The Surprising Truth About PCOS (It’s Not an Ovarian Disease)

The Truth about PCOS

If your PCOS was diagnosed by ultrasound, it may not be an accurate diagnosis. The so-called ‘cysts’ have very little to do with your actual condition. And no, the cysts will not cause weight gain and infertility and heart disease.

But the word ovary appears in the very name of the condition polycystic ovarian disease. So it must be an ovarian disease? Right?  Wrong.

In truth, your ovaries are not to blame at all. With the right nutritional support, your ovaries can and will go back to doing exactly what they’re supposed to do.

True and false about PCOS

False about PCOSFalse: PCOS can be diagnosed by ultrasound

Cysts are normal for ovaries. Because cysts are the sacs or follicles that contain the eggs. (And what would an ovary be without those?) Every month, your ovaries grow new follicles grow and then reabsorb them.  So every month, your ovaries will have a completely different set of follicles. And every month, your ovaries will look different on ultrasound.

The normal ovary should have—on average—6 to 12 variously sized follicles (more if you’re a teenager). The polycystic ovary has—by definition—more than 12 small undeveloped follicles (more than 25 if you’re a teenager).

But why are the follicles small and undeveloped? Because ovulation did not occur that month. The ultrasound cannot explain why ovulation did not occur, nor can it predict whether ovulation will occur the next month. Sometimes ovulation just doesn’t happen, and that’s why normal women have polycystic ovaries 25 percent of the time. Test them again in a few months, and their ovaries will be normal. That’s why all experts agree that PCOS cannot be diagnosed by ultrasound.

(A quick note about other types of abnormal ovarian cysts. There are large functional cysts—which are the most common ‘ovarian cyst’— and can grow to 5 cm or larger, and sometimes require surgery. There are also pathological ovarian cysts such as dermoid cysts, hemorrhagic cysts and the chocolate cysts of endometriosis. Those are completely different sorts of problems, and do not enter into the discussion about polycystic ovarian syndrome.)

PCOS cannot be diagnosed by ultrasound

True about PCOSTrue: PCOS is frequently misdiagnosed

The story that I hear most often runs something like this: 1) went on the Pill as a teenager for skin, 2) come off the Pill, 3) periods don’t show up (probably because of post-pill syndrome), 4) acne flares up (because of Pill-withdrawal), 5) ultrasound shows ovaries have a polycystic appearance, 6) doctor diagnoses PCOS without doing any blood tests, 7) doctor prescribes the Pill.

Please understand: At times—and for all sorts of different reasons—you can face temporary obstacles to ovulation, which means you’ll have irregular periods and possibly polycystic ovaries. That does not mean that you have the hormonal condition of PCOS.

Common obstacles to ovulation include having been on the Pill, sugar, inflammation, environmental toxins, gluten, thyroid disease, prolactin, stress, nutrient deficiency, and many other things. Proper diagnosis requires a detailed health history and blood tests for hormones (including insulin, androgens, prolactin, thyroid, and others).

 Tip: If you’re avoiding carbs because someone saw polycystic ovaries on ultrasound, you may be on the completely wrong track.

False about PCOS

False: PCOS is an ovarian disease

PCOS is not an ovarian condition. It is one of several whole-body hormonal conditions (all called PCOS) that affect the ovaries. Hormones are the problem. Ovaries are the victim.

When confronted with inflammation and impaired insulin signaling and several other issues, the ovaries of some women respond by shutting down ovulation and making excess testosterone. Yes, that happens because of a genetic susceptibility. Other women without that susceptibility can face the same inflammation and insulin resistance, but their ovaries don’t make testosterone.

Still, the best treatment is not to treat the ovaries, but to treat the underlying inflammation or insulin problem that is disturbing the ovaries. (See Treatment for 4 Types of PCOS.)

True about PCOS

True: PCOS needs a name change

In January 2013, an expert panel from the NHI stated that the term PCOS is confusing.  They called for PCOS to be renamed. It needs a new name, they said, because PCOS is not an ovarian condition.

Dr. Robert A. Rizza from the Mayo Clinic (and a member of the NHI panel) sums up the name change:

[The name PCOS]..focuses on a criteria – namely the polycystic ovarian morphology – that is neither necessary nor sufficient to diagnose the syndrome. It is time to assign a name that reflects the complex metabolic, hypothalamic, pituitary, ovarian, and adrenal interactions that characterize PCOS.

In July 2016, the new name was proposed to be: metabolic reproductive syndrome.

Please also read:

Yours in health,

Lara

115 thoughts on “The Surprising Truth About PCOS (It’s Not an Ovarian Disease)”

  1. My daughter is 17 Years 4 months. She started her period 9 months ago and had only 2 periods. Now 9 months later no period and she is gaining weight and her breast’s are increasingly rapidly. She is a very healthy eater no processed food or sugary drinks. She drinks tea and water. My daughter also works out and dances. She has gained about 9 pounds and her breast size has gone up by 2 sizes so quick. It makes no sense. Thank you for
    Any feed back. Her sister 10 years older is thin and diagnosed with pcos.

  2. This is nonsense!!!! I have polycystic ovaries (not the syndrome) not ovarian cysts!!! Just polycystic ovaries this contradics itself by saying normal ovaries have 6-12 follicles (ovarian cysts)

    And polycystic ovaries have 12+

    So if this is trying to say I have ovarian cysts not polycystic ovaries but I full into the polycystic Ovary range of 12+

    Is ignore this and find another site… very contradicting xx

    • The new International Evidence-Based Guidelines for PCOS recommends polycystic ovaries no longer be used to diagnose PCOS. They say that the very word polycystic “is a misnomer” because it refers to ovarian follicles (eggs), which are normal for the ovary, and are not abnormal structures like other types of pathological ovarian cysts. Neither polycystic ovaries nor the hormonal condition PCOS is a cause of pain.

      According to another recent study, the inclusion of polycystic ovaries as a diagnostic criterion may have resulted in overdiagnosis of PCOS and unnecessary distress and worry for patients.

      You can find the references in this article I recently wrote about PCOS.

  3. Hi Lara,

    We had our second baby – 6 months back and had tubectomy performed along with the Second C-Section. In a regular ultrasound now, our radiologist diagnosed PCOS for me. I have had no issues having babies (became pregnant in less than 2 months of planning both the times), No weight gain whatsoever, Thyroid, Sugars are well under control. No facial hair or any bothersome hair loss.

    However, Ultrasound gave away enlarged ovaries with more than 12 Follicules and hence diagnsed as PCOS. This Ultrasound was done just a week before the current impending period. I have had very regular periods so far – last 15 years. However this time, I was due for periods yesterday it has not happened. Would this be the start of irregular periods? Does it really mean PCOS, i was hoping not!

    Can tubectomy cause/trigger PCOS?

  4. Hey Lara . I am at 27 years .I have normal weight regular period and detected polystic overy on ultra sound also had prolactin at 36 at that time had 6 tablet for that. Sugar and thyroid levels are normal.I have little acne and hair loss too.No other hormone test are performed. Currently having metformin 750 dose and folic acid . Could you help in detecting pcos type.

  5. Hello Dr. Briden,

    Thank you so much for your posts–they are definitely helping this community out.
    I was diagnosed via ultrasound when I was 19. My periods were completely out of whack, I have always had excess facial hair, acne, sleep issues, and mood swings. I went on the pill for a short year, then got off because I had enough of the side effects. I am now 30 years old. I have since cleaned up my diet. My periods have been regular for about 3 years now, my acne gone except for breakouts a week before my period–all good stuff. However, my facial hair is still bad, I have VERY stubborn belly fat, loss of head hair, and sleep problems (not quite sleep apnea) Can you please advise if my symptoms are severe enough to warrant me seeking a proper diagnosis with blood work?

    • Hi Maria,

      thanks for your comment and sharing your story. The first step is to figure out if you still have insulin resistance. So, the blood test is “fasting insulin” or “glucose tolerance test with insulin.” Beyond that, yes, it would probably be worth testing androgen and thyroid. Please see Chapter 7 of my new book for a complete discussion of blood tests for PCOS.

  6. Hi Lara,

    I had an ultrasound done on Day 3 and I’d ovulated according to my Luteal phase Progesterone value. My question is, can you ovulate and still have peripheral cysts on an ultrasound?

    Also, on what day of one’s cycle would you typically recommend getting an ultrasound done?

    Thanks.

  7. Good morning,
    I’m 22, and I was diagnosed of PCOS when I was 17. My doctor saw some cysts in the ultrasound. She recommended me to take pills and I had been taking them for 2 years. Now I’ve been two years without the pill, but, the facial hair is back and I have terrible pain during my first day of period. I’m reading your articles now and I feel outraged that they made me take the pill without telling me all the consequences and diagnosing PCOS without an analyisis. If I don’t have PCOS there are other explanations for the facial hair? And If I actually have it, I don’t feel identified with any of the causes you mentioned in the other post. How can I know wich type do I have?
    Thank you very much for all your work!

  8. Thank you so much for this post!
    I am 17 and have been suffering with unidentified abdominal pain and painfully severe/ irregular / very heavy periods since they first began ! About 6 months ago I had an ultrasound and they told me during the scan that I had over 12 cysts on each ovary and that this likley indicated PCOS. I have always had strong motherly instincts and known I wanted children since a relatively young age (albeit in the future) and reading about the complications of this disorder (such as infertility) utterly depressed and terrified me!!
    Reading other sources online only furthered my worries! And now I have read that it is normal for me to have many more cysts at a young age !

    Thank you very much!

  9. i am a diabetic patient and i am not having regular menses. i had ultrasound which diagnosed pcos. the pills which i took effected in the starting three months but now everything is going worse. i m having hair loss, excess hair growth on face, hair thinning and curl and rough hairs, although they were straight and silky. my weight is dropping and i m having wrinkled skin, skin tone is becoming darker. plz guide me

  10. Hi doctor..In chapter 7 you say that we must meet all the 4 criteria for pcos which includes high androgens. But in the next paragraph you say that either of high androgen/low shbg/high LH is a sign of pcos. I am confused. Because my tests show high LH but normal androgen levels

    • Hi LH is a pretty clear feature of PCOS.
      High androgens can be high on blood test OR androgen symptoms. I explain it in more detail in the new edition of my book which I’m just about to release.

  11. I always had high androstenedione and testosterone since starting puberty. Not really super high tho but enough to cause some pimples on my back and excess hairgrowth. My periods however are always perfectly on time + I chart my temperature which shows a normal pattern. I have a regular 24-27 day cycle and ovulate at day 12. I bleed arouond 5-6 days.
    My cortisol, glucose, progesteron, estrogen, FSH, LH etc… is all normal. I am also slender bmi 20.
    They did an ultraound but saw nothing.

    So the only thing I can try to do is supplements and laser for the hair :/ I already eat very healthy and have really good blood test results except for my vitamin D which is always too low.
    But beats me why those hormones have been too high since puberty. I am now 31.

  12. Hi Lara- I was just wondering, when you say ‘younger’ what age does this refer to? As you said 25 is normal when you are younger and I am 22 and have 9 follicles on my right ovary and 14 on my left. Would this be classed as normal or elevated?

  13. lara please tell is it treatable or not because my wife is suffering in pcos i am worring about her i am from pakistan i am waiting for ur replay and also tell me is it dangrous or not pleassssssssssssssssssse

  14. Hi Lara,

    Thank you for sharing your expertise on your blog – it’s been really helpful and gives me hope. I don’t know if you’ll be able to look over my comment, but I figured I would ask and see if you have any thoughts about my situation.

    I’m now 30 years old, and it’s been about a year since I successfully weaned myself off of Effexor XR, which I was on for 3+ years for anxiety/panic. It caused me to have severe night sweats & brain fog, fatigue/exhaustion, 50 lbs of weight gain, and my period completely disappeared. The sweating and brain fog stopped immediately after weaning off of the drug, and I had much more energy, but I still have all the weight and my period has been mostly MIA.

    My naturopathic doctor just recently pre-diagnosed me with PCOS (before ultrasound or blood work) and then after I had both done, she said the ultrasound confirmed that I have PCOS, and that I would have to wait to go over the ultrasound & blood work results until she got back from a 2-week vacation (nothing urgent then, right?)

    However, due to having somewhat recurring vaginal infections, I went in the other day and was seen by a medical assistant, and while she was looking over my recent blood work (of which I didn’t know the results yet) she became very concerned that my Prolactin levels raised from 16 in 2016 to 54 currently. She was surprised that no one had told me about it, and quickly proceeded to tell me that she was going to schedule an MRI brain scan to see if I have a pituitary tumor because elevated Prolactin could mean there’s a brain tumor. She didn’t have any other explanation of what else it could be.

    A couple of questions:

    – Can PCOS cause elevated levels of Prolactin?

    – Could there be other reasons my Prolactin is elevated?

    – Is 54 considered a really high level for Prolactin, and is there a certain level that typically indicates a pituitary tumor?

    – Any thoughts on if the Effexor XR (or antidepressant drugs in general) have been known to cause hormonal problems? None of the doctors I’ve seen seemed to think there was a correlation, but I didn’t have ANY of these problems until after being on this drug.

    Thanks for your time,
    Laura

  15. I’m here to post a sidebar about the effects of estrogen dominance that is not widely known. Estrogen Anaphylaxis.

    I was born with a Mast Cell Disorder. At the time (41 years ago), Mastocytosis was the only known mast cell disease – it is a cancerous disease – but in 2007 the WHO finally recognized that mast cell activation can occur outside of Mastocytosis (too many mast cells) when a person has either A) a mutation on their C-Kit Gene or B) an autoimmune disease causing their mast cells to degranulate (release). Neither form of this disease are about too many mast cells at all, but instead genetic and Autoimmune messages telling normal numbers of mast cells to release, release, release.

    Mast cells are vital to the healing process. They store and release all sorts of mediators that attack invaders, including histamine.

    Histamine is something most people are familiar with due to seasonal allergies and food allergies like peanut Anaphylaxis. Well, this estrogen-dominant PCOS girl nearly died this year of ESTROGEN induced Histamine Anaphylaxis.

    I am a PCOSer. I was always chubby, always. I hit puberty and suddenly I had a host of allergic disease processes like asthma and Urticaria. That same year (age 11) I was diagnosed with Stein-Levanthol Syndrome, the original name for PCOS. Cystic ovaries on ultrasound yes, but also lab work with high testosterone and LH and prediabetic glucose. This was 30 years ago and I’m amazed I had a doc who actually did labs but he did.

    By age 15 I was on the pill because I never started a period. That same year, I was placed on daily oral Prednisone because my asthma exploded out of control at certain points every cycle. I’ve been off and on steroids for the rest of my life. And yes I know how this exaccerbates insulin resistance! I had to breathe to stay alive though. Sigh.

    Most people do not know that estrogen raises Histamine levels and vice versa. In fact there is an alpha estrogen receptor on a mast cell and when that key enters that receptor and unlocks it, the mast cell releases Histamine. Mast cells also release over 200 other mediators of inflammation. When they’re releasing nonstop you can imagine the nightmare scenario this could cause in a body (and it did, in mine). Again I am unusual. I have an autoimmune disease driving my mast cells to go wild, but the connection between estrogen and histamine is important to know in general.

    It took nearly dying of Anaphylaxis for several months before we finally put me in chemical menopause (Lupron) and three days after the first injection, for the first time in 16 months, I was out of Anaphylaxis.

    My story is extreme. I have the complication of MCAS (mast cell activation syndrome) and another autoimmune disease running amok, attacking me. Still I wanted to post this because those of us with estrogen dominance/PCOS who are experiencing hives/asthma/chronic bowel issues etc really could benefit from understanding the role estrogen can play in histamine, including reducing our ability to neutralize histamine due to reducing DAO production.

    And the brain-gut connection is not to be ignored, as Histamine is actually a neurotransmitter, regulating serotonin production among others. It also releases gastrin, which is the cause of histamine-induced reflux. Many, many bowel disorders are now being understood as Histamine/mast cell induced. Estrogen raises histamines. You do the math.

    Education is everything. I am a CNC and licensed herbalist but I am here to tell you, I knew NOTHING about digestion until I learned the histamine connection in everything. I’ve been out of practice years now due to my illness, but it has been delightful to take my core knowledge from my education and be able to start pairing it with the understanding of mast cells in the gut.

    I hope your readers who have been suffering with things like chronic diarrhea/bloating/constipation alongside rashes/eczema and sensitivities to foods like cheese, yogurt, beer and wine, bananas, avocados, pineapple, honey, yeasted breads, mushrooms and peanuts will be aware that histamine intolerance (and down the road, mast cell disorders) is directly related to ESTROGEN in some people!

    Dr. Larry Afrin wrote a book on mast cell disorders – I recommend it if you suspect you have one. Many doctors are still very ignorant of MCAS so finding a specialist is difficult. There are lots of support groups on Facebook though.

    God bless and thank you,
    Michelle the CNC

  16. Thanks for the info. I was dx’ed with PCOS years ago- ultrasound showed many cysts (possibly 3-10mm?) on the ovaries, thin hair, extra body hair, blood tests barely in normal range, weight/ fertility issues, menstruation started at almost 16 yrs old, highly irregular (60-90 days without) periods. The whole list…

    I was on the pill (age 20+) except for trying to conceive my kids. My husband had surgery 5 years ago, and I stopped taking it. About 2 years ago, my period finally became normal (30-40 days). Now the ultrasound tech says my ovaries look pretty normal, a few follicles on each side, nothing that screams PCOS, but the doctor has to read it as well.

    Could the fact that I started getting normal periods done something to the follicles, or does it mean that I was never properly diagnosed?

  17. Hi Lara,

    “The story that I hear most often runs something like this: 1) went on the Pill as a teenager for skin, 2) came off the Pill in 20s or 30s, 3) periods don’t show up (probably because of post-pill syndrome), 4) acne flares up (because of Pill-withdrawal), 5) ultrasound shows ovaries have a polycystic appearance, 6) doctor diagnoses PCOS without doing any blood tests, 7) doctor prescribes the Pill.”

    This is exactly what I’ve been through, but what do I do after? I’m at the point where my cysts have disappeared on the ultrasound after 5 months again on the Pill. What should I do now? I’ve been to an endocrinologists 5 months ago, he said nothing to worry about, except my LH was high.

    Thank you.

    • Having the so-called “cysts” disappear on ultrasound doesn’t mean anything. Remember, the cysts are actually the ovarian follicles or eggs, and the number of follicles cannot be used to diagnose the hormonal condition PCOS. If you were my patient, I would go back to the drawing board and try to figure out if you really do have PCOS. I would also think about the treatments that I discuss in my post How to Prevent and Treat Post-Pill Acne.

  18. I am reading these post over and over again as well as Laras amazing book.. In hope to get some clarity..

    Since my daughters gynecologist said she does not have PCOS . SHBG and- DHEAS -FSH and thyorid all came back normal. I am not sure wheather I as her mum should we be satiesfied with this when all her sympthom points in in a different direction.. Now her cycle are late for the third months in a row. We still belive she has some kind of insulin-related PCO and even though she has done some fantastic inprovement in health still no sign of oavulation and since menstruation is that long it has probably not happend.:-(
    Does it harm to intake Peony and Licorie along with other supplemnents as Alpa Lipoic Inositol and NAC e.g ?

  19. Hi Lara,thank you very much for this information,I was diagnose with pcos 3years using just an ultrasound alone,I was placed on the pill which I did not stay on cause of feeling sick an I started to do my own research cause of stories I’ve heard from girlfriends where doctors only put them on pills an more pills,which I do not want for myself,so I am going to use herbs to get rid of this issue. My hair is falling and its driving me crazy, an no I have not been to another doctor as yet…going to an herbalist thank u again for this info….

  20. Hello I didnt ovulate last month (due to stress) and had trans vaginal scan it showed polycystic ovaries..but since My periods is usually regular and I have no other symptoms..doctor said its fine and It will be gone after few months most probably
    Is that true?

    • Yes, in a few months your ovaries could look completely normal. As I explain in the post, it’s normal for ovaries to have cysts–the cysts are the eggs. Ovarian cysts/eggs are constantly growing and being reabsorbed. The finding of polycystic simply means that you had not ovulated this month so there was not dominant follicle (egg/cyst). Instead, there were multiple small undeveloped eggs.

  21. Trying to ovulate more regularly.. Can a lean person with belly fat be insulin resistance.? No cyts ovaries. Some hair on unwanted places and a little hairloss…acne before healthy living food exercise etc

      • No , no insulin at the doctors visit. He was ignorant towards my daughter. (21 yrs, she is beautiful and in good shape so he might have been confused why we were there.) She explained her symptoms. but he was not interested. ( I told him I , her mum have PCOS as well) I asked for blood test androgens , thyroid etc. And he said ok. Test result came yesterday. All within the normal range. No exact numbers just a letter in which he said she does not have PCO. Her ovaries had no cyts.
        We have followed your plan for insulin resistance PCOS in your book chapter 7 since April . I have bought every supplement you recommend there. Add spearmint tea as well. No dairy, no wheat, no sugar or no vegetable oil. Exercise and intermittent fasting since April as well. She still has a little belly fat. Lost 3-4 kilo. It has always been hard for her to loose weight . Maybe her PCOS has been reversed ?!..and maybe period will come in a more regularly pattern. 28-33rd days we just have to keep up the good work and be patient . We have a blood test machine at home (her dad is diabetic) and her fasting insulin since life-changing is perfect.
        I just have two questions ..
        Maybe her androgens was in the upper scale of normal and even the thyroid ? Should we ask for exact numbers on the test result ? (Sorry such a long story.)

        Burden mother.

          • Her cycles they have been quite regular but last time it was over 42 days. I would say It was when we saw her hairloss she knew it was about time to make change in lifestyle and look for help. I searched on internet and found you. A great blessing because we have seen very good results. I am very convinced after reading your book that ovaulation is the goal.

            Symptoms has been cystic acne, hirsutism yes, upper lips arms and legs. Very hard for her. Lean but with some belly-fat. This belly-fat she was born with. It has never really disappeared just grown with her. Hairloss, yes. Low energy. Strong cravings for sugar and some food. I think sugar has been a strong trigger over the years. Aleopecia areata in childhood -Thank God it never came back. Dont know if it has something to do with this…Maybe I worry to much and maybe we should just continue with the good habits we have started.
            My fear is it will be another long cycle…:-( .progesterone deficiency?
            I have PCOS my self and I had a hard time being pregnant the first time and a lot of trouble before that..

  22. Best written article and so true. I treated my ovaries with copious amounts of ginger, fish oil and salads etc,no dairy. it is true it is all about inflammation. It was the overall issue leading to a symptom.

  23. HI Dr Lara,

    I have just recently found your blog post, I have been battling my weight for years thanks to PCOS and the doctors are not doing anything to help I’m literally had enough.

    I was diagnosed with an Underactive Thyroid after I had my son 8 years ago and been on medication since, I lost all my excess weight and never felt better. Then all of a sudden I started experiences bloating and stomach problems and my weight just crept up and up.

    I started developing other symptoms of PCOS such as prolonged period of times between between periods, acne and facial hair as well as the weight gain. I have went to the doctor on several occasions they even tested me for glucose resistant which was negative. They now say they will only help me when I want another child, I do not want another child just want to be healthy for the one I do have as I feel I don’t have any energy during the day.

    When I change my diet I struggle with cravings for sweet things, I seem to lose a bit of weight initially then it just bounces back on, thankfully I’ve floated around the same weight steadily for a few years although I’m still grossely overweight.

    I was struggling to put myself into a category and was wondering if you could clear things up so I can finally start to be healthy before further health problems emerged.

    Thanks in advance

    Sarah

    • I personally recommend raw ginger for women daily. i juice it with a whole lemon with skin and carrots and an apple or I have it raw with my food. I was in so much pain I thought I had to be operated but did my research and overcame it. Part of that involved visualization too.

      I am rarely without my ginger. It is magic. I have salads with vinegar too, lemon and olive oil. The combo enhances PH of body. Olives do too if you can eat them. I take easily 10 fish oil a day and feel amazing. It is important to exercise too but while you in pain you may not be able to. Loads of ginger and no processed foods or dairy at all while treating it. I recommend laying off any bread, sugar , sweets , until have eliminated it , then if do have bread have the sourdough wholemeal one, affects ph differently.

      when cyst breaks you will bleed and be in pain. This condition to treat took me over 2-3 weeks and then , I felt entirely better but was in pain for days and bleeding. The pH of the body is out of whack and so the body suffers since at its basis, all is frequency. The organs are getting wrong frequency by environment, stress , food , etc.

      I wish all the ladies the best here and to keep your mind strong and powerful .

      TRY THE GINGER NINJA. (mind you raw is best, I found tea and powder not effective for me personally)

      Disclaimer: am not a doctor, this is my personal experience. Please monitor yourself accordingly with self knowledge and get medical assistance if necessary.

  24. Hi Dr. Briden,

    First off I’d like to say I really like your book, The Period Repair Manual; it’s very helpful and has a wealth of knowledge.

    I would like to ask you some things.

    I have been struggling quite some time now with amenorrhea; the longest I remember going without a period was about 5 months. I’m almost 21 and not overweight. I was told I had no cysts on my ovaries from being seen through ultrasound. My testosterone levels have been high though (along with symptoms of slight hirsutism and acne), progesterone low, and my TSH was 2.5. Could this be a thyroid problem or PCOS? I really would like to get to the bottom of this and get back to normal. Doctors were unsure of the problem. How do I regulate ovulation if my body is not doing it naturally and what would cause it to not be doing it?

    • Do you have testosterone on blood test? That almost always means PCOS. It doesn’t matter that the ultrasound is normal. Do you also have elevated LH?

      • Yes it was elevated on the blood tests. I am not sure about LH, I will have to find out again. So can PCOS be reversed? I read there is no cure. Can it be caused by stress? I am of healthy weight and not sure if it’s insulin related in my case.

  25. I know this post is a bit old, but I hope that you’ll be able to see my comment come through anyway. I have recently gotten a PCOS diagnosis based on an ultrasound. My blood work was all normal except my SHBG was high. I’ve been having acne, fatigue, and recently a ruptured ovarian cyst. Should I get a second opinion then?

    • Do you have regular periods? Were your androgens checked? PCOS cannot be diagnosed by ultrasound alone.
      Also, just to clarify: An ovarian cyst is not related in any way to the hormonal condition of polycystic ovarian syndrome

  26. Dear Lara. I’m writing to you because I don’t know where else I can ask for help. I’m 35 years old. Years ago I’ve been diagnosed with PCOS (I had many cysts on my ovaries and an elevated testosterone – I wasn’t on the pill then). From approx 2006 until 2010 I was taking the contraceptive pill. The reason for that was to regulate my periods and also I’ve had problems with severe acne and started to show the sign of hirsutism – on my chin. When I stopped it I luckily fell pregnant with our daughter. When our daughter was born I was put back onto the pill. I’ve had severe acne and also my hirsutism has gotten worse (much worse). I’m on the pill now for about 5 years and I really want to stop taking it. For the last year or maybe even more I’ ve started to feel extremely anxious, depressed and had many anger outbursts. I think it’s the side effect of the pill. I’m anxious about it. I don’t know if I can just stop taking the pill. My hirsutism is bad (all chin area is very hairy) and I’m also worried about acne. I went to see my GP (I live in Scotland) and I’ve had some tests done while on the pill. My LH U/L is 0.5, FSH U/L is 0.5, Prolactin mU/L 195, Progesterone nmol/L 3.0, Oestradiol pmol/L 50, Testosterone MS nmol/L 0.8. I also had insulin checked – it’s been fine. An ultrasound scan of my ovaries has been carried out – this time my both ovaries appeared normal (maybe because I was taking the pill for so long?). I’ve asked my GP if I could have any other treatment for my condition apart from the pill and I’ve been said thad in UK contraceptive pills are the only treatment for my condition. They don’t care if my symptoms gets worse (hirsutism or acne) – the only way to treat it is the pill. Please tell me what else I can do to improve my health. I would love to have another baby but not until I get my health back . I don’t want to take the pill any more. It has actually ruined my health.

  27. Dear Lara,

    This article is a breath of fresh air – thank you. A few weeks ago a pelvic U/S originally aimed at tracking my fibroids happened to reveal “polycystic appearance” of my ovaries. My GP found this odd as another U/S two years ago showed no such thing (I see from your article that this is not surprising). I **believe** I remember that an U/S I had 11 years ago also turned up some cysts on my ovaries, but the nurse at the time told me that was very common. The other thing my GP (in the present day) found to be inconsistent with PCOS is that I have always had 25-day cycles (+/- 1 day, rarely 2) and I have never missed a period. I was on the mini pill a couple of times, most recently four years ago, which messed my cycle up considerably, but since then I’ve been off BCP and definitely menstruate regularly. I’m of a healthy weight and do not suffer from hair loss. Having said that, although I do not have what I consider problematically excessive hair growth, I do have moderate upper lip hair that I’m compelled to bleach maybe once a year and a few stray dark hairs on my abdomen and nipples (I thought this was maybe an Eastern European thing!). Perhaps most significantly, I have had pretty bad acne since age 18 and could only shift it with two rounds of accutane. I have been acne free now for four years; I just get a couple of zits here and there. Because I am trying to conceive, my GP sent me for bloodwork, which turned up slightly low iron and HDL levels, but everything else seemed normal. I have no idea what bloodwork was ordered and whether the battery would look for androgens, LH and other relevant hormones as standard, because it was ordered before my U/S revealed possible signs of PCOS. My “sugar levels” were normal, if that has any relevance?

    Do you think PCOS is likely given the above? I am particularly concerned because I just started tracking my cycles using OPKs and charting, and I am worried that it looks like I ovulated without temps going up (but this could just be a fluke… I will find out in a few days) or, if I ovulate in the next few days, that I ovulate so late that my luteal phase is far too short.

    Many thanks for your time and, again, for the great article!

    J

  28. I just happened to come across this article at the seemingly right time. I am 26 years old and was ‘diagnosed’ with PCOS a few years ago after having an ultrasound. My doctor has done blood work but did not mention the testing of PCOS in the blood work, so I am unsure of whether or not that was a factor in diagnosis. I have always been a slim, healthy, normal weight and have not experienced any other symptoms of PCOS aside from irregular periods and mild to moderate acne. My doctor even said that I don’t fit the typical description of someone with such condition.

    I have been taking the pill since my late teens for the reason of irregular periods. Earlier this year, I decided to go off it because of migraines I was experiencing. (I have gone off the pill in the past, but was put back on after months of no period. It was at that time that my doctor did the ultra sound and declared the cause PCOS.)

    It’s been several months since I have stopped taking the pill and my skin has started to really break out. Hesitating to go back on the pill, I made an appointment with my dermatologist instead, hoping they can shed some light but the appointments are always quick, to the point, then out the door. Your posts have got me thinking more about the possible causes of the irregular periods and the acne – would you suggest giving another Rx from the derm a try? I also read your posts about Thyroids and do not experience symptoms of hyperthyroidism, though interestingly enough my mother has hypothyroidism.

    As far as the periods: how can I tell if my body is back to normal after having been on the pill for years, and does very light spotting count as a period?

    • Hi CC, I encourage you to have a look at my book Period Repair Manual. In Chapter 7, I discuss all the different reasons why you might not be getting your period. I also discuss the proper diagnosis of PCOS with blood test.
      As for whether light spotting counts as a period. It all depends on whether you’ve ovulated or not. I discuss this in the book.

  29. THANK YOU SO MUCH FOR THIS ARTICLE!!! I was recently diagnosed with pcos with no ultrasound and no blood work. I went it in for excessive menstrual bleeding, (which has yet to be taken care of) and all that quack said was here the pill and lose weight…. In the 5 minute window I had with him I hardly had a chance to talk, so I couldn’t tell him that I can’t work out because if my heart rate goes up so does the bleeding… So here I am on the pill which is doing nothing other then clearing up my oily skin, and now suffering from symptoms of anemia, possible low blood pressure, all while reaching the 2 month mark of this “period”.

  30. Hello, I read your article on PCOS. Thank you so much for writing it. I was diagnosed with PCOS (ultarsound alone) when I was 30, I’m now 36. I had irregular periods when I was a teenager but that is about it. I dont have excessive hair growth or acne. I’ve never been overweight, I weigh more now then ever but still in normal weight range. Considering I’ve had 5 children with no difficulties getting pregnant. My question is should I go back to my doctors and have other tests run to see if I do in fact have PCOS? I have always felt like I didnt really fit the criteria. Thank you once again for your article.

    LY

    • If your cycles are regular and you don’t have testosterone symptoms (hirsutism and acne) then it’s highly unlikely you have PCOS. As I explain in the article, the ultrasound finding alone means nothing. Yes, it’s worth talking to your doctor again.

  31. Hi Lara ,I was diagnosed with pcos yesterday. I’m just wondering whether it’s possible to have this having hardly any of the symptoms, I am 17 years old , 5ft 1 and 8 stone 7 pounds. I have always had very irregular periods and once I come off the pill went a year without one, I’ve had the ultrasound and blood tests which confirm I have it, but I do not have any of the usual symptoms, my hair is still thick ihealthy and long, I am not overweight, I do not have excess body or facial hair etc. I’m just very confused at the moment as pcos seems to have many symptoms I do not have , thanks in advance for any help and advice

  32. Hi Doctor,
    I’m lean PCOS with slightly IR. And I have controlled my diet and using inositol , NAC, Magnesium, multivitamins, omega3.
    Got 2 period back within 6months, but the third time is so hard, haven’t notice any sign of O on CD28.
    I don’t know what to do next ( 44kg, 163cm), I don’t think this weight is good for me, but I don’t know how to gain weight healthily.
    Please help, thanks so much.

    Phoebe

    • Yes, you’re underweight, and that’s a big problem for periods. You don’t restrict fat or starch, do you? If you’ve always had trouble maintaining body weight, then you may need a blood test to screen for celiac disease.

  33. Hi Lara, congratulations for the article. You mention about hemorrhagic cysts. I have this type (5 cm in size), which causes me pain. My doctor said the treatment is taking birth control pill. There are cases of thrombosis in my family and I have varicose veins. I know that these factors together with the pill are dangerous to my health. What can I do about the cyst? (my periods are regular)

    • Hi Iza, I discuss a natural approach to large ovarian cysts in Chapter 9 of my book Period Repair Manual. They often respond to an anti-inflammatory diet combined with low-dose iodine and selenium supplements.

  34. I was just wondering if you could clear something up for me. My husband and I have been trying to conceive for over a year and a half. In that time I have had numerous blood hormone tests done, 3 ultrasounds, 2 vaginal ultrasounds, a test to check my tubes, and pretty much everything else you could think of. Everything came back fine. Now in the last month they sent me for sent me for yet another ultrasound and a dye test. The dye test and everything came back normal, except my doctor told me that my scans show “slightly polycystic” ovaries. I don’t have any symptoms except my last 2 cycles have been 10 days late. Obviously I’m very concerned with all of this. Is it possible for me to be polycystic but have it not show up on previous ultrasounds (when clearly they would have been looking for signs of things like this)? Also what is considered slightly? And is it something I should be worried about or is it probably nothing? Thank you in advance

    • Hi Gie,
      As I explain in the post, PCOS cannot be diagnosed by ultrasound. On its own (with no symptoms or abnormal blood results), the finding of polycystic ovaries means nothing. And yes, it’s definitely possible to have a polycystic appearance one month, but not the previous month, and not the next month. That’s because ovaries change their appearance every month (as follicles form and are reabsorbed).
      I explain this in detail in Chapter 7 of my book.

  35. I am glad I found this. For the months of February March and April I have had very odd cycles. I have had normal cycles my whole life and have a two year old son i conceived very quickly. Nothing abnormal ever came back in any of my ultrasounds or bw. I went to the doctor for a transvag and uterine ultrasound bc she was concerned I had a polyp. She said my ultrasound showed quite a few follicles and she thinks I have PCOS. She did bw but now I have to wait all weekend for the results. I have no weight gain or acne or weird hair growth. I am very Italian so I have always had a little extra….but nothing out of the ordinary. I’m so upset but still trying to be hopeful that’s not what it is.

    • PCOS is a long-term condition. It doesn’t just appear out of nowhere.
      If your cycles were always regular before, then it’s unlikely to be suddenly PCOS. You’ve probably just had a couple of cycles that were thrown out by stress or illness or antibiotics or something like that. It’s also worth checking your thyroid (see my irregular periods—thyroid post).

      Finally, don’t put too much focus on the ultrasound finding. As I explain in the post, and in my book Period Repair Manual, polycystic ovaries is a very common finding and also occurs in 25% of normal women.

  36. Lara, if PCOS were to stunt your breast development and fat composition such as fat distribution to breasts, hips, buttox…let’s say due to the anovulation therefore low Pro & Estro & high Androgens, are you forever doomed even if you begin to ovulate as an adult? Will the breasts be stimulated & catch up & will your body composition changed or are you cursed & bound to what has occured/failed to occur? Please answer, I really need at least your opinion even if you aren’t sure, so that I may rest.

  37. Laura, I researched I shouldn’t stop taking vitex and maca just because my cycle is late. I read it’s normal, and my hormones are just balancing. Idk. I’ve always had a normal cycle, so this is frustrating. Idk if I should continue or stop. Seems like it effects everyone so differently. How do I know if I need these supplements? My lab work always shows I have pcos. Any advice is greatly appreciated. Thanks again, Nicole

  38. Hi Laura, my question is I went through infertility treatments to have my first child. I was dx after having him w pcos. My Dr said it was from over stimulating my ovaries w fertility drugs. Is that possible? I’ve been fighting pcos ever since. I have normal cycles, but the weight loss has been difficult. I started taking vitex and maca a wk ago, and I’m a couple days late. I read your blog that vitex isn’t always good for pcos, so I’m going to stop and hope my cycle comes. If my pcos is due to over stimulating how do I reverse it? It’s been 9 yrs now. Thanks, Nicole

  39. Hi Lara it’s Julz again, I forgot to mention my daughter is 23 and has been on dinette on and off for 5 years for the purpose of painful periods and no other pill would agree with her to many side effects!! She stopped her pill and never seen a period fell pregnant straight away!! No facial hair or thinning and has always struggled to gain weight tiny size 8 and went straight back to pre baby weight within a month. She has always had a 31 day cycle . Cud she have been wrongly diagnosed or will she struggle to get pregnant again? Thankyou Lara your advice would be welcome .

  40. Hi Lara, just found your article very interesting. My daughter has a nine month old and conceived first try, she’s very slim and has always had regular periods, because she had a pain in her hip a scan was advised and doctor said he’s 98% sure she has pso !! How can he be so certain just from a scan and my daughter having no symptoms ??

    • I’m shocked by how many doctors think an ultrasound finding is enough to diagnosis PCOS. It’s not! On it’s own–with no symptoms or blood results showing hormonal abnormalities–the ultrasound finding means nothing. As I explain in the post, healthy normal women show polycystic ovaries at least 25% of the time. Test a few months later, and the ovaries will be normal again.

      I suspect that your daughter is absolutely fine, but if she really wants to rule out PCOS, she should ask for tests for androgens (male hormones such as testosterone, SHBG, androstenedione, DHEA).

  41. hi lara,

    I am 22 years old and was on dianette from just before 16 (2008)for acne. normal periods before.

    I came off of dianette in august 2013 after 5 1/2 years and have struggled with periods since. I have only had light spotting twice since then.

    scans showed follicles on ovaries and slightly elevated lh levels. the glucose test they gave me seemed normal however this was not a fasting test.

    I am also about 1 stone heavier than I was when i was 16-20 due to probably over eating or binging sugar.

    would you suggest any herbs or what would you say for next steps ? and how do i know if this is just post pill pcos or insulin resistant?

    • Hi Sarah,
      If you binge on sugar, then you probably are insulin resistant, but it’s worth testing. You need a blood test for fasting insulin or glucose tolerance test. A non-fasting glucose test means nothing.

      Then your best treatment is treatment for insulin resistance, which I describe in my insulin resistance post.

  42. Hi Laura, thank you for all your information about PCOS. I am having a really difficult time in trying to understand this syndrome to say the very least!

    Ever since I was born I’ve always had a hypoglycemic-like reaction after I consumed sugar (I say “like” because I never had low blood sugar levels but I experienced all of the symptoms of hypoglycemia: anxiety, shakiness, irritability, rapid heart beat, sweatiness, etc.) so my mom said I had a “sugar problem” and limited my intake of sugar. At age 9, I put on a lot of weight and I was the “chubby kid” in my class. I started my period at 11 but it was always extremely heavy (8+ days long and about a 35-38 day cycle) and very painful. Then, around age 15 I noticed breakouts on my face that did not just show up with my period but were constantly there and resistant to any type of face wash (I’ve tried proactive, epi-duo, and a 10% benzoyl wash and nothing worked). At the same time, I noticed my hair started to fall and I was having a lot of hair loss. Then, another symptom I noticed around the same time was that after I would run or exercise I would get extremely painful cramps in my pelvic area and would notice bleeding after I experienced these cramps. I realize now that these painful cramps were due to a ruptured cyst. I was diagnosed as insulin resistant and my DHEA-S are high normal.

    I am having trouble in understanding where PCOS originates from and how it is affecting my hormones. Is it truly a genetic syndrome that I inherited from a family member, could I have developed PCOS in the womb, or does the environment cause it (like diet and exercise)?

  43. For those that are thin but have PCOS symptoms such as excess hair- get your Androstenedione levels checked.
    It’s what’s likely causing your symptoms but doctors usually only focus on Testosterone.
    I was very skinny,had PCOS and high Androstenedione but normal Testosterone.
    Then I gained a lot of weight and my Testosterone went way above normal and this was accompanied by a change in body shape from feminine to more “manly”.
    My Insulin has always been normal although I suspect I’m still insulin resistant.
    It’s time for doctors to pull their head out and start categorising the different types of PCOS that exist and also a change to the name PCOS is in order.

  44. Another fantastic article. I would like to know if having a tubal ligation effects a persons hormone levels at all? I do happen to have cysts on my ovaries, very large ovaries I am told, and was wondering if the surgery could have been the tipping point for all my symptoms, the stress I have put my body through not letting my body correctly ovulate etc. (I’m wishing now I had been more informed on the possible side effects….I would have never of done it.) I never had any PCOS symptoms until after I was done breast feeding, a year after my tubal ligation. Two years later I am still struggling.

    • hi Erin, there is anecdotal evidence of Post Tubal Ligation Syndrome, but the research is not conclusive. Sometimes the symptoms can be attributed to coming off the Pill (which often happens at the same time as ligation). It sounds like you had the ligation shortly after delivery before your periods came back. Were you on the Pill before pregnancy?

      • I had not been on the pill for at least 10 years before the surgery. After my second pregnancy, I nursed for a year, not having a period during this time. Once I stopped nursing, right after my first period, the symptoms came, I had experience ovarian pain, the non-stop bleeding or spotting for 4 months. I after uterine and ovarian cancer was ruled out by tests, I was educated on my “huge/oversized” ovaries with cysts in them and PCOS diagnosis. I had them test my hormone levels, those all came back what the Dr. considered normal. They wanted to put me on the pill (ugh!) to control the bleeding, but I researched natural approaches and was able to dump all processed carbs and sugars, limiting my meat intake, and taking natural supplements, working out everyday, and it was working great. But now and again, I still have random spotting, with PMS symptoms, and cramps (which I never experienced before….my periods were always normal and easy) whenever my body feels like it, I also get hot very easily, oily skin and extra hair loss, and having an EXTREMELY hard time losing any weight, even with my clean lifestyle. I’m 34 years old and thought it might have been menopause, but my Dr. assured me that I was not going through it yet. I’m so regretting having the tubal ligation now, I thought I had done my research, but my body just couldn’t go through another pregnancy and I never liked how my body reacted to birth control.

  45. Hi Lara,

    I’m an 18 year old girl with normal ovulation, regular periods and normal hormonal blood test results. I’m also quite slender and have no difficulty loosing weight. My problem is however, that I have had quite a significant amount of hair growing under my chin which concerns me. Is hair growth always caused by PCOS? Or can it have something to do with my teenage hormones/genetics? If the hair growth was an isolated incident, I wouldn’t be worried, but I have also had acne in the past, which makes me think it may have been a hormonal problem. As I said, everything came back fine in the tests, but I’m still not convinced. Can you please reassure me?!

    • Facial hair is usually associated with elevated testosterone or androstenedione (another male hormone) on blood test. Are you certain that those hormones are normal? Sometimes doctors say: “all hormones are normal”, but they haven’t really tested everything.

  46. I was recently diagnosed with pcos – I have polycystic ovaries and elevated LH and AMH. Testosterone, prolactin, thyroid, estradiol, FSH all within normal ranges. My doctor is not helpful and rushes me out of his office without even giving me a chance to ASK questions let alone answer them. Any thoughts or advice???

  47. Its me again Ramona. I am happy to invest a one off amount to come and see you in Sydney or is there someone who can see me in Perth. Where can I find info about your charges. also could you recommend some over the counter reasonably priced supplements that I can regularly buy. The naturopath I see gives me the stuff and it costs the earth.

  48. Lara, your blog and website are a God send . I cant thank you enough. My 16 year old was admitted to hospital earlier this year with sharp abdominal pains. This was on day 2 of seeing a naturopath for 7 months of missed period. Maybe the naturopaths medicine triggered something. This is a high strung, sprinter girl with much facial hair. she was a tall baby 55 cms but stopped growing after year 7. National level sprinter with poor eating habits. very feisty and stressed. poor concentration and focus. anyway the sharp pains were caused by 10 cm cyst on right ovary and twisted tube. After surgery (they managed to save both the tube and ovary) we continued with the naturopath and introduced acupuncture with chinese herbs. two months later she got her period and was regular for three months. both these are expensive options for me and I think we have hit a hurdle. I was hoping to wean her from naturopath and she was becoming non complaint with taking meds and we went on holiday and her sleep patterns got messed and the period stopped coming. Now we have no period for 2 month and acne has broken out again. we have reintroduced naturopath and acupuncture for the last month but no change. Her diet has improved and we are having green smoothies each morning but she still consumes junk on weekends and has deserts on weekends. she is very skinny and still exercises a lot. sleeps very little and is highly stressed due to exams. from your description she seems more type 2 than type 1. next week we will have another ultrasound. Docs are keen to put her on the pill. Now I know its not an option at all. mY HUSBAND IS on a temp job and I am a poor yoga teacher. We cannot afford to continue to see the acupuncture and the naturopath. I was hoping to educate myself and propose the following tell me what you think. Blood tests next week to determine her vit d, iodine, testorone thyroid etc. following which I might add the tribulus, indole 3, peony and liquorice, mag and zinc, vitamin d. I will avoid the dairy and refined carbs. is it ok to have some soy mild. will get her to try some meditation and yoga. not sure about the progestorne ant this stage. I could still see the naturopath and discuss my options and get the ok from her but I cant afford to go on for much longer.

  49. Hi Lara,

    I’m 32 years old and I was told by my Endo, that I’m “on the road” to PCOS. Whatever that means. Basically, i don’t miss any periods (my cycle is every 35 days) but my LH was high in comparison to my FSH which is what caused my GP to send me to see an Endo. Also, I donated my eggs to a friend and the docs there said I had very high AMH levels indicative of PCOS.
    My estrogen was also high, and everytime I’ve been tested over the last 2 years my LH was high- I’ve also gained 35 lbs in 2 years.. which now puts me at overweight.. i’ve been in great shape my entire life. I cant seem to lose weight no matter what i do. I’m currently taking Metformin, which hasn’t seemed to help although it’s only been 6 weeks..

    I just ordered natural progesterone cream. Do you think this is the right course of action? Do you think I have PCOS?

    • The most important question is whether you are insulin-resistant or not. If you were prescribed Metformin, then presumably the doctor found evidence that you are (on test for fasting insulin or glucose tolerance test). If you are insulin resistant, then the best natural treatment is to eliminate sugar, and supplement magnesium and maybe berberine (as I discuss in the PCOS treatment post). (but please speak to a Naturopathic doctor or herbalist to learn how to use berberine safely). Once you improve your insulin sensitivity, your LH should come down on its own. You probably don’t need progesterone cream.

  50. Dear Lara,

    Firstly, I would like to thank you for writing such informative educated articles. In my moment of desperation your articles have somewhat calmed me down.

    When I first got my period at the age of 12, my periods were not monthly and I would always be late and sometimes skip a couple of months so at the age of 14 I was diagnosed with PCOS, by an over the abdomen ultrasound and no blood work. They told me to take birth control pills to fix my period but my mother was completely against this approach because she did not want to play with my hormones at such a young age whilst not knowing the long term damage it could cause. So ever since then I thought that I had this illness and I would suffer all my life. At 13 I started having severe hair loss and after a course of vitamin injections it stopped and I grew a thick long mane.

    At about 18 years I started having regular periods on exactly the same dates with normal amount of bleeding. I don’t know exactly why but I presume it is because I lost my virginity and started having regular sex with my boyfriend, I thought maybe it affected my hormones in a way balanced them out. My hair grew even thicker and longer during those years. I went to check if I still had PCOS and the doctor (again by checking with ultrasound) said that I don’t seem to have PCOS and I had a healthy lining of the uterus and that I was ovulating. However during those years I developed a few thick hair that kept on grown on my chin, I would pluck them out and for about a week or two they would not grow back.

    At 23 I broke up with my boyfriend therefore stopped having sex, I am 26 years old now. Ever since then I started experiencing diffuse hair loss and more hairs on my chin that I would have to pluck out every three days now the growth was more rapid. At 25 the hair loss stopped almost completely, with lots of baby hair and new hair growth, my middle parting, sides, and the crown filled out completely and then about five months later started falling out again. A thing to note is that ever since 18 my periods have remained regular also I have never been overweight. My height is 5 foot 4 inches and my weight minimum has always been 49kgs and maximum is 53kgs.

    I guess my question is can having sex balance out your hormones and get rid of the symptoms of PCOS? Also, If someone has a female pattern baldness can it stop regrow and then start again 5 months later?

    I completely understand that you can not give me any specific advise because you have not seen me in person but can you please roughly evaluate my case and answer my two questions above? Doctors usually just want to either push me to take the pill or prescribe minoxidil without a proper explanation. I will be having an extensive blood test done in a week however I am extremely depressed because of my hair loss and it would be helpful if you could just at least answer my two questions as I did not find any information in regards to that anywhere.

    Thank you very much in advance, for taking the time out to read this long message to you and even more thankful if you will respond. P.S. I am from a middle eastern background if it helps.

    • Hi Mariam, As I explain in the Treatment for PCOS post, PCOS is not a permanent condition. The experience of symptoms improving on their own is not unusual. You describe that hormones were better in your early 20s (regular periods, improvement in the hair loss). I couldn’t say that it was specifically because you were sexually active then, but it could have just been that you were happy, and your stress hormones were better, or your diet and exercise (and therefore insulin balance) were better at that time.

  51. Dear Lara,
    thank you for this article.
    I have been diagnosed with PCOS myself just about a month ago but i simply do not want to believe it is true so I’m constantly researching and currently searching for another doc for a second opinion.
    After 6 years of taking the pill i stopped taking it last year in june (i was 22 1/2 years old) and I did not get my period for 4 months. then I got it again after 5 weeks and now i haven’t had it since the end of November of last year.
    Apparently I have cysts on my ovaries and they checked my blood… the testosterone is slightly higher (I do have to get the correct data about that because it seems to not make sense) I do not have excessive body/facial hair, not the slightest indication of acne (I’ve always had perfect skin with probably one or two zits a month), definitely no balding on the head and my libido is pretty much dead. No indication of a higher testosterone level to me.
    Also I have always been really small. Never struggled with my weight. I gained about 10 kilos when I was abroud for a year (which is 4 years ago) but lost 8 of those kilos again without much trouble.
    I am 178 cm tall with 59-61 kg.
    Can we please agree, that I’m absolutely and without doubt overdiagnosed?
    If you answered that question with yes, can you helo me figure out what to do next? Ask as many gynecologists as possible until i find one that will help me balance out my hormone level?

    I am so so thankful that I found your website because there’s literally nothing in german about this subjet area and I really, really, reeeeaaaaalllyyyy do not wanna take the pill again. ever ever ever ever ever!

    Thank you so so much for your help in advance
    If you can help me figure this out i will cherish you forever and send you flowers coming all the way from germany :)))

    Thank you!!!
    Luisa

    • Since you have elevated testosterone and irregular ovulations, you may be closer to a PCOS-diagnosis than many of the young women I talk to (who have been diagnosed on ultrasound alone). However, I suspect that your situation is caused by the Pill, and should therefore improve with natural treatment. The Pill is never a solution for PCOS. (Why take the very thing that caused the problem in the first place?)

      PCOS is not a true medical diagnosis. It is a description of what is currently happening with ovulation and hormones. That can and does change over time.

      • Thank you so much for replying!
        My testosterone is 0,56 so barely higher than on an average woman.
        Do you have any tips on natural treatment because I don’t know where to start….
        Thank you so much.
        Luisa

        • I need to write a PCOS-treatment post. The reason that I have not yet done so is that is quite complex. There is no one simple natural treatment that will work for everyone (I can only wish! how easy my job would be then).

          As I discuss in the post above, temporary ovulation shut-down for lots of different reasons. Insulin resistance, certainly. Also: subclinical thyroid problems, zinc deficiency, and quite probably inflammation caused by a problem with the intestinal bacteria (see this medical hypothesis linking PCOS to dysbiosis).

          What I do with my patients is talk through their medical history – in detail – to try to discern where the problem lies. It’s slightly different with almost every patient, so no easy task. 🙁

          That said, when it is a clear-cut case of Post-Pill PCOS (especially when LH is elevated), then the herbal combination of Peony & Licorice works very well. (This is not a prescription. I cannot give individual advice online. You must speak to your local clinician – hopefully you can find one- about what will work for you.)

  52. Hi Lara,

    I also wanted to include my inability to concentrate. It is really hard for me to focus, and I”m not sure if it is due to having thoughts about eating, even when I am not hungry or just ate an entire full meals.

    My ferritin is 120, Vitamin D is 24, so I don’t think it has to do with this…

    Please let me know your thoughts.

    THank you

    Anita

  53. Hi Lara,

    I’m 26 and was diagnosed with PCOS at the age of 22. I am 5’2 and 100 pounds right now, my typical weight prior to PCOS was always 90-95. I was on BC pills for about 3 years, and when I came off, suddenly I began to gain weight, not have a period for 5 months, and had excess body hair. I finally went to the doctor; I had cysts on my ovaries, elevated LH (2 to 1 ratio to FSH), and high levels of DHEA (320). I have always been very thin; in fact, up until I had PCOS I always tried to GAIN weight and I would feel full VERY quickly, which is what made gaining weight difficult. Everyone in my family has a high metabolism; no one has PCOS that I am aware of.

    Once the PCOS began, I also experienced IR. My A1C was at 5.7, which for my body I am sure was high. I began to exercise and eat properly, and it only helped minimally. I was put back on the birth control pill (Lo-estrin, which I learned later has high androgenic activity) and Metformin. THe most I weighed was 111, and this was only in a matter of a few months. When I gained weight, it went to horrible places. My always slim jaw suddenly was puffy, and my cheeks were puffy. The weight went to my stomach and I had increased muscle mass and smaller breasts.

    I ended up losing a signifcant amount of weight later but not due to the medications, it was due to an extreme diet change (I was hardly eating) and heavy exercise. My hair began to fall out months later. My iron was low but I got this up and still have suffered hair loss for the past couple of years despite gaining weight and eating properly.

    Right now I am on Orthotricyclen Lo and 50mg of spirolactone. I also take licorice, spearmint tea, maca root, and saw palmetto.. I am no longer on Metformin as my endo says I am at 5.2 for A1C. Instead of he gave me the 50mg of spironolactone.

    I still feel hungry (this was with and without the Met) all the time despite eating low carb, healthy fats, only meats I really eat are fish and hormone-free eggs. I take a multivitamin, get plenty of magnesium from raw hot cocoa… but still hungry all the time and it appears to ALWAYS be worse in the second half of my menstrual cycle. If I didn’t just stop eating on my own (I rarely feel full) I would continue to put on weight and weight loss is not easy for me.

    I exercise almost daily (running, weight training, yoga). I am not sure what I need to do at this point. My endo ruled out adrenal fatigue due to a test. My free testosterone was on the low end. He did not test my other hormones since he knows I already have PCOS and am on the pill.

    THe only 2 times I felt the most normal was my first week of going only herbal and still being on Lo-Estrin. However, the effects faded after a couple of weeks. The second time was my first week being on Yaz; I finally felt the way I used to, prior to PCOS. I didn’t think about food all the time, hair was growing back. I had to get off of Yaz after a month though due to the horrible effects it had on me mentally (depression, etc), and I have never had issues with depression. Of course, I still dealt with the hunger issues in the last week of Yaz (this was before taking 50mg of spiro, I was only on 25 then).

    Any suggestions or an idea on what I would need to do? I would appreciate any help you could offer, whether it is a natural solution or not. I just want to feel normal again.

    Anita

  54. Hi Lara,
    I’m 41, diagnosed with PCOS and trying to have baby #2 (been 5 years!). I’ve had all the blood tests done that show slightly high in testosterone/insulin but I’m also ovulating. I had my ovaries drilled late last year to try and help ovulation and pregnancy. I was also put on Metformin which I recently went off due to being so ill on it. I have now changed my diet and work load (stress) radically to try and conceive a baby this year and deal with this all naturally. I’m just concerned because of my age whether I should just give Metformin a go this year – to give it the best shot.
    Thank you, I live in a regional area of Australia otherwise I would come and see you personally to seek this advice. I understand you don’t do Skype consults.
    Many thanks
    R

  55. Lara, How can I lower my androgens production, from my adrenal glands? specifically DHEA, for many women diagnosed with PCOS like me, this is our problem and not the insulin resistance, testosterone or obesity. I’ve been struggling to find articles with information about this, the causes of this, and naturally treatments to get back my period and ovulation and get away for all the horribles symptoms, like hair loss unwanted hair which is so sad to me. We really need an article that can help us.

    Thanks Lara!

    • Hi Ashley, I will work on a blog post to address excess adrenal androgen production. It occurs because of an overactivity of the enzyme 11 beta-hydroxysteroid dehydrogenase (11B-OHSD). 11B-OHSD can be down-regulated with glycyrrhiza (licorice), but you should use under guidance, as it is a tricky herb to use. Magnesium, zinc and vitamin B5 support adrenal function, and the minerals have the added benefit of blocking androgens at the receptor. Also, yoga and sleep are very good for stabilising the HPA axis and normalising adrenal hormone output. In my clinic, I find that patients with this “type 2” non-insulin-resistant PCOS respond very well to natural treatment.

      • THANK YOU Lara for your reply. I will take every advice, and looking forward to read that future post.

        I would love to read your opinion about the drug “Spironolactone” One of the most famous drugs prescribed by doctors in the U.S. to treat women with PCOS. My Doctor called “the safe drug” But I hardly believe this is true. Could Licorice be the best substitute?

        Thanks again Lara.

        • Yes, Peony & Licorice combination can be a good choice, but please seek guidance from your local Naturopathic Doctor or herbalist. My comment is not a prescription. There other very effective natural methods for blocking androgens. As I mention above, both magnesium and zinc block androgen receptors. Zinc also inhibits the 5-alpha reductase (the enzyme that activates testosterone at the hair follicle). (Other natural 5-alpha reductase inhibitors include turmeric, resveratrol etc). Health of the intestinal bacteria seems to have a HUGE impact on androgen sensitivity in women (I’m not 100% sure why). In short, I do not think that spironolactone is the best choice. Yes, it has a mild androgen blocking effect, but it can mess up periods, and it often causes fatigue I suspect due to it’s suppression of adrenal function.
          You can read more about 5-alpha reductase in my Hair Loss post.

          • Hi Dear Lara! Is me again, It has been 6 months since I started to lose my hair by the hands full. Short story, I had a miscarriage last week, one day before this I requested my doctor lab work again, I was desperate trying to figure out what was wrong. Well, this time my Testosterone comes considerable high, dhea comes high as well. funny thing because last time according with the lab my T was low, maybe a lab mistake but (can pregnancy higher androgens?) I’ve trying licorice, vitex ( my LH is very low, so I guess is good for me) peony, natural progesterone, etc. nothing seems to work. I refuse to use the pill but this is very hard. One question for you. Is there any real possibility to re grow your hair back once the folicule do contact with the DTH ? I’m trying to be patient. I just wanted to read your opinion, how many months can take to see results with diet, and natural things? my diet is healthy already, I’m not IR. It seems that a thin cysters have more difficulty to fight vs PCOS. I’m agree with Ashley, there so little informacion out there for thin cysters. Women, with IR, and obesity know the cause. But for us, is very confused the cause, besides the pill. I’m trying to find a good naturopatha, just like you in my area, to find more solutions.
            Thank you Lara!

          • Hi Laura, It can take many months, or even a year, to see a real change. I’ll respond to your other comment on the Hair loss post.

  56. Hi Lara I’m 26 years old im from Argentina, mi name is Laura, thank you for this great articule . Lara what’s the best natural way to reduce my DHEA. My testotetora is low more than normal range. But my DHEA seems to be a little high but still in “normal range” However I have symptoms like facial hair, hair loss and irregular periods, everything start like 4 months ago, I never have any problem in the past with my period or infertility . I’m not overweight, I started a month ago a very strict organic nutrition and I’m so looking for a good natural supplement that cal help. I refuse to use Spiro. any suggestions Lara??

    My fsh y lh are also low, can I use Vitex and evening primrose oil or progesterone cream?

    Thank you so much in advance Lara.

    • Hi Laura, thank your question. I should try to answer in Spanish because I am learning your beautiful language (I am in Mexico this month learning). I think that your question about the adrenal hormone DHEA is answered below in my answer to Ashley’s question. But – in truth – in your case, I do not think that a “slightly high” DHEA is the reason for the change to your periods. Please ask your doctors to test thyroid and prolactin (if they have not already), and consider whether there could be any medication that has interfered with your periods (antibiotics etc). (Please do not write that information here, but you can send me a brief private message, if you like.)

  57. Hi Lara, I had an ‘incidental finding’ of polycystic ovaries on an ultrasound scan during a fertility check recently. I have regular periods and no symptoms. I am really grateful for this blog as I left my scan feeling a little bewildered at whether I have PCOS or not and how my fertility will be effected. Thank you for writing an article with useful facts and information as there seems to be zero other info online on cases like mine.

    • Hi Cathy, thank you for sharing your comment. Yours is a common story that I see in my clinic. And I am so dismayed by the confusion that is being generated by these useless ultrasound findings.
      The main thing to find out is if you are ovulating regularly, or not. Only a blood test can show that.
      If you are not ovulating, then there can be different reasons for that. Are you ovulating? Do you have elevated insulin? Do you have elevated testosterone? Those are questions to ask your doctor.
      I hope that PCOS will be replaced by not one name, but a few different names. Names that will hopefully be a more precise description of what is interfering with ovulation.

  58. Women with PCOS generally have low progesterone and high estrogen … take a NATURAL progesterone cream (not synthetic as body can’t handle it) and both estrogen and progesterone will normalise along with a number of other debilitating side effects of imbalanced hormones. Read research on Lawley Pharmaceuticals website (from Perth, Western Australia) and you may have many ‘ah ha’ moments likes I did.

    • Yes progesterone can be helpful because it suppresses LH and blocks testosterone, but it’s not a fix for every case of PCOS. There are many different types of PCOS, and that’s why the same treatment does not work for everyone. For some women, insulin is the main issue. For others, it is chronically elevated LH after Pill-use. For others it is excess androgen from the HPA (adrenal) axis. It’s complex.

  59. Dear Lara,
    I’d be interested to hear reasons why ovaries would shrink? 8cc to 2.1cc over ~5 years (I am 28 years old)?
    Regards,
    Sarah

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