Is It PCOS or Hypothalamic Amenorrhea (Undereating)?

PCOS versus hypothalamic amenorrhea.

What is the difference between polycystic ovary syndrome (PCOS) and hypothalamic amenorrhea?

PCOS is the condition of androgen excess when all other causes of androgen excess have been ruled out. It can also cause irregular periods.

Hypothalamic amenorrhea (HA) is the loss of periods due to undereating. It can also present with mild acne, facial hair, and polycystic ovaries.

The two conditions are similar enough that your doctor might mistakenly say you have PCOS when you actually have hypothalamic amenorrhea.

Is it PCOS or hypothalamic amenorrhea?

Here’s a summary of the similarities and differences.

PCOSHypothalamic amenorrhea
absent or irregular cycles absent or irregular cycles
polycystic ovaries polycystic ovaries
hirsutism and elevated androgens possible mild hirsutism
normal or high fasting insulin low fasting insulin
thickened uterine lining thin uterine lining
bleed from progesterone challenge no bleed from progesterone challenge
mild risk of bone loss significant bone loss
few periods when first stopping the pill no periods when stopping the pill
any age but can outgrow itmore likely under 30 but any age
high LH to FSH ratio low LH to FSH ratio

Do you notice that polycystic ovaries can occur with both PCOS and hypothalamic amenorrhea? That’s why PCOS cannot be diagnosed by ultrasound. In fact, relying on an ultrasound can result in hypothalamic amenorrhea being misdiagnosed as lean PCOS. And that’s a problem because the treatment for PCOS is to eat less while the treatment for hypothalamic amenorrhea is to eat more!

The simplest way to distinguish between PCOS and hypothalamic amenorrhea is to look at the ratio between luteinizing hormone (LH) and follicle-stimulating hormone (FSH). When measured on day 2 of the cycle (or random day if there is no cycle), the LH to FSH ratio is high in PCOS and low in hypothalamic amenorrhea. LH increases with age so there is no “perfect” value for LH. What matters is how high or low it is compared to FSH.

Luteinizing hormone or LH to diagnose PCOS versus hypothalamic amenorrhea.
Luteinizing hormone (LH) is high with PCOS and low with HA.

3 steps to diagnose PCOS

Step 1. Are there excess androgens or male hormones? For example, are androgens elevated on a blood test or is there significant hirsutism (facial hair)? If not, it’s not PCOS because PCOS is the condition or androgen excess when all other causes of androgen excess have been ruled out.

Step 2. Have other causes of excess androgens been ruled out? One common cause of androgen excess is congenital adrenal hyperplasia, which accounts for up to 9 percent of cases of androgen excess and is frequently misdiagnosed as PCOS.

Step 3. Determine the type of PCOS and treat the main underlying driver. Read 4 types of PCOS (a flowchart).

It is also possible to have both hypothalamic amenorrhea and PCOS. In that case, the strategy is to first eat more to recover from hypothalamic amenorrhea and then treat the androgen excess.

Ask me in the comments.

365 thoughts on “Is It PCOS or Hypothalamic Amenorrhea (Undereating)?”

  1. Hi Dr. Briden,

    Do you have more information on how hirsutism can manifest in HA? I’d like to learn more about that. I have a history of anorexia so I’m all too familiar with HA, but I resumed regular cycling while firmly in recovery… until last year, when stress caused me to lose weight and my cycles significantly lengthened, and it was clear I wasn’t ovulating consistently. I assumed PCOS because I developed acne and facial hair on my upper lip, but I just got labs back and all my androgens are low. Insulin was just on the high side of normal and blood sugar okay. Now I’m wondering if it’s HA, not PCOS… but the hirsutism is really puzzling.

    Thanks so much for all you do.

  2. Hello- Is it PCOS if I have high LH but normal androgen levels (LH 20.4, FSH 4.9, measured day 2 of a 60 day cycle)?
    I have mild acne on jaw, no other physical symptoms of androgen access.
    Should I test insulin resistance even if no androgen excess?
    Could it still be Hypothalamic Amenorrhea even if I have high LH?

    I am 33, 60 day cycles. Always had irrgeular cycles but the long cycles are new in last 3 years. I am currently treating SIBO and on low FODMAP diet. Always been skinny, can’t gain weight, and tend to be tired. Gyno diagnosed PCOS.

    Remaining blood results (day 2 of cycle):
    oestradiol is 142,
    prolactin is 120,
    T4 is 16.2,
    TSH is 1.47,
    androstenedione is 2.7,
    DHEA is 2.2,
    SHBG is 94,
    testosterone is <0.5 nm per litre
    Thyroid tests in past have been normal.

    Thank you for all that you do for women!

  3. Hallo my Name is Nikki. I went of the pill and my last period was November last year and still no period? How long can a person wait for a period to return after the pill?

    thank you

  4. Hi Dr Briden,

    Is it possible to have long term hypothalamic amenorrhea? I was diagnosed with PCOS two years ago when I was quite underweight. The lowest I have been in the past two years was 46kg due to anxiety. I’m managing my anxiety now but it has been a problem my whole life and I have always been very slim. I read your article and now I’m doubting that I have PCOS

  5. Hi Lara,
    I have been experiencing extremely light and irregular periods—the disruption began sometime in October, as late September was when I had my last normal period. Due to limited healthcare available in my area I haven’t gotten an LH:FSH test or androgen test yet. I don’t have hirsutism or acne and was told my ultrasound looked normal but I do have hairloss. I accidentally lost about 9 lbs over the past year and a half and had a breakup and some personal drama over the summer, so ive been told to suspect FHA. I also have very persistent bloating and constipation and went through a period of weird hunger cravings and feeling cold all the time.
    My question is, how should I eat while I’m waiting for the tests to rule out PCOS? I don’t want to undereat because that will make it worse if it’s HA but I don’t want to gain weight if it’s PCOS. Thanks

  6. Hi Dr. Briden, I have a 2:1 LH to FSH ratio. I was wondering if that can ever be “normal”– it was tested 5-7 days after ovulation during my luteal phase (I did ovulate). Is that not the best time to test LH/FSH? Thank you so much for any help!

  7. I am so sorry but, hypothalamic amenorrhea is not related just to undereating. i have HA but I have actually gained weight, and used to have normal period and no cysts being lighter. STRESS, traumas and NOT SLEEPING, can be a very powerful triggers for HA. Cortisol can shut everythin off.
    stop saying that evrybody with HA is undereating… maybe they have intestinal issues and they do not absorbe nutrients in a proper way.

  8. Hi Lara

    Sorry to bother you. I have a question i would love you to answer.

    Came off pill after 10 years nov 2020 and no period. No other symptoms.

    Confirmed on USS and bloods (high androgens) that i have PCOS.

    I am very active and eating about 1800 cals a day. And have tracke food macros iver past 5 years pretty consistent.

    Although i appear to have a high LH to FSH ratio could i still have HA? (Attachdd are my bloods in april 2020 and repeat in august 2020)

    Values and Investigations (Latest Value)
    26-Aug-2021 Serum cortisol – (HMA) – Normal – No Action 384 nmol/L 133.00 – 537.00nmol/L
    Reference range applicable to morning samples collected
    between 6-10am.
    26-Aug-2021 HbA1c levl – IFCC standardised – (HMA) – Normal –
    No Action
    32 mmol/mol
    Adults (>=18 years of age)
    Tight Glycaemic Control* HbA1c <48* mmol/mol
    Good Glycaemic Control HbA1c =59 mmol/mol
    *Increased risk of significant hypoglycaemia with tight control
    Children and Adolescents (<18 years of age)
    The typical therapeutic target for Children and Adolescents
    is 48mmol/mol (WHO2011)
    26-Aug-2021 ! ANDROGENS – (ZH) – Suggestive of PCOS
    Note raised androgens. ? suggestive of PCOS
    despite normal FAI.
    Serum sex hormne binding glob 89 nmol/L 32.00 – 128.00nmol/L
    ! Serum androstenedione 7 nmol/L <6.00nmol/L
    FREE ANDROGEN INDEX (MS) 3.1 0.00 – 4.50
    ! TESTOSTERONE (MS) 2.8 nmol/L 30
    Serum LH level 13.8 iu/L
    Serum FSH level 5.7 iu/L
    26-Aug-2021 Plasma fasting glucose level – (HMA) – Normal – No
    4.6 mmol/L 3.00 – 6.00mmol/L

    Im convinced thats more of a problem.

    I have just started clare goodwins PCOS protocol and via questionnaire came out as ‘suspected type 1 (insulin resistance)’ but suspected,

    Should i increase cals to 2500 and treat as HA frist then deal with high androgens?


  9. Everything in my labs looks normal except FHS. I’m not ovulating and my doctor says it’s PCOS but I don’t have insulin resistance or high androgens.
    I am underwaight and a pesquetarian.
    Is there an article or something I can use as information to lower my FSH? I’m reading the book 🤗
    Thank you!

  10. Hi Lara,

    Thanks for the article. How do you determine if you have a low or high LH to FSH ratio? What are the ranges of the ratios?

  11. Is a low LH to FSH ratio always consistent with HA? Or can it vary? Because most of my symptoms seem to line up more with HA, but my LH to FSH ratio is that of PCOS. My free testosterone was borderline low, and only my DHEA-S are slightly elevated (though still in normal range). My other hormone levels seem pretty normal, but my uterine lining only got up to about 7.5.
    I managed to regulate my cycles not sure if it was better diet or the inositol. Then I recently missed my period about 3 months after cutting too many calories and over working my body in the gym. Now been dealing with light brown spotting for like a week ): Anyone else deal with this ?

      • Thank you for your reply. I’ve had it tested twice, the first time they tested me in the middle of my period . The second time they tested, my period came a day later . My cycle has been pretty irregular for some years now so it’s kind of hard to find the right time to test

      • Thanks for your reply. Ive had it tested twice. THe first It was day 3 of my cycle I believe. Another time it was tested, my period came the day after

  12. Dear Dr Briden,

    I am a 22 year-old student who has struggled with a restrictive eating disorder for over ten years. I have also struggled with absent or extremely long cycles, which my doctors have told me is a result of PCOS.

    When I was eighteen, I had the Mirena IUD placed, which I finally removed a few months ago after reading your book and wanting to restore my hormone (as well as overall) health. I have since gained about five kilos, though I am still underweight for my height. I do my best to eat well according to your recommendations in PRM, including fats, protein and starches in each meal, and I feel my body is truly healing now that I have removed the IUD and am eating more. Since I have made these changes, I now get my period every month and a half or so. While this isn’t normal, it is a significant improvement from my cycle pre-IUD (with anorexia), which was no cycle at all.

    At the moment, I do not have any symptoms of androgen excess, have severe bone loss (I am in the 0.1 percentile for my age and gender group), have polycystic ovaries (though a very, very mild case) and low to normal androgen levels. My progesterone is also extremely low. All of this tells me I am still struggling with HA according to your findings. However, my most recent hormone panel in March indicated I also had a high LH to FSH ratio (2:1), so I’m not sure.

    If you have any insight or thoughts on my case, I would appreciate it so much, as well as any pieces of advice.

    Thank you again.


    • how many days after that LH result did your period arrive? (just checking if it was a normal LH ovulatory surge)

    • polycystic ovaries are not “cystic” despite the name. They just have a high-ish follicle count and no dominant follicle because no ovulation. As soon as you start to ovulate, ovaries will look normal again. see my book Period Repair Manual

  13. How many androgen is considered too much in lab test? for example mine, in the lab test, is only a few point out of range, it is enough to determine high androgen and agree with one of the 3 principle of pcos?

  14. Hi Lara, firstly thank you for your work, I have your period repair manual book and have learnt so much from it.

    I’m currently trying to work out what is going on with my body post pill. I stopped the pill after 14 years in October 2020, and only had my first period in March 2021. It’s now been 50 days since my last period and I haven’t had another yet.

    I had testing done, and am unsure what is wrong. I have no acne or facial hair, and my 1 period since finishing the pill was very normal (no pain, minimal cramping etc.). If anything my period symptoms were better than when I was on the pill!

    My bloodwork (completed on 2 Feb) showed the following:

    LH: 11
    FSH: 8
    Androgen: 2
    Testosterone: 0.6
    Free testosterone: 11
    Oestradiol: 179
    Prolactin: 90
    Free androgen: 2

    I have a relatively low BMI (18.4) but do not feel like I don’t eat enough (always have 3 meals a day plus snacks in between!).

    Should I have blood work done again in case it was in the wrong phase? The fertility doctor said everything was normal so I’m very confused as 1 period in 6 months doesn’t seem normal.

    Thanks in advance!!

  15. How very interesting! I haven’t had my levels checked in a long time but have recently come across someone else who says women don’t eat enough. So I’ve been eating more and I’ve noticed way less hair on my chin. I don’t really want to eat much more because I’m on the verge of being too heavy for my height.

  16. You mention the LH to FSH ratio as significant, but is there a “normal” range for that ratio–one that would indicate neither PCOS or hypothalamic amenorrhea is likely? Like, suppose you’re looking at numbers from the beginning of a cycle, should they be the same? Should one be roughly twice as high as the other, etc.?

      • Thank you for this!! I suggest putting this ratio in the blog post itself.

        My LH and FSH both came at 4.9 mIU/mL on 3rd day of period, and I am 28 years old, 108 lbs 🙂 Might there be anything I should be aware of?

        Thanks so much for your info, Lara. I used to do fad diets and lots of compulsive research on diets, exercise etc and had very bad period pain and irregularities affecting my life and work.

  17. Hello, my name is Sharen hopefully you are able to catch my comment because I’m glad I found this article. My gyno told me (based off an ultrasound) that I have PCOS but it’s only a mild case and not to worry, my uterus is also tilted but that’s normal. I’m just annoyed because I want to know is that even a proper diagnosis, especially when I haven’t seen my period for 2 months but i am currently experiencing period symptoms.
    Sorry thank you

  18. Hi Lara,

    Does a high LH:FSH ratio indicate anything if all my other parameters are totally normal?

    I came off Yaz 12 months ago and have been dealing with acne ever since. After reading your book I was inspired to do a hormone check.

    All my markers came back smack bang in the middle of the normal range (Test, Free Test. SHBG, Oestro. Proge, Prolac, Insulin, Cortisol and DHEAS-S, Thyriod) however LH was 3 IU/L and FSH was 1 IU/L, which makes the LH:FSH Ratio 3. Those were the only two things on teetering on the lower end.

    My cycles are a regular 33-34 days and my only real symptom is acne, which has been a battle for me. I thought the test would reveal a hormonal cause for it but it doesn’t look like it.

    Sincerely, confused Adelaide-ian.

    • Was that on day 2? Because LH/FSH is only meaningful on day 2 or 3.
      Even it was day 2, I wouldn’t read too much into a one-time reading especially as they are both so low (which I’m guessing is because you’re young?).

      Big picture, this is more likely to be the classic post-pill acne that can happen when trying to withdraw from drospirenone. It should settle down after 18 months or so. See my blog post How to prevent and treat post-pill acne.

      • It was taken 7 days before my predicted period (which it ended up starting 3 days early anyway), and I’m 27 years old 🙂

        Thank you for your response, I really appreciate it! (And for continuing to reply to comments on posts that are almost a year old – it’s why I decided to leave a comment)

  19. Hi Laura, I cannot make sense if I actually have PCOS, I don’t seem meet any of the four criteria for PCOS, but I also don’t meet the criteria for HA.

    I have been diagnosed with PCOS and lean PCOS has been mentioned. I have;

    – high LH and high LH to FSH ration
    – high anti mullerian hormone
    – cysts
    – normal testosterone (8.2)
    – low DHEA-S (58)
    – high end of normal Etiocholanolone (844) and Androsterone (1290)
    – high progesterone (25 ng/ml)
    – high end of normal Estradiol E2 (4.05)
    – high estriol E3 (29.2)

    Any help would be so appreciated. Thankyou

    • Is your main symptom lack of periods? And are those hormone levels from a blood test?
      Because a serum progesterone reading of 25 suggests you ovulated so you would either have 1) got a period within 2 weeks of that blood test or 2) you’re pregnant.

      Do you have symptoms of high androgens? (ie. hirsutism)
      and finally, what is your SHBG reading?

  20. Hi,
    I just finde your blog and im really in love with your content. I`m not sure how its in other countries – i`m form Poland and i know women in this countries know like nothing abut their own bodies (the worse is that doctors know nothing either). Blog dedicated to women`s health, feels like warm in the heart.
    it’s quite an old post, so expect no reply, but maybe if you read it you could tell me whats wrong with me.

    (I`m 25y old)
    My last lab-test, (5th day of the cycle):

    Prolectin: 219.54 mU/l
    Estradiol: 17 beta 65 pmol/l
    FSH: 2.71 IU/l
    LH: 1.46 U/l
    17-hydroksyprogesterone: 0.75 ng/ml
    Dihydrotestosterone: 161,4 pg/ml
    Androstendione: 2.24 ng/ml (0.3 – 3.5)
    DHEAS: 158.0 ug/dl (ref.65-380)
    SHBG: 134 H nmol/l (ref.18 – 114)
    ACTH(EDTA): 20.6 pg/ml

    5 moths ago, (in 2nd day of cycle) it was:

    Estradiol: 41,4 pmol/l
    FSH: 0,94 U/l
    LH: < 0,3 mIU/ml
    Progesterone: 1,02 nmol/l
    Prolactin: 171 mU/l
    Testosteron: 0,553 nmol/l

    I have hirsutism, terrible ichy, dry skin, hair lost, geting fat around my waist… just terrible things are happening with my body and soul. I have periods, but irregular.
    I`ll be really thankfull for any help.

    Greetings from polish girls 🙂

  21. Dear Lara,

    Been reading your book very carefully and trying to determine whether I have pcos (like doctors tell me: you have lean pcos) or hypothalamic amenorrhea.

    I’ve given birth to my beautiful son in june 2018 and a couple of weeks after I got hpv diagnosis, so I needed surgery. All these events made me stress out (a lot) and 4 months after giving birth (got pregnant first cycle after stopping my pill) I still did not have my period.
    My gynaecologist took my blook and this was the result:
    Oestradiol: 57 ng/l
    Progesteron: 0,21 µg/l
    LH: 5,6 U/l
    FSH: 6,7 U/l

    Because I was so stressed (I also lost weight and was thinner than before I got pregnant (around 3kg to 4 kg)) my gynaecologist suggested I got back to my old birth control. And, that’s what I did (still sad about that). So I took Diane 35 again (and they gave me this birth control when I was younger for no reason! No acné whatsoever!).
    In april 2020, I was fed up with it. Stopped my pill and well… I didn’t get my period. Went back to gynaecologist beginning of June and she took my blood and I had an ultrasound. Which showed of course some cystes, but only 7 or so and a thin uterine lining.
    Oestradiol: 63 ng/l
    Progesteron: <0,20 µg/l
    LH: 8,5 U/l
    FSH: 8,4 U/l

    On september 5 I finally got my first period (5 months after stopping BC and after moving into our refurbished house I woke up the first night and had my period, yay!). On september 17 I went back to my gynaecologist and she took blood once again and perfomed another ultrasound. By then I did loose another 2 kg (stress + also was following pcos advise: so less carbs).
    Oestradiol: 149 ng/l
    Progesteron: <0,20 µg/l
    LH: 6,9 U/l
    FSH: 9,3 U/l
    Also this time she checked my androgens:
    Testosterone: 42,3
    Androsteendion: 262

    She told me again: you have lean pcos: you have some cysts and your androgens are slightly elevated.

    I got another "period" recently: december 4 🙂 (so my cycle went from 150 to 90 days) yay! And it felt like a real good period: 5 days and the right amount of blood (like you describe in your book).

    The reason I reach out to you, is because I don't know which advise to follow anymore… I thought I had what my doctor calls "lean pcos", but the more I follow pcos eating guidelines the more weight I lose and the more anxious I become. Now I've been eating a bit more starchy foods and some gluten too and it honestly feels better, but I don't know if I'm doing the right thing.

    Should I take vitex? Or peony & licorice? So in doubt. I really hope to hear back from you.

    Thank you in advance for helping me.

    Best regards from Belgium,

  22. Hi Lara,

    I was diagnosed with PCOS around 2 months ago by two separate gynecologists. The evidence of this was multiple cysts on both of my ovaries as-well as an absent period. However, my blood tests showed no abnormalities apparently.

    I will add, I had been on the pill since I was 14 years of age.. and finally came off the pill in February this year (I am soon 20 years old), due to experiencing bad side effects, as well as finally learning about all the implications the pill truly has… Since then, I am still yet to regain my natural cycle. (My sister is diagnosed with PCOS and endometriosis). My doctor tells me I must go back on the pill to deal with my PCOS in order to conserve my eggs if I ever want to conceive in the future. However, as I read again and again, the pill doesn’t solve the issue in the first place. So, I am at crossroads with what to do next…

    My LH:FSH is 5,6:4,6
    Fasting Insulin: 5,4
    TSH: 1,92

    I started the pill due to irregularities in my cycle as well as really bad acne. It was what my gynecologist at the time recommended I did to solve this. My acne now is still bad.

    I am desperate to seek some help and guidance in a more natural way to regain my cycle…however I am now even sure what kind of PCOS I have.. if it’s even PCOS!

    Thanks so much in advance if you manage to reply.

  23. Hi Lara,

    thank you for your posts about this, there are really helpful.
    Evendo, I am still a little bit lost..

    I haven’t got my period for 10 months since I ended with the pill. I am 23 years old and I was exercising a lot and eating very clean. From the start, I thought It would be AH. My bloodwork was:
    LH 1.18
    FSH 5.11
    TSH 2.39
    I stopped exercising and only doing yoga and walking. I went to the doctor and my bloodwork actually is:
    – LH 9.5
    – FSH is 6.2
    – TSH: 1.57
    – Prolactin 14.3
    – Progesterone: 1.69
    – Cortisol: 18.1
    – SHGB: 54.9
    I dont know if my LH has increased because I am near to recovery or if I have PCOS.
    I don’t find a doctor well informed about this and it would be wonderful to have your opinion.

    Thank you for everything yo do.


  24. What is considered a high or low LH/FSH ratio? My ratio in the last two year is 2018 0.527, 2019 0.479, my last LH was too low, LH=2.3, FSH =4.8
    Though I am 43, I think I have HA, I have symptoms of low progesterone and stress like poor sleep, fat around belly area but not in any other part of the body, low body temperature (cold hands and feet), insulin resistance with high blood sugar levels (pre-diabetic levels on fast glucose), low libido.
    How do you correct HA with women with high blood glucose and insulin resistance where I need to limit my carb intake.

  25. Dear Dr. Briden, I am almost a year postpartum and my cycle is yet to come back (I stopped breastfeeding at 5 months). I have just had a blood test done and my testosterone levels are high (78ng/dl). SHBG is also relatively high at 112 nmol/l. TSH is low-ish at 1.91mIU/ml and there are no thyroid antibodies. Never in my life did I have high androgens in any blood test, though I have been struggling with irregular periods (including a long period of post-pill amenorrhea which brought me to your book) forever. Before getting pregnant, I had irregular cycles with low L.H but still ovulated. Now it looks like this is inflammatory PCOS and the whole ovulation process is shut down. I have started zinc and have been taking magnesium. All my life I have been hearing (from conventional doctors) that as soon as I give birth all my menstrual problems will magically disappear. It seems to be quite the opposite for me. Any insights for this ‘Postpartum PCOS’ are much appreciated!

  26. Hi from Chicago! I have had regular periods all my life. I was never on the pill either. However since April of this year My periods have been irregular with the last cycle being 46 days apart. I went to my doctor because in June I didnt get a period and it had been about 52 days. She put me on birth control indefinetly leaving me very confused. She didnt order a blood test or anything. I was confused on how birth control is supposed to help regulate a period when it is only withdrawal bleeding. Any insight to what it could be? I do not have excess body hair, or any issues with my period before April ever.

  27. Hello from Greece ❤️
    I have read your book but also I can’t find what I have !no period almost a year!
    In my blood test I have only low estrogen and little up cholesterol!All the others hormones are normal !I’m trying to find a diagnosis and I can’t and the doctor doesn’t tell me anything clearly! Is it HA or Pcos?

        • hmm. Unfortunately, those results don’t offer much insight. Did you have normal results for prolactin, thyroid, and insulin? And was it the loss of a real period or no period after stopping the pill?

      • I have hasimoto and right now my TSH is 2,99 mIU/ml ,I take T4 75mg every morning!Also my insulin right now is 8,95 mU/ml and my prolactin is normal!
        Reading your book, the chapter that says about the gut health troubled me because I have bloating all the time! and listening to my body I feel that there is blocking! That’s why I wanted your opinion!As far as the period is concerned, the last time I had a period without a pill was 3 years ago, and since then I have period only with progesterone! The last time I took progesterone was 1 year ago and I didn’t see blood and since then I haven’t taken a pill again and I found your book and I’m trying to find the right diagnosis to recover naturally!!!
        Thank you for your time ❤️

        • If you had no bleed after the progesterone challenge, then that is suggestive of hypothalamic amenorrhea.
          I assume you’re already off gluten because of Hashimoto’s?

      • The truth is that not yet but I have greatly reduced it! Because until I find the diagnosis I am confused in what exactly to do!
        However, I had lower than normal testosterone 4 months ago which returned to normal now! And the last 4 months what I have changed is that I have stopped the intense exercise and I eat better!
        so should i start vitex and magnesium?

        • In general, with patients with a similar combination of things going on, I would say strictly gluten-free combined with increased calorie intake including animal protein and non-gluten starches like rice and potato. And think about supplements for Hashimoto’s.

  28. Hi Laura, love your blog, thanks! I came off the pill (Dianette) 18 months ago and never got a period. I was diagnosed with PCOS and started taking metformin about 10 months after coming off pill and got a period two months later, but haven’t had one since then (that was 5 months ago). My LH to FSH is 4.1/4.9 and SHBG is 121 n/mol both of which aren’t generally consistent with PCOS but I’ve got a really healthy body fat % of 25% so unsure it could be HA?

  29. Hello Dr. Lara, thanks for all the knowledge you share with us. I’ve just read your book and it’s been revelear for me.
    Im 28 and I’ve been under pill almost 10 years, Ive mild hirsutism, acne, hair loss and BMI 20.4. I stopped the pill 7 months ago and I havent got the period since then. Im confused as I dont know if it could be HA or Pcos. Blood test: LH 6.96, FSH 6.20, DHEA 3.8, SHBG 40.1, testosteron 0.69, prolactin 8.14.
    Ive visites many doctors, all of them recommended take the pill again…

    Thank you so much

  30. Hi there, I am just now starting to learn about my hormones and I’m unsure why my periods are always very short. I have a feeling it’s the result of trying to do intermittent fasting or repeatedly trying to do some very restrictive cleanses before I started to learn about the effects of those kinds of difficult diets on hormones. The past few years have been very emotionally stressful and I was simultaneously trying to repair gut/dysbiosis using restriction. I’m finally starting to sleep better – more deeply and getting around 7 hours a night and haven’t done a restrictive diet cleanse in a few months. However, I just got off my period and it was the lightest I’ve had, very light pink color to start and end, but also some brown which is what confuses me. I do have a very small amount of evidence of hirsutism (literally one thick hair that keeps growing in the same place on my chin). I recently read Alisa Vitti’s book In the Flo and ordered her suggested supplements which I am excited to begin. I guess I am just looking for some reassurance that I don’t have PCOS and that I can heal my hormones, get my period back and be sure that I am ovulating. I also have some very stubborn saddlebag fat that I’ve had since I can remember – even when I feel very slim and slender I don’t seem to lose weight in this area. Thank you for all you do and any clarification you can give 🙂

  31. Hello Dr. Biden,

    I just finished reading your book, and so appreciate your guidance, both there on on your website. I am 34 and have had an irregular period most of my life. I got my period late (around 17). It was was irregular for the next 4 to 5 years and then I had one year of regular periods ages 22/23 before going on the Nuva Ring. I was on the Nuva Ring from ages 24-28, came off for a year (it took me 12 months to spontaneously get a period) and then shortly thereafter I went back on the Nuva Ring, which I regret. I was on it again from age 29-33, and have been off it now for 14 months. I got my period right away at age 33 after stopping the Nuva Ring, and consistently got a period for 10 months ranging in length from 30-35 days. My last three cycles have gone beyond that “normal length” window– a 39 day cycle, a 50 day cycle, and now a 43 day cycle. I have had an ultrasound, which came back as not meeting criteria for PCOS, and I have had day three blood work done a month ago. My FSH was 4.5 and LH was 6.5. I am wondering about that ratio, whether is qualifies as high or low. My other results were Estradiol:18, Testosterone: 32, SHBG: 98. Prolactin: 16. TSH: 1.8. I’m 5’3” and weigh between 54-56 kg. I was underweight as a teenager, but I’ve been at a consistently health weight for my entire 20s/30s. I don’t follow a particular diet. I exercise regularly, eat too much sugar, but also eat a lot of vegetables.

    I just feel lost in trying to understand what is happening with my period. My doctor’s response was that my levels are normal, so there is nothing to do. It is just disconcerting to me that my period was in the normal length range for 10 months and now it’s dropping off.

    From reading your book, it seems like it could be PCOS or hypothalamic amenorrhea, but neither feel like the clear diagnosis. I’d just be grateful for more guidance, as I don’t feel like my doctors have more suggestions for me at this point.


  32. Thank you for replying! The last time I got my LH and FSH tested was almost a year ago, so a year after losing my period and then being half-in for a few months (eating way more but still not enough) and my LH was 5.5 and my FSH was 7.5. Now it’s been about 7 months that I’ve been all in. I still haven’t gotten a period yet but my breasts were sore and I had really light spotting about a week ago.

  33. You said ask me in the comments so here it goes! I do have visible cysts on ultrasound and I have a high LH to FSH ratio (2.7). I have also had a few periods normally after stopping the pill, HOWEVER-although I have slight insulin resistance, my BMI is 17, I eat vegan and low GI and have no excess of androgens or hirsutism.Based on yoiur table it is basically 50/50% for both PCOS and HA. What do I have?

        • you’re right, that is a mix of HA and PCOS, which can happen, but the solution is always to eat more first — ie. fix the HA, and then address PCOS issues. A BMI of 17 is not good. Also, for what it’s worth, my observation is that a vegan diet can be a problem for periods. And I see you’ve also commented on my vegan blog post so I’ll answer there.

          • Thank you SO much for answering. I’ll eat more and incorporate some fish and goat dairy/reduce soy and flax. (My appetite is very low though). I read your whole book (amazing!) and wanted to ask another thing : I’ve pre-Hashimoto (tested + for Abs, but still within range) and actively avoid iodine. However-my breasts are sore since I started doing that. Should I opt for the min. 150 mcg/day? Also-is there an alternative to Peony-Licorice (as it covers both PCOS and HA)-I can only find Licorice here in the Balkans. P.S. I have had terrible pelvic pain ever since I quit the pill. They’se sent me everywhere (a urologist/an ortopedist/a gyno…) but I haven’t been screened for endometriosis. Should I insist on a test? The pain is still pretty bad.
            Last but not least-please please please check out this article! It links adrenal PCOS to autoimmunity with a later decompensatory (HYPOandrogen) phase! To me,as a med student with a DQ8 (predisposition for caeliac and Hashimoto)
            this makes immense sense!

            Stay as great as you are 🙂


  34. I am struggling to figure out if I have PCOS or HA. I am 19. My period has been gone for almost 6 years. I lost a decent amount of weight around the time I lost it. After blood tests, I do have elevated DHEA (567). So maybe adrenal PCOS? However, I do not feel that I have many other symptoms of PCOS (no acne or excessive facial hair). Also my LH has been low (.1 and 1.0) compared to FSH (4.7 and 5.4). ( it was taken at random times since I do not have a cycle)

    • Hi Breanna! Did you ever find anything out about this? My DHEA is also elevated but no other symptoms of PCOS. My LH & FSH numbers are almost identical to yours as well!

  35. Hello, Lara. My daughter has not had menstruation for 110 days. The doctor injected progesterone and said menstruation will begin, since the thickness of the endometrium is 10 mm. But 2 weeks passed, nothing has changed. Can a daughter take Vitex capsules to normalize her menstrual cycle? Thank you.

  36. Doctora buena tarde yo la sigo en redes sociales y de ves en cuando la leo aunque aun no he comprado el libro😬 me realice mis estudios anuales y en mi ultrasonido me detectaron miomas y mis ovarios tiene 23 foliculos cada uno estoy en espera del periodo para poder realizar el perfil hormonal tengo 34 años y no he tenido embarazos creo yo que tengo resistencia a la insulina se me cae el cabello, se me complica bajar de peso, mis periodos son muy abundantes, muy leves manchas obscuras en cuello y axila, no quisiera tomar anticonceptivos, he visto que algunos doctores medican metformina que tampoco quisiera utilizar, gracias por leerme

  37. Hi Lara. Thank you for updating this blog. I believe I started with pcos, insulin resistant and adrenal based. Then I swung to HA. I’ve recovered 3 times from HA but believe I lost my period again now due to under eating carbs and fearing insulin resistance again. My main symptoms of pcos years ago were severe cravings & cystic breakouts. When I got my period back from HA each time I started jawline breakouts again usually at mid cycle and possibly pre period( I know that is normal in Ha recovery). I also have a lot of vellus hair on my face + some black body hirusitism (upper lip, belly button and bikini line increased). My Dutch test in July right before my period returned showed high androgens, low estrogen and low progesterone . I also have low FT4 and FT3. I realize this all indicates I need to eat more but I’m scared about insulin resistance issues returning so I find the balance hard. How much complex carbs should I eat as a 120 pound 5’2 athletic woman working out 2-3 times a week and fast walking 5-6 times a week for 40-60 mins? I already take a lot of anti androgen supplements, inositol, spearmint, FemCO by MediHerb and more. I just started L-Lysine because I read it’s good for hormonal acne. Thank you

  38. Hi, I lost my period RIGHT when I started a very low carb diet for my acne. I went too extreme with my diet and I was so thin I lost about 30 lbs. I did this diet for around 4 months thinking it would clear my acne (which it didn’t), and then I started to eat more, but definitely not as much as i should have been, I was starving ALL the time. I lost my period now it’s been a year and a half. I got tests done which show my progesterone and estradiol levels are super low, my testosterone is within range and my DHEA is high. I’ve been eating as much as I want it’s been 4 months now and I gained my weight back to normal and I’m stable. Still no period, though. I see a naturopath who thinks it’s hypothalamic amenorrhea & wants me to go on bioidentical hormones. My doc just wants to give me birth control. Endocrinologist said to wait another 6 months, get blood tests and go see him, also thinks its HA but says that it could be PCOS and that we’ll see in 6 months. I am very lost!!!

    • If your LH to FSH ratio is still low, then it’s probably HA. The main strategy is to eat in the 2500 calorie per day range for at least 6-12 months.

  39. Hi Lara – I haven’t had a period since coming off the pill over 2 years ago now. I have been diagnosed with PCOS but I have tried acupuncture, and seen an endocrinologist who prescribed provera but nothing has yet worked, and I’m starting to think it might be HA. I eat healthily but also exercise 5-6 times a week, at least 3 of which includes 30 mins of high intensity intervals on a treadmill. I have put weight on in the last couple of years since coming off the pill but only a couple of kilos, I find it very hard to lose it though.

    Recent blood tests were FSH 9.4, LH 8.6, AMH 17.2, insulin 2.83, prolactin 148, SHBG 88, testosterone less than 0.4, TSH 2.04 – all of which I believe are in the normal range, so struggling to figure out what’s next!

    Any help you can provide would be much appreciated! Thank you.

  40. Should you do the insulin assay with oral glucose tolerance during the follicular phase or can you do it at any day of the cycle? I’ve read that insulin sensitivity worsens in the luteal phase.

    • good question. I’d say in general, it’s probably best in the follicular phase, but I’ve never seen any research on that.

  41. This is so helpful! My daughter has never had a regular period, has jawline cystic acne that is worsening. We are trying to figure out if she has PCOS or if it is hypothalmic amenorrhea. First, if both her FSH and LH have been within the “normal” range, is it possible for the ratio to be high or low? If so could you give an example of a high ratio and a low ratio? And could hypothalmic amenorrhea be triggered by a brief period of low carb eating, say 6 months she was told to be paleo by a doctor, but she returned to balanced diet for the last year but still no regular period and worsening jawline acne? It seems like that could reverse with a normal diet. She also has consistently low estrogen and progesterone, but normal testosterone and DHEA (except 1 test a year ago where it was low but normal now). Could this mean she has excess androgens as a ratio and that could point to PCOS? Thank you so much!

  42. I got confused after reading your article. And think deeper. Im just curious, can I have a laboratory Blood Test on hormonal count and check if im an insulin-resistant or not, without any physician request?

  43. Is there anything you need to keep in mind before doing a test for “fasting insulin”? How many hours should you not eat before, and is it advisable to eat a bit more carbs the days/weeks beforehand? Thanks!

  44. Yes it was a blood test. I don’t have a SHBG reading unfortunately. It’s frustrating as they did all the tests, got the above results but just said there was nothing further they’d do unless I struggled to conceive in due course. So I still don’t know what the problem is!

  45. Hi Lara, I generally lose my period whenever I lose weight, even just a pound or two. I don’t restrict any food groups. I do 20-30 mins of moderate/heavy weights a few times a week but no cardio. However even now that I’ve increased cals to 2000+ (From 1600-1700 when dieting) it hasn’t come back. I am 170cm and 140lb, so not underweight.

    I was diagnosed with PCOS in my 20s (now 34). In recent years tests have shown that my testosterone is very low (almost non existent) but my LH is always very high. Does this sound like HA or PCOS?

    • That’s interesting that your testosterone is very low. Was that on a blood test? Do you know your reading for SHBG (sex hormone binding globulin)?

  46. I stopped the birth control pill about 6 months ago and have not had a period since. I don’t have high androgens (testosterone came back low even; normal DHES)normal prolactin and low LH. No hirsutism but have developed acne. But I am not under-eating and do have a lot of carbs (300g/day).
    I really enjoyed reading your book and posts – I feel like I understand my body so much more. I’m just feeling a little lost about where to go from here. Getting into see a doctor is proving to be months of waiting (I got referred to see a specialist by my family doctor back in Aug and still waiting to even get an appointment date)

  47. thanks for sharing this! i believe i have true PCOS — elevated testosterone levels and excessive hair growth, along with the irregular periods. fortunately i’ve been able to conceive naturally which was always my biggest concern. however, have you found any way to help the excessive hair growth through diet, medication, etc. — other removal methods have not worked. would eliminating sugar help?

  48. Was diagnosed with PCOS in my 20’s because of my crazy periods I started when I was 14 then didn’t have a period for 3 years..then in my late teens I had normal periods went to college and my periods got all out of wack! Went and had blood work done and ultrasounds done and was told I had PCOS. Fast forward I’m now 40 I’ve stayed active and tried to loose weight (I am 5’4 in the 175-180 weight rang) I now have normal periods every month around the exact same days and I have been off BC for about 10 years. In my 30’s I gain about 40 pounds and lost that weight had crazy heavy periods had one miscarriage. I guess my question is was I miss diagnosed and should I get tested again?

  49. Thanks for this wonderful article! So what if your lh and fsh are almost the same but you have a super high amh level? My amh level was 31! I have not had my insulin level checked but my test results looked like my lh and fsh were almost the same number.

  50. Hi Lara,

    I lost my period from the age of 17 to 23 and I just got it back in December of last year due to an eating disorder and high stress. During that time I also went on and off the pill twice. My big concern for me is acne as I feel I’ve done everything I can to heal it naturally and I don’t know what else to do. I thought that my acne would improve once I got my period back but it is still very persistent (jawline, neck and cheeks) and I am wondering if it’s possible if I have PCOS now? I eat a really good diet of whole foods and am confident I eat enough, and I’m not low carb, but my skin just won’t budge. I am unsure whether I have hirsutism or whether it’s just peach fuzz on my face but it’s enough for me to remove every so often. I am hoping you have some insight as I feel like no matter what I try nothing can give me clear skin. My period is now coming roughly every 35 day’s but it is still irregular after around 7 cycles I.e 32 days , 24 , 24, 35,48 , 35,30

  51. Hi!!

    I’m 16 and currently recovering from HA. The main causes were under eating and stress for me (exams etc) so I did lose a little bit of weight. However, I’ve stopped exercising for the past 2 months and gained back all the weight I lost plus more. Since I now weigh more than I did when I had my period shouldn’t it be back? This is super frustrating and school starts again soon, I would really like to be able to focus on other things apart from my HA. Any help is appreciated!

  52. Hi!
    I have always had irregular periods which have worsened now after being on the pill for 1 and a half years. I have been off for 10 months, have more acne than I ever had, multiple cysts on an ultrasound but no excessive androgens on blood test, no excess hair and no insulin sensitivity. Only thing is is LH to FSH is 2:0 ratio. How do I know what I have?? Any advice would be so helpful, thank you!!!

  53. YEEEEES this finally worked 🙂 must have been the signs.
    Please read just this comment (not the embarrassingly long thread before this one)
    What a mission! I hope you will still read this 🙁

  54. HI Lara,

    Ok I am really sorry, this is getting ridiculous, but it seems like something is not working on the page, it still cuts out half of the paragraphs in the middle and I don’t know why (maybe it was all the slashes and smaller than icons) . I add it again with writing out the icons, I am really sorry for the crazy amount of comments. I hope this one works and has all the info in it. If so, please ignore the previous comments (wish I could delete them, sorry). Hope you will still read this.

    First of all thank you so much for all your efforts and the comprehensive information you provide online and in your Period Repair Manual.

    I have read your book cover to cover more than once and I tried everything I could to help my body heal naturally. However, after four years of unsuccessful natural treatment and worsening symptoms, I am desperate and I feel horrible, psychologically as well as physiologically. I am shortly before giving up and going back on a BC pill just to alleviate the symptoms, even though I really wanted to fix my body naturally.
    After coming off the pill 3 years ago (7 years combined and 3 years progesterone only pill Cerazette) at the age of 29, I have not had any period at all, whereas I had no withdrawal bleeds on the progesterone only pill either (so no bleeding for 6 years). I have to mention I had normal and regular periods from the age of 15 to 19, with a few months of amenorrhea during my school leaving exams (I assumed at that point due to stress and restricted eating). However, I didn’t have acne, hirsutism or weight problems at that time.

    After waiting and trying to help myself for a year, the consultation and testing started. Tests confirmed polycystic ovaries (20 cysts per o. in the meantime and one ovary is enlarged with 10cc) and a very high AMH (118.8 pmol per L). However, other blood tests at that time (2 years ago) such as low androgens (less than 1nm per L ) and lower LH (between 2 and 6mIU per L over the first year) didn’t fit the picture. Long story short, after consulting with several doctors and refusing HRT, BCP and Metformin, I found an endocrinologist who said I might have HA, considering a few stressful years and “clean” vegetarian eating (although I ate lots of healthy carbohydrates). I also had a bone density scan which confirmed osteopenia. Trying to not jump on the PCOS wagon, I followed the HA recovery plan, I stopped all exercise, other than walking and yoga, and reintroduced lots of different foods (including organic meat and lots of fats, I already ate a lot of carbohydrates, however, I sill avoid highly processed food especially sugar and dairy – although I have organic non- homogenised yogurt and butter).

    Fast forward, I have gained around 7 kg (I weigh more than I ever had in my life) and I experienced significant hair growth (especially face, breasts, upper legs, belly) and hair loss on my head, being at its worst right now and making me suffer badly. My most recent blood tests show now high testosterone (Testosterone 2 nmol per L, free testosterone = 24 pmol per L, SHGB = 61 nmol per L, FAI = 33) means both LH and testosterone doubled, confirming all the symptoms. Does that mean all the changes actually caused me to develop full on PCOS or could this be an adjustment phase? If so, why would only my testosterone rise but not my oestradiol and no progesterone in sight at all.

    On that note, other results: My oestradiol has been in the 100-150 pmol per L range over the last 2 years, FSH always between 6 to 8IU per L. Progesterone less than 1 as expected (no ovulation since a decade I guess, considering pill prevents it). My Mg, Ca, B12, Folate and Vit D levels were checked last year and perfectly fine. Coeliac Antibodies – negative. My fasting insulin 4 to 5 mU per L with a Fasting Glucose of 5.2 mmol per L each time and HbA1c of 30mmol per mol. IGF-1 was 215 ng per ml last year. My blood lipids were fine and my last TSH was 2 mIU per L and my morning serum Cortisol last year was 539 nmol per L.

    Over the years I have tried everything on the herbal side (Vitex, Peony & Licorice, Dong Quai and Black Cohosh, Reishi, Ashwagandha…). I am supplementing since a long time with Zn, Mg and Inositol plus a comprehensive good quality prenatal supplement including everything from Vit A to Zinc. Over the last few months I added Saw Palmetto & Spearmint. As mentioned, I have adjusted my lifestyle, incorporated relaxation strategies and even tried acupuncture.

    I had been hoping for a long time that my system would kick back in and in turn everything would normalize again, however, it seems that everything just got worse now and I don’t know what to do anymore. Apart from the extreme changes in my appearance which made me avoid social activities, thus lead to isolating myself, I go through a constant emotional roller coaster. Being far away from my home country and family doesn’t make it easier. I am afraid I have developed full blown PCOS now, which highly confuses me and I am shortly before giving up and going back on BC to alleviate the symptoms and get back my life back.

    I feel completely left on my own and I don’t know what I should do, any advice you could give me would be much appreciated! I hope to hear from you soon.

    Thank you so much!

  55. HI Lara,

    I am so sorry for bombarding you with this comments, but I can’t delete comments and it seems like there is an issue with the length of comments as it always cuts out half of the 4th paragraph, randomly in the middle, thus the paragraph will make no sense to you. I don’t know why it does that.

    I try now copying just the relevant paragraph that always got shortened in the previous posts, hope it makes sense then:

    After waiting and trying to help myself for a year, the consultation and testing started. Tests confirmed polycystic ovaries (>20 cysts per o. in the meantime and one ovary is enlarged > 11cc) and a very high AMH (118.8 pmol/L). However, other blood tests at that time (2 years ago) such as low androgens ( both LH and testosterone doubled, confirming all the symptoms. Does that mean all the changes actually caused me to develop full on PCOS or could this be an adjustment phase? If so, why would only my testosterone rise but not my oestradiol ☹ and no progesterone in sight at all.

  56. Hi Lara,

    I am sorry it is me again, I just read my comment again and saw the 4th paragraph made no sense at all, it seems like I deleted a part accidentally while submitting (It should have included that I had low LH and testosterone the first year and now double – see corrected version below). Please ignore my first 2 comments and just read this one, this should make all sense now 🙁 I am so sorry!

    First of all thank you so much for all your efforts and the comprehensive information you provide online and in your Period Repair Manual.

    I have read your book cover to cover more than once and I tried everything I could to help my body heal naturally. However, after four years of unsuccessful natural treatment and worsening symptoms, I am desperate and I feel horrible, psychologically as well as physiologically. I am shortly before giving up and going back on a BC pill just to alleviate the symptoms, even though I really wanted to fix my body naturally.

    After coming off the pill 3 years ago (7 years combined + 3 years progesterone only pill Cerazette) at the age of 29, I have not had any period at all, whereas I had no withdrawal bleeds on the progesterone only pill either (so no bleeding for 6 years). I have to mention I had normal and regular periods from the age of 15 to 19, with a few months of amenorrhea during my school leaving exams (I assumed at that point due to stress and restricted eating). However, I didn’t have acne, hirsutism or weight problems at that time.


    After waiting and trying to help myself for a year, the consultation and testing started. Tests confirmed polycystic ovaries (>20 cysts per o. in the meantime and one ovary is enlarged > 11cc) and a very high AMH (118.8 pmol/L). However, other blood tests at that time (2 years ago) such as low androgens ( both LH and testosterone doubled, confirming all the symptoms. Does that mean all the changes actually caused me to develop full on PCOS or could this be an adjustment phase? If so, why would only my testosterone rise but not my oestradiol ☹ and no progesterone in sight at all.

    On that note – other results: My oestradiol has been in the 100-150 pmol/L range over the last 2 years, FSH always between 6-8IU/L. Progesterone <1 as expected (no ovulation since a decade I guess, considering pill prevents it). My Mg, Ca, B12, Folate and Vit D levels were checked last year and perfectly fine. Coeliac Antibodies – negative. My fasting insulin 4-5 mU/L with a Fasting Glucose of 5.2 mmol/L each time and HbA1c of 30mmol/mol. IGF-1 was 215 ng/ml last year. My blood lipids were fine and my last TSH was 2 mIU/L and my morning serum Cortisol last year was 539 nmol/L.

    Over the years I have tried everything on the herbal side (Vitex, Peony & Licorice, Dong Quai and Black Cohosh, Reishi, Ashwagandha…). I am supplementing since a long time with Zn, Mg and Inositol plus a comprehensive good quality prenatal supplement including everything from Vit A to Zinc. Over the last few months I added Saw Palmetto & Spearmint. As mentioned, I have adjusted my lifestyle, incorporated relaxation strategies and even tried acupuncture.

    I had been hoping for a long time that my system would kick back in and in turn everything would normalize again, however, it seems that everything just got worse now and I don’t know what to do anymore. Apart from the extreme changes in my appearance which made me avoid social activities, thus lead to isolating myself, I go through a constant emotional roller coaster. Being far away from my home country and family doesn't make it easier. I am afraid I have developed full blown PCOS now, which highly confuses me and I am shortly before giving up and going back on BC to alleviate the symptoms and get back my life back.

    I feel completely left on my own and I don't know what I should do, any advice you could give me would be much appreciated! I hope to hear from you soon. Thank you so much!

  57. First of all thank you so much for all your efforts and the comprehensive information you provide online and in your Period Repair Manual.

    I have read your book cover to cover more than once and I tried everything I could to help my body heal naturally. However, after four years of unsuccessful natural treatment and worsening symptoms, I am desperate and I feel horrible, psychologically as well as physiologically. I am shortly before giving up and going back on a BC pill just to alleviate the symptoms, even though I really wanted to fix my body naturally.

    After coming off the pill 3 years ago (7 years combined + 3 years progesterone only pill Cerazette) at the age of 29, I have not had any period at all, whereas I had no withdrawal bleeds on the progesterone only pill either (so no bleeding for 6 years). I have to mention I had normal and regular periods from the age of 15 to 19, with a few months of amenorrhea during my school leaving exams (I assumed at that point due to stress and restricted eating). However, I didn’t have acne, hirsutism or weight problems at that time.

    After waiting and trying to help myself for a year, the consultation and testing started. Tests confirmed polycystic ovaries (>20 cysts per o. in the meantime and one ovary is enlarged > 11cc) and a very high AMH (118.8 pmol/L). However, other blood tests at that time (2 years ago) such as low androgens (T 10) and high testosterone (Testosterone = 2 nmol/L, free testosterone = 24 pmol/L, SHGB = 61 nmol/L, FAI = 33) -> both LH and testosterone doubled, confirming all the symptoms. Does that mean all the changes actually caused me to develop full on PCOS or could this be an adjustment phase? If so, why would only my testosterone rise but not my oestradiol ☹ and no progesterone in sight at all.

    On that note – other results: My oestradiol has been in the 100-150 pmol/L range over the last 2 years, FSH always between 6-8IU/L. Progesterone <1 as expected (no ovulation since a decade I guess, considering pill prevents it). My Mg, Ca, B12, Folate and Vit D levels were checked last year and perfectly fine. Coeliac Antibodies – negative. My fasting insulin 4-5 mU/L with a Fasting Glucose of 5.2 mmol/L each time and HbA1c of 30mmol/mol. IGF-1 was 215 ng/ml last year. My blood lipids were fine and my last TSH was 2 mIU/L and my morning serum Cortisol last year was 539 nmol/L.

    Over the years I have tried everything on the herbal side (Vitex, Peony & Licorice, Dong Quai and Black Cohosh, Reishi, Ashwagandha…). I am supplementing since a long time with Zn, Mg and Inositol plus a comprehensive good quality prenatal supplement including everything from Vit A to Zinc. Over the last few months I added Saw Palmetto & Spearmint. As mentioned, I have adjusted my lifestyle, incorporated relaxation strategies and even tried acupuncture.

    I had been hoping for a long time that my system would kick back in and in turn everything would normalize again, however, it seems that everything just got worse now and I don’t know what to do anymore. Apart from the extreme changes in my appearance which made me avoid social activities, thus lead to isolating myself, I go through a constant emotional roller coaster. Being far away from my home country and family doesn't make it easier. I am afraid I have developed full blown PCOS now, which highly confuses me and I am shortly before giving up and going back on BC to alleviate the symptoms and get back my life back.

    I feel completely left on my own and I don't know what I should do, any advice you could give me would be much appreciated! I hope to hear from you soon. Thank you so much!

  58. Zero processed foods or refined carbs/sugars, but I eat a ton of sweet potatoes (literally multiple of them every day). Thank you for responding! I am desperate for any insight

  59. Zero processed foods or refined carbs/sugars, but I eat a ton of sweet potatoes (literally multiple of them every day). Thank you for responding! I am desperate for any insight.

    • it’s possible that you need more starch or calories or both. And the fact that your LH is low-normal is more consistent with HA.

  60. Lara – I am DESPERATE for a response. I have seen my OBGYN/RE and have had a ton of tests done but she hasn’t diagnosed me as either having PCOS or HA. I have only had 3 periods in the past year (the last one was in early April). My FSH is 4.8 and LH is 3.2. I had them tested a few months prior and they were FSH 7.1/LH 7.5 so not sure if that is a material change or what would explain it. I am normal BMI (21). I am so frustrated because I don’t know whether to ramp up the exercise (PCOS) or dial it down (HA) and am worried I will shoot myself in the foot by doing one or the other. PLEASE help!! Thank you so much.

  61. Hi Lara, I am very confused. When I was 17 I was diagnosed with what at the time I thought was PCOS. I had raised testosterone levels in the blood test. But no ultrasound. I went on birth control for a number of years. When I came off my periods took 6 months to return and when they did it then happened every 2 weeks. I was then diagnosed with PCOS for a second time, the GP said my left ovary had lots of cysts on the ultrasound. And again I believe my testestorone levels were raised. I only suffer very minorly with some cystic spots around my mouth and chin. And have a little hair on my upper lip which is dark in colour. I was told to go back onto contraceptive pill to regulate my period. Which I did not. Since then I have had erratic periods. I have not had a period for 5 months. I also meet a lot of the HA qualities- but I have never gone low carb. I am a healthy BMI and do exercise at least 5 times a week. I don’t know what bracket I fall under. So I don’t really know how is best to move forward and try and get my period back. Thanks for reading this.

  62. It looks like I fit the HA profile minus some facial hair/ slightly elevated DHEAS/ Free testosterone. I know you mentioned Vitex as a good supplement for HA in conjunction with upping food. Can you still take Vitex if your prolactin is on the lower side? If so I plan to do Vitex, magnesium, Zinc and HPT Adapt for adrenal fatigue. Thanks!!

  63. Wow this is a total eye opener to me! I have been going through the medications clomid and femara without any progress so I was doing Goal-F shots and it finally got me to have a period, but it was a failed attempt because my lining was too thin at 5mm. Until the shots I haven’t had a period since I got off my birth control in August of 2018. I was also diagnosed with PCOS, but nothing matches up except having all the follicles and a low LH. I am fit and healthy.

    After spending thousands without any true progress we currently we have stopped with that treatment until I can get a natural period, but don’t know if that is the best plan of action or how to get it back. I have reduced my exercise to 3x a week and added more carbs/fats into my diet to see if that would help, but how long does that take?

    Thanks and any advice is so greatly appreciated!

  64. Thank you so much for your information – it’s really helping me to start to understand things. Howver I’m confused when relating this to me!
    I have been diagnosed with PCOS due to and ultrasound scan and irregular periods – which I picked up when TTC around 18mths ago. They never used to be this irregular but have definitely got worse. In this time my diet and weight have stayed the same with a BMI 21. I eat a plant based diet with meat twice week and oily fish 1-2/week and I’d say it was very balanced (I’m a Nutritionist). I don’t have any other symptoms of acne etc.
    Blood tests showed everything within normal range (testosterone, thyroid) apart from SHBG which was high @ 135 and free androgen which was low 0.8. No test for oestrogen or insulin. My hba1c was 32mmol/mol. LH:2.5 FSH:3.6.
    I was put on ovulation induction therapy but it didn’t really help so the next option is IVF which is rather avoid!
    Thank you so much again – any clarification would be very helpful 🙂

    • the combination of high SHBG and slightly low LH to FSH pretty strongly suggests that you’re not eating enough to be able to ovulate.
      It’s less about BMI and more about energy intake. As women, we need a lot more food than we think. Check out the book No period, now what.

      Also, given you don’t eat a lot of meat, you might want to look at zinc — my favourite nutrient for promoting ovulation.

  65. Dr. Briden – my LH is 3.2 and FSH is 4.8. I haven’t had a period in about 3 months. I have a normal BMI (21.4) & eat enough calories for my level of activity. Are those LH and FSH levels consistent with either HA or PCOS?

    • Hi Lara – I haven’t had a period since coming off the pill over 2 years ago now. I have been diagnosed with PCOS but I have tried acupuncture, and seen an endocrinologist who prescribed provera but nothing has yet worked, and I’m starting to think it might be HA. I eat healthily but also exercise 5-6 times a week, at least 3 of which includes 30 mins of high intensity intervals on a treadmill. I have put weight on in the last couple of years since coming off the pill but only a couple of kilos, I find it very hard to lose it though.

      Recent blood tests were FSH 9.4, LH 8.6, AMH 17.2, insulin 2.83, prolactin 148, SHBG 88, testosterone less than 0.4, TSH 2.04 – all of which I believe are in the normal range, so struggling to figure out what’s next!

      Any help you can provide would be much appreciated! Thank you.

  66. Could it still be HA if you have acne, moderate hirsutism, slightly elevated DHEA-S, low LH, and lower prolactin? Came off the pill 1.5 years ago and have only have one cycle since. I’ve been taking OvaBlend (saw palmetto blend) and inositol as recommended by a local Naturopath for the past couple of months but am now thinking it may be HA. BMI of 20.5 and I do find myself restricting calories/carbs some days. Fasting insulin blood test was normal. Trying to determine if it is indeed PCOS or HA causing my period problems. Thank you!

  67. Thank you so much Lara!…..can vitex still work when prolactin is low? (I read it works by lowering high prolactin)

  68. Hi Lara, not sure best place to ask this. ..Could it still be HA if prolactin is low? …LH also low (and low compared to FSH). Thanks.

  69. Hello Dr Lara,

    Please can you help. I wonder if I have PCOS, HA or both!

    Current: age 27, BMI 21, exercise 30mins 2-3x per week, eat mostly healthily but I do have a sweet tooth! No acne, no hirsutism. Stopped progesterone only contraceptive pill 5 months ago, no period since. Now TTC and taking 2g myo-inositol, omega 3 tablets and pregnacare daily.

    Background: Periods started aged 12 years, briefly stopped aged 14 for 2-3 months when I lost weight due to stress, then returned after weight gain. Went on COCP at 17 years, had withdrawal bleeds, had contraceptive implant aged 20 for 1 year and lost period altogether but also lots a lot of weight, BMI 17. Removed implant for a few months, periods didn’t return, went on COCP and had withdrawal bleeds. Transabdominal USS at the time was normal, oestrogen 87, low LH and FSH, high SHBG.

    Had migraines so changed from COCP to progesterone pill and periods stopped. Had another USS which showed ovaries >10ml volume with numerous follicles. Weight gained, BMI approx 19.5.

    Recent weight gain to BMI 21 in past 5 months. Repeat bloods 1 month ago showed oestradiol 128, LH 3, FSH 6.5, testosterone 1.7, normal thyroid tests, normal prolactin.

    Please help!
    C xx

  70. And what frustrates me more all this gynes dnt understand me n my body. They keep on saying i must go back to the pill. N i am like for me that doesnt make sense i want my period to come bck n be regular again. I dd blood test plus ultra sounds sooo many timed and everything appears normal. But still cnt concive nor get my period bck.

  71. I was on traphisal contraceptive pill for a year n i regret. Because now i have not being on my period for over a year

  72. Dear Lara,

    I bought your book and have found it super informative but a number of consultants are struggling to identify whether I have PCOS or not.

    I have cysts on my ovaries, started periods at 18 and they have been irregular ever since. I have no acne, hirutism or obesity. I am now 26 and my periods have been gone for a year. At 5ft7 and 62kg i am a healthy weight and exercise regularly (4x a week). I am gluten, dairy, caffeine and almost entirely sugar free with LH of 17 iu/l to FSH 6.4 iu/l. I sleep 8 hours every night and am at the stage where I don’t know what more I can do to bring my periods back. I do work a 6 day week at a boarding school and am planning a wedding this year but practise yoga and have relaxing baths/walks to de stress.

    The options available are to start metformin (I tried for a couple of days but caused a rash on my face and diarrhoea) or perhaps natural progesterone topical cream? Should I pay to see a functional doctor?

    What would you suggest?

    I appreciate your advice on this immensely.


  73. Dear Lara, I’d really like to have your view. I was diagnosticed last year with PCOS, the in February with HA and not PCOS. Now a third OB-GYN says I have both and should try IVF (I’m ttc). My last blood test (February): LH =3, FSH=7, estradiol=8, free testosterone=0, AMH=11.2. I have no insulin resistance. Both estrogens and testosterone are very low and my ovaries are multifollicular. No hirsutisme / hair loss. My BMI was 18. According to the last specialist I met, LH is not low enough to have only HA and AMH is too high to rule out PCOS. What do you think ? Thank you so much. I am super grateful for your help. Eva

  74. I am afraid I might be in the last category: was forced to go on insulin resistance diet a year after pcos diagnosis. Insulin resistance wasn’t discovered until my body began rejecting starches such as rice and potatoes, along with other characteristic symptoms. After several months of following the diet and switching to complex carbs I’ve slowly begun to lose my period. I also cut out sugar as much as possible. I feel better overall and have even gone from being underweight to gaining a few pounds on the new diet, but am becoming increasingly concerned about the fact that I seem to be slowly losing my period. What do I do, given that I can’t currently tolerate starch? I recently started taking inositol and magnesium which seem to be helping with insulin issues overall. It just feels like I’ve tried everything. I’m also on progesterone.

  75. My 16 year old daughter is having irregular periods and when they do come can be very light. She started menstruating when she was 12 and a half. At first she seemed to have normal cycles before gradually becoming lighter and irregular. I initially thought it might be down to adolescence but I now I think a visit to the doctor is due. I’m wondering about PCOS but she doesn’t have acne or major weight gain. Some body hair but then she is dark anyway… If it’s isn’t PCOS what else may we be dealing with ? She eats well and is definitely not underweight.

  76. I find this article so helpful. I was diagnosed with PCOS at 16 due to irregular periods and high testosterone, Put on birth control and that was that. Following the years after that I went through prolonged times of high intensity exercise and low carb diet (as well as low fat) with definitely not enough calories (1200-1500). I am now 33 and TTC for 15 months. I just started with a RE who put me on keto for the insulin resistance and inflammation all have with PCOS. It has helped regulate my periods to 30days (from 5-6 weeks), But they are extremely light and annovulatory. I do have the classic pearls on ovaries and high AMH of 21.1, But my FSH, LH and testosterone are all extremely low (.63 at CD3) and from my understanding if I had PCOS I would have high testosterone? My estradiol is WNL at 206. How could I better find out if I have hypothalamic amenorrhea. I am so frustrated!!!

  77. Please help! I was diagnosed with PCOS last year. My LH 0.4L, FSH wnl, AMH wnl, testosterone bioavailable 9.5H, ultrasound showed cysts, haven’t had a period in almost a year, previous on BC for years, no insulin resistance, very healthy athlete/dietitian, BMI 25. This is driving me crazy I don’t know if I have Pcos or Ha. Thank you so so much.

  78. I have been doing keto for many years and I’m just worried about regaining weight back. I’ve lost over 140 lbs and kept it off for many years.

    My FSH was only 2.6 and my LH is 15.8. I had insulin resistance before I started. I haven’t had a period in years and I’m reading your book. Estrogen was 20. What are your thoughts? I’m on HRT Estradiol 0.075 and Progesterone 200mg. 36 years old and no babies. Not trying to conceive.

    Just want to feel better. Feel really crappy most of the time.

    • It sounds like your diagnosis was PCOS… at least before weight loss. It could have swung to hypothalamic amenorrhea now. You can tell by looking at your current LH. Is 15.8 a recent result?

      Reversing insulin resistance with a keto diet should have reversed PCOS and given you regular periods. If not, that improvement may have been masked by continuously dosing HRT. Also, you shouldn’t need HRT at 36….

      Please check out Period Repair Manual and hopefully it will guide you to a proper diagnosis and maybe PCOS treatment such as inositol.

  79. I was recently diagnosed with PCOS. I am 29 so this is definitely alarming as I would like to start a family in the next couple of years. I wasn’t diagnosed by ultrasound – which until I read your posts, I didn’t realize is a legitimate sole source! My bloodwork appears normal. I don’t meet the majority of the “standard” criteria! I do tend to under-eat just with my crazy night shift schedule. HELP!

  80. Good morning Dr. Briden,

    I finished reading your book The Period Repair Manual, and am interested in supplementing with magnesium and zinc for my PCOS.

    When it comes to the zinc supplement, I know your book did not mention it, but should I take a supplement that combines copper and zinc? Or just plain zinc? An article that I read said that the combination of the two only matters if zinc will be long-term supplementation.

  81. I have been having long cycles (40 days minimum or longer) after recovering from a 2 year long post-pill amenorrhea. My recent lab work shows low LH on day 3 of the cycle. According to your book, this can mean that i need to eat more, particularly starch, and take vitex. I have been taking Vitex for 6 months and I do feel like I eat enough (though I certainly didn’t used to). I am also gluten and dairy free and have noticed huge improvements in digestion. What am I missing? My body is clearly feeling too stressed to ovulate, but I am not sure why.

  82. I’ve been googling frantically over the past week (since my last doctor appointment) and am so happy I came across your post…. I was diagnosed with polycystic ovaries via a sonogram a few months ago (combined with not having a period in nearly a year) but my hormones were “normal” … and last week I saw a Reproductics Endocronologist who said it may not be PCOS and could be something else… she also mentioned my uterine lining was super thin. Is that characteristic of HA? I do work out a lot (an hour a day) but I eat enough calories to offset it and I’m in the middle of my healthy BMI range.

    • Hi Laura – as follow-up to my question above, I just got my blood work back and my FSH is 7.1 and LH is 7.5. Thyroid, Vitamin D and Prolactin are normal. She did say my liver function was slightly elevated. Would you think that these things are common with either PCOS or HA? Separately, I have been on and off of birth control over the past year. Most recently, I’ve been OFF of it for 7 weeks.

      Thank you so much in advance for your help, I appreciate all that you do!

      • Hi Laura – I just got my Brain MRI results and everything is normal there as well. Do you think my symptoms could be PCOS or HA? It seems like the blood tests aren’t in line with either diagnosis… and my doctor hasn’t diagnosed me with anything.

  83. Hi, I’ve recently had some bloods done after 21 weeks without a period I had these tests done on the 7th November and by the 14th my period was here but the doctor did the tests as though I wasn’t having a period but obviously I was getting ready to have one, and my results were progesterone 1.4nmol/L estrogen 1048pmol/L fasting testosterone 1.4nmol/L fsh 9.8iu/L and LH 26.4iu/L I’m iron deficient at 20ug/L freeT3 is 4.2pmol/L TSH 1.4miU/L T4 12.1pmol/l and my prolactin is 155miU/L C reactive protein is 0.3 mg/L she says they’re normal! I’m pretty sure they’re not I’ve read your book and although I don’t have cysts I relate more to stress causing this and inflammation and androgen issues even though my Hpa axis shows up normal on two different tests, I’ve started taking dim, vitamin D, zinc and magnesium. Acne, hirsutism irregular periods and never been on the pill I’m 23 and eat well. The doctor had basically told me I’m fine and she can’t do anything for another 6 month if I don’t have a period and she’s got no idea why I have hirsutism. Your book is great but I know the doctor didn’t read my results right so and insight would be great thankyou!

  84. I’ve been diagnosed with thin PCOS (anovulation, amenorrhea, polycystic ovaries on ultrasound, and high AMH), but I do not have clinically high androgens and my free and total testosterone levels on labs are not high. From reading your book, it sounds like I do not, with the lack of androgen excess, have PCOS. However my LH is high in relation to my FSH. I’m 32 years old, and my estradiol is <5. I had a baby 5 months ago, conceived through IVF, and I'd love to FINALLY figure out what's actually going on with me. I hoped pregnancy might make me "normal," but my labs have gone back to being exactly the same as they were prior to pregnancy (aka they follow the above). I stopped breastfeeding 3 months ago and have not had a period. It doesn't sound to me like I have either PCOS or HA, according to your descriptions, but then what else is left?! I have been diagnosed as hypothyroid as well, and I take naturethroid. My thyroid is being monitored and my lab levels there look good. There must be something left that we have not thought of?! Any thoughts would be much appreciated 🙂

      • My blood work from 2016 (pre IVF) shows an LH of 17.9 and FSH of 6.6 (this is what I was referencing in my last comment). I just checked my most recent blood work from last month and my LH was 1.1 and my FSH 3.4. I’m not sure what to make of that, other than I seem to be all over the place!

        • Is there any chance the high LH (17.9) was ovulation? Because if your baseline LH is low (1.1), then it’s a pretty clear sign that you’re not eating enough to be able to ovulate.

          • Before pregnancy my LH was consistently high as compared with my FSH, which is another reason I was diagnosed PCOS. My eating habits and weight are the same now as they were before, so I’m not sure why my LH this last round of bloodwork was so low!

          • Thank you; I will try that. When would you recommend retesting FSH/LH? In the meantime, I’ve read all of your posts about how great and important estrogen is in women. Since my baseline estradiol is <5 for a 32 year old female, would you recommend supplementing estrogen, bioidentical or otherwise? I feel tired and run down all the time, and I'm nervous about my bones and overall health.

          • The best way to get your estrogen up is to eat enough to ovulate and make your own estrogen. If you aim for 2500 calories per day and regular intake of all macronutrients including rice and potato, you should get there within six months.

            Estrogen is the *result* of a healthy menstrual cycle, not the cause of one.

  85. Hello,
    Iam salima. I have diagnosed of PCOS when i was 20 on the basis of irregular periods,and polycystic all lab results was noraml.I had given BC pills to regular my periods. When i was taking BC pills my periods was regular when i got off than again i was having missed period. When i became 22 gadually i have developed facial hair and little bit on my lower abdominal area. I went to Endocrinologist he did Glucose tolerance test and advised Spironolactone and BC pills for 6 months. I think i dont have insuline resistance. again i have given BC on and off. Now i just off from BC for 5 months i have only one natural period without pills.Yes now iam 26 and married about 2 years. I dont have kids please give me some suggestions thank you.

  86. Hi Lara- I just got done reading the second edition of your book and it was soooo educational. I am shocked about how little I knew about my own body! The reason I got your book was because I came off 15 years on the NuvaRing last October and haven’t had a period since. Of course I was concerned the first few months and saw a doctor who told me wait longer and dismissed my concerns. Long story short (and sparing you details about a bunch of doctor visits) I was diagnosed with PCOS based only on “a few too many follicles” and an AMH of 14ng/mL. All other androgens are on the low side of the reference range. That’s the case for all the hormones actually. I was extremely skeptical of this diagnosis bc I am lean (18%bf), workout, eat healthy, don’t drink or smoke and no other symptoms of PCOS. Unfortunately I cannot remember my period before I started hormonal birth control. I was overweight for most of my life and lost around 15% of my body fat within the last 5 years via tracking macronutrients. I’m now a month into slowly eating more/gaining weight before I try supplements and wanted to get your thoughts on if I am on the right track! I am sooooo happy I found your information as a resource so I can take control of my own health. Thank you for all you do!

  87. Hello Lara!
    Thank you for your great job! Let me ask you for help please.

    I have 17-OHP 8,69 mkg/l and DHT >2500 pg/ml, DHEAS 349 mkg/dl, LH 4,40, FSH 6,40 on the 5th period day.
    Insulin was 3,80 mIE/l.
    I’m 27 years old. I can’t get pregnant for one year. I have a horrible acne and am loosing my hair.
    It got worse after I come off pills after 6 months.
    The DNA test says that I don’t have the congenital adrenal hyperplasia.
    Is it PCOS? What should I do?
    I don’t eat sugar, dairy and so on.

    Thank you!

  88. Hello Lara,
    I was diagnosed with PCOS from ultrasound and absence of period
    My hormones exames are ok,no overweight or acne nor excess of hair
    Do you think it can be HA?
    Would metformin help me?
    I ve got no period since March
    Anna xx

  89. Good morning Lara!

    Thank you for your book and for everything you do – you really are amazing and we need more doctors like you in the world who truly care about the health of women!

    I started my periods at 12 and they came like clockwork, every 28 days without fail. I then went on the pill at 16 and came off this year, at 22. My periods returned straight away – 28 days each cycle, for 2 cycles. But then the next cycle was 36 days. And I havent had a period since then (37 days). It’s quite clear to me that I haven’t been ovulating, but I’m not sure if its PCOS or HA. I’m quite a petite frame (7st13 at 5’3) but I’m not underweight as such. NHS doctors in the UK won’t see me until I haven’t seen a period at all for 4 months.

    Is this post-pill PCOS or HA? Is it possible to suddenly develop PCOS? I’m not quite sure what to do going forward, so would massively appreciate your help.


    • That pattern of having a couple of cycles after the pill and then nothing is quite common. It’s part of post-pill amenorrhea and could be exacerbated by either undereating or an underlying PCOS tendency. I’ve heard from other readers that it’s quite hard to get blood tests in the UK, but if you can get tests, then the potentially most helpful tests would be day 2 FSH/LH ratio as well as a fasting insulin or glucose tolerance test with insulin.

  90. Hi Lara,

    I was diagnosed with PCOS by an endocrinology consultant a couple of years ago, and was started on Metformin 6 weeks ago as we’re trying to conceive. I haven’t had a natural period since before I went on the pill at 21, over ten years ago, despite longs break during that time to see whether my cycle would regulate.

    My general doctor reviewed my (recent) blood results though and said they appear normal to him:

    A1c level (IFCC), blood: 34
    Free T4 level, serum: 15.2
    TSH: 1.86
    LH, serum: 4.4
    FSH, serum: 5.8
    Prolactin level, serum: 153
    Testosterone level, serum: <0.5

    On paper, I seem to fit the profile of someone with HA (ex-dancer, very low BMI, many stress fractures in the past, regular exerciser), so I'm just wondering whether what I've been advised to do – eat low carb and be on Metformin – might actually be counter-productive in trying to get my period back? I know I'm very underweight at the moment, and the Metformin seems to be making it impossible for me to gain any back.,,

    Thank you.


  91. Hello,
    Fantastic post.
    Most of the PCOS posts and questions I see are about people who are either not having a period at all or their periods take time to come.
    My kind of Pcos is the one where I bleed almost daily. I have had ultrasounds,some show I have cysts and some show I don’t. I have dark hairs on my chin and body, and I am lean and I don’t have a problem losing weight, I lose it quite easily. I had a mirena IUD for 6 months to try and stop the bleeding but it didn’t stop,so I had it removed.i took some pills before that and they didn’t help too. I don’t like eating sugary stuff since it makes me feel like vomiting,so mostly when I eat sugary things I have to drink water to feel better.Am just wondering what could be the main issue with my body?or what should I do,eat or not eat etc.

    • Periods all the time is a clear sign that you’re not ovulating– which is typical of PCOS and can result in either no periods, irregular periods, or very long, frequent periods (periods all the time).

      Has your doctor tested for androgens (male hormones) and insulin? Please read my book Period Repair Manual and look at the section “how to speak to your doctor.”

  92. Hi Dr. Lara,

    Just listened to you on the Period Party podcast and I own and reference your book often. Thank you for all the work you do to help women!

    I came off BC a little over 2 years ago and have not had a natural period since (I was on the pill for 10 years).I saw an endocrinologist a few weeks ago and she prescribed a 10 day dose of progesterone, which successfully resulted in a period a week after finishing the dose.

    She did blood work and did not find anything alarming on her end, but I wanted to get your trusted option, please…

    FSH: 9.4 miu/l
    LH: 6.4 miu/l
    Progesterone: <.5 mg/ml
    Prolactin: 6.9 ng/ml
    ESTRADIOL: 40 pg/ml
    DHEA: 64 mcg/dL
    Glucose (did not fast): 93 mg/dL
    AMH: 1.90 ng/ml
    TSH w/reflex to FT4: 2.21 miu/l
    Testosterone total: 25 ng/dL
    Testosterone free: .9 pg/ml
    Thyroid antibodies: <1 iu/ml
    Thyroid peroxide antibodies: 7 iu/ml
    Sex hormone: 125 nmol:L

    I’ve been told in the past by gynecologists that I might have PCOS, although I’m not overweight, I don’t have weird hair growth or loss of hair, etc. A cyst did show up on 1 ultrasound a year ago, but it was gone by my next check up (this is normal as I understand).

    I’m not vegetarian or vegan and I eat plenty of healthy fats and animal protein.I take supplements as well (fish oil, vitamin d, b12, probiotics).

    I’m not interested in going on birth control again as I’m looking to try to get pregnant in a year or so.

    Please help!! Thank you!

  93. Hi Lara,

    Thank you so much for the great information work you are doing. What about women with low testosterone levels? I got off the pill two years ago and have not had my period since. I have been diagnosed with PCOS based on Ultrasound, and LH/FSH ratio which is around 4.7. However my free testosterone and my DHEA-S are low (below the standard value). I hardly can find any information on treatment for PCOS women with low male hormone levels. I am normal weight eat whole food/ no sugar diet but I am still struggling to get my period back. Any tips for women with low testosterone levels?

    • If your testosterone is low and you don’t have any signs of testosterone (facial hair etc), then it is probably not PCOS. Are you sure you’re eating enough?

      The ultrasound finding means nothing. And the highish LH might mean something or it might not. Depends on how low both LH and FSH are.

  94. I had periods every two weeks and had decently severe acne until eventually my period disappeared completely and my acne got worse. I didn’t have a period for two years and had pretty bad acne but I was also at a BMI of 17. At the time of my “Worst” acne, I was also eating a vegan diet. I was diagnosed with PCOS by a simple ultrasound and NO hormone testing. Now I am on hormonal birth control and of course my skin has cleared up, i’m also now at a normal weight. I am a little confused at what I should do.

  95. Hello Lara!
    I am so happy to find you! I am a medical student from Brazil, and I am trying to learn more about PCOS, specially because I was diagnosed, but it’s so hard to find things that actually make sense.
    I was first diagnosed from an USG image, because of acne and menstrual irregularity after taking hormonal pills. But the irregularity stopped with antrophosofic medication, and in april I had an oral test for insulin resistence, and eventhough my HOMA was fine,my insulin level were 152,1uUI/mL at 120 min, and so I started with metfomin and a diet low carb-like, and aerhobic exercises. Since that I have had no period, I gain weight, (my BMI was 21, now is 22,6), I am feeling quite bloated, constipated, and I can’t find someone here that can help me! I tryed endocrynologists, gynecologits.
    So my question to you is how I can make a diferential diagnosis now? Should I test my LH and FSH levels only?
    I appreciate you attention 🙂

  96. I’m so happy I found your website! I’ve already binged on articles. Could you tell me what do you think about my results ? My doctor wants to put me on BC pills and said I need to take it all my life or my symptoms will come back. Is it really the only way?
    i’m 23 , I have polycystic ovaries, irregular periods, acne and excess hair. I’m 5.7 , 127 lbs.

    FSH 3,44 mIU/ml
    LH 1,2 mIU/ml
    Estradiol 28,73 pg/ml
    Prolaktyna 11,63 ng/ml
    Testosteron 40,7 ng/dl

    I didn’t have insulin resistance test yet.

  97. Hello,

    I had a baby 1 year ago, fell pregnant in the first month of trying. Now, my first day of my last period was 88 days ago with no sign of coming.

    I recently had tests. My LH came back at 17 and my FSH was 6. Is this an indication of PCOS? What should I do to treat it as we would like to have another baby.


  98. Lara,
    In reading the article you referenced (Complex Relationship between Hypothalamic Amenorrhea and Polycystic Ovary Syndrome), it seems to (if I’m understanding it correctly) state that HA can mask the PCOS, and recovery from HA can lead to recurrence of the PCOS symptoms. Do you think there is any way to balance between HA and PCOS, or to treat the PCOS without causing a return to HA?

    • Yes, exactly right. HA can mask the PCOS, and recovery from HA can lead to recurrence of the PCOS symptoms. My strategy with patients is to ensure that they eat enough of all macronutrients, including carbohydrate. BUT (in many cases) keep a lid on sugar and cow’s dairy because those two foods can worsen acne and androgen sensitivity. And from the very beginning of treatment, have a natural anti-androgen supplement in place (usually zinc). And then monitor LH. If LH goes high, then I might give peony and licorice at some point.

  99. Hello Dr Briden,
    I’m 35 and was diagnosed in my 20s. I have hirsutism on my face and body. I’m currently on metforim with borderline high BP and Diabetes. The majority of my excess weight is located in my midsection. It’s very hard for me to loose weight. My periods were always irregular since I first started getting them. However, I haven’t had an actual period now in about 6 months. What can I do to get it back? I have been beginning to worry if i am menopausal. I am defiantly going to cut back on my sugar intake and try zinc and magnesium after reading your articles. Any other advice? Thank you for what you do. I am happy I stumbled upon your page.

  100. Hello Lara, can you tell me what is the correct measure of how high or low LH is in relation to FSH, which you talk about in your tip?

    Thank you, Elizabeth

  101. Madam, my daughter is not getting periods, lately it is after 90 days or more. A wellness clinic Dr has put her on supplements such as magnicium , zinc , proteins etc. I can share her test reports. All tests shows normal. She has severe acne on face and body. Very irritated and tensed mood. She is fifteen. She got her first period at 11 years and it was never this bad in the past..
    Worried Father.

  102. Hi there. I am 27 years old, came off the pill in January And have yet to get my period. I am one year recovered from anorexia and one year at a healthy body weight. I have had my bloods done which states ratio 1:1 lh and fsh. I was over exercising but have cut down to 3 times per week. I have poly cystic ovaries and hadbe been diagnosed with PCOS by a fertility doctor. I have mild acne which is cyclical. I have just got my bloods done to check for testosterone, amh and prolactin as my endocrinologist is querying the diagnosis. I am a highly anxious Person and I am stressing eveydua about this. Do you think I have been givien the right diagnosed based on the above? Any advise would be great. Thanks so much.

  103. Hi Lara, are you able to comment on High Leptin levels when all other signs point to HA? Or could this be an inflammatory PCOS?
    Thanks Sophie

  104. Hi Lara – First thank you so much for your wealth of knowledge! At 27, I have come off of the hormonal birth control pill after being on it for nearly 10 years. I wish I would have stopped years ago, instead of right as my husband and I want to start a family! Anyway, I was originally prescribed Yaz by a dermatologist for acne. At that time my periods were regular. I have been off of the pill for 3 months. The first month off, I had no bleeding at all. At the end of month 2, I had 4 days of bleeding that seemed like a normal period. Now at the end of month 3…into month 4, I have no bleeding, have taken pregnancy tests that have all been negative. I have also experienced a steady increase in acne which is at an all time high right now. My BMI is 23, I exercise regularly, and eat a generally low carb diet focused on mostly veggies (zucchini, salad, broccoli, mushrooms, green pepper), eggs, and meat, including some dairy with cheese mostly. I have been to see my OB, she tested my thyroid levels and prolactin. Both were normal. Should I go back to be evaluated for PCOS? I’m feeling very depressed and anxious about my future, feeling like I’m doomed to irregular periods and infertility. Any thoughts and advice would be SO appreciated!

  105. My 14 year old daughter started her period when she was 12. She had 8 normal periods in a row and then quit having periods. She is very athletic 5’2 and weights 110. The doctor said she has mild PCOS the blood tests showed her male hormones were elevated. The doctor wanted to put her on the pill but I declined. Still no sign of a period and she will be 15 in December. She also is dealing with embarrassing facial hair.Please advise me on what to do. I’m very worried and can’t get any good answers.

    • Bear in mind that teens have higher male hormones than adult women. That’s normal and its why some experts say that a PCOS diagnosis should not be given to women younger than 20.

      If she’s athletic and has lost her periods, there is a very real chance that she’s not eating enough to get a period. Please read Are you eating enough to get a period?. And re-establishing regular cycles will help with the facial hair because both estrogen and progesterone (made by ovulation) reduce facial hair.

      • I do feel like she’s been miss diagnosed. She does eat a lot. I make sure she gets lots of carbs and packs extra snacks on school days. I was hoping over summer break while she was less active her period would start back. But no luck. I tried her on inositol supplements this summer as well but she felt like it was suppressing her appetite so she quit taking it. What do you recommend as far as further tests, supplemens and calorie intake? Her last blood test showed testosterone total of 48 H, free testosterone 6.3H. I wish I could bring her to you. I feel like the doctors in my area only want to give birth control pills and it makes no sense in her case. We live just outside of Houston, Tx are there any doctors in my area you would recommend??

  106. Thanks for this post! 14 months ago I quite the pill and I haven’t got a period since. I started the pill at age 15, after having only 3 (somewhat regular) periods, because of severe acne. The pill helped a bit (acne on the back and chest was almost gone, in my face it became less). Now I’m 30 years old. I still suffer from acne. Became worse after quitting the pill. Then I stopped eating dairy and the acne became less again (also my hayfever and runny nouse disappeared after quitting dairy).
    This spring my doc sent me to the gyno. Ultrasound showed multiple follicles in different stages and minimal lining of the uterus. Bloodwork (done in april): TSH 1.56 mU/L, LH 1.8 U/L, FSH 5.1 U/L, prolactine 225 mU/L, progesterone <0.6 nmol/L, estradiol <50 pmol/L, testosterone 0.9 nmol/L, DHEA-s 8.11 umol/L.
    They didn't gave me a diagnosis. I hope to get pregnant. They sad they could give me clomid. I refused because I hope to get a natural cycle. I'm done with hormonal medicine (wish I never started with the pill, but lets not dwell in the past…).
    I know low estrogen runs in the family. But so does insulin resistence, diabetes type 1 and PCOS. Though I feel like HA is the case right now, I also feel like I have a tendency to PCOS also. In the past I've had symptoms of insuline resistence like being thirsty a lot, drinking a lot and needing to go to the toilet a lot. That disappeared when my lifestyle became healthier and I stopped consumin dairy.
    I don't have a history of distorted eating. I do eat quite healthy but don't limit myself in calories. No white sugars and I make all my meals myself. I do eat carbs. My favorites: oats, sweet potatoes, buckwheat. Most off my protein comes from collagen (every morning with matcha), eggs and nuts (sometimes I eat fatty fish like salmon, I don't eat meat). I do eat fruit everyday, mostly apples or berries. I eat lot's of veggies. I get my fats from coconut- milk/yoghurt/butter/oil, avocado's, 99%dark chocolate, nuts, ghee and olive oil (and sometimes fatty fish).
    I'm not under or overweight: 59 kg and 168 cm tall. I do yoga daily, so I move a lot. But I don't stress myself out with running or so. I get my 8 hours of sleep. I also don't have that much stress of work.
    When I quite birth control I ate strictly vegetarian, almost vegan. For example: Oats with fruit for breakfast. Sweet potato soup with raw veggies on the side and buckwheat crackers with nutbutter for lunch. Dark chocolate to snack. And lentil stew with veggies for dinner. Since april, after getting that bloodwork done, I've upped my fat and protein intake a lot! A day may look like: coconut yoghurt with an apple and nut butter for breakfast + matcha with almond milk and two scoops of marine collagen. A salad of leafy greens, raw veggies, avocado, chickpeas or a grain and boiled/baked egg for lunch. Dark chocolate to snack. Sweet potato soup with ghee for dinner. Just an example.

    Oh and I supplement magnesium, vitamin D, and a multivitamin for women who wish to get or are pregnant. Two weeks ago I also started using zinc (there is 10 mg in the multivitamin, now I take 20 extra).

    I don't know what to do anymore… I want a cycle and I also hope to get rid of that acne after all those years… Do you have any advice?
    Thank you for reading this long comment.

    • p.s.2. I’ve got your book and read it. Learned so much about the female reproductive system! Also via your blog. Went off vegetarianism because of your advice. But don’t know what to do next. I’m kind off stuck right now. That’s why I ask for tips.

      I do also supplement turmeric by the way.

      Tried vitex in february but I made me feel crappy (depressed) and my acne got worse.

      I do feel better since I upped my fat intake. Big difference in mood. No difference in my skin though.

      Also started acupuncture in june. The sessions make me feel relaxed. Don’t know if it does anything else…

    • Hi Maud, I was wondering how you are going? Did you hear back from Lara? This sounds similar in many ways to me! I have recently been reading No Period Now What by Nicola Rindali and have increased my calorie intake (which has been hard to let my body put on weight)!.

  107. I was diagnosed with PCOS aim my early twenties, I had cysts on my ovaries, high testosterone and irregular periods and my doctor put me on Metformin and birth control. Several years later I switched to the paleo diet and went off those meds and my cycles are like clockwork now. While I still have problems with elevated blood glucose levels and my A1C has been as high as 5.7, at 40 would it be safe to assume that the PCOS has “self corrected?”.

  108. My LH is 0.5, FH is 3.0. Estrogen 40, progesterone under 0.5. No period. I’m guessing HA but I’ve a lot do Body fat! Responded to Letrozole so my specialist thought it was issue with ovaries response vs hypothalamus messaging.

  109. Great, great blog article Lara & I love your repair your periods book.

    I have had the DUTCH test done & am totally confused by the results. I have normal androgens & androgen pathways & normal progesterone but low estrogen.
    I have PCOS type symptoms and am of average weight. Can you point me in the right direction?!

    Thank/you so much

    • Are you having regular periods? Are you ovulating? What is your FSH/LH ratio (on a blood test)?
      Please check out my book Period Repair Manual, if you haven’t already.

      • Thank you so much for your response Lara, I really appreciate it.

        I am ovulating and my periods are sometimes regularish & sometimes pretty irregular & always have been. I have checked out your fabulous book & need to get my FSH/LH tested.

        I’m struggling with fatigue, acne etc. What are your initial thoughts on what is likely?

        • Dear Karen

          Have you found any solution or direction for your problems? I am stitting in the exact same boat. With every blood test that I do i get more confused.

          Thank you for your sharings,


  110. This article has my name all over it! This is an area of care that is so confusing for women and honestly heartbreaking. I am now becoming a nurse because of this and following my passion of integrative medicine! Thank you Lara.

  111. Hi, I’ve had saliva test and blood test and I have LOW LH, FSH and low oestrogen. I’ve had acne for 10 years and I’ve got abnormal hair growth for about 8 years. My periods have become irregular in the last 4 months I’ve gone 9 weeks and 10 plus weeks with no periods. I have normal testosterone but very very high morning cortisol. My GP looks baffled and suggests the pill, which I don’t want. Do you have any advice? Thank you!

  112. Hi Lara 🙂 Thanks so much for these so helpful articles. Would it be safe to try use Berberine, as I am not sure if I have PCOS, but maybe it would help against my acne. Would it also be okay to use Berberine in combination with Vitex? I thought using Berberine and then seeing if facial hair decreases and Acne then I might not need to go through all the tests at the moment? So it can’t hurt right? Have been using Vitex now for 6 months and will be finishing it soon, it helped me get regular periods and definitely a lot less Acne, but period still takes like 30 days to come and (25 days Vitex on and 5 days Vitex off) and also there is still Acne and facial hair … I used to have no periods around 10 years ago due to anorexia, so maybe my body has a tendency as you describe to go from HA to PCOS? I have normal weight and eat very healthy and balanced now though. Thanks heaps!!!

  113. Hi Lara,
    I am enquiring regarding my daughter who is 30 years of age. At age 18 her blood count dropped dangerously low from excessive menstrual bleeding. The hospital pumped her with high doses of hormones to suppress it. This has resulted in irregular periods. Currently she has not had a period for 9 months. We are interested in natural treatments only if possible. We have tried many so far with varying degrees of success. Do you have any suggestions? Kind regards.

  114. Hi Lara 🙂 I heard about you from a friend here in Auckland, and im so so happy to have found name is also Lara (a sign from the universe in my humble opinion!), and im 22 years old…I started my period at the age of 11, and over the years it was fine apart from significant pain during the period onset plus my mother always thought it was a short lengthly period that only lasted on average 2-3 days . I have suffered acne, and have excess hair (on my face, chest, etc..), and flat-chested (all signs of excess male hormones). At the age of 19 my period just stopped. When I was 20 my doctor put me on the pill, my period came but when I stopped the pill my period stopped also. I was diagnosed with PCOS at the age of 21 with my blood test showing slight excess male hormones, etc etc…but then I started going to the gym, eating more healthy, and after 6 months another blood test showed that I have no signs of PCOS anymore, so my doctor could not diagnose me. My situation is also a bit more complicated because from the ages of 14-18 I was taking medication for a head injury that I incurred, which apparently was not “suitable for women” (it was an indian brand called Desval 500 – which was a sodium medication thats a medic for seizures). From reading some of what you have to say I feel like your someone that can really help me with this…Sorry for the over comments but I would just like to lay everything out on the table as I now the body is a complex system, especially when it comes to stuff like this !! xxxxxx

    • Hi Lara, common reasons for young women to lose periods include undereating and medications like the one you were on. If you’re off that now, you should be able to regain regular ovulation and cycles. Please check out my book Period Repair Manual, available from any bookshop in New Zealand.

  115. Lara! I’ve found you and I need SO MUCH HELP! I have NEVER had regular periods, didn’t get one until late 15-years-old, and had 4 after that until 19 when I was put on the pill. I have cysts on my ovaries but don’t know if I have HA or PCOS or both but I do know that in high school for years I had a borderline eating disorder of eating seriously low carb or calories most M-F then bingeing on the weekends. I was an athlete and almost always hungry, but still healthy/thin & muscular looking, so no one noticed. Then in college I started bingeing with laxatives sometimes or fasting breaks, then when seriously depressed I just started bingeing. Right before that at 19 in August that year I went on the pill and within 5 months had gained 25 pounds. I was binge eating and super depressed freshman year of college in a long distance relationship. Looking back I don’t know if it was the pill or my ed/lack of control that triggered everything. Over the next 3 years I lost most of the weight but have always been in a food obsession cycle w/ binges and doing different diets. My mother has been obese my whole life but also doing weird, mostly low carb extreme diets here and there. She also never had a regular period and had to take “drugs” to get pregnant the first time….

    I went off the pill January of this year and have had one period since. I have become consumed and obsessed with research and supplements. From reading your stuff I am under the presumption that I have inflammatory PCOS but also insulin-resistant maybe? I have high DHEA, low cortisol, high estrogen and basically no progesterone… so little. My anxiety has been so out of control but I determined to heal naturally. I take vitex (although still one month new to it), berberine, myo-insolitol, milk thistle, a DHT blocker, lysine, zinc, B12, B6, SO much Ashwaganda, L-Glutamine, a skin pill that’s mostly a TON (as in 1,000’s of %’s) of niacin, B5, biotin, and folic acid, DIM (super new to, only a week), CALM, acupuncture, and sometimes weed to sleep. I quit coffee 3 years ago but recently started having matcha a few times a week for the first time and GOD is it great?! I also do Apple Cider Vinegar every morning and tons of cinnamon and tumeric whenever I remember to. I spent the first half of the year cycling in and out of keto but would crash w/ anxiety after a few days of my skin clearing, having lazer focus, and really getting excited about it. I’ve also gone through vegan periods for the past 2 years, one even lasting almost a month with tons of fruit and grains…. which I now think was not the best for my body. The past 2 years I’ve definitely taught my body to accept less protein through both vegan and keto. What’re your thoughts? I’m a workout instructor of weight lifting and high intensity classes so I’m wondering if I should try being less afraid of more meat and bringing more of it back in? But now when I eat a lot of meat my body feels slowed down and not so good. I feel frustrated and confused seeing all these beautiful, thriving women on youtube and instagram that have healed their pcos with veganism or paleo and not knowing what’s right for me and feeling like none of it works and SO MAD AT MYSELF. I also loved keto bc the rules were so strict. Sometimes when I let myself eat rice or potatoes I get too excited and eat other things I shouldn’t…. Weed is helping my anxiety but I fear it might be hurting me in other ways? I feel a little bit slower in the morning and hungry before the afternoon for the first time. The woman who tested my hormones said it’s bc weed causes your blood sugar to drop in the night. I lost like 10 pounds 3 years ago and felt great intermittent fasting with mostly low carb but it did start to feel like it wasn’t maintainable and I got depressed after and gained it back. I’m not unhealthy or big. I’m a size 4-6 but I don’t feel good and I am a prisoner to my nutrition and hormonal information obsession and food obsession and I don’t feel healthy. It’s so hard to sleep, I’m super anxious, and I do feel 5-7 pounds heavier than what is ideal or comfortable for me.

    I think it’s so sad that ED can trigger a waterfall of hormonal issues that women will have to live w/ forever. This needs to be shown to more younger girls to help remind and even scare them even further away from abusing their bodies. I don’t know but I’ve shared almost everything I do know and I really hope you can help. I would LOVE to meet and pay you but I am a broke, struggling artist. Any advice would mean everything to me. My low income acupuncturist referred you. 🙂 Thank you.

    • My skin is out of control like never before but my hair has always been incredibly thick w/ no problems. I also have HPV but I think the cells are dormant right now, not sure. Sorry, I just forgot to mention these other issues that might be pertinent.

  116. My periods were perfect for my whole life and unfortunately at age 24 I began taking birth control and it has been a nightmare ever since I stopped it in 2015. It’s been 3 years I stopped birth control and my periods NEVER went back to regular as they used to be and it seems as if the pill left me with a different body. My periods were irregular after the pill but never went beyond 60 days. I’m currently on day 75 or so of amenorrhea and based on my bbt I have not yet ovulated. I just started vitex today and I LOVE your book. It is so clear and has helped me not freak out and understand my body more. I really hope it is nothing major, I’m still waiting on blood results from doctor. She gave me provera to take but I’m terrified of taking any hormones. Hope Vitex works.

  117. Hi Lara,

    I’ve been following your blog for a while and have read your book… hoping you can provide some insight to help repair my period.

    I quit HBC cold turkey 1.5 years ago, before finding all of your great content and have been practicing FAM since then. It took 8 months to get a period and since then I’ve gotten my period every 14 days consistently. I am not seeing spikes in temps and my periods are extremely light, typically lasting 1 or 2 days.

    Due to extreme post-pill acne, I’ve been on 100mg spironolactone since February but recently dropped down to 50mg, since my acne has cleared and I’d like to ween off. I supplement with turmeric and omegas daily. My diet is mostly clean, no dairy, lots of veggies and usually consume 140g carbs, 150g protein, and 70g fat daily. I’ve also tried acupuncture for the past 4 months with no luck.

    Would love to hear what your suggestions would be for lengthening time between periods and weening off of spironolactone! My doctor has only suggested going back on birth control.

    Thanks! Kristina

    • Two-week cycles are anovulatory cycles. In other words, you’re not ovulating yet, and it very well could be because of the spironolactone, which is almost the same drug as the progestin drospirenone used in many pills. With my patients in a similar situation, they find that they have to get right off spiro to start to have normal periods and hormones.

  118. Hi Lara, thanks for your blogs and book – loved it! Just wondering can you comment on Vitex for HA? I read that it can cause more harm and actually prevent return, when prolactin low-normal? I have not had a natural period in 2 and half years since coming off the pill and was just started on this by naturopath.
    Can you comment any further on DHEA supplements for low DHEA? And can this help HA recovery?
    Also is post pill amenorrhea diagnosed differently than HA? I couldn’t find this clear in your book.
    Thanks again! Sophie xx

    • I think it’s okay to use vitex for HA. It just won’t do anything unless there has also been enough food and carbs for at least four months.
      Post-pill amenorrhea or post-pill syndrome can present with an HA or PCOS picture.
      Finally, yes, low-dose DHEA supplements could conceivably help with HA. But please check with your doctor.

      • Thank you Lara for your response. From reading your book I think I have HA (PCO but low androgens, low DHEA 2,5, low tesosterone 0.6, SHBG 100, insulin 3, GTT normal). Persistent thin endometrium lining resulting in chemical pregnancy in last IVF transfer. Pattern of low estrogen with IVF cycles.
        I have one more frozen embryo PGS tested but have since been focusing on restoring my period for last 4-5 months after reading your book before going ahead with frozen cycle. Do you think my best chance is to get period back before I do artificial cycle with last embryo, we are planning to do GCSF infusion to see if helps my lining also.
        Naturopath has started me on Vitex, Tribulus Forte and recent bloods LH 3, FSH 8, estrogen 115, progesterone 2 (normally <1). She has also put me on Glutamine , priobiotic and herbal meds for parasite. Also on supplements vit D, zinc/selenium for T3 3.3, DHEA supplements, iron (8), vit B12, cod liver oil, vit E.
        Is it ok to go for a few 5km runs per week, plus pilates? I previously did a lot of running but have cut back. And trying to incorporate more carbs but worried about putting on weight.
        Are Vitex and Tribulus Forte going to cause any harm?
        I keep getting so many conflicting views its hard to know whats right and wrong?! Do you think if I get ovulate again it will subsequently help my lining versus the past poor response with thickening to IVF meds?
        Thank you again!

        • That hormone profile suggests you are not eating enough to ovulate. In that case, Tribulus and vitex will not work. Most likely, you need a lot more food than you’ve been having including a lot more carbs. Please read my book Period Repair Manual and also the book No Period, Now What?

          • Thanks Lara, can you tell that from my hormone profile? And by carbs I presume still mean no gluten ?
            Yes have your book have read a few times !

          • Hi Lara, can you have Post Pill Amenorrhea and not HA? I’m confused with what is going on in my body and never get straight answer from my Dr or Naturopath. Or how do you know difference between HPA dysregulation vs HA?
            Thanks !

          • Technically, post-pill syndrome is classified as hypothalamic amenorrhea. But, it’s a different situation, in that it’s not caused by undereating (like classic HA), but rather by drug suppression of the ovaries. It can take many months to get periods going again after the pill. It’s not something wrong with the woman, but rather with the drug she was given.

          • Thanks again Lara, I have been off the pill for 2 and half years now and still no natural cycle. So would it be more likely HA (undereating) as you suggested above from my blood profile? Only thing was my Leptin was high?
            Guess I don’t want to start increasing my calorie intake if that not the reason for no periods for me!!

  119. Hello Dr. I stumbled into a podcast about PCOS VS hypothalamic amenorrhea (which I have never heard of) and after diving into the plethora of information on your website, I wanted to ask your option. Long story short after having issues in birth control my doctor at the time did a scan of my ovaries which came back as “covered in thousands of cysts”. From that scan alone she diagnosed me with PCOS and switched my birthcontrol. A few years went by I was receiving projestorone pills to get my cycle if it didn’t come on it’s own. Which my body reacted negatively to with breakouts almost boil like and mood swings. In dec of 2010 I stopped birth with the goal to start a family. After a few years of no success and spuratic to no menstral cycle I asked A new doctor at a consult (non exam) appointment for help conceiving and explained the previous PCOS diagnosis and backstory. Without examination or tests of any kind she prescribed me metformin and told me it was what I needed in conjunction with progesterone. The metformin made me so so I’ll after less than a week I stopped taking it. It was clear to me that’s is was not what my body needed. It made me extremely dizzy and nauseous. After this experience it was suggested to me to try a fertility specialist for additional testing. Thousands of dollars, lots of blood work, two ultrasounds, and a test where they push liquid through your Fallopian tubes to make sure they aren’t blocked.. and I was told everything comes back normal but I have a very high egg count for my age and must not be ovulating even when I do get menstration. The next line of testing was extremely expensive and I was starting to get depressed so my husband and I decided to step away and take a break. We also began eating primary Organic which I believe helped. 6 month’s and a vacation later I conceived my daughter without mensuration. I had a cycle two months prior to conception. We have an amazing now 3year old daughter and would love to give her a sibling. I never went back on birth control. I stopped breast feeding completely 5 months ago. I have had a few menstration cycles and I believe two ovulation(based on feeling) but my cycles are still not regular. I’m curious what your thoughts are on my situation. When I read that stress plays a big factor in HA I felt like I had an ah ha moment and it all made sense in hind sight.

  120. Hi Dr. Briden,
    My cycles have always been irregular ranging at about every 60 days. I started taking Vitex 2 months ago and my first cycle was 32 days—-this has NEVER happened before and I know it’s because of Vitex. Now on the second cycle, havent ovulated yet and it looks like another 60 day cycle….hopefully not longer. Why would Vitex work one month and not the next? I take 800mg/day. Should I take more?

  121. Anyone in the same position as me? I’m 49 and always had regular as clockwork periods. I conceived my 2 kids super quickly at age 30 and 32. In 2008 I went on a very low calorie diet and lost 45lbs in 10 weeks. I was still a good 172lbs but looked and felt a million dollars. I kept most of it off for about 4 years by very low fat and low calorie eating, cycling and walking. Nothing major. In 2011 I started to gain wait very dramatically for no reason and then by 2012 my previously always perfect cholesterol had gone up dramatically and I was diagnosed with fatty liver, raised inflammation levels and high blood pressure. Of course the doctors just blamed it on me eating too much. In order to try and lose the weight I intermittently did the very low calories dieting and low carb way of eating but the weight would just pile on and nothing would budge it. In 2013 or so at 45 I started to miss periods. I thought it was just my age. By 2014 they were disappearing for 6 -7 months and then coming back regular for 5-6 months. This has been going on now for the past 4 years. The doctors told me it was my age. I am now heavier than I have ever been and my whole body aches all over. The weight just won’t budge even though I try and walk most days and watch what I eat. I recently demanded hormone tests from the doctor which have showed I am not menopausal and my testosterone levels are higher than they should be. My doc says the results are indicative of PCOS. I’ve never known anyone my age to be newly diagnosed with PCOS. I am hoping that after all these years I may have a diagnosis so I can try and do something about it. Perhaps I also have insulin resistance and maybe I have caused this to myself from my disordered eating and starving myself all those years ago. Feeling very confused and depressed about it all

    • It’s really worth having a test for “fasting insulin” to see where you’re at and maybe confirm a diagnosis of insulin resistance.

      • Thanks lara….I’m going to see an endocrinologist next month so will see what he has to say. Just hoping he listens to me as i am really fed up talking to a brick wall

  122. Hi Lara,

    I had irregular periods on my teens (about every 3-4months) from approx 15years. I went on the pill at 19 and came off at 30 and haven’t had a period since. I’m now 32 and wanting to try to conceive. I have been on a low carb diet for the last 10 years and have also intensely exercised doing about 8hrs a week. I have a high AMH and cysts in both ovaries on ultrasound and diagnosed with PCOS but could this be wrong? Progesterone, testosterone and oestrogen are all low on my bloods.


    • I would love to hear what Lara has to say about this. This is almost me to a T. I went on the pill younger, but came off at 27. Only had a few natural periods far apart. Diagnosed with PCOS, but all low hormone levels. I teach group ex and eat very healthy as i used to be heavy. Took 3 rounds of IVF to get pregnant. I just failed another 3 rounds of IVF and now I don’t know what to do bc I won’t get a period without going back on the pill.

    • The pattern of low-carb diet, intense exercise, high AMH and no periods strongly suggests that under-eating (and not PCOS) is the reason you’re not ovulating. If you were my patient, I would probably ask you to eat potatoes or rice every night for four months, and then you may finally ovulate.

  123. Wow! Lara! I’m so happy to find your post, because THIS IS TOTALLY ME!

    I’m Mahdis, from Iran… I’m 24 years old, 5’1 and 94 pounds… I workout 3 days a week, and I’m super fit. (NOT A CRAZY GYMAHOLIC HAHA…I started working out 10 months ago.)

    After 2 years of routine period, when I was 15 I was diagnosed with PCOS…
    But I always wondered: I never had insulin resistance, I never had high androgen, I was never overweight…SO HOW IS IT POSSIBLE? JUST BASED ON ULTRASOUND/HIGH AMH/ AND LACK OF PERIOD?

    So the doctors put me on birth control pills for years and years…

    Until last year….I became really tired, and I FINALLY STOOD UP TO FIND A SOLUTION…
    So, I had some serious blood tests, and the result HAD NOTHING TO DO WITH PCOS!
    Every single hormone from was low to normal… and that was when I realized I might have HA, not PCOS…

    (Really low estrogen, normal but close to low LH, FSH and progesterone, normal testosterone, normal blood sugar and insulin resistance, normal prolactin…..Have been having a stressful life always, I have eating disorder too.)

    SO AGAIN, THE DOCTOR PUT ME ON BIRTH CONTROL PILLS, but I’m always wondering if it would truly help me to conceive one day. They tell me the possible way to get pregnant in your case is Gonadotropin, but the thought of it scares me…

    I am quite sure it was never PCOS… because I never cut out sugar or carbs (A BIG FAN OF ICE CREAM, CHOCOLATES, PASTA, FRENCH FRIES HERE, HAHA) so, again, this could have never been PCOS…

    What are your thoughts Lara?
    What can I do?
    Should I keep on BCP? Can I conceive one day? Should I worry? Could this possibly change to POF?
    Please reply, that would mean SO MUCH TO ME! …

  124. Hello Dr. Briden, my name is Riham; 42 years old from the Middle East. I have lost my period and have seen four doctors since October 2017 and my results were as follows: a). Progesterone was 7.3 ng/ml, FSH was 7.5mIU/mL, LH was 3.90mIU/mL, Prolactin was 4.17ng/mL -I breastfed by baby for 2 years and 5 months-. Naturally conceived my baby 3 years ago after a failed IVF. I had two uterine polyps removed in Jan 2018 followed by an HSG in Feb 2018 to discover that my right tube is blocked. Last week my last OB GYN treated my retroverted uterus and I am on treatment now. Still no period and I wish I could know what is happening; is it menopause, then fine, i will just live with it and forget about trying for another baby. I really wish you could see my message and I wish you well.

  125. Hi there,

    I have recently been diagnosed with Pcos.
    I am normal weight, 64 kg and 5,6ft. I am 27 and have always had regular periods no issues and ovulate regularly when I was a teenager pre birth control . I went on yaz for 7 years for contraception and came off it for three months- periods came back straight away perfect 28 day cycles I then I had an mirena place in for three months and absolutely hated it -acne,hair loss but a lot of weight loss (5kg). Only to now have no periods for 3 months and multiple Cysts on my ovaries on ultrasound but no elevated testosterone, androgen but a raised sbgh ? Hbac1 is normal too. No facial hair and no weight gain. ??? Very confused

  126. Hi Lara,

    I am so happy I found your book and this blog. But still I have a question for you..

    In a few words, I am 28 and maybe about 10 years ago I was on a diet where I lost a lot of kilos and had become very skinny and then I lost my period. It took me a years to get it back, my period was regular but then I became overweight. I got an Insulin Resistance PCOS diagnosis so I started with taking a Glucophage (1000 mg twice a day). My period was still regular. I lost a several kilos, but I still was overweight (about 80 kg).

    Last year I wanted to quit taking the Glucophage and try to reverse Insulin Resistance naturally and lose some weight. So I took a blood test again before I started with it – I still had insulin resistance (glucose tolerance was good).

    I quit using Glucophage from November. Then I skipped period for one month, but after that I had it again.
    My cycle is about 31-34 days.

    In March, this year, I started a diet based on carbs cycling – I got a meal plan from nutritionist. But from then I haven’t had a period for two months (March and April). I thought this diet is balanced, but maybe I miss something.

    For 2 months I lost about 8 kilos – and that is almost my ideal weight as my nutritionist said that for me 70 kg is ideal weight, I have 72 kg now. My height is 172 cm.

    I have a 4-5 meals per day, in every meal I have proteins and salad and carbs are varying from day to day. Every day I eat some fruit (low GI fruits like apples, oranges, kiwi, strawberries, etc). I am also taking magnesium, zinc and Vitamin C supplements.

    What should I do to recover my period but still take care of insulin resistance? Maybe my doctor missed something, so I want to check every possibility.

    Thanks a lot in advance,

    • You might not be eating enough carbohydrate to get a period. Most women need a minimum of 150 grams of carbohydrate to be able to ovulate.

      • I have my period after several months, I started with inositol 3 months ago and now I am adding maca powder in some meals. I did a blood test 2nd day of the cycle: LH-8.82, FSH-4.9, SHBG-56.75

        Is this normal result?

  127. Sorry for the lengthy comment ive watched your website for almost a year and really would be ecstatic to hear from you on ANY of this. I am so thankful for your committment to ovulation and hormone harmony by spreading the word about “small men’s” health. 😂

    I have taken notes on everything however I cant find any information on my one big question. My first birth control method ever was the mirena (4 years) which caused many symptoms for me my acne being the most identifiable. I removed it. I got a copper iud. My acne did not subside. I had that removed as well its been 5 months since that and I do have periods. MY QUESTION:




    unfortunately I have switched doctors twice now and they disagree with every word I say or convince me not to get a blood test and encourage more hormones or spironolactone so i have been left in the dark .



    • Are you ovulating regularly? Because that can give some insights into why your acne persists. How old were you when you first had it put in?

  128. Hi Dr. Briden,

    My husband and I have been trying to conceive our first child for a year. I am 26 and he is 27. I came off of birth control pills 1 year ago after having taken them for over 10 years (in hindsight, I probably wouldn’t have taken them in the first place had I know the effects they can have). The original recommendation for birth control pills was due to heavy, irregular cycles. After coming off the BC pills, I have been taking a prenatal vitamin and fish oil supplement religiously. My first 3 periods were between 35-45 day cycles. Then “something” changed and I went without a cycle from June 2017 to December 2017. Conveniently in June 2017 I received a TV US by my obgyn showing no signs of PCOs. A little stumped, my obgyn sent me to a fertility doctor in December, who recommended another TV US and it showed PCOs. Blood work was done showing higher LH, with relatively low estrogen, progesterone and normal FSH. I have no other classic signs of PCOS (normal weight, normal-low DHEA, minimal acne, normal-low cholesterol, normal-low A1c, no excessive hair growth). I have now undergone 3 cycles of Letrozole for cycle day 3-7 with trigger shot for ovulation and progesterone supplements following ovulation, but no luck. I just went in for another cycle day 12 US after taking Letrozole from CD 3-7and my follicles just don’t seem to be growing like they should (9mm was largest).

    I’m feeling a bit lost because I obviously want to conceive but I also want to regulate my cycle, and most importantly, my hormones. I can’t understand why my body isn’t quite getting into the groove. I’m taking a prenatal vitamin, zinc, garlic, B6, omega-3, and D3. I try to eat as clean as possible, and have considerably increased my water consumption. Is there anything else that I can do to try and naturally encourage my body to regain some normality? My RE is not overly open to discussing evening primrose, maca root, or anything more holistic, so any suggestions you might have regarding how I can address the potential root cause of my problem would be more than appreciated!

    Thank you so very much!

  129. Hi Dr. Lara,
    I am so happy to have come across this wealth of information.
    Since stopping birth control pills three years ago, I have had cycles ranging from 40-100 days. I track my BBT so I do ovulate, and I was able to get pregnant. But I still wondered—why the irregular cycles?
    My TSH was recently 4.2, so my OB/GYN prescribed synthroid and now my TSH is 2. My cycles are more regular, but still 60 days apart.
    I have always been an under-eater, which I NOW suspect is the cause of my underactive thyroid. THANKS TO YOU! Especially since I was negative for TPO antibodies.
    I have a 2 year old, and when I had her the nurses kept commenting on my low heart rate–40 bpm at rest. They said it was very healthy, but I was always skeptical. Then a day after her birth my blood pressure skyrocketed, although the nurses had no idea why. I took medication for 6 weeks until it came back down.
    1) Could either of those mysteries be attributed to an out-of-whack metabolism?
    2) I am trying now for baby number two. I started Vitex a couple days ago. Should I first fix my diet before trying Vitex or do both?
    3) Will I eventually stop needing Synthroid when I eat more nutritiously?
    4) I am a little confused on the carb/starch thing…can frozen peas, beans or bananas be substituted for potatoes or rice, or are they just not starchy enough?

  130. Hi Lara,

    I bought your book and believe I have HA due to a high FSH low LH balance and weight loss. My period came back for two months and I started taking Vitex a month ago and now my period has stopped again? Could Vitex be messing up my cycle?

      • Yes, eating way more carbs and gained 10 pounds and that’s why initially I thought everything was back on track when my period started coming back. Should I stop the Vitex?

  131. Hi Lara,

    I am 30years old and have been on the pill (Yasmin) for 5 years, which i stopped in September 2017, since then i have had a withdrawal bleed in December 2017 and light spotting in January 2018 and 2 days light spotting in February 2018, since then nothing at all. My periods were normal before starting the pill and i have always suffered from occassional acne which has now become worse since i have stopped the pill. I have had blood tests to check my hormone levels which came back normal and also had an ultrasound which found cysts and i was diagnosed with polycistic ovaries ( however the GP was unsure herself as my bloods are normal and never had any exessive hairgrowth) im really worried as me and my husband wanted to start a family and now im all over the place and not even sure if im ovulating at all!
    Really need some advice in what to do, would you recommend starting a dose of vitex? Ive always been in good health, i have had a stressful past few months and i am into my boxing/gym, however i have slowed down and take rests and also increased my carb intake as i was not eating enough, my appeitite has increased recently. I hope this helps any advise would be very much appreciated. Thank you 🙂


  132. Dear Lara,

    I am 25 and have had recurrent vaginal infections both Yeast & BV every month for about 10 years. I took antifungal and antibiotic pharmaceuticals monthly for that time until about a year ago I got BV again and couldn’t tolerate the antibiotics anymore. I have tried several Probiotics orally, but they always increase my symptoms: burning, itching and discharge and after a few days they give me bloody discharge and I have to stop them. The only Probiotic that doesn’t give me bloody discharge or increase my symptoms is Jarrow Fem-Dophilus which I take daily. Why might the Probiotics be causing the bleeding and symptom increase? Would this be a symptoms of Histamine Intolerance? Thank you so much, I look forward to your opinion.

  133. I went off the pill in November 2016. I then had a withdrawal bleed as when on the pill. I then got a couple of days of light spotting early Jan 2017. Then nothing until march 2017 (same two days light spotting). Then nothing until December 2017 (again two days light spotting).

    In this time I started a new job which was stressful. I also walked to Everest base camp. I am a fit person and was advised to slow down by my GP (which I did from April to November 2017), I disregarded this in December and have started training again as I enjoy it and dont feel stopping training helped.

    I started taking a supplement called Alpha Mars from ATP Science in early Febuary, 3 weeks later I got a period that lasted 6 days and had a “normal” pattern of bleeding (heavey, moderation and then light).

    On day 15 I started light bleeding for 4 days. I was hoping I would ovulate but not sure whats happening now.

    I have had blood tests, internal and external ultrasounds (which were clear but showed multiple follicles), a hysterosalpingogram which was clear, bloods are all “normal” other than a LH of 24 and a sex hormone binding globulin of 180. I have a retroverted uterus.

    Living in a remote area means we have a gynocologist clinic visit every 3 months, each time I go its someone new.

    The first doctor I saw said to get the hysterosalpingogram and my partners semen tested and then we would try letrozol as she was confident I have PCOS. The last Gyno I have seen has said even though we now have the test results she wants to send me to a fertility specialist to look into IUI as I am “skinny” she doesn’t think I have PCOS.

    I feel frustrated that I cant get a clear picture and plan of attack.

  134. Hi Lara! Recently finished your book and wanting so badly to get a consult in Australia but I live in the other side of the world. Im trying to figure this out. Both ovaries full of cysts in my last ultrasound done today. The only lab levels that seem to be a little out of control are (done November 2016). Androstenedione: 6.4, TSH: 3.70, 25-Vitamin D: 250, Prolactin: 26.6. After reading the book I put myself into the hidden category. Any idea on this? Thank you for existing! 🙂

    • When you say “full of cysts,” do you mean polycystic? as you may recall from my book, the finding of polycystic ovaries does not mean very much. How old are you? Also, for what it’s worth your thyroid looks a little underactive. Please also refer again to the thyroid section in Chapter 11.

      • Wow, thank you so much for the answer. Im 27. Yes, polycystic in at least one in almost every ultrasound Ive had in my gyn appointments. They gave me pills but I stopped them about a year ago. Now Im looking for a baby and they prescribed me Provera (which I didnt like), went to another doctor who prescribed natural progesterone, and then went to another doctor who prescribed Metmorfin. I just want to know WHY Im not ovulating and having long cycles ranging from 38-55days. Also my Glucose was in 94, which I believe is high? I have all these altered random values like TSH, glucose, androstenedione, prolactin, but none of them highly above the normal. HELP please!

  135. Hello Lara! I came of the pill and 6 months later I was diagnosed with PCOS. I went to the gynecologist because of problems with bad acne and excessive hair growth. I’ve never had those problems before. So the gynecologist took a bloodtest which showed an elevated level of male hormones and an ultrasound which showed black spots on my ovaries. Sadly I started with birth control again to balance out the male hormones and to stop the acne. I don’t feel being on birth control forever is an option for me but I am also afraid of what will happen If I come off the pill again. Do you have any advice for post-pill PCOS?

  136. Thanks for the helpful article!

    I’m not sure if I have PCOS or hypothalamic amenorrhea, or something else. I haven’t had a period in 6 months and thought it was because I was under-eating. I’ve been eating more for several months and still no period. I am fairly lean (19% BF), lift weights 4x per week, walk a lot, and eat about 2400 calories daily (plenty of carbs). I prioritize whole foods in my diet and eat lots of veggies. I’m wondering if you have any thoughts as to what it could be?

    Thanks you!!

  137. hello!
    I am 19 years old and haven’t had my period for three months now. The last period I got was about 3 weeks late. These past few months at the times that I should have gotten my period I am getting very little brown spotting but very very little, no blood. Before this my period was fairly regular but I did sometimes have certain cycles that were 40 days and some cycles that would 30. I eat fairly well although about a year ago I was vegan for 4 months. I also lost my period a year after I first got it when I was 12 because of undereating. When I recently went to the doctor she brushed it off as stress and after some pleading she tested my LH and FSH. My LH is 12.2 and my FSH is 8.4. I don’t think I have any hirsutism or anything like that but I might have a problem with insulin. Does this sound like HA or PCOS? Thanks for everything! I enjoyed your book a lot!

  138. I was wondering if you know if a higher FSH (8 mIU/mL) to LH (3 mIU/mL) ratio can be one indicator of Hypothalamic Amenorrhea? Also does FSH and LH ratios change throughout a cycle?

      • Hi Laura, hope you don’t mind me commenting but my FSH and LH levels are the same as yours above! I have been 2 and half years post pill with no natural period and failed fertility treatment and IVF cycles. Can I ask how you went ? I am trying to restore my period naturally before going ahead with further fertility treatment.
        Thanks ,

  139. I was diagnosed with “thin PCOS” 2.5 years ago. My Dr never did any insulin testing, but I did have cysts and high testosterone. After going low carb (while being vegetarian besides fish) I saw no improvement in my periods. In fact, they seemed to get further and further apart the more restricted I became (and the thinner I got). I had fasting insulin and an A1C test done more than a year after eating low carb and they both looked low. Not high at all! So very long cycles (up to 75 days) and no sign of insulin resistance. Doctor still insists PCOS is always about insulin. So frustrating and not sure what to try next!

      • Wow thank you for responding! My fasting insulin was 3mlU/L while I was eating one serving of carbs a day. I had irregular periods from puberty on, so I don’t think underrating in the only issue I am dealing with, but it might be a factor now! Thank you thank you thank you!

  140. Hi Lara,

    I just finished your book, which I found incredibly informative. I wish I had read it sooner! My husband and I have been TTC for over 2 years. As background, I am 34 and was diagnosed with PCOS about 6 months after going off the pill in June 2016. My period before going on the pill was regular (from what I can remember – it was so long ago). I had one period after the pill and then never again until I started fertility treatments. I had polycystic ovaries on an ultrasound and was not ovulating. I was put on Metformin, which didn’t seem to do anything except suppress my appetite a bit.

    We then went to CNY Fertility and had my AMH tested, and it was 6.3. We went through 2 rounds of IUI with Letrozole and then onto IVF. I then proceeded to do a fresh transfer where I got pregnant, but lost the baby around 7 weeks. I went through 3 more transfers and got pregnant 2 more times and lost those as well. I was on progesterone among other drugs and everything always looked fine. I took a break last summer from fertility treatments and didn’t really watch what I was eating and just tried to enjoy my life, and I started to have a cycle again. But then I jumped back into IVF where I had the other 2 losses. Now I am at the point where I just want my body to heal naturally. I just started taking Ovasitol and was looking into taking peony and licorice. I am also following gluten-free lifestyle and have cut down on sugar and have just decided to cut out dairy as well. I had a d&c 7 weeks ago, and my period has still not returned. I had an ultrasound recently and I no longer have polycystic ovaries. I do, however still have a bit of excess hair on my chin and have noticed some acne, but nothing too bad. I am just kind of at a loss and am wondering if maybe I suffer from post-pill PCOS?

    Any feedback you can provide would be incredibly helpful and appreciated!

  141. This is exactly what happened with me. I did a whole30 5 years ago and discovered paleo and unintentionally went very low carb. My weight, body fat and carb intake all dropped significantly. My periods became irregular and then stopped for about 6 months. I went to my GP who did some blood tests and sent me for an ultrasound. The radiographer said I had PCOS but no discussion of why or treatment. I just thought it was what it was. Eventually I found the low carb article on this website and I upped my carbs back to 150g per day and my body fat up about 2%. I got periods back almost immediately albeit with a longer cycle but now have had 28-34 day cycles for 6 months. I’m convinced I never had PCOS just undiagnosed HA.

  142. Hi Dr. Lara –

    I’m planning to end my birth control in 7 weeks. I’m 30 and when I was 20 the only symptoms I had of PCOS were flipped LH:FSH ratio and elevated total testosterone (everything else, including Free T and fasting insulin was normal). I did suffer from bulimia at the time, so anything I was eating was high sugar/carb. My Dr then put me on the pill for PCOS, I then started having hair thinning after starting the pill.

    My Dr now thinks I may not have PCOS, since my eating disorder could’ve messed with my hormones. She and I both want me to quit BC, but I’m quite nervous of the transition. Any suggestions for transitioning off BC? I read your new book, but I wasn’t sure if I should hold on any supplements until after I see how I do. I was planning on limiting sugar to a couple servings of fruit or dark chocolate but still keeping starches such as potatoes and rich. I am going on vacation in a couple months and was wondering if a beer or two for a few days would set me back. I really want to get myself ovulating again to hopefully restore my hair to what it was before BC.

    THank you!

  143. Hi Dr. Briden,

    First off, I love your work.

    I purchased ‘The Period Repair Manual’ after listening to you speaker on the ‘Harder to Kill Podcast’. I’ve been struggling to get my period back after years of birth control, under eating and overtraining. I took control over my health last April, after completing the Boston Marathon. I drastically cut back on exercise, put on some weight and have been working on stress reduction.

    I just got a call from the fifth OBGYN in five years. She took one look at my blood work and referred me to a REI.

    My LH (35.5) and FSH (73.4) are high for a 29 year-old. I’m at a loss as what to do next or how to work with an REI. In th past, they’ve just thrown pills.

    Any guidance you could provide would be greatly appreciated!

    Thanks for all you do,

  144. Hi im a mother of a 19-1/2 teenager(girl) my problem is that according to her bloodtest she had hyperprolactinemia R/O pituitary adenoma her doctor reccomended her to undergo CT SCAN OF PITUITARY GLAND & SELLA TURCICA.after treating it is there a posssibility that her period be normalize?thanks and hope to hear from you.

  145. Thanks for this interesting article.
    You mention that women can go from PCOS to HA, but have you seen it happen the other way round?
    I’m in recovery from HA, having lost my periods 8 years ago when I started running and restricting calories. I struggled to get a proper diagnosis and doctors just told me to go on the pill. Last year I was actually diagnosed with HA and around 6 months ago I started eating a lot more (particularly more carbs) and exercising less. I’ve gained around 10kg up to a BMI of around 22, but still no period.
    When I had HA, all my hormone levels were low, particularly oestrogen, but my recent tests showed that my oestrogen has improved a lot but my LH is very high now (14), and I know that a high LH is usually indicative of PCOS. My testosterone, free testosterone, androstenedione and DHEAS are all normal, but testosterone has increased (was low before) and SHBG has decreased (was high). My TSH has also jumped from 1.5 up to 3.5 since I gained the weight, which makes me think my thyroid is working harder.
    I don’t know how to explain the high LH since my oestrogen isn’t high enough for me to be ovulating. I’m worried that gaining weight fast and eating a lot more carbs has given me PCOS. Also, my hair has started falling out. I’ve had dramatic hair loss twice before after going off the pill due to the drop in oestrogen, but I don’t know why it would suddenly start falling again when oestrogen is increasing. I’m worried this could be another sign of PCOS.
    Have you seen anything like this before? I’m a bit worried about what to do. I want to cure HA, but not if it means pushing me into PCOS. 🙁 Any advice appreciated.

  146. Hi Lara,

    I am not sure where to begin. I don’t have a period and haven’t had one for almost15 years. I had an on and off eating disorder starting at age 20 until about 25. My eating has improved immensely and am at a healthy weight but still have yet to get my period back. I also had a bit of a workout obsession but that has also ceased and I am now keeping my workouts to yoga and walking (which has been very hard for me). I am now 34 and struggle with not only missed periods and ovulation but, obviously, infertility. I was blessed with twin girls in 2012 and another girl in 2016 thanks to the power of clomid and IUI. My husband and I are ready and really feel strongly about having one more but I really just wish I could get to the point where I can get my period back and do it on my own.

    I recently have been suffering from some serious chin acne which I have NEVER had before. I was secretly hoping that maybe it was my hormones kicking in and that I might have a period but I know better. I have tried everything topical then decided to do a little research. Everything I read pointed me to PCOS for which I have never been diagnosed with but wonder if that could be an underlying issue to what is going on. I have very low estrogen and progesterone as well as no FSH. My fertility doctor always tells me that my brain is asleep.

    I am so tired of being a mystery to my doctors as well as myself. I have tried so many things… increased fats, zero exercise, no sugar, eat everything and anything, etc. I don’t want someone to just tell me to go on birth control anymore! It is just a band-aid and I want to be healthy again. I want to play with my kids and grow old with my husband. I don’t want to be a crinkly old woman that can’t stand up straight.

    Ok, I am done. That is my story and I sobbing just writing it down. Even if nothing comes from it, it was good for me to get it out. So, thanks for that. If there is anything you can suggest or do please, please let me know. I have wasted so much money and time trying to figure it out and I am just tired.

    Thanks for listening/reading,


    • Ashley – I’m so sorry. My sister’s name is Ashley and I’m crying reading your story. I haven’t had even a sign of a period in 4 years. I’ve spent a lot of time, money, and energy for drs to just say I don’t know. I’ve tried all kinds of diets and natural ways to take care of myself. I recently went to dr to find out that what I was hopeful were cramps were actually just cysts on my ovaries.
      I can’t imagine the situation you feel. I just wanted to say that I admire your drive to keep trying, to keep going.
      2 Corinthians 1:3-10

  147. Hi Lara, thank you so much for your informative book! I thoroughly enjoyed it and have started to implement the dietary changes and supplements. I wonder what are your thoughts on organic blackstrap molasses for period pain? I am still having incredible cramping and pain on day one despite light and regular cycles. Any information would be greatly appreciated. Thank you!

  148. Hi Lara, just listened to your podcast on the Melissa Ambrosini show and all of the topics you covered are so relivent to me at the moment. I was on the pill from age 14-25 with only one 7months break in between. Since going off the pill 18months ago I have had one period and have been diagnosed with PCOS, although Recently I was told that diagnosis was incorrect and I don’t have PCOS at all.. maybe it is HA..? I am not over weight, I am not insulin resistant , I was exercising 5 days a week with weights and HIIT training but have been told to only walk and do yoga. I have cut wheat and dairy and taken all the herbal supplements under the sun. My skin and facial hair has improved. We are now at the start of fertility treatments for ovulation to try to conceive but I am interested what you might think of my situation ? I would love some reassurance that I might be able to get a period back but after 18 months it’s starting to be a worry .

  149. Not sure if I have something going on that needs additional help beyond magnesium and zinc or if I have PCOS or HA. When should I seek professional help?

  150. I never had regular periods. I had a very stressful childhood and adulthood although more recently I have been dealing and am MUCH calmer. I have gone from having no periods to staining every 2 weeks after my last baby , to regular cycles for 3 months and now again I lost my periods. I am breastfeeding an 18 month old and have a relatively clean diet although I do snack in the evenings. My sugar levels are fine. My androgens are normal. I tested my thyroid a couple of years ago and it came back with a low T4 but regular TSH at that time I was on a low carb diet. I added more carbs and last time I tested both levels were fine.I sleep at least 7 hours a night and still need 2 coffees not to feel tired, but with 2 coffees I feel good. I had hirsitusim although I got rid of it with electrolysis and it hasn’t come back. I also have joint pain , particularly in my knees.I read your book , but could not figure out where to start, any suggestions for a starting point? I scheduled a visit with an endocrinologist in 2 weeks and would greatly appreciate any suggestions.

    • And some more info: I did very low calorie diets as a teen although I eat a sufficient number of calories now. I have also always had and still have acne even if my diet is clean. I suffer from constipation if I don’t take something to help me eliminate which I do. Also, I am more of a cold type person especially my hands are always cold and I have trouble losing weight.Although those 3 months that I had regular cycles I dropped 10 lbs it came right back plus an additional 5 lbs when I lost my cycles.

      • Hi Esther, I’m not medically qualified but if you’re breastfeeding then that could be why your periods aren’t coming at the moment. When you had thyroid tests, did you have them early in the morning after fasting for 8-12 hours? TSH rises throughout the day, so testing it early in the morning is the best time to find out if you’re hypothyroid. Also, were your thyroid antibodies tested?

  151. Thank you so much for this blog, Lara! I have been following it for years, and it is a wealth of information. This may not be the most relevant post for this comment, but I’d love to hear your thoughts on what role mild-to-moderate alcohol consumption plays in period health and also insulin sensitivity. I really enjoy a glass of wine a few nights per week, and sometimes on the weekends it’s more like two glasses, but it’s hard to find consistent information on how much, if any, is a healthy amount. Would love to hear your thoughts!

  152. I been trying to get pregnant for 8 years and nothing happen , i also did a round of iui and it didn’t work too . I got diagnost with PCOS when was 28 and now i am 40 years old , i start see a Homeopathic Dr for a certain time and she really help my body to b able to get a period every month but couldn’t afforted any more so i stop seen her .Did you think i still have the chance to naturally get pregnant ?

    • Have you ever tried vitex? I have used it successfully several times for myself & to help others get pregnant as well. Some of us had long histories of trying to get pregnant without success. I was advised to take LIQUID vitex that has alcohol in it (there is an alchol version & one that is just glycerine; I was told the alcohol one is better absorbed). I took it this way & this is what I told others that they could try, but there are no guarantees it will work for you too, of course.

      Cycle days 1-21:

      30 drops 2x per day in a a few ounces of room temperature water (so 30 drops in the Am & 30 drops in the PM)

      IF you feel great taking it, you can actually take it until day 26, but I always felt “edgy” by day 21 & was told if I felt that, stop on day 21. I also didn’t want to get pregnant & then suddenly stop taking it, & then cause a miscarriage, so I always used it days 1-21.

      I have had YEARS of infertility. Went through the whole infertility route with doctors and they found nothing wrong, but gave me a less than 1% chance of ever getting pregnant without their help. First child was conceived with medical help (IVF) & others were with vitex.

      I hope that helps.

      • PS I was advised to take the liquid vitex only (the capsules take the longest to work with the average being 6 months, but it can be longer) & to take it for 2 (maybe 3) cycles on it & 1-2 cycles off of it to give my body a chance to rest.

        I took it incorrectly a couple of times (i forgot how I was advised to take it) so I started it on the wrong cycle days (I think I started on day 7 instead of day 1) & it didn’t work. Also one of those times I took it wrong, I got my cycle the day after I stopped it, which was almost 2 weeks too early.

        The key is to take it correctly & to take the “breaks” from it. I have always had success with it my 1st cycle when I took it correctly, but it did take a few cycles in my 40s which I suspect is because I was in premenopause at that point.

        I got pregnant using this, even though injectible fertility drugs & IUI’s didn’t work.

    • I also did 5 rounds of IUI in my 20’s & 30’s & none worked. Vitex worked in my 30s & 40s (I never tried it in my 20’s, but suspect it would have worked for me then had I known anything about it).

      You may want to start using bioidentical progesterone cream too if you are not already. It could help prevent a miscarriage if you do conceive. When TTC, I was told to use it starting on cycle day 16 (or 2 days after ovulation, I was having a 28 day cycle & ovulating on day 14 at that time) until I get my cycle when I am TTC. If I am not TTC then I use it cycle days 15 until 26. If your cycle is different than a 28 day cycle with a day 14 ovulation, then use it according to YOUR cycle. Start 2 days after ovulation (if you aren’t 100% sure, it’s easiest to use ovulation test strips & observe your cervical mucus) & then stop when you KNOW you are not pregnant, or if you do conceive, keep using it until 14 weeks. Some say week 12 is enough, but since you are counted as 2 weeks further along than you really are, I stop at 14 weeks to be on the safe side.

      I prefer LifeFlo brand progesterine cream because I have thoroughly researched which brands are safe & have had great success with LifeLow (I use this one: Life-Flo Progesta-Care with Natural Progesterone Body Cream for Women, 4-Ounce). They also have one with peppermint oil in it, but you should not use any essential oils when pregnant, especially in the 1st trimester (some are copnsidered safe after that). Dr John Lee’s website (I think it’s or something like that) has a great deal of progesterine information on it & all of the “recommended brands”.

      Hope that helps you.

  153. I’ve never been on birth control. I’m almost 28. Its been exactly one year with no period. I have no idea if I have pcos but the last two times I got blood taken within the last year my fasting glucose was actually low. I hardly ever eat sugar. Like, for real. But I am one who binges on dates. Hmm…

  154. Hi Lara.

    I don’t think I have PCOS as medical tests identified a very high sex hormone binding globulin level and all other hormone levels were nomal. Indeed, androgenic alopecia was diagnosed by my doctor. Apologies if this comment should be in a different blog post.

    I have been on co-cyprindiol as an oral contraceptive for many years – probably over 15 years – and for the last 2 years I have been losing the hair on my head. I would estimate I have lost more than 60% to date. I initially put this down to temporarily stopping the co-cyprindiol for a month or two, 2 years ago now, and out of anxiety restarted it. The hair loss has not slowed down since then.

    My dilemma is this: I want to stop taking the pill but am very anxious that it will cause more hair loss. What can I do? I am at my wits end and the hair loss is impacting on all areas of my life. I am 37 years old.

    • Unfortunately, yes, you could get some hair loss coming off cyproterone. I’ve had many patients in the same predicament. All I can say is what I say to them: “coming off the pill and making some progesterone is the best long-term plan. To get through the withdrawal shedding period, you can think about taking zinc and iron and natural progesterone.”

  155. I am pretty sure I had PCOS — I had an ultrasound that showed all of the cysts in the ovaries, and I also had irregular periods and the hirsutism. I went paleo in 2011, lost about 40 lbs and the PCOS resolved. I didn’t stay strict paleo for the long term — I got bored, but many of the changes I made (eg, using grass fed butter and coconut oil instead of vegetable oils, less dairy and when I have it, it’s organic or grass fed) have been permanent changes. Diabetes is a hereditary condition in my family and if I had not stuck with the changes from paleo I would still struggle with insulin resistance. (I now have irregular periods but I’m pretty sure it’s due to my thyroid because I finally saw a doc and had labs done, started on NatureThroid 1/2 grain a day and it’s becoming more regular now.)

    Another nice thing about paleo is that I learned so much about how my body responds and to pay attention to that now, because symptoms will crop up if I stay off the wagon for too long.

  156. Hello Lara! thank you so much for all this information put together, your book is amazing! I ve been off the pill for 7 months, with acne starting 2 months ago. Tests showed high testosterone and DHEA, for which I started taking zinc picolinate, drink licorice tea everyday plus miositiol and a good probiotic. Also,some vitamin D. Am I doing smth wrong because I can see only small improvments overall, or should I keep going with those? Greeting all the way from Bucharest!

    • Post-pill acne typically starts after 3 or 4 months off the pill. And then peaks about 6 months off the pill. It’s possible you’re doing everything right, but just need more time. Please do be careful to avoid all sugar including dates, smoothies, fruit juice, honey etc.

  157. Hi Laura! I have your book and I love it 🙂 I was diagnosed with lean PCOS because I have very irregular cycles (every 5-6 months), an AMH level of 11 ng/mL, LH 16.3, FSH 8.8, and polycystic ovaries on ultrasound. My androgen levels were all normal. My fasting glucose is 84, fasting insulin 4.4, and hemoglobin A1C is 5.2. I’ve been trying to conceive for two years and I’ve gotten pregnant twice, but miscarried. I’ve been refusing fertility drugs and want to do it naturally.

    I’ve always been a normal weight with a BMI of 22.3, but I’ve been on and off a vegan diet for 5 years. I also had binge eating disorder for 7 years where I would binge, restrict, binge, restrict. I have hypothyroidism and I’m on 50 mcg of Levothyroxine, but I’m still constantly cold, tired, and my resting heart rate goes down to 41 when I sleep (and I am NOT athletic or in shape). All my endocrinologist cares about is that my TSH is “normal” at 2.0. I do not have Hashimoto’s, my antibodies were negative.

    Four months ago I started taking Inositol, eating meat/fish/eggs, and increased my calorie intake. I’ve been eating a diet similar to Paleo but not as strict. I’m eating moderate carb, about 35% of my calories. I ovulated and had a period in October, and then again last week! It was a 98 day cycle which is really good for me. I started seeing a new reproductive endocrinologist and just yesterday he switched me to Nature Throid. I’m hoping it helps my hypothyroid symptoms better than the Levothyroxine.

  158. Hi Laura

    I am 27 and a professional female athlete.

    I have long cycles (35-42) days, however, I do think that I ovulate (I can some signs 12-14 days before I bleed).

    I did have hypothalamic amenorrhoea during my teens (due to lots of exercise, stress and not eating enough) but recovered (by eating a lot more, including more meat and gaining a small amount of body fat) 3-4 years ago.

    My doctor has suggested that the long cycles now may be due to PCOS. I have some very slight signs of hirsutism but not enough to convince me he is right.

    I was wondering whether these long and slightly irregular cycles may be due to the fact that I am recovering post amenorrhoea or whether you think my doc might be right.

    Or could this just be how i am? as I had amenorrhea through most of my teens, I am not really sure what my ‘normal’ periods are like.

    Or could it just be that I still need to eat more and reduce stress levels. I have tracked what I eat via an app and it seems to be sufficient. I am on the small side – my BMI is 19-20. Obviously, I do a lot of sport due to my job but now work with a coach to make sure the training is well balanced with rest.

    Any thoughts? Thanks!

    • Hi Hayley, It doesn’t sound like PCOS. I suspect it’s just the stress of the training. If you’re managing to ovulate and have the occasional normal 35-day cycle, I think you’re okay now, and also okay in terms of future fertility.

      And yes, please try eating more and resting more.

  159. Hi Lara, my name is Odette and I’m a 22 year old female who was diagnosed via blood test with pcos in 2016 and then in 2017 told my new blood tests suggested I did not have pcos. I have been off the pill since the end of 2015. I went on it originally to “regulate” and stop acne. I have had acne since coming off the pill and hirtuism ( not terrible but I have to manage it). I have also recently been diagnosed with low iron (12) and have very heavy periods and started loosing my hair. I have been very stressed recently as well about all of this. It’s horrible! I have been seeing a fab naturopath and she has given me a cocktail of herbs- magnesium, zinc, alpha EFA, kolorex, DIM, L- theanine and Fe/ Restored that are starting to help my skin and mood she has also told me to take the iron sup fe-restore twice a week 1 cap (24mg). Would you suggest upping the iron? Do you think my symptoms suggest I have pcos or just that I’ve been really stressed? Is it most likely my hair will grow back? It’s thinning but not having bald patches… yet. Thank you so much, I look forward to reading your book 🙂

    • Sounds like it could still be post-pill. Which pill was it? Turmeric could really help with the heavy periods and therefore save your iron. And maybe no-dairy.

      • I was on a cocktail of different pills… last one Brenda. Sadly I think I’m allergic to turmeric. My naturopath gave me a mood stabilising herb with turmeric and saffron and I broke out in a rash… may have been something else though so I’ll try again. Should I be taking iron every day- 25mg? Or stick with twice a week… the hair keeps falling 🙁

  160. Hi Dr Briden.

    I’m 28 and have had amenorrhea for about 7 years now. My periods were never quite regular but were consistent prior to this (I got my first period at age 16).

    I have hair growth under my neck area but no where else on my face. The most recent pelvic ultrasound showed I had no cysts on my ovaries. And all of my bloods show very low/non existent levels for my sex hormones (the dr said they are that of a woman going through menopause 🙁 )

    I lost about 8kg 3 years ago from cutting sugar and increasing my excercise – but have since put the weight back on. I’ve never been underweight. I love food and eat all of the important foods you talk about (carbs, fats, meat) – so not sure if it’s diet related? I am someone who appears calm but feel like I’m often “worried” or “stressed”.

    I’ve had my full panel bloods checked for my thyroid and my naturopath has me on NAC & a herbal mix. I’m just confused about what to do next? And am just trying to be patient but would love to hear your thoughts.

      • My prolactin is 180?
        FSH – 5.1
        LH – 4.6

        No I haven’t been screened for celiac, but willing to for sure if you think this may be the right direction?

        Thanks so much


          • Ok thank you so much for that info. If you have any recommendations on what I should approach next please let me know? Not sure if you saw the blood results:

            My prolactin is 180
            FSH – 5.1
            LH – 4.6

    • Hi Clare,

      So strange to read this – we are almost exactly the same! I am also 28 and have had missing periods for about 7 years too 🙁 All my sex hormones were also very low.

      What is your weight? And has it bounced up and down a lot in that 7 year window? Would you say that even though you eat the ‘right’ foods, you still tend to eat restrictively?
      I’m only just coming to terms with the fact that I’ve been suffering from an ED for the last 7 years – eating restrictively and mild bulimia, which I think has undoubtedly contributed to the missing periods (despite the fact that they were always irregular throughout my life). I’m now seeing a therapist and trying to recover.

      Also, like you, I generally appear calm but easily get stressed and anxious – I’m finding meditation (Mark Williams audio & book is great) is really helping with that.

      One thing I will say you should be really careful about are your bones – I recently was diagnosed with osteopenia in my spine because of the lack of estrogen for so long. My doctor has now prescribed a low dose HRT (Femoston 1/10 mg) to protect them.

      Like you I was really confused and frustrated about what was causing my lack of periods – and it was difficult to come to terms with the fact that it was because I was undereating & generally quite anxious. You might not be the same but body definitely does respond to life’s challenges in strange ways 🙂

      • Wow yes so similar. Thanks for sharing your story with me ♥️

        My weight has fluctuated, definitely. I’m in a healthy range now but have also only realised that I have been suffering with an eating disorder for at least five years. I restricted and deprived myself of calories for a long time. I’m finally at a point where I eat when I’m hungry now and there is no longer restriction.

        I feel so much more engergised because of this but also because I’ve recently stopped working shift work. As a nurse I was doing all sorts of hours and didn’t have the best sleeping pattern which I know most like also contributed to me feeling ‘burnt out’.

        Thanks for your advice about meditation. Absolutely has also changed my life 🙂

        Did you have any symptoms with the osteopenia? How are you finding the HRT?

        • So sorry to hear you have also been suffering from an eating disorder too <3 I think often our minds are good at convincing ourselves that we are healthy and there's nothing wrong. I went to naturopaths, tried herbal remedies etc to try and fix my HA, but none of them worked – and I'm finally realising it's because I have been restricting my food intake. I'm still struggling with it, but working through it with therapy.

          There are no symptoms for osteopenia or thinning bones – which is why it's important to get a DEXA bone density scan. I was referred for one by my Dr and it definitely gave me a scare (it's what finally convinced me to seek help for my ED). I would really recommend you do this, and to make sure you are supporting your bone health through Vitamin D / Magnesium and Calcium intake.

          I've only been on the HRT for a month so it's hard to say, but so far it's fine! I found the last week I was very drained and a little short-tempered – but I guess that happens with a normal cycle right?!
          During the oestrogen weeks I found my energy was a lot better than before and I feel less anxious overall.

  161. Quick question. I know the difference between glucose and insulin but I really need to know if the fasting insulin the same as the one with glucose.

    That sugary drink makes me terribly sick. I still remember the taste 15 years since I last did it when I was pregnant and it makes me vomit just thinking about it.

    I stopped eating any kind of sugar except gentle carbs and don’t want to do the test with sugar if I can avoid it but I need to get a insulin reading soon.

    • The test fasting insulin doesn’t involve the horrid sweet drink. Fasting insulin is not a perfect test but it can detect moderate to severe insulin resistance. I like it to be <8. (To detect mild insulin resistance, you'll need the glucose tolerance test (GTT) WITH insulin -- and that involved a sweet drink.)

    • JUst an fyi that if you need any test that involves that gross drink, there are option to substitue the drink for something less gross & not full of chemicals. You just need to make sure for the 1 hour test whatever substitue you use, it has 50 grams of sugar/carbs. It still wouldn’t be easy for some people to take sugar like that in any form, but at least it’s better than the orange junk. Some alternatives are 100% grape juice, 100% apple juice, jelly beans (there are some jelly beans out there without dye & while they aren’t necessarily healthy, stil better than the orange drink), etc. The juice can be organic, so at least there’s that.

      I used juice for my tests or instead observed my glucose via a diabetic monitor after meals for 3-4 days instead of the glucose test, because that’s a much more practical way of seeing how your body deals with carbs than eating / drinking a sugar laden drink, candy, etc. anyway. If it’s for your own knowldege the monitor would be fine, but if you have a doctor wanting the test, then you would have to go the sugar route. I was advised by my midwife was alternative to use to the orange drink (juice, jelly beans, etc.), but didn’t tell my doctor because they insisted on the orange cocktail that would make me vomit and that was not happening. I did the orange cocktail 2 times before I found out about the alternatives, & don’t want to drink that again.

  162. I have irregular periods and the only thing that they detected is very high prolactin.
    Is there any natural treatment to regulate it?

  163. Hi Lara, I have very few ovulations per year and the last time my doctor did a blood test, my testosterone levels were too high. I’ve then taken myo-inositol for 6 months. Now my doctor did a blood test again and my testosterone levels are normal now, but my prolactin is too high (it is still in the normal range, but on the upper bound). (However, I don’t know if it was normal before or if she just hadn’t tested it before).Do you have any suggestions what could be the reason for this?

  164. Thank you so much for this article. It’s very interesting and it made me think (yet again) if I have PCOS. My periods have never been regular and I had hirsutism on the face as a teenager. I went on the pill when I was 20 and when I came off it 8 years later it took 2.5 years (and a horrible episode of acne 6 months after I quit, exactly as you describe in your book) for me to get a period. Now my cycle is quite long (85-90 days). I am not insulin resistant (my doctor did the test you suggest in your article), and even though I do not have elevated androgens in my blood work, I still suffer from limited hirsutism on my face. I have Mediterranean origins so I have always wondered if that’s just not due to my genes. I am supposed to have PCOS according to my gynecologist because of cysts on ultrasound and hirsutism. But do I? My zinc and vitamin A levels were very low and i have been taking supplements for that. My thyroid is also underactive (though still within limits). I do not think I am undereating but I definitely was for a very long time. For the past 3 years I have been making sure I eat plenty of good fat and protein with every meal. I am dreaming of a more regular period but I’m not sure what else to do!

    • Is your DHEA high? That would suggest an adrenal type of PCOS. You might be a good candidate for the herbal medicine peony& licorice combination.

      • Thank you so much for your reply! My DHEA levels are normal, but my free cortisol is low, suggesting adrenal dysfunction indeed. I have been taking ashwaganda and another adrenal support supplement but it’s not making a huge difference. Since cutting out gluten my zinc, vitamin A and magnesium have gone up so I am sticking to that and I hope that it will also help my adrenals. Otherwise in terms of lifestyle I have been sleeping early and enough, doing meditation, not exercising too much (and especially not when my body feels weak), and eating seaweed once or twice a week. I do eat carbs. How long should I wait until I start “worrying” and what else is there to do? Can I ask if you have any opinion on heavy metal toxicity and adrenal function? Could that be a problem?

  165. Oh my goodness, it’s like you wrote this for me! I’m 33 and still trying to figure out if I have PCOS or not.

    My period has rarely been regular. I was an athlete when I was a teenager, and would only menstruate when I took time off training, approx every 3 months. I didn’t get my period for two years when I was doing my masters (high stress) age 22-23, but had also just come off the pill right before that. I’ve done the glucose tolerance test multiple times and never had an abnormal reading, and I’ve never had a blood test show high androgens either, nor had hirsutism/acne/overweight. An ultrasound age 23 showed polycystic ovaries.

    Age 29 I was on a low carb diet for 9 months as part of a parasite-killing protocol, which meant I didn’t get a period for a year. I eat plenty of good carbs now, I do eat very well – lots of meat, fish, veg, fruit, healthy fats, good starches both root veg and gluten-free grains. I’ve also always historically tested as very deficient in Zinc, and a couple of years ago found out I was severely deficient in Iodine. I supplement both, plus Magnesium. My cycle is now around 45 days, and we’ve been trying to conceive for the last 4 cycles with no success. I know it’s still early days but I’m so anxious about it! Do you have any advice as to what my next move should be? (I’m on your waiting list in Sydney, so even if there’s anything useful I can do before I get in to see you!) Thank you Lara 🙂

    • Hi Claire, For how long have you been back on carbs? (including rice and potatoes, correct?)
      It can take 5 or 6 months back on carbs to really get things going again.

  166. Hi Dr. Lara,

    I went off BC a year ago and still have not gotten my period. I am 28 years old and went on BC when I was 17 to regulate my periods (started my period when I was around 14/15 years old). I was “diagnosed with PCOS” last summer after an ultra sound showed I had a follicle (which, I understand is normal to have follicles). I had blood work done July 2017, my lab results were basically “normal” according to my doctor.

    TSH: 3.26 (uU/ml)
    Prolactin: 14.3 (ng/ml)
    FSH: 3.7 (mIU/ml)
    LH: .5 (mIU/ml)
    Progesterone: .8 (ng/ml)

    Every other result seemed to be in the “normal” range, I did notice that my Red Blood Cell Count came back “low” – 3.82 M/ul. Again, my doctor was not concerned with any of my lab results, but rather she urged me to go back on BC if I was getting anxious about my period. It is deeply upsetting that I don’t have a period and I know ultimately not healthy.

    Just for more reference, I’ve started to incorporate more meat into my diet this past year and I’m generally a very healthy eater- whole foods/lots of veggies/no dairy, etc… I limit my caffeine intake and I’m a moderate drinker. I’ve tried Vitex for a bit, but it hasn’t helped me get a period (I still take it though). I take vitamins B12/B6, Vit. D, Magnesium, Probiotics and have recently started to take Zinc more consistently.

    Based on some of the lab results I posted is there anything that strikes you as concerning? Any help would be SO, SO appreciative. I’m trying not to stress, but I just want my period back! Thank you!

    • In addition…. I’m not a crazy exerciser (I usually do yoga most days, but not everyday). The only sugar I consume comes from moderate fruit intake, dark chocolate, and moderate alcohol consumption.

    • A year off the pill is not very long. You may just need some more time.
      The thing that stands out from your results is a TSH > 3 which could suggest that your thyroid is underactive. When you say you’re incorporating more meat, do you mean you were vegan before? A vegan or vegetarian diet can impair thyroid and make it hard to ovulate.
      Zinc could make a big difference but it will take at least 3 months because of the “100 days to ovulation” I describe in my book. If you haven’t already read my new book (2nd edition), please take a look. I describe a case of post-pill amenorrhea in Chapter 1.

      • Thanks so much for your quick reply, I appreciate it!

        To answer your question, I was a pretty strict vegetarian for a few years. I will give it more time with taking zinc and eating meat regularly. I do have your book and reference it often.

        After how long would you suggest I see a specialist on my thyroid to explore if that’s an issue?

        • If you were my patient, I would retest TSH after 3 months of zinc and eating meat regularly. I would also think about giving some low-dose iodine. (I call zinc + iodine the “ovulation cocktail for vegans.”) But be careful with the dose because you don’t know if you have thyroid antibodies or not. Please refer to the iodine section in Chapter 6 of my new book (2nd edition Period Repair Manual).

  167. I was recently diagnosed with PCOS after quitting birth control and having a missing period for over a year. The diagnosis was based off an ultrasound, though I had also had a full hormone blood test done and EVERYTHING in my blood work came back normal (insulin, progesterone, testosterone, etc). Before starting the pill I had regular periods and I show no other symptoms of PCOS except hair thinning and moderate acne. Is pill induced PCOS a real thing? They want me to get back on BC but I feel like that’s just masking a problem and not solving it.

    • Pill-induced PCOS is a variant of Pill-induced amenorrhea. It’s a situation of stalled ovulation from the pill drugs. Plus a temporary androgen excess (in the case that you really do meet the criteria for PCOS, which I’m not sure you do…. Post-pill acne is not a true androgen symptom).

      Have you read my new book (2nd edition). I describe a case of post-pill amenorrhea in Chapter 1.

  168. Hi Dr. Briden,

    Thank you so much for this post! My gynecologist just recently diagnosed me with a mild case of PCOS. My total testosterone came back at 61 ng/dL and my LH was 9.9 and my FH was 6.3. Free testosterone was within the normal range (5.4 pg/mL). After reading your book, I asked to have my insulin tested but my doctor said that it’s not necessary because I’m at a healthy weight (I weigh 125 and am 5’5). I came off of the pill in September and have not had a regular cycle since (just a light bleed from Provera after 3 months). The doctor wants me to go back on the pill, but I don’t want to. I have been lightheaded/anxious ever since stopping the pill. My thyroid came back normal as well. He said it’s either the pill or Provera every 3 months.

    Do you think I really have PCOS or could this be just post pill PCOS?

    I was on the pill for 9 years (age 17-26) but remember my cycles being regular prior to that (age 12-17).

    Any advice is greatly appreciated as I’m not sure what to do.

    Thank you so much!


    • You’ve only been off the pill 4 months which is not very long. It can take up to 2 years to start ovulating again after the pill.
      That said, I find that most of my patients can get something happening sooner than that with the right nutritional support–namely a fully nourishing diet (with meat and starch). And zinc plus iodine.

      • Thank you so much for your reply, Dr. Briden! I ordered the Zinc that was recommended in your book and am going to start taking it.

        Based on my labs, do you think I have PCOS or HA? I have been focusing on eating enough but definitely have been more stressed than usual.

        Thanks again for your advice!


        • Also, do you think I should take the Provera again as my doctor is recommending or is that like taking birth control? He keeps stressing the importance of bleeding at least once every 3 months but I just don’t feel right taking it.

          Thanks again for your advice as it seems every doctor’s answer thus far has been to “just take the pill.”

          • Ideally, you want a monthly cycle. But while you’re waiting to reestablish ovulation, it’s not necessary to bleed every few months–UNLESS you are building up a thick uterine lining (which what your doctor is worried about). Instead of Provera, you could ask to have an ultrasound to check that your uterine lining is okay. And your goal is to start to ovulate. I do think that taking Provera every few months could interfere with that.

  169. Hi Lara,
    Thank you for this post! I went off BC in May ‘17 after 8 years. I haven’t gotten my period except for when my doctor made me take provera in August. In November my Prolactin was at 4.9 and TSH was 0.83 (all normal). However, my AMH was 13.48. I started getting horrible acne and more and more peach fuzz, but that isn’t actually technically herustism, is it? My father and paternal grandfather are both diabetic, is it likely that i have the “inslulin” type of PCOS? Please note I am 5’0 & 90 pounds, not over weight or underweight. Just have always been small//petite. What blood work tests would you recommend to get done in order to try to figure what “type” of PCOS I have? Any advice would be much appreciated!

  170. What a fantastic blog post!

    I have been diagnosed with PCOS and HA at different times in my life.
    In 2007 I had very irregular cycles. After a ruptured ovarian cyst, my gynecologist at the time decided to do further testing to determine what was going on.
    The bloodwork she ran showed LH at 7 IU/L and FSH at 2 UI/L, a ration of 3.5:1. Fasting Insulin was 41 pmol/L
    (or 5.9 uiu/ml) which I was told was normal. Total testosterone at 4.9 nmol/l (or 141ng/dl) where the normal range at the time was considered anything under 3.1 nmol/l. Here’s the interesting part – Free Testosterone came back at 4.0 pmol/l (or 0.311ng.dl) where the reference range was 4.16-22.2 pmol/L. Free Testosterone was just slightly below normal. I was told this wasn’t consistent with typical PCOS but was diagnosed with it none the less.
    The diagnosis never sat right with me. Over the years I’ve asked for several second opinions. In follow up bloodwork, my Total Testosterone had never come back even slightly elevated and yet all but one time I was still told I had PCOS – this was based purely on irregular cycles.
    Only once was I given a different diagnosis. In 2010 I saw a different gynecologist who diagnosed me with HA.

    To this day I do not know if I have PCOS which I put into remission and before it turned into HA or if I never had PCOS to begin with (as my initial bloodwork wasn’t typical of PCOS anyway).

    I would love to hear your thoughts.

      • how old were you back in 2007? I actually got the year incorrect, it was 2006. I was 25.
        And were you trying to come off hormonal birth control at the time? I had come of the birth control pill 8 months prior.

          • None of that sounds like PCOS. I think what happened was that your total testosterone was high because of high SHBG (which is common post-pill). Do you have the original report? Is there an SHBG reading there? (High SHBG is consistent with the low free testosterone)

          • I do have the original report. All that was tested was fasting insulin, Total Testosterone, Free Testosterone, LH and FSH. And an ultrasound was done.

    • Yes, stress can play a role. But my experience with patients is that there’s almost always also some degree of undereating.

  171. This was a fascinating read! I was “diagnosed” with PCOS at 14 due to cystic acne (which is also genetic for me from my paternal side), heavy and irregular periods, and a touch of hirsutism… Although nobody ever ruled out NCCAH either. Put on the pill, stayed on it until I could no longer bear the side effects at 19. From there, my weight, moods, skin and cycle see-sawed until I went onto a low carb diet on the recommendation of my old naturopath. I did lose weight and regained regular cycles with the help of bioidentical progesterone, but after six months I felt awful. Fast forward a few years and back on carbs, my periods all but disappeared when I had a Copper T inserted last year, and ever since then they’ve been absent or extremely scanty, even after having the T removed. I’ve tried a low carb diet again to no avail, and some of my “PCOS” symptoms like excess hair and mild acne are returning despite my best efforts. I’d be forever grateful for your input, because I just don’t know where to go from here… And I’ve also had just as many doctors telling me that I do have PCOS as those who tell me I don’t!! I have no idea what I’m doing wrong!

    • The copper IUD would not have been why you lost your period again. Was there anything else going on a few months before that point? Stress? The morning after pill? Other medication?

      Do you eat 3 solid meals per day including meat and potatoes or rice?

      • I moved provinces shortly afterwards, and I have a history of Generalised Anxiety Disorder to boot, so I am ALWAYS stressed… I bled consistently for about 3 months on the T until I had it removed, but I haven’t had a normal period since… That was about August last year. No other medication apart from a short course of Xanax for stress around the time I moved… And I tried two types of birth control pills but couldn’t stay on them longer than a week 🙂 I don’t eat three meals a day, no… I’m ashamed to admit that by the time I get around to eating in the morning it’s usually at 11 and something low in carbs like flax porridge and nut butter. I’ll then typically skip lunch (or have some raw whey in water) and then have a good dinner of meat and veggies, although I have been forgoing the carbs there too! I’m terrified to eat potatoes and rice in case I start packing on the pounds again!!

          • Thank you so much for your help! 💗 How many grams of carbs would you recommend per day…? And do you think I’ve perhaps got more of an HA scenario than a PCOS one? I’ve always had difficult eating patterns because of teenage bulimia…

          • Yes, it’s sounding like an undereating-HA scenario. I don’t think so much in grams of things. You need 3 solid meals per day. For example: Breakfast of eggs plus avocado plus fried potato. Lunch can be leftovers of some kind. Dinner is a protein (meat, chicken, fish) plus vegetable plus rice or potatoes–every night.

            If you can eat like that, then you will probably start to ovulate and have periods starting about 4 months later. So, in June or July.

  172. Hello Lara,
    I was told that i have pcos 4 years ago. I am 24 years old now. My period is not regular. My Progesterone is very low. My FSH and LH are normal as well as the androgenic hormones. But i still have hirsutism and hair loss. I dont have insulin resistance too. Just low progesterone. I eat well. I avoid fast food and sugar,because i dont like them. I tried one year with out any gluten or sugar and i didn’t get any positive results. I bought your book and i am reading it now. But i am really confused and dont know what to do.

  173. This is such an interesting article and a subject I’ve been struggling with for years! I’m 25 now and haven’t had a period since I was 17, this is when I went on the pill until I was 19 and never regained my cycle. I was first diagnosed with PCOS because I had slightly elevated testosterone and went back on the pill, fast forward to age 23 I came back off the pill again (after learning a bit more and realised birth control was NOT the answer) and my fsh, lh, and estrigen was all low but my AMH was high. I’m now 25 and am about to start Gonal f injections after clomid and letrozole failed to get me to ovulate. After gaining weight from a bmi of 21 to a bmi of 23 (the same weight I was when I used to get a period) my fsh has gone from 4 to 9, and my LH has gone from 0.9 to 3.2. My AMH is high at 45pmol. Sorry for the essay, but does this sound more like HA than PCOS to you? I wouldn’t say I over excercise at all, but I do run sometimes, suffer with anxiety and have a history of restrictive eating. Any feedback from an expert who is a little more open minded than my RE would be wonderful! X

    • It does sound more like HA. Are you fully nourished? Do you eat protein, fat, and starch (including rice and potatoes)? You’re not vegan, are you?

      And just a query as to the use of fertility drugs in your case…? Are you trying for pregnancy?

      • Yes we are trying for a baby, it’s been so stressful with month after month of no response and no concrete diagnosis for my amenorrhea, but I feel a bit of renewed hope with injectables- especially now that my hormone levels seem to have raised slightly. I’m not vegan no, but while I was never “underweight” I was always trying to loose another 5lbs

        • Hi! I am currently trying to find out if I actually have PCOS or HA. 1.5 years ago, i ditched almost all pastries, sweets and other unhealthy foods, and for one year I have been working religiously 5 times a week (weight lifting). Since having a healthier food intake, I still got my period, my cycle lasting between 50, 82, 67 days. Since working out, my periods were 103, 107, 33 days, and now longest 133 days. Previous to that, my periods averaged 64 days. Last august, my LH:FSH (3.49) was indeed high, but i am doing all the good things and my condition is getting worse. Can it actually be HA and not PCOS?


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