For some, irregular periods are a struggle. You never know when you are going to get your cycle. When it does come it is usually heavy, with clots or cramps, and it can last 2-4 weeks. A large proportion of women with irregular menses (medical term for periods) have a disease process called polycystic ovarian syndrome (PCOS). “Poly what now?” you may say… Let’s break it down.
In a regular menstruating woman, the brain, ovaries, and uterus have a synchronous relationship. Hormones are secreted from the brain, causing the ovaries to release estrogen and progesterone (by way of a normal ovarian cyst), which in turn create a plush uterine lining. If there is no pregnancy, this lining is then shed, which is your period, triggered by an abrupt drop in the ovarian hormones. The cycle then starts again. In PCOS, however, this communication is disrupted. There is an abundance of testosterone and estrogen, and this throws off the brain- ovarian- uterine cycle, which in term leads to irregular periods. Essentially, there is an unopposed exposure to estrogen, and this leads to continuous stimulation on the uterine lining. The ovaries secrete low levels of estrogen but never cycle, and the cysts that form never rupture- leading to the name “polycystic ovarian syndrome.” The once plush lining becomes overgrown and irregular. This leads to the irregular and heavy bleeding.
What time is it? Infographic time!
Women who struggle with PCOS also are at risk for other things. You could be overweight, have increased hair growth, and may be at risk for something called “metabolic syndrome”. The weight contributes to the abnormal hormonal balance, and the hormonal imbalance contributes to the weight. Fat cells, or “adipose” contribute to estrogen and testosterone production (hence the hair growth). Also, women with PCOS (even the 20% who are normal body weight) tend to be prone to diabetes, heart disease and cholesterol abnormalities.
Don’t lose hope. First and foremost, exercise and diet are key. Women who lose only 5% of their weight notice considerable improvement in their symptoms. That means if someone clocks in at 250 pounds, they only have to lose about 12 pounds to help drastically improve their quality of life. That being said, it can be challenging to change your lifestyle, diet and habits. During this transition, there are options to help regulate your cycle and help protect against heart disease/ diabetes. If fertility isn’t an imminent concern, birth control is one of the best options to regulate your cycle. It controls the excess hormones and regulates your cycle. Metformin (a drug used for diabetes) can also help control insulin resistance caused by PCOS.
If a woman is ready for child bearing, the biggest challenge is timing ovulation (egg release). Because the cycles are irregular, usual ovulation predictor apps or symptom trackers are hard to rely on. The most common medication to help stimulate ovulation is a pill named Clomid. As with anything, there are risks involved, and not everyone is a good candidate for this medication.
If your cycles are wildly irregular or unpredictable, or your symptoms correlate with some of those discussed here, it is a good idea to discuss the evaluation for PCOS with your physician. There are significant health consequences if this is left untreated. Keep in mind though, that this is a very manageable and treatable disease.