According to a 2017 study, pain is the most frequently reported symptom of PCOS. Even though pain is not a symptom of PCOS!
The solution to this paradox is that both PCOS and period pain are common, so it’s easy to have both a PCOS diagnosis and period pain (including pain due to endometriosis).
That’s true whether the PCOS diagnosis is valid (i.e., there are symptoms of androgen excess) or invalid (i.e., the diagnosis was mistakenly based on an ultrasound finding).
PCOS cannot be diagnosed by ultrasound
Having polycystic ovaries does not mean you have the hormonal condition PCOS. It does not mean anything at all. Why? Because polycystic ovaries are follicles or eggs, which are normal for the ovaries.
👉🏽Tip: You have more eggs when you’re younger, so you’re more likely to have “polycystic ovaries” when you’re younger. “Polycystic” really just means “many eggs,” and more specifically, it means there is no evidence of ovulation in that cycle (and therefore no dominant follicle)—but says nothing about how likely ovulation will be in a future cycle. In fact, ovulation is very likely in a future cycle because many women outgrow PCOS.
Polycystic ovaries can show up on an ultrasound when:
- you’re perfectly normal,
- you have hypothalamic amenorrhea,
- you have the hormonal condition PCOS, or
- you have a gynecological condition such as endometriosis, adenomyosis, or any number of other issues that cause pain.
👉🏽 Tip: Polycystic ovaries are different from ovarian cysts, which are abnormal structures that can burst and cause pain. Ovarian cysts are not polycystic ovaries.
PCOS is a whole-body hormonal (endocrine) condition
PCOS is the endocrine condition of having high androgens or male hormones—when all other causes of high androgens have been ruled out. It’s not a gynecological disease affecting the female reproductive organs.
Effective treatment for PCOS is to lower androgens with strategies such as metformin, spironolactone, and cyclic progesterone therapy. For natural treatment ideas, see Chapter 7 of Period Repair Manual and Treatment for 4 types of PCOS and note that some PCOS treatments will coincidentally improve mild period pain (even though they weren’t prescribed for that) but can usually do nothing for severe pain.
The first step to finding effective pain treatment is identifying the cause of pelvic pain. Then treat that.
Possible causes of pelvic pain include:
- primary dysmenorrhea (normal period pain)
- ovarian cysts
- interstitial cystitis
- STDs and PID
- pelvic floor dysfunction
- digestive problems.
If your period pain is “normal period pain,” it should respond to simple treatments such as zinc and a dairy-free diet. If it doesn’t respond to those simple treatments, it’s not “normal period pain”— it’s severe pain, possibly due to endometriosis, and you should see your doctor.
Finally, yes. The pill can suppress the symptoms of both PCOS and period pain, but it cannot fix either problem.
Ask me in the comments.