In which areas of your life can you easily modify your habits? (diet, exercise, stress management, dietary supplements).
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In which areas do you struggle, and who can help you with that? (doctor, midwife, psychologist, endocrinologist, naturopath, osteopath, etc.).
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What changes can you make to improve your quality of life without incurring costs?
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If you’ve had a blood test, what were the results? (high insulin resistance, elevated stress hormones, etc.).
These considerations will help you prioritise your actions and create a coherent plan to enhance your health and restore your periods.
Reducing the levels of androgen hormones
To lower your levels of male hormones, you need to address factors that exacerbate hyperandrogenism: insulin resistance, hyperglycemia, inflammation, and oxidative stress.
There are several approaches to tackle these issues:
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Diet: A low glycaemic index diet rich in proteins, complex carbohydrates, and healthy fats can reduce insulin resistance and stabilise blood sugar levels. Anti-inflammatory omega-3-rich fats, in particular, and an overall anti-inflammatory diet can reduce insulin resistance, androgen production, and general inflammation. Omega-3s also lower total cholesterol and triglycerides in women with PCOS. (1). For more details, check out our article: Nutrition and PCOS: The key rules of a diet adapted to your type of PCOS.
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Exercise: Regular exercise improves insulin resistance, lowers hyperglycaemia, and reduces the risk of cardiovascular diseases associated with PCOS. It also benefits mental health when done approximately 2 hours per week. (2).
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Digestive Health: Supporting your digestion and microbiome can also help stabilise blood sugar levels. Several studies have shown that dysbiosis (microbiome imbalance) increases insulin resistance, blood sugar levels, and inflammation. (3)
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Stress Management: Stress exacerbates inflammation, which is associated with PCOS. (4) If you have an anxious or stressed temperament and feel quickly overwhelmed, it’s advisable to work on this to balance your hormones and encourage the return of ovulation and periods.
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Sleep: Poor-quality sleep exacerbates memory issues, fatigue, anxiety, inflammation, and blood sugar fluctuations. (5) Sleep apnoea is a common sleep disorder in women with PCOS. If you suspect you have it, consult for diagnosis and appropriate solutions. For insomnia, awakenings, or unrefreshing sleep, consider adjusting your bedtime routine (less screen time, relaxation, lighter meals).
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Dietary Supplements: Numerous supplements are available, with Inositol, omega-3s, magnesium, zinc, and vitamin D being particularly notable. We’ll delve into these in the following section.
What supplements and medications can help you get your periods back?
To get your periods back, it is often beneficial, and sometimes even necessary, to give your body a helping hand. The use of hormonal contraception, exposure to endocrine disruptors, nutrient depletion in soils, or even stress can lead to vitamin and mineral deficiencies.
Micronutrition
D-chiro-inositol combined with Myo-inositol helps to lower insulin levels, androgen hormones, and the HOMA index. This combination also increases SHBG (Sex Hormone Binding Globulin) levels, which helps regulate and balance your hormones. Additional studies have shown that myo-inositol supplementation improves ovulation rates and menstrual cycle frequency. (6) These two nutrients are found in our supplement, Ovastart, combined with zinc.
Zinc reduces insulin resistance, total cholesterol, and triglyceride levels. It also helps to decrease androgen hormones that disrupt ovulation in women with PCOS. This micronutrient is an excellent antioxidant that promotes ovulation and helps regulate the menstrual cycle. (7)
Vitamin D is particularly important for women with PCOS, as about 70% of them are deficient in it. Vitamin D encourages ovulation, lowers testosterone and LH levels, and improves insulin resistance. (8)
Omega-3 fatty acids help reduce insulin resistance as well as cholesterol and triglyceride levels. A six-month Omega-3 supplementation can lead to more regular periods, likely due to a reduction in testosterone levels. (10)
Magnesium reduces anxiety and modulates the hypothalamic-pituitary axis, which, under the influence of stress, can disrupt your hormonal balance and block ovulation. (11) If you often feel stressed and anxious, you might want to start with this supplement, which is easy to take.
Herbal Medicine and Gemmotherapy
Shatavari appears to improve hormone imbalances caused by stress. An Ayurvedic treatment containing Shatavari has been shown to help 62% of women with PCOS and infertility conceive within three months. Shatavari may thus encourage ovulation and the return of menstruation. (12)
Fenugreek taken over three months may reduce ovarian size, the number of follicles in each ovary, the LH/FSH ratio, and help restore regular cycles in women with PCOS. (13)
Raspberry bud extract is a hormone regulator that balances oestrogen and progesterone secretions. Its regulating action corrects female hormonal disorders, including PCOS, and may help reduce hirsutism. It may also stimulate ovulation and thus the menstrual cycle by acting on the hypothalamic-pituitary axis (the hormone control centre). It is generally taken for three weeks each month at a dose of five drops, three times a day. However, it is not recommended for those with hormone-dependent cancers.
Medical Solutions
Antidiabetic medications: These drugs, typically used to treat type 2 diabetes, can be prescribed to women with PCOS to improve insulin sensitivity. They help encourage ovulation and the return of menstruation by reducing insulin resistance.
Ovulation-inducing treatments: These medications can help restart ovulation but are mainly prescribed in cases of assisted reproduction and when there is a desire for pregnancy. (14)
How do you know you have genuine periods?
Your periods may occur with some regularity, such as every two months, without ovulation taking place: this is known as withdrawal bleeding. Your body essentially resets in an attempt to ovulate again.
This is a normal and quite common process in women with PCOS, and you may go through this phase before regaining ovulation and a regular cycle.
To determine if your period is genuine, you need to ascertain whether you have ovulated or not. For this, we recommend observing your cycle using the symptothermal method.
Taking Your Time and Getting Support
Getting your periods back may take time as many factors come into play: insulin resistance, hyperandrogenism, inflammation, stress.
Give yourself time to gradually change your habits and reach this goal. If you find it difficult, don't hesitate to seek help and get support in this process!
Références scientifiques
