My periods are irregular, and someone said it might be PCOS

Polycystic ovary syndrome is a hormonal pattern, not an ovary problem. The ovaries make a little more of the male-type hormone than they should, the signal to release an egg each month becomes unreliable, and the body handles insulin less well than it might. Those three things, in different mixes, produce the symptoms: irregular or absent periods, hair and skin changes, weight that is hard to shift, and difficulty conceiving because an egg is not released every month.

The “cysts” on the scan are not cysts at all. They are small follicles, eggs that started to grow and stopped, and many women with perfectly regular cycles have them. A scan alone does not make the diagnosis. Two of three things are needed: irregular ovulation, signs of the male-type hormone (on your skin or in your blood), and that scan picture. One of the three is not PCOS.

Irregular periods have other causes too, and they are looked for before the label is applied: thyroid, prolactin, stress and weight change, the years after coming off contraception, and the years before menopause.

The story first. When your periods started, how they have run since, when they changed. Hair, skin, weight, over time. Whether you are trying to conceive now, would like to later, or would rather not think about it yet, because the plan is different for each. Any previous scans or blood tests, which you should bring.

Then an examination, and a scan of the ovaries and the uterine lining. Blood tests where they will change the plan: the hormones behind the pattern, thyroid and prolactin to rule out the look-alikes, and a sugar and lipid check, because PCOS is also a metabolic condition and that is the part that matters for the next thirty years.

You leave with a clear answer to “is it PCOS?”, and if it is, with a plan that starts from what you want.

What is tried first depends on which of three things you want most right now: regular periods, the hair and skin, or a baby. They are all treatable and they are not all treated the same way.

• Weight and movement, if weight is part of it. A modest change, around five percent of body weight, is often enough to bring periods back and restart ovulation. This is said gently and it is said every time, because it is one of the most effective treatments there is, and because it is not the same as being told to “lose weight”.
• For regular periods. Where you are not trying to conceive, a hormonal pill or a cyclical progesterone brings the cycle back, protects the lining of the uterus, and usually helps the skin. Which one, and whether you need one at all, depends on how irregular the periods are.
• For hair and skin. Time, first: hormonal treatment takes six months to show on skin and longer on hair. Local treatment alongside. Laser is for after the hormones are settled, not instead of them.
• For the sugar side. Metformin, where the tests show the body is handling insulin poorly. It is not a weight-loss tablet and it is not for everyone with PCOS.
• For a baby. Tablets to help an egg release, letrozole usually, followed by scans to see whether they worked. Most women with PCOS who are not ovulating respond to the tablets, and for many that is the whole treatment. The fertility page picks up from there: Trying to conceive.

You have not had a period for three months. Come. Three months without a period is the point at which the lining of the uterus needs protecting, and it is easily done. Do not wait for it to sort itself out.

You were diagnosed years ago and told “come back when you want a baby”. Come now. The years in between are when the sugar and lipid side is either watched or ignored, and they are the years that decide how easy the baby part will be.

You are getting married, and your mother is worried. Bring her, or come alone and take the answers home. PCOS does not mean you cannot have children. It means an egg is not released reliably, and that is one of the most treatable problems in fertility.

• No period for three months
• Bleeding that is heavy or lasts more than a week when it does come
• Hair or skin changes that have come on quickly, over months rather than years
• Trying to conceive for six months with irregular periods, at any age
• A strong family history of diabetes

Rarely. Where tablets have not brought ovulation and IUI is being considered, a small keyhole procedure on the ovaries is sometimes discussed, and its place is explained honestly: it is an option, not a routine. You are told who will do it and where, before anything is booked.