Can you have PCOS with regular periods? Your top questions, answered by the Women’s Wellness Centre

We recently asked the Instagram TTC community what they wanted to hear more about and the resounding response was Polycystic Ovary Syndrome (PCOS). For those who may not be aware, PCOS is a health problem which affects approximately 1 in 10 women. That’s huge!

With so many of you wanting to know more about how it can be treated and how it can affect fertility, we’ve spoken to the brilliant Fertility Specialist, Dr Despina Mavridou at The Women’s Wellness Centre in London, to find out all about it and the latest development in the treatment of PCOS. She also talks about when to seek fertility advice and help.

The Women’s Wellness Centre in London have the most resourceful and supportive free Facebook group, which we would strongly recommend you join.

Over to Fertility Specialist, Dr Despina Mavridou.

Your one-stop PCOS Q&A

Here’s the key thing to understand about PCOS: it’s a syndrome. That means it’s not just one issue, but a cluster of symptoms that tend to show up together. PCOS doesn’t affect a single body part or stem from one specific malfunction – it shows up across multiple systems in the body, making it a complex condition to manage.

PCOS is typically diagnosed when someone has either irregular or infrequent periods, signs of high androgen levels (like acne or excess hair growth), and/or ovaries that appear polycystic (meaning multiple cysts are visible) on an ultrasound scan – remember, you may not have all of these symptoms.

There are also several health conditions that more commonly show up alongside PCOS, including:

• endometrial hyperplasia
• insulin resistance and diabetes
• endometrial cancer
• cardiovascular disease

Wondering if you can have both PCOS and endometriosis? You’re not alone. These two conditions can co-occur – and it’s worth understanding how they overlap.

What are the symptoms of PCOS?

Because PCOS affects multiple systems in the body and involves a complex web of hormonal pathways, it can be tough to sum up neatly – especially in a short consultation. The symptoms women experience are often wide-ranging, making the condition feel even more confusing.

If you’re noticing any signs that feel off, or if you’re TTC (trying to conceive) or thinking about it soon, it may be worth seeking help from a fertility specialist to explore what’s going on.

How is PCOS diagnosed?

There are agreed diagnostic criteria for PCOS. In order to receive a diagnosis, two out of three symptoms need to be present – keep reading for what these are.

That said, many women don’t tick every box – and as a result, they may remain undiagnosed or misdiagnosed for years. If any of the symptoms above feel familiar, don’t hesitate to ask your doctor to evaluate you for PCOS.

Getting diagnosed early – ideally during your reproductive years, not just when you’re trying for a baby – is important. That’s because PCOS doesn’t just affect fertility. It can also increase your risk of long-term health issues like type 2 diabetes, cardiovascular disease, and even certain cancers. Later in this guide, we’ll get into how PCOS may require fertility treatment if you’re TTC.

Can you have PCOS with regular periods?

Short answer: yes. PCOS is diagnosed when two out of three key symptoms are present:

• Irregular periods (or no periods at all)
• Elevated levels of androgens (think acne or hirsutism)
• Polycystic-looking ovaries on an ultrasound scan

So, can you have PCOS with regular periods? Absolutely – because a diagnosis doesn’t require all three signs to be present. You might have a completely regular cycle, but still meet the other criteria.

What is androgen excess?

Androgens are hormones typically found at higher levels in males. In women with PCOS, these hormone levels are usually lower than in men but still higher than in women without the condition.

This hormonal imbalance is what causes many of the visible symptoms of PCOS. The most common signs of androgen excess? Hirsutism and acne. Hirsutism refers to excessive hair growth in areas where women don’t typically grow much hair – like the face, upper lip, abdomen, or back.

How common is PCOS?

PCOS is the most common endocrine disorder affecting women of reproductive age. It’s estimated that around 5-10% of women have PCOS, making it the leading cause of infertility in those experiencing ovulatory issues.

Broadly speaking, there are four main causes of subfertility:

• Male factor
• Unexplained infertility
• Anatomical and tubal factors
• Ovulatory problems (which includes PCOS)

Read more: Male factor infertility and improving sperm health after a poor semen analysis

Is PCOS hereditary?

While PCOS has multiple contributing factors, there is a clear genetic component to its aetiology (underlying causes).

It is strongly linked with type 2 diabetes, which itself has hereditary patterns. In fact, populations with a higher prevalence of type 2 diabetes also tend to have a higher prevalence of PCOS.

PCOS is also more commonly observed in South East Asian populations.

What causes PCOS?

Unfortunately, it’s complicated. There’s no definitive answer yet on what causes PCOS. The good news? Ongoing research is steadily uncovering more. While there are several theories, no single cause has been confirmed.

Let’s unpack a couple of the most common, to give you a starting point.

Theory 1:

Intraovarian increased androgen concentrations are often seen in women with PCOS. This means there are more follicles in the ovaries compared to women without PCOS, at the same age. Usually, this happens because ovulation isn’t occurring regularly. So follicles, in a way, don’t want to ‘come out’.

Theory 2:

The two-cell theory looks at how oestrogen and androgen are produced in the ovary. In PCOS, luteinizing hormone (LH) levels are much higher, which leads to more androgen production in the ovaries. PCOS is also associated with insulin resistance, which can further impact androgen levels.

Ultrasound findings & PCOS: What you might see (and what it all means)

At a typical scan, you’ll often spot one dominant follicle in the ovary. In very basic terms, we can see this as the ‘chosen one’, which usually continues to grow and releases an egg. After ovulation, what’s left behind is called the corpus luteum.

The number of follicles seen on an ultrasound can give insight into your ovarian reserve, and this is something best assessed by a fertility specialist. Some people, especially those in their 20s, may have ovaries that look polycystic (with lots of follicles) without actually having PCOS. Often, this just means a naturally high ovarian reserve.

Your AMH (Anti-Müllerian Hormone) level, produced by those follicles, also reflects ovarian reserve. Again, this is something a specialist should interpret.

Some women with high AMH levels may have a high ovarian reserve or possibly PCOS. Because of this, AMH has been suggested as a potential extra marker for diagnosing PCOS, though it’s not officially part of the criteria yet.

Lastly, it’s important to rule out other hormone-related issues, like thyroid disorders or hyperprolactinaemia (a condition where prolactin levels in the blood are too high), which can cause similar symptoms.

Is PCOS linked to low oestrogen or early menopause?

PCOS and early menopause are totally separate conditions, but they can sometimes share similar symptoms, which is where the confusion comes in.

Interestingly, women with PCOS usually have a higher-than-average ovarian reserve, which means they tend to reach menopause later than those without PCOS.

In fact, on ultrasound, women with PCOS who are nearly 40 often have ovaries that look more like those of someone in their 30s, based on follicle count. That said, this always needs to be properly assessed by a specialist before any diagnosis is confirmed.

How does PCOS impact fertility?

So, PCOS typically disrupts regular ovulation. Without the release of an egg, fertilisation and implantation cannot occur.

Let’s take an example. In a 20-year-old with PCOS who ovulates just 3-4 times a year, natural conception is still possible (likely, even) with regular sexual intercourse, because the chance of conception per ovulation (fecundity) remains relatively high.

However, for women in their late 30s, this window of opportunity may be narrower. It’s important to have ovulation patterns assessed by a fertility specialist over time, especially when trying to conceive.

Can lifestyle changes influence ovulation?

Yes. In many cases, the frequency of ovulation can be improved through lifestyle adjustments. For example, a woman with PCOS and a BMI of 40 who adopts nutritional and exercise changes may experience the return of regular periods and ovulation. This can even reverse the PCOS diagnosis. However, outcomes vary based on the severity of the condition, and improvement is not guaranteed in every case.

Why it’s important to detect PCOS early

Early detection of PCOS offers more options. When diagnosed in their earlier reproductive years, women can work with their doctor to plan not only for future fertility and family-building, but also for the long-term management of PCOS itself.

PCOS is linked to a higher risk of metabolic syndrome, type 2 diabetes, and cardiovascular disease, and ongoing screening and general health promotion with a healthcare can be pivotal. A multidisciplinary approach, including tailored nutrition, movement, and health strategies, is key to managing PCOS effectively. Connect with The Women’s Wellness Centre for a deep dive.

The goal isn’t just to support conception, but to promote healthy pregnancies and long-term wellbeing. By reducing chronic health risks, we aim to help women age well and enjoy life with their children.

Treatment of PCOS for fertility

Inducing ovulation

The primary medical treatment for inducing ovulation in PCOS is clomiphene (commonly known as Clomid), an oral medication. Clomid stimulates ovulation in women who do not ovulate and encourages the development of multiple follicles in those who do.

Another effective treatment is letrozole, an aromatase inhibitor also used in breast cancer treatment to reduce oestrogen production in oestrogen-sensitive tumours. Letrozole works by supporting the hormonal environment needed for ovulation.

So, which is better – Clomid or Letrozole? Research suggests that letrozole leads to higher live birth rates than Clomid, has fewer side effects, and carries a lower risk of multiple pregnancies.

Although concerns have been raised about a potential link between letrozole and birth defects, studies have consistently found no significant increase in risk. Letrozole is considered safe and is now widely used.

Next steps (if oral medications don’t work)

If ovulation doesn’t occur with Clomid or Letrozole, the next line of treatment usually involves injectable gonadotropins (FSH analogues). These are often used as part of timed intercourse or intrauterine insemination (IUI) protocols.

While effective, FSH injections carry a higher risk of multiple follicle development, and therefore multiple births. This is particularly relevant for women with PCOS, who can experience a rapid increase in follicle formation once a certain hormonal threshold is reached. That’s why treatment must be closely monitored by ultrasound, and dosage adjustments are often needed throughout the cycle.

What if the follicles over-respond?

In some cases, if the ovaries respond too strongly and too many follicles develop, it may be unsafe to trigger ovulation. At this point, the treatment plan can shift to in vitro fertilisation (IVF). In IVF, all follicles are collected and fertilised outside the body, and only one or two embryos are transferred, significantly lowering the risk of multiples.

Managing PCOS and fertility isn’t just about getting pregnant. It’s about supporting your whole health, now and in the future. Whether through lifestyle changes, medication, or assisted fertility treatments, the right support plan is personal, and can be powerful.

If you suspect PCOS or are struggling with irregular cycles and fertility, speak to a specialist early. With the right clinical guidance and a proactive approach, many women with PCOS go on to conceive and thrive.

PCOS and gynaecological cancer

Research shows that women with PCOS may be at a higher risk of developing endometrial cancer (cancer of the womb lining).

In PCOS, the follicular phase (the first half of the menstrual cycle) tends to be longer than normal. This means oestrogen builds up in the body over an extended period without being balanced by progesterone. Ovulation often doesn’t occur, so there’s no corpus luteum (the structure that normally forms after ovulation to produce progesterone).

Without progesterone, oestrogen is left “unopposed”, which causes the endometrium (the lining of the womb) to thicken continuously. Over time, this unregulated thickening can increase the risk of endometrial hyperplasia – a precursor to endometrial cancer.

How is endometrial cancer or hyperplasia tested?

If your doctor suspects endometrial hyperplasia or cancer, usually based on ultrasound findings and your medical history, they may recommend an endometrial biopsy. This can be done in the clinic and is a key tool for diagnosis.

Can endometrial hyperplasia be treated?

Yes. If caught early, endometrial hyperplasia is usually very treatable. It’s often managed with high doses of progesterone, which help to regulate the growth of the endometrial lining. There are also other ways to protect the endometrium, especially in women with PCOS, so early discussion and monitoring with a healthcare provider is essential.

Weight and PCOS – cause or symptom?

Weight gain doesn’t cause PCOS, but it can make symptoms worse. Obesity is a known exacerbating factor, and for some people, lifestyle changes can help manage this. Not every woman who is overweight will have PCOS, and not everyone with PCOS is overweight, so personalised medical advice is key. Speak to your doctor to get guidance that’s right for you.

Is it harder to lose weight with PCOS?

Losing weight is hard, full stop. But for women with PCOS, it’s often harder still, because of the hormonal and metabolic factors involved.

That’s why support and structure matter. At The Women’s Wellness Centre, we encourage a focus on nutrition, especially understanding the types of carbohydrates you’re eating, cutting back on processed foods, and lowering your sugar intake. Tracking your meals and building sustainable habits can make a real difference.

Is specific medical treatment available?

Metformin is the medication most often discussed when it comes to PCOS and weight loss, but it’s also one of the most mis-prescribed. PCOS itself is commonly misdiagnosed, so it’s essential to get a clear, accurate diagnosis before starting any treatment.

Originally used to treat type 2 diabetes, metformin was later found to support ovulation in some people with PCOS, likely due to the overlap between PCOS and insulin resistance/type 2 diabetes. That sparked a lot of enthusiasm in the early 2000s.

But more recent research suggests that diet and lifestyle changes are pivotal for managing PCOS symptoms, especially in terms of long-term health. When it comes to fertility, clomid has also been found to be more effective than metformin for ovulation induction.

If you’re looking to optimise your fertility, it’s worth reading up on the ideal BMI range and how it connects to reproductive health.

PCOS in pregnancy – are there any affects on the baby?

A 2018 study looked at how high AMH levels in pregnant mice with PCOS might influence the development of their foetus – and whether this could play a role in the onset of PCOS later in life.

Researchers found that the offspring developed PCOS-like reproductive and endocrine traits in adulthood. But when they introduced GnRH antagonists to block these effects during pregnancy, the adult mice developed normally, without PCOS traits.

This opens the door to a potential new therapeutic option in the future.

Wrapping it up

That completes our big PCOS Q&A, featuring expert insight from Dr Mavridou. Connect today and book a consult for super-specific support.

Don’t miss out – join The Women’s Wellness Centre’s free Facebook group to keep learning and chatting.