PCOS Cannot Be Diagnosed (or Ruled Out) by Ultrasound

Polycystic ovary syndrome (PCOS) cannot be diagnosed by ultrasound because polycystic ovaries are not cysts. They’re follicles or eggs which are normal for the ovary.

It’s normal for all women to sometimes have a higher number of follicles. It’s normal for young women to always have a higher number of follicles because young women have more eggs. That’s why PCOS cannot be diagnosed by ultrasound. At the same time, PCOS cannot be ruled out by ultrasound because it’s possible to have normal-appearing ovaries on ultrasound and still have the hormonal condition PCOS.

This problem of PCOS overdiagnosis is explored in a new British Medical Journal article called Driven by good intentions: why widening the diagnostic criteria for polycystic ovary syndrome may be harming women.

PCOS cannot be diagnosed by ultrasound.

In the article, the authors explain why labelling women with an unnecessary PCOS diagnosis can have harmful, lifelong consequences. They also observe that some women with hypothalamic amenorrhea (undereating) are being mistakenly told they have PCOS and that furthermore, PCOS can be temporary in some cases. In other words, PCOS can be outgrown.

Two situations of temporary PCOS


Polycystic ovaries, irregular cycles, high androgens (male hormones), and even mild insulin resistance are all normal and healthy during puberty. That’s why now experts recommend that PCOS not be diagnosed until at least three years after the onset of periods.

👉Tip: Pain is not a symptom of PCOS so if pain is your main symptom, there’s something else going on.


Post-pill PCOS is a temporary state of androgen excess when coming off the pill. It happens for several reasons:

  • Coming off an androgen-suppressing contraceptive drug such as drospirenone (Yasmin) can cause a temporary surge in androgens, which can lead to a PCOS diagnosis. Given time, post-pill PCOS usually resolves. Read 4 types of PCOS and How to prevent and treat post-pill acne.
  • Hormonal birth control can cause or worsen insulin resistance and is a major contributor to the classic insulin-resistant PCOS.
  • Hormonal birth control disrupts the healthy signalling of the HPO (hypothalamic-pituitary-ovarian) axis which can make it hard to resume ovulation once stopping the pill.

You might be thinking, “but surely I would not have been given a PCOS diagnosis when it’s only a temporary post-pill situation?” Unfortunately, yes, you could have been.

Check out my 2022 YouTube video about this topic.

128 thoughts on “PCOS Cannot Be Diagnosed (or Ruled Out) by Ultrasound”

  1. Hi, after having cramps, nausea and not being able to feel my mirena strings I got an a ultrasound to see if it’s in the right place. Dr says that results show that the mirena is fine but he has now diagnosed me with PCOS???

  2. Hi Dr. Briden, is a 2:1 LH:FSH ratio normal during the luteal phase? I was diagnosed PCOS a few years ago but never had elevated androgens (have had acne and mild/moderate scalp hair loss but no hirsutism) or insulin (4.5). Normal SHBG. Most of my cycles are ovulatory now. Twice I have had a 2:1 LH:FSH ratio but it was during my luteal phase…would this still be indicative of PCOS or another problem, or could that be normal? Thank you!

  3. I have been diagnose with PCOS I have been struggling for about 6 years now. I was recently diagnosed with it at 20 years old. I have tried 3 different forms of birth control, but I simply can’t tolerate it because I have excess fluid retention in the feet, ankles and hands. I am about start a new pill that has no estrogen and only progesterone. I am not a candidate for the IUD due to an anteverted uterus. I will not try the implant in the arm or the shots, and my OB agrees I should probably steer away from those. But my main aggravation is, I never knew there were 4 types of PCOS, my OB never went over there being 4 types, and after reading the symptoms of the 4 types, I have a lot of symptoms from each category. I have more symptoms regarding towards the Inflammation PCOS. I was wondering are there any tips other than listed above you have for me? and why wouldn’t my Ob inform me about the 4 different types?

  4. Hey..First of all i would like to thank you for your post that relaxes me so much.
    I was worried after seeing my Ultrasound test that says i have PCOS.
    Since last two months(June and July)my periods are getting delayed by more than 6 days and this is the very first time for me that periods are delayed.

    I am being treated for H.Pylori and Gastritis since last 4 months(From Feb 2021) before my periods got delayed.
    From April, i am noticing my digestive system is not working properly, so may be my body is not getting proper nutrition.

    So, Is my PCOS temporary ??

    Age – 27

  5. Dear Lara

    Greetings from the south of Germany! Thank you so much for your valuable content! It helped me so much already! I read your book twice now and loved it so much!

    Unfortunately I just can’t figure out my diagnosis, whether I have PCOS or not? My blood tests are no help either.
    I switch gynaecologist five times in the last two years and they just want to put my on the pill again. It makes me so sad. I have been to a naturopath for 6 month, but no naturopath here has the knowledge that you seem to have. I don´t know who to ask for help anymore.

    I got my blood tested twice lately, once on the 3th day and once shortly before ovulation (I can feel the “Mittelschmerz” and monitore my temperature). I have a long follicular phase (approx. 24-28 days) and a 10-14 luteal phase.

    I got on the pill when I was 16 years old and got off when I was 21, two years ago. My main symptoms are very irregular and long cycles. (60d, 40d, 48d, 37d, 44d ) PMS, and especially my stubborn, hurtful acne. I had acne before I took the pill but I believe my periods where regular (I am not sure though). If I eat anything with sugar, diary or high GL I break out horribly. So I generally avoid these foods. You could watch the acne forming. I am hiding at home for 7 years now, because I just don´t feel confident in my skin.

    Blood tests:

    Day 3

    E2: 26,6 pg/ml
    FSH: 4,7
    LH: 4,9
    Prolactin: 8,3
    Testosteron: 1,5
    TSH: 1,86
    Zinc: 14

    1 Day before ovulation:

    E2: 486,7 pg/ml
    DHEAS: 273.2
    FSH: 5.5
    LH: 27.7
    Progesteron: 0.78
    Prolactin: 16.3
    Testosteron: 1.40
    TSH: 1.51
    Zink: 11
    Vitamin D: 64.1

    Do you think I have PCOS with the irregular long cycles and the acne? Or ist it insulin resistance from the pill, even though it has been two years since? My blood test confuse me so much. The only thing I can see is the low FSH on the day before ovulation? Is that important?

    I take 400mg magnesium and 25mg zink per day. Also I took berberine for a while, wich seem to help for the acne but is not safe for long term use….

    I would be so unbelievably happy if you reply! You give me so much hope, I just wish I could talk to you directly.

    Thank you so much Lara.
    Be safe,


  6. Hello, I have been diagnosed with PCOS although I do not have high androgen levels. I got off the pill 5 months ago and havent had my period since. An ultrasound showes that i had many cysts on my ovaries. My tbyroid levels and androgen levels are all normal (low), but i have still been diagnosed with PCOS. The doctor has told me to lose weight or go back on the pill. What do you recommend my next steps be?

    • If you don’t have any symptoms of high androgens, then it could be hypothalamic amenorrhea or undereating. Was your prolactin tested?

  7. Hi Dr Lara,

    I was diagnosed with PCOS, I have acne, 12 follicles in one ovary and LH is higher than FSH, to make sure I got tested for androgens (Free testosterone, androstenedione and DHEAS) on day 3, the results is normal, but my previous cycle was anovulatory, then I have some questions: Is there an specific day to test them? The test can be wrong because I have an anovulatary clycle? What are the range for androgens?

    Hope you can see this comment, thank you for sharing all this information.

    Greetings from Mexico.

  8. Hello Dr, Lara,

    Thank you so much for sharing valuable and so much needed information here. I’m 41 and have changed to a vegan diet about a year ago and since then have been getting very irregular periods. The last one I had was back in Jan so didn’t have a normal period for almost 4 months now.

    Did the labwork and below were the results. Ultrasound showed polycystic ovaries and noticed my weight dropped when I first changed to vegan but now it’s back to where it used to be. Also recently I’m getting acne but not just in my jawline…thought it was due to wearing masks but now thinking it could be sign of PCOS.

    Hydroxyprogesterone 35
    Prolactin 9.2
    DHEAS 147
    Testosterone 33
    Free testosterone 3.5
    FSH 7.2
    LH 11.2

    Any input would be super helpful – planning to get zinc level checked in my next labwork since I’m not eating meat, dairy or fish.

    Thank you so much!


  9. I think this article made me fall in love with you. I had been seeing a great endocrinologist that I fully trust when a PCOS “specialist” said “You don’t have PCOS” based off an ultrasound and NOTHING else. Whether right or wrong, it was a devastating ans disastrous experience!

  10. Hi Dr Lara,

    I have quite a few of the classic PCOS symptoms – hirsutism, recurring ovary cyst (surgery for a 10cm cyst 2 years ago and a recent ultrasound showed multiple on my left ovary and a large collapsed one on my right ovary), enlarged left ovary, depression, pelvic pain etc.

    So my GP recently diagnosed me with PCOS, but said I needed further confirmation with a blood test. However, my hormones apparently came back normal.

    I’ve been referred on but now I’m left pretty confused about what’s going on. Is it possible it’s still PCOS despite my blood test? Do you have any other diagnosis options or questions I should ask at the next appointment?

    Thank you so much in advance!!

  11. Hi Lara, I have recently started following your Instagram and am interested in what you talk about. I was diagnosed with PCOS when I was 14/15. I saw a gynaecologist at the time and had an ultrasound. My main reasons for seeing the doctor were absence of periods and a lot of excess body hair. I was put on the pill and never told how to control it. I have decided recently to come off the pill as I feel like I may be causing my body damage by taking this for so many years (even though the doctor has said no). My periods are appearing to come back to normal after 6 months body hair has returned. I am looking at trying to go back to the gynaecologist to further investigate but also looking at seeing a nutritional therapist. What do you suggest?

  12. Any insight on PCOS and still getting your period? I was diagnosed with PCOS and within the same conversation, undiagnosed after my GYN realized I still get my period. This has left me confused for the last couple of years. Long story short – after rupturing an actual cyst, my Transvaginal ultrasound showed multiple follicles consistent with PCO in both ovaries. Also both enlarged, my left measuring more at 24.37ml in volume. What I don’t get is that this result changed dramatically- After an ER visit with severe left ovary pain; my ultrasound showed normal appearing ovaries.
    At the time of my initial ultrasound I was sent for bloodwork. My LH 22.6 and my FSH 7.3 and
    DHEA 219. My testosterone total normal at 36.
    Any insight would be helpful, thank you!

  13. Hi! 3 doctors so far has diagnosed me with pcos just because I have hormonal acne and cysts in my ovaries. I dont have high levels of androgens. I even ovulate once a month. My period these months were a littke bit irregular thats why i went see a docktor and learnd about pcos. Im 19. How do u think? Do i have this sindrome?

  14. Hi Dr. Lara,

    I have a lot of trouble understanding nutrtion and PCOS. Most people say low carb and keto is the only way to reverse this. Is there an amount of daily total carbs you reccommend for a lean pcoser?
    Also is it possible to regrow my lost hair from pcos and it be restored over time when hormones are balanced and maintained?

    really hope i hear from you and thank you so much.

  15. Hi there!

    I’m 22 and I was diagnosed with PCOS when I was around 14. I had a high level of testosterone and I was told from an ultrasound that I had ‘cysts’ on my ovaries. My period was also every where. Had it for two weeks, stopped for a couple months, had it for 8 weeks, went normal for a month or two and then all over the place again.

    I went on the pill to control it, my periods were normalish, I was on the pill till I was about 18, tried to go off of it but my periods were everywhere again and I was told by my doctor that my ‘cysts’ will get worse and worse unless I take the pill again and I would need surgery to remove them. She then put me on metformin to reduce my testosterone levels (which reduced them to a normal level) (I also had a bit of hair but nothing extreme just 2 or 3 black hairs on the chest or chin) I was still not taking the pill but I decided to go back on it when my symptoms weren’t getting better.

    I have been on the pill ever since then (now Estelle). I have no problems with hair, except now and then but I’m pretty sure it’s just normal hair (I’m a hairy person). I had but not quite an under active thyroid, I took pills for that for 8 weeks and my thyroid levels went back to normal.

    I want to go off the pill as I’ve never liked being on it because I know it’s not the best and I don’t need any contraceptive.
    I exercise, eat healthy, not too much sugar. I can lose weight if I want too so that’s not a problem. It’s just my periods are so irregular. What can I do to help myself? Will testosterone go back up if I go off the pill? Will more ‘cysts’ grow if I go off of it? Is it ok to have irregular periods? Does it do something bad to my body if I don’t have my period for ages or if I have it too much?

    Sorry there’s so many questions but every doctor I’ve been too hasn’t been too helpful and then I just found you on Instagram and had to ask!
    Thank you so much, you’re writings have been very insightful.

    – Kalina

  16. I was diagnosed with PCOS when I was about 30 – clearly visible on the ultrasound. By the time I had had my daughter, aged 37, they had disappeared. I had a dermoid cyst removed aged 45. Any connection between PCOS and dermoid cysts?

  17. Hi Lara.

    I am have been diagnosed with PCOS but I am not sure I trust this diagnosis.

    LH:FSH are 5,6 : 4,6
    Fasting Insulin: 5,4
    No excess androgens.

    I Have not had a period for almost a year since stopping the pill (I am 20), I started the pill when I was 14 due to irregular cycles and acne. I still have bad acne. I am of a healthy bodyweight and eat well. Not sure what my real diagnosis could be…

  18. Hello Dr Lara

    I started taking the pill when I was 21 because I started to have acne problems, before that I never had them. I’ve been taking the pill on and off since then and all the doctors gave me the same diagnosis, I needed to take the pill to improve my acne but every time I finished the treatment the acne came back.

    So, I took Roaccutane for 6 months when I was 23 and it worked, but soon after it came back. I moved to live in Paris 3 years ago, I visited a dermatologist and a gynecologist and again the same treatment, I was supposed to take the pill for a longer period of time (2 years) and that was going to make the difference. After 1 year with the pill I started to have bleedings between periods, so I stopped the pill and the acne didn’t come back for the first 6 months and then in November of 2019 I began to have pimples on the jaw.

    By March I developed an aggressive acne, I went to the endocrinologic, she sent me some blood test and a pelvic echography (the results showed nothing, no cysts and no hormonal imbalance) therefore the solution was a pill for the diabetes, but we were supposed to test it and see if it was going to work (I didn’t take it). Then I visited the dermatologist last week and he recommended Roaccutane for 1 year (I don’t want to take it). Today I visited the gynecologist because I felt something on the abdomen, he took another echograph and apparently, I do have cysts, so he sent me the pill, again, even though I asked if it didn’t exist a different solution, he said no.

    I do have hair in the face and acne all over the jaw and the neck, also I’m doing the seed cycling but before that my period went missing for two months.

    I don’t know what to do now, but i believe the pill is the where everything started

    Thank you

  19. So Post-pill PCOS is basically when the birth control causes PCOS? I took Nikki birth control and now i have high testosterone levels (before it was normal).

  20. This week i’ve been diagnosed with PCOS due to high level of AMH and excessive follicles visualised on the left ovary during HyFoSy ultrasound scan. I do not have acne or any of the PCOS symptoms. However, for the past 1 1/2 years i’ve experienced irregular and prolonged period. This happened after coming off the yasmin pill and my period has always been regular prior to the pill. I would like to know if my PCOS diagnosis is accurate?

  21. Hi Lara, I really hope you see this comment.
    I saw here that a lot of people could have PCO’s post pill. And I saw here that you say that insulin resistance causes PCO’s in some people. In my researches, insulin is totally correlated with acne and hormonal imbalance (because can improve the testosterone levels and all that stuffy), which can causes acne, alopecia, hisurtism. Even if I don’t have insulin resistance, an low carb diet or paleo (In Brazil we say low carb), is not going to help me to pass trough this post pill acne? I’m confusing in this question. (I’m not saying cutting all the carbs, but cutting sugar, refined carbs, and prefer to eat vegetables, sweet potato, pumpiking…)
    I don’t know if I have PCO’s (I’m 50% sure that I don’t have or I had an PCO’s post pill) but I notice when once I was dealing with acne that high carb foods was getting this worst.

  22. Hello! Diagnosed with PCOS but don’t have high androgens and ultrasound was unclear (one ‘clear’ ovary and one with potential signs but unsure). Physical symptoms though only post-pill and recently. What would you advise as next steps please?

  23. I was recently diagnosed with PCOS after missing two of my periods and have bloodwork and an internal ultrasound done. They found my ovaries to be polycystic, and so with my symptom of irregular periods and having polycystic ovaries i was diagnosed as apparently having the two symptoms qualifies for a diagnosis. I do not have elevated testosterone or any symptoms related to elevated testosterone. I am not overweight. I had gone off the hormonal birth control pill in November 2019 and had regular periods until March 2020 when I then missed two periods. Is it possible that my PCOS is temporary, and is related to me stopping birth control?

  24. What if I have a big number of follicles but I don’t have any other symptoms of pcos? Well I used to get delayed period when I was younger and over weight but since I lost weigh and changed my diet, I get normal period. Doctors look at me and say I don’t have any pcos features but other did ultrasoun before my period and said I have pcos.

    • If you don’t have symptoms of PCOS, then you essentially don’t have PCOS. The condition is, by definition, the symptom of androgen excess.

  25. Hi Dr. Lara,

    I recently lost 20 pounds (about a year ago) and have been having 30-33 day cycles. I was diagnosed with pcos in my early 20s. Im 28 now and continue to struggle with symptoms: acne, Hirsutism, oily skin. I also had hypothyroidism a few years ago that’s under control now (Hashimotos). I haven’t had my hormones checked in a while, but i wonder if they’re normal considering i still struggle with some symptoms. Is it normal to bleed for 7+ days on the paraguard iud or is that caused by a hormonal problem? My gyn believes i dont have pcos since i have monthly cycles. Please help. Thank you

  26. Hi Dr Lara Briden! Wow so glad I have stumbled upon your work. It seems like no health professionals know much about PCOS which can be very frustrating. After coming off the pill I didn’t get my period for a year and after a ultrasound was diagnosed with PCOS. My doctor gave me medication and I started seeing a naturopath and now have my period back. How do I know if this is insulin resistance or just post pill PCOS?
    Thank you ❤️

  27. Hi,

    I am 24.I had irregular periods from the time they first occured when i was 15. I did not care about it then.But recently,I visited a gyn and she diagnosed me with PCOS on the basis of my ultrasound. But my blood test showed normal hormone levels and also i dont have family history of PCOS or diabetes. Also, I dont have any syptom of PCOS other than irregular periods.

  28. Hi,

    I am 24.I had irregular periods from the time they first occured when i was 15. I did not care about it then.But recently,I visited a gyn and she diagnosed me with PCOS on the basis of my ultrasound. But my blood test showed normal hormone levels and also i dont have family history of PCOS or diabetes. Also, I dont have any symptoms of PCOS other than irregular periods.

    • If you don’t have androgen symptoms, it might not be PCOS. Are you sure you’re eating enough to get a regular period? You’re not vegan or low carb, are you?

      • Hi Lara, I am 21 and have not had a period since coming off the pill Yasmin, over 8 months ago. I was recently diagnosed with PCOS from an ultrasound scan. However, I do not have any of the symptoms, other than absent periods that is. Since then, I have had blood tests which show my LH:FSH to be in a ratio of 2:1, I also have high (just out of the normal range) levels of DHEA-S, does this evidence suggest that I was correctly diagnosed?

        The doctor recommended I should go back on the pill, and said that if I don’t there is a risk of me entering early menopause. Having read your book, I do not believe this would be a wise decision. I am taking Magnesium and Zinc everyday as recommended in the book, but I am feeling very anxious and stressed about what to do. Any help would be greatly appreciated.

        More specifically, am I at any risk by not having a cycle, or is it safe to just wait it out.

        • your LH is quite low which suggests you’re not eating as much as you need to be able to ovulate. You might need to aim for 2500+ calories per day. See the work of Nicola Rinaldi and her book No Period, Now What.

  29. Hi Lara, I am 21 and have not had a period since coming off the pill Yasmin, over 8 months ago. I was recently diagnosed with PCOS from an ultrasound scan. However, I do not have any of the symptoms, other than absent periods that is. Since then, I have had blood tests which show my LH:FSH to be in a ratio of 2:1, I also have high (just out of the normal range) levels of DHEA-S, does this evidence suggest that I was correctly diagnosed?

    The doctor recommended I should go back on the pill, and said that if I don’t there is a risk of me entering early menopause. Having read your book, I do not believe this would be a wise decision. I am taking Magnesium and Zinc everyday as recommended in the book, but I am feeling very anxious and stressed about what to do. Any help would be greatly appreciated.

    More specifically, am I at any risk by not having a cycle, or is it safe to just wait it out.

  30. Dear Lara,

    I hope someday, every time we talk about PCOS we distinguish between the Adrenal & the Ovarian type, because it seems they both vary in treatment & diet options. I wanted to ask you. Do you recommend a Keto diet for an Adrenal PCOS type that is also IR with elevated DHEAS? Keto feels very stressful, but I think giving up carbs in any scenario probably does. Would love your insight into this. Obviously, the goal with PCOS women would be to lose that stubborn, hard to lose abdominal weight.

  31. Hello, I appeal to you with a huge request to help me, to figure out how I can normalize my cycle, put my hormones in order and get pregnant and successfully bear a child in the future. I’m 30 years old, I’m from Russia, Natalya, I’ve been trying to get pregnant for many years and I can’t, I am diagnosed with PCOS, had ovarian cauterization, but it did not bring any special results. I don’t go to any gynecologist, they prescribe the same treatment with oral contraceptives, the result is zero. .. The results of hormones and Uzi attached.

  32. I recently started reading your book.
    I Am 25 years old.
    I have been off of birth control pills for 10 months now, the first three months of post bc bleed my cycle was between 28-32days. The months after this my cycle is now be between 39-50days.
    Is this normal after stopping bc? Is there something that could help normalize my cycle?

  33. Dear Lara Briden,

    About two weeks or so after the first day of my period I experience a very depressed mood. What hormone or hormones might be responsible for this? Is there anything I can do? I have PCOS and not sure if I ovulate. Thank you so much for your help.

  34. Hi Lara,

    Just a quick follow up to my previous post, I’m now wondering if skipping the placebo week in my birth control to intentionally skip my period for almost 2 years is what “caused” my PCOS – and if it would all reverse after being off birth control for a while. I never had period irregularities before, and the only actual PCOS symptom that I’ve ever had was cystic hormonal acne. However, I met with my family friend who is a dermatologist recently – he told me that having 1 or 2 pimples doesn’t even really count as chronic acne so I should stop considering it that. And the only reason why my dermatologists have never said that to me is because they don’t want to seem like they are belittling me. And also to clarify, I would skip the placebo for 2 months, then take it for 1 month. So basically I was forcing my body to only have 4 periods per year even though normally before the pill I had 12 per year.

  35. Hi Lara, I just ordered your book. I am 32 and was just diagnosed with PCOS. My ultrasound was consistent with PCOS, many follicles, and one of them had a higher volume. I also have an EXTREMELY high LH:FSH ratio of 4.6:1, so very extreme. I was tested just 7 weeks after stopping the pill and also on day 20-something of my cycle. Is there any point in asking to be re-tested, or with a ratio that extreme and my ultrasound results, is it pretty definitively PCOS? I have never had period irregularities, they were fine before the pill, and after stopping the pill I got a normal 5 day period just a few weeks later. The only reason I even sought an evaluation for PCOS was cystic acne. But, I thought about it and realized my cystic acne started when I found out that you could skip the placebo week of the pill in order to skip your period. I asked my gyne and she said it would be fine for me to skip the placebo week for 2 months, then take the placebos the 3rd month. I was happy with being able to have the convenience of skipping my period by skipping the placebo week. Somehow I failed to realize the timing of my cystic acne starting lines up with when I started doing that, until today when I was really thinking back on my symptoms. I would also get random spotting on the same day that my acne would appear. I am beginning to regret seeking an evaluation just less than 2 months after stopping the pill. I only stopped the pill to get tested for PCOS. The doctor that I saw told me being off the pill for 4 weeks would be fine for testing, I only waited until 7 weeks because I was really busy.

  36. Hi Laura,

    I am still going through all your PCOS blog posts.

    I am 26 now, back when I was a teenager my doctor put me on the hormonal birth control pill for PCOS.

    I am still not sure if I have PCOS as it was diagnosed by ultrasound and my dr. never told me what type I had.

    I am wanting to come off the pill and try other alternative.

    What are your thoughts on the pill and ways to come off it?

    Thanks for your help.

  37. I’m going crazy!!!I was diagnosed with lean pcos because I have irregular periods, polycystic ovaries and am skinny.
    I have no insulin resistance or high androgens but I DO have a high LH to FH ratio.
    What o earth do I have??

  38. Hello Lara,
    I would just like to say a massive thank you. I have recently discovered your book and website and everything I am experiencing suddenly makes sense. I came off Yasmin in May and had no periods. Before birth control I had normal, regular periods. I had blood tests and everything appeared normal. After 6 months with still no periods I had an ultrasound and was diagnosed with PCOS. I al a normal weight with no other symptoms of PCOS apart from no periods. I am awaiting an appointment with the gynocologist but your book and website has given me the information I need to dig deeper. I will be asking for further tests to check my LH levels again and asking for advice on how I can reverse this, as thanks to you I believe it is possible. It has caused me a great deal of anxiety as me and my husband would love to start a family but because of you I feel there is hope.

  39. I am confused- I feel like I might be misdiagnosed with PCOS and rather have HA, however if I don’t have a cycle, how do I get tested on day 3 of a cycle???

    • If you don’t have a cycle, then you have to test LH and FSH on random day. But the result is only valid if you do not then get a period two weeks later (which seems unlikely if you haven’t been cycling).

  40. Hello Dr. Briden, I was diagnosed with PCOS five years ago due to no period, polycystic ovaries, and being overweight. But I am wondering about the diagnosis since I have low LH to FSH ratio. I also have low testosterone levels and no issues with insulin resistances. I wonder if it could be HA; however, I don’t think I undereat carbs and as I said I’m overweight. Could it be something else? Thank you in advance for your help!!

  41. I have not had a period in nearly 8 months. My doctors are suggesting I have PCOS but I’m not convinced. My FSH was 5.3 and LH 4.3 in blood work. Not having a cycle so not sure how helpful this is? No high androgens in blood work but do have a little acne. Came off the pill 11 months ago. Had 2 normal periods and then they’ve stopped. Lost my mum at the same time so was emotionally stressed at same time as coming off the pill. Bulky looking ovaries on ultrasound

  42. Dear Dr. Briden, I quit taking hormonal birth control 4 months ago and have only had 2 very long cycles (45 days and 50 days). The third cycle is already looking to be over 50 days. I am not positive, but I believe that I had regular periods before going on the pill (was on it for 3.5 years – I’m now 28). Doctor diagnosed me with PCOS because I have high AMH (~9 – us measurement). I also recently got bloodwork done and had elevated liver enzymes, which I think is a sign of insulin resistance. I am waiting to hear about my androgen, insulin, an LH/FSH levels. If that comes back normal, do you think it could be post pill PCOS?

  43. I’ve been diagnosed with PCOS based on a ultrasound, where my ovaries were larger then normal.
    I’ve had irregular period cycles every 2nd month but no other symptoms related to PCOS

  44. Hi I am really confused by my pcos diagnosis. It was based on ultrasound findings of multiple follicles, however I don’t have high testosterone levels. I do have high LH, responded to metformin and ovulation induction medication for fertility treatment and definitely have issues losing weight. If based on your article I don’t have pcos, what’s going on! Help!

    • high LH and ovulating in response to metformin are evidence of possible PCOS.
      Do you know if you have insulin resistance?

  45. A referral to oncologist for removal of my ovary because of unusual cyst. It is not enlarged, painful, not weight gain, just found with ultrasound and has not changed in a year – I don’t want unnecessary surgery but their message was MOST unusual cysts that are post menopause are cancer. I don’t believe this.

    • An ovarian cyst is a very different thing than polycystic ovaries.
      An ovarian cyst sometimes does require further investigation and possibly surgery.

  46. My Dr diagnosed me with PCOS and possible Endometriosis. I have been so lost and confused as the only thing indicating PCOS is follicles on my ovaries and pain (think that’s the Endo). My cycle is regular, no extra hair growth, no weight gain. I began to question if it is really PCOS. This blog post answered some of my questions. Thank you!

  47. I am still getting through all of your PCOS articles. I recently had my period may 30th through june 3rd. It stopped for two days and then I started reddish/brown spotting (only when I wiped) June 6th through June 11th. On June 13th i started bleeding. A red flow a little lighter than my normal period but enough for pads. I went to my OB and ended up going for an ultrasound. Through that they informed me they suspected PCOS. I’m so confused what would cause me to have two periods that close together. We wanted to get to have another. Any and the more I read about PCOS the more I am unsure if it is. Any insight would be helpful as I have questions I want to ask doctor this coming week.

  48. Is it possible to have more than 1 type of PCOS? I definitely seem to have Insulin Resistance, but also my DHEA is very high, but no other androgens are high which points to Adrenal PCOS in your book. Also could you be in perimenopause as well as have PCOS at the same time?

  49. I want to tell you first how much I enjoyed your book, it really made me understand so much about PCOS.

    Just that I don’t understand where I fit.. I was diagnosed in 2007 with PCOS with elevated insulin. I gave birth at 23 yo after a treatment with metformin and chlomid. After, my period become regulated (I ovulate) with no pills, no BC at 30-33 days. But my Androgenic Alopecia gets worse and worse. I repeated the blood tests but they are all normal (LH, FSH, testosterone, DHEAs, progesterone, estradiol, AMH, prolactin ), all except insulin that is now to low. The doctors here are saying I don’t have PCOS anymore, but then why I have still hairloss, acne on the jawline and hair on my nipples. I don’t understand. Please give an advise.

  50. Hi
    I have been diagnosed with PCOS by ultrasound. But after reading this it seems it may be wrong? I have had all blood tests done and absolutely nothing is irregular. The only thing wrong is I stopped taking the pill August 2018 and haven’t had my period since…. how can I bring this on naturally? My doctor wants me to go back on the pill so I can have a ‘period’… I refused!

    • Have you read my book Period Repair Manual?

      The result to look at is your LH to FSH ratio (as discussed in the blog post), to know if it’s more of a post-pill PCOS situation or undereating (hypothalamic amenorrhea)

  51. Hello, I’ve been reading the book on how to repair the menstrual period and I want to know in what order I should go integrating the magnecio, zinc, vitamin B6, and finally recover my natural fertility

  52. So happy I found your blog and reading through everything now, finally something with more answers!

    My story:
    I went on the pill when I was 14, to help my acne, aswell as the help of roaccuatane which I stopped taking at 16 once my facial acne had cleared. At age 18, my friend convinced me to move to the implanon. I’m now 22, and my skin for the past 6+ years, ever since I went off roaccuatane (but still had the pill or the implanon in) has been great. I would get the occasional pimple but that was all. (Another random back story of me – I have had eczema on my feet, arms & fingers since I was a baby)

    2 and a half years had gone by of having the implanon in (in this time I did not get my period or any spotting once), and in June 2018 I noticed a drastic change in my skin. I started developing cystic acne and visible pimples all over my chin and on the sides of face. I went and got a facial where the lady advised me that she thought I should get an ultrasound of my ovaries as my acne was all hormonal related and she noticed other symptoms of PCOS, such as black hairs on my chin/neck. Long story short, after multiple doctor appointments, who all said I didn’t have any issues with my ovaries, I finally got an answer from my naturopath, who confirmed from my scans and another doctor that I have 30+ cysts on both ovaries. To say I was confused was an understatement and still wonder how long I’ve had this for and what was the root cause of it. I still haven’t been to a gynocologist as when I asked my doctor for a referral she told me “not to bother until I want to have kids.” I guess this takes me to my first question – Do you believe it is necessary for me to go see one? Should I get regular ultrasounds to see if I have less cysts?

    I stuck with my natropath and saw him a few times, where he drilled into me that to help control my PCOS, I needed to start with my diet. He put me on the paleo diet and gave me a lot of different vitamins. All my blood tests came back completely normal, including my insulin resistance and testosterone levels, so I struggle to understand what benefit the vitamins are really doing for me. I also have constantly struggled to loose weight – I’ve been the same weight for 4 years and I work out atleast 5 times a week, mixture of cardio and resistance training. I also find I am always hungry, and find myself urinating a lot, although I do drink roughly 3L of water a day.

    In August 2018, I decided to take the implanon out as it wasn’t doing my body any good and I needed to start tracking when and if I got my period. I got my first period back in December 2018, and get it every month, roughly 18 days apart. I get a heavy flow for the first 3 days, and light on the last day (making it 4 days in total)

    Pretty much I have found myself at a plateau now. I am really happy that I have my period back, and do not see me ever using any type of contraception again, but my skin is still constantly bad. I definitely have improved my diet and eat a lot less diary, gluten and sugar, but I find it hard to stay motivated when I see no improvement with my skin or with weight loss. A part of me just wants to go back on roaccatane because I’m sick of my bad skin, but then that goes against all my new morals of not putting any toxic chemicals into my body again and fixing myself naturally.

    Any thoughts or tips would be highly appreciated! Thank you!

  53. Hi, I am 19 years old and have had irregular periods since I was 12 years old, and had pretty bad acne now near clear after taking accutane. since I’ve been taking evening primrose it has helped it to be more regular, but I wanted to know for sure if i had pcos. so went to gp, got bloods on hormones incl for thyroid, but results were normal. I’m a bit lost, so does that mean I definitely not have pcos??
    What should i do?
    Thank you!

  54. Hi Laura, I am learning so much about PCOS from your site – thank-you! My doctor thinks I might have PCOS solely on the fact that my LH is 1.5 times my FSH (FSH is 6 and LH is 9). Everything else is normal re. hormone levels, hsg, ultrasounds, etc. Do you think I should seek another opinion? I don’t want to start taking inositol if it isn’t meant for me. Thanks in advance!

    • No, a slightly higher LH is probably not enough to diagnose the condtion. Do you also have irregular cycles and signs of androgen excess?

      • Thanks for your input! I do have irregular cycles (35-45 days long with confirmed ovulation every month and regular 15 day luteal phase). I have had androgen levels tested twice now, 6 months apart, and they are completely normal. I wonder if I should ask for insulin resistance testing?

  55. Hello Laura! I’ve been following your page for about a month now and you have truly help me understand PCOS better! I showed the symptoms of PCOS for years but me and my doctor never made the correlation until she sent me to get an ultrasound of my ovaries. I was diagnosed last year and all my OBGYN advised was to watch the intake of sugar and fatty foods. I’ve been trying to understand PCOS better and what really can work for me. Listening to your pod cast last night you mentioned that an ultrasound showing cysts isn’t the best way to diagnose PCOS and that sometimes doctors can over diagnose. The reason this concerns me is because when I got blood work done my testosterone levels were normal. But I’ve been told I should get another blood test that is more specific toward androgens. I have all the symptoms on PCOS but would like to know which “type” I am so I can understand my body better. What would you recommend? Any information would be helpful. Thank you so much.

  56. Dear Lara

    I recently listened to your PCOS presentation because I am seeing a young lady dx with PCOS. I wondered if I could ask you to point me in the right direction as I’m struggling a little.

    After listening to your presentation, I really doubt she has PCOS, as she is 19, very slim–although seems a little obsessed with being overweight as teens are. She has never taken the pill.

    They dx with ultra sound in Dec 18, and at the time her Testosterone level was low (0.9nmol/l). Her GP won’t test for any other androgens. She recently retested Testosterone, and her serum Testosterone was above range (1.9nmol/l) and free Testosterone within range (24pmol/l). SHBG was 53 nmol/L, prolactin 140miu/l. They also won’t do a GTT, but did fasting BG is 4.8mmol/L and A1c is 29 mmol/mol, so all ok. Her Trig/HDL ratio is .45 so there seem to be no IR

    Her sx are low energy, fatigue, issues with concentration, history of irregular periods (although have been ok for 4 months), acne, hair on face and back, although she this may be due to ethnicity and says her family is hairy and she has been waxing her back for years. Her acne improved with targeted Zn and Vit A. She thinks she’s had hair loss but isn’t sure. More recently she has low mood & anxiety.

    Recently she says she is always hungry, thirsty and needs to urinate often, but her fasting BG and A1c were ok, so can’t be diabetes. Her Thyroid markers are TSH ( 0.70 mu/L )and FT4 (15.1 pmol/L), so TSH is a little low. She wanted to go low carb to lose weight, but I advised against it, her BMI is 19.4, waist hip ratio is .76 so she doesn’t need to go on a diet.

    Any other tips on where to look, or testing to do to investigate further would be greatly appreciated!


  57. I honestly don’t know what I have… I don’t have irregular periods, only long and heavy ones. I got a vaginal ultrasound sound and they didn’t find any cysts. All I have are high testosterone levels from both my ovaries and adrenals. They also did the blood test for NCAH but that came back negative so I don’t know what it that’s causing high testosterone levels 🤷‍♀️ I also don’t have diabetic or thyroid issues… just the high testosterone. If Dr. Briden or someelse could give me any ideas on what it might be that would be wonderful. Thanks!❤️

  58. Hey Lara just looking for some help,
    I have never been one to have regular cycles, at 18 I went on the contraceptive pill for regulating my period/contraception and for my acne. During this my period was regular however I was not happy with how I was feeling and didn’t like the idea of treating something like this with pills. I stopped taking it around 10-12 months ago and have not had a period since however my skin has stayed clear, I am 56kg and 167cm tall (20yrs old).
    I have trouble sleeping (constantly waking up) I always feel hungry even when eating enough, I experience excessive body/facial hair and it often falls out (on my head), I am very anxious/depressed majority of the time.
    Some of these seemed to be symptoms of PCOS however after having a internal ultrasound I was told by the doctor that my ovaries were perfectly normal and prescribed me progesterone if I wanted to bring back my period. I have not taken them and are wondering what your suggestion in order to regain my period and minimise the abound sympotoms

  59. I was on the pill for 12 years, and have stopped to try to conceive. At first my periods were increasingly regular for around 5 months, and then they disappeared all together. I have slightly high testosterone according to my blood test, but I don’t have any PCOS symptoms. I’m also not underweight and I don’t diet or over exercise. I’m 30 and I really want to get my periods back on track and get pregnant but doctors are unsure. I’m starting to worry now. Help!

  60. Hello, Mrs Briden!
    This post encouraged me analyzing my symptoms more to regulate my diet correct. I have LH level 2-3 times higher than my FSH level, while my testosterone level is not high. Again have never suffered with weight losing, on the contrary I am underweight with facial hair, hair loss, irregular periods. I have been diagnosed with PCOS and have polycystic ovaries in ultrasound result. But can not relate to what you said HA, is it the same with having “PCOS correlated with hormonal imbalance from brain”, like my gynecologist said? Thanks!

  61. Hello Lara,
    I was diagnosed with PCOS and insulin resistence, even though I was with regular cicles.
    As soon as I started medication (metformin), a low carb-like diet, and doing exercices I had no more cicles. I stayed 7months in amenorrhea.I stopped with the medication and with the diet two months ago.
    Two weeks ago I had a blood test and it came: progeterone : 0,57 ng/mL; fsh: 3,29 mIU/mL; lh: 4,71 mIU/mL. One week after this teste I had some kind of bleeding, very short and very little, I don’t even know with it was menstruation.
    Now I am totaly lost and clue less about what is going on .

  62. Hi Lara, I just started reading the period repair manual and I’m excited to start my natural period journey. I was prescribed the pill around 16 for lack of periods (I had one extremely heavy one for 2 weeks and then nothing but spotting) – I also have irregular hair growth, mostly blonde but some course dark hair on chin, neck, nipples. I got on the pill and spironolactone. When I tried to get off at 23 I broke out in SEVERE acne, I never had an acne problem prior. I got on back on the pill, traumatized and thinking that was the only answer. I now want natural periods and am ready to try to get off but also terrified. When my blood tests were done in the past the Dr said everything was within range..but I’m now thinking I was on the pill when my blood was taken.
    When getting off the pill, I plan to take Zinc for acne and quit sugar and gluten. Is there another supplement you think I need? Thank you!!

  63. Hi Lara,

    I have lean PCOS and am sure I have barely ever ovulated in my life (that’s how it feels anyway!). I’ve always had irregular cycles, which lead to spotting and very heavy bleeds every three months or so. The only thing that works for me to stop the bleeding is the OCP. I would prefer not to be on the pill but in the end I need to function….,I have tried natural progesterone pill which worked for a few months, and the recommended diet but nothing has ever changed in a major way, my progesterone is always close to nothing, my FSH around 7 and LH around 21. My TSH, androgen and insulin levels are essentially normal on test results but I feel my blood sugar and energy are constantly out of whack. I’m 37 now and tired of endless doctors vists….any help would be appreciated.

    Thank you!

    • Yes, sounds like something is definitely going on. Do you have signs of male hormones? (facial hair) and has the androgen DHEAS been tested?

      also, has anyone ruled out prolactin or adrenal hyperplasia?

  64. I am very perplexed by a symptom I have yet to find an answer for. I have been working out and doing weights and dancing and for about three years I have fluid retention in places I’ve not heard of thus far. I have fluid retention in lower arms upper arms, lower legs upper legs I have stretch marks on my lower legs and lower arms. There’s no fat but fluid that I cannot shake. I consider myself fairly informed in the holistic field but am not a doctor of any sort. I have found out that I have raised tsh levels but normal t3,t4,rt3, and no hashimotos. I haven’t taken meds for anything. I also suffer with a lot of coarse facial and other parts of body hair. I am being treated with electrolysis. I should tell you I went off gluten for 6 or more months and nothing felt different or changed. I went to naturopathic doctor and it didn’t change sny.of the symptoms. I also get hot flashes I believe. I have been extremely patient with this over the last few years and wanted my body to find equilibrium without pushing and pulling. I took a saliva test and my testosterone number was 91. I also suffer with cystic acne on body including neck, back, chest, shoulders. I started getting a hair problem noticeably different from any other girl I knew when I was around 18. I had the unwanted hair begin at sides of lower inner face by lips but lower than the lips. I tried laser hair removal and it didn’t do any good and in fact, I think made it more severe. Anyways I’m much older now and am very concerned with cystic acne leaving more scarring not only on my face anymore, but now my back etc. OK if anyone reads and responds to this long layout of another story. I’m open to all info. My main concern is weird places for fluid retention that never goes away and the unwanted hair and acne. Thanks. Best to you.

  65. Hello Lara,

    Thanks a lot for this article! It shows how late the PCOS medicine is!
    But I read that above 12 follicles, and it was even my doctor who told me, we are diagnosed with PCOS (It scares me a little bit, actually) !
    Do you have any studies that show that even at 25 follicles an ovary remains healthy before it is filled with cysts? (I don’t know if you know what I mean)
    And of course I’m sorry by advance for my english, it’s not my first language.

    Kind regards,

  66. I am looking to get some direction as I continue the journey to healing form hormonal contraception. I came off of the pill in April of this year to start trying to get pregnant. I had been on the pill for 4 years, and from age 12 to 26 I had regular periods. So I get off the pill and after 3 months of no period my OBGYN proscribed me provera. After no bleed resulted, it was determined my lining was too thin. I then went to an RE. After seeing cysts on my ovaries, she said I had PCOS……We immediately dove into letrozole, injectables, etc. I had one successful ovulation round on letrozole. The first round of letrozole and the round of injectables, did not end in ovulation….. Well I finally called it quits a week or so ago and am ready to get to the root of my cycle issues. I truly do not believe I have PCOS and I am ready to recover my cycles.

    I have no idea if I have HA but I’m trying to figure that out. I have a history of disordered eating, mainly throughout my late high school to early college years. I always ebbed on the side of overweight, but after meeting my husband in 2014 (only a few months after i started taking the pill), I began a “weight loss” journey that ended in about a 15 pound weight loss. After our wedding in January 2017, I spent the year reverse dieting, repairing my metabolism, and reincorporating every food into my diet. I gained about 7-10 pounds and felt really good about where I was mentally (still do :))….. I love fitness and health but I started backing off my workouts in the past few months, especially during the fertility treatments. I take fitness classes and can’t say I overdue it. Moderate exercise at best….I currently exercise a max of 3x per week……..I got an iDax scan yesterday which confirmed what I already in my heart knew, I have a good body fat percentage at 26%. My BMI is is at 22.5 and hopefully rising as I continue to rest. My bone density looked average (I think the tech told me I was right under the 50 percentile in density). Is it possible to have a healthy body fat percentage, a healthy BMI, and still have HA?

    I am currently taking a supplement called CONCEPTION (it has vitex and myo inositol), CoQ10, Acai, Fish oil, Vitamin E, and Magnesium Citrate. I am on an estrogen regimen and will add in progestin next week to have my last “fake bleed”. ( i wish i wouldn’t have agreed to this, but my RE suggested i do this to have a better chance at spontaneously ovulating after). After that fake bleed I am starting the Fertility Cleanse that i purchased through The Natural Fertility Shop. It is supposed to really help your liver flush out the excess hormones.

    At this point I’m stumped. I’m continuing to try and be more “free” with my eating and fitness, but wondering what else could be going on. I have a history of gut issues (constipation) and really want to get a handle on that, as I know it can affect the way the body processes hormones. I believe my gut issues stemmed alot from a combo of pill issues, and my old eating habits. I have an appointment with a naturopath next month. Any advice of what I can help her really dig into???

    I’m new to all of this and appreciate the support!

  67. Hello!

    I was wondering if I might be able to get a little help understanding the underlying mechanisms of post-pill PCOS.

    I stopped taking Diane 35 in May (6 months ago), after taking it for 15 years (2 short breaks). My period has returned, and I’ve been tracking my cycles with BBT and cervical fluid observations. After stopping the pill I became extremely oily (skin and hair), and developed moderately severe acne. My follicular phases are consistently too long (28-32 days), and my luteal phase too short (9 days).

    Androgen hypersensitivity makes sense to me with regards to the oiliness and acne, but I’m struggling to find an explanation as to why it might delay follicle maturation and induce luteal phase deficiency. If you could please shed light on how androgens interact with the other sex and pituitary hormones it would be a huge help for me to figure out how to fix my cycle!

  68. Hi Lara! Thank you so much for this blog which gives me hope!
    My name is Kathy and I live in Germany where amenorrhea doesn’t seem to be real a concern for doctors.
    I’ve always had my period on a regular basis (a light one but a real one) eventhough I’ve been through anorexia and bulimia for 13 years (which was surprising the doctors).
    For the last 3 years, i’ve been on the pill and when I decided to get off to have a baby with my husband , I stopped having my period.
    It’s been 2 years now that I haven’t gotten my period.
    I’ve been through all the tests you can imagine : One Obgyn told me I have PCOS because I have 12 and 13 follicle on each my ovaries (which are totally normal otherwise).
    teh two other Obgyn told me nothing is wrong with me, I should relax..
    My bloodtests are quite normal eventhough my estrogen levels are very very low.
    I’m concerned with my LH as it was 4,7 in 2017 and 11 in 2018.
    One of the Obgyn told me it’s totally fine.

    I can’t sleep at nights…I feel very crappy.

    I presume I have Hypothalamic amenorrhea regarding my former ED (And I’m still restrict my eating..)..eventhough it looks like PCOS.
    But As I’ve had my period eventhough I was on a lower weight I do not understand..
    thank you so much for your response,


  69. This recently happened to me!!!
    I came off the pill 6 months ago and haven’t had a period yet, went to a GP who specialises in women’s health and she orders bloods and a pelvic ultrasound. My hormones were all normal but I had >follicles on both ovaries. She said I have PCOS, I’ll have it for life and have me a basic pamphlet about it.
    I’ve grown up with a mum as a doctor so I had a feeling I wasn’t getting the correct information whicnis how I stumbled on a podcast with Lara and I’ve ended up here!
    It terrible that so many women are getting this as a diagnosis when for many its probably incorrect

  70. Hi Lara such a valuable content , I learned a lot from you , I am a Sonographer with the specialty of Obstetric and Gynecology , I am starting to blog recently to help women out there , perhaps you will like to check my blog post , it will be live tomorrow, thank you so much .

  71. Hi Lara. I’ve stumbled across your page and what an enlightening read. I have been having irregular periods for the last 3 years. I was tested for PCOS and I had a internal and external scan, from that the drs didn’t confirm I had PCOS. I also had a test for CAH which came back negative. In the mean time I was put on Ava 20 to regulate my period, which helped but because I suffer from migraines I was taken off that and put on the mini pill (noriday). In January this year I stopped taking Noriday as my partner and I wanted to start trying for a baby. My periods are still irregular and I’m currently not taking anything. What would your advice be for my next steps? I’m 34.

  72. Hi Lara.

    Reading your article feels like a breath of fresh air and mirrors exactly what I have suspected for the past 18 months since my PCOS diagnosis. I was on Yasmin for the 10 years, 3 years ago came off the pill and haven’t had a period since. My GP suspected either HA since I don’t have the ‘typical’ PCOS symptoms but then after ultrasound diagnosed me with PCOS, but I never felt she was 100% sure. Since then have been put on metformin which didn’t have any affect on my cycle, still no period. The gynae I was then referred to said my AMH was low and FSH high which is unusual to see in someone with PCOS? I am starting clomid in a few weeks time. The doctors seem to only be focused on me having a baby, which I do want, but I keep saying – what do I do for the rest of my life, just not have a period at all? And their answer is to go back on the CP which to me isn’t a solution. I now feel a little frustrated and hopeless. Crossed fingers clomid will help, although Gynae thinks it is unlikely and will need IVF treatment.

    Sorry for the long post but do you have any advice at all? Thank you

  73. I have suffered from PMS for years and have tried lots of different things including homeopathy which didn’t work. I recently came across your book, which is amazing! Every girl/women should have a copy. I am implementing the approach by changing my diet as you suggest and also by taking supplements – magnesium and b6. I am a bit confused about how much b6 to take. In your book you suggest 20-150mg a day, but online you recommend that if you take more than 50mg you should get advice as it can lead to nerve damage. I would be so grateful if you could clarify the recommend amount and also how regularly it should be taken e.g for a few months, part month or continuously?

    • With my PMS patients, I generally recommend 30 mg B6 take 2 or 3 times per day during the days of symptoms. It’s possible to go higher with the dose but you should check with your doctor.

  74. There is a lot of discussion about hirsutism being fundamental to the diagnosis of PCOS. We are supposed to either use a clinical examination or a blood test to identify these higher androgens. My question is that if my total testosterone level is 0.29 ng/dL and DHEA is 169 ug/dL (which I am told is within normal limits) yet I have course hair on the tops of my toes (and have since I was about 10 years old), does this count as a clinical manifestation of hirsutism? Or for PCOS must the majority of course hair be located on the face (which I do not have)?

  75. Hello Mrs Briden,
    I am 30 years old with facial hair. It is not the typical “peach fuzz”, nor too black/strong, but it is a lot, it’s borwn and long and the only think I can do is to bleach them. Beauty salons refuse to try laser removal of my facial hair though, because they claim it is not too strong to be targeted and removed by laser and maybe the hair follicles will be even more activated and my problem will become worse. Also, I cannot apply topical cream treatment, because my skin is prone to acne and when I was young I was suffering from acne which I had to teat with strong antibiotics for over a year!
    When I was 16 years old I had been diagnosed with PCOS. Since then, I am on-and-off with the pill containing (2+0.035) mg/tab cyproterone acetate + ethinylestradiol respectively and since over 5 years I have no ovarian cysts anymore and my cycle is normal. My weight is also normal, I am 1,65 m tall and I weight 53 kg.

    Recently my gynecologist suggested me to take the Agnus Castus as a hormonal balancing agent, but I read in your articles that it might have side effects.

    Would any herbal treatment could help me to fight the facial hair problem?
    Should I do specific medical examinations other than the routine gynecological examination?

    Thank you in advance!!

  76. Hi Lara, I’ve had significant hair shedding recently, my bloods showed ferritin was 30, and FTS4 just at lower end of range, FTS3 untested howere TSH fine? i’ve started taking active iron and have some baby hairs growing in, do you have any general advice?

    • Victoria – saw a very expensive dermatologist at NYU in manhattan who only does scalp hair. He said Ferritin below 40 will cause hair loss. 70 optimal, but you do not it to be 200, so you need to retest serum ferritin and not overshoot it. The very best product have found for absorption and no constipation side effects is Proferrin ES, it is a peptide version. Most docs are clueless, and I was told by one my ferritin being 20 which was just the lowest bar on the lab reference range was normal. Not if you want hair. Also know ferritin can really spike when you are sick as part of immune response. So do not test it if under the weather. If you get a high reading retest in a few weeks.

  77. I was diagnosed with PCOS prior to having my son. Then after giving birth, they told me it just magically went away. After gaining some weight during maternity leave, I was given the diagnosis again. Reading your article is giving me second thoughts about my diagnosis.

  78. Hi, Lara.
    I’m a 27 years old woman with PCOS.
    I don’t know what type of PCOs I have, I’m lean, have hirsutism, high LH, testosterone,androstenedione and 17 OH progesterone.
    My periods have always been irregular, but since last year (september) my periods became regular, and I feel that I ovulate.
    I haven’t been medicating for the last 5 years, nor have I been exercising or eating healthy.
    So, why my periods regulated? Does it happen to other women with PCOs too?
    It’s been a year that I get my periods regularly, but unfortunately my hirsutism didn’t decrease, exept a little in my face.
    Do you think hirsutism would go away with time, now that I get periods regularly?

    Best regards!

  79. Hi Laura,
    I’ve been off the pill for 2 years and have yet to have a period (I’m 33). My naturopath put me on thyroid meds (said I was sub clinical hypothyroid as my t3 and T4 was low but TSH normal) and wants me now to take progesterone for 14 days to induce a period. Would this help with ovulation?

    As a side note related to this post, my LH and estrogen were low when tested on day 3 after a progesterone induced period. I had awful skin from age 16-32 which made my think PCOS, but ultrasound was okay. So maybe it’s HA? I was a marathon runner and pretty active from age 23-30.

      • I may have been at the time. I’d restrict during the week at eat a bit more or maintenance on the weekend. I’m a normal weight so I didn’t think that was the issue. Since August I have not restricted food and eat closer to 2000 cals a day and have cut back on exercise. Basal temps show no big rise in temps. Should I hold off on taking progesterone then?Thank you for your response!

        • Nicola Rinaldi from No Period, Now What? recommends a minimum of 2500 calories per day to recover from hypothalamic amenorrhea. She says it can take up to a year, but I find most women respond by four months (not usually before that). So eating more since August is just the beginning.

          • Okay, thank you so much! I’ll try that first. I’m trying to conceive and we have a 6 month wait to get into a fertility clinic, I’d rather find out the root cause first instead of going the clomid route.

          • After eating enough for four months, you might want to consider cyclic progesterone rather than clomid.

    • So, the answer to your question about cyclic progesterone therapy is that it good be a good treatment if you have PCOS (high LH), but not helpful if you have amenorrhea due to undereating (low LH).

  80. Hi Lara,

    I am really enjoying your Period Repair Manual—I wish I had had it 15 years ago! I was wondering if you have written anything anywhere about hormone levels during breastfeeding? I am trying to figure out if I have PCOS—or really, what type I have, since I’m pretty sure I have PCOS. I am a 34 y/o mom of 4, just over a year postpartum and still breastfeeding frequently. My lactational amenorrhea usually lasts over a year (and I have breastfed all babies for ~2 years). I have always charted for family planning and my luteal phases are always short until baby is completely weaned, at which point they return to 14 days.

    I have struggled with postpartum anxiety since this baby was born and in reading about my hormones I began to suspect I had PCOS, which is quite shocking. Drs always attributed my wildly variable cycles (35-80 days) to being very lean or being stressed. I am quite small, but I have never dieted or exercised much so I don’t think HA is a possibility. I have mild acne and mild male pattern body hair—neither serious enough to motivate me to pursue treatment.

    Anyways, my PCP just ran some but not all of the tests that I asked for, but I’m not sure how much I can rely on them since I’m still nursing. Do you have any thoughts on this? I suspect I have adrenal androgen PCOS (because I am lean and have higher DHEA) but I don’t know if I can be sure until I wean and retest? How does lactation affect FSH, LH, and androgens? (My values are below.)


    FSH 5.5
    LH 9.9
    Estradiol 32.22
    Progesterone .27

    Prolactin 4.8

    Free Testosterone 5.34
    Total Testosterone 35.1
    DHEA-S 345

    TSH .905

    Serum Cortisol 21.1

  81. Hi Lara,

    I was diagnosed with PCOS about a year after I started my period, which was at about 16. I don’t remember blood work, but I do remember an ultrasound. My periods, when I was younger, were very painful and very irregular. Other than that, I never had any other symptoms. As I have gotten older, my periods have evened themselves out and I haven’t missed a period in about 7 years. They are still painful on the first day, and then are pretty light, but my cycles are rather long. I didn’t have my period for the entire month on September because I got it at the end of August and should be getting it this week. The more I read, the more I don’t believe I was diagnosed properly. I’m 30 years old and my husband and I just started trying to have a baby. With these long cycles, should I be worried about infertility?

    Thank you!

  82. This is helpful info, Lara! I’m looking forward to reading more. I was recently diagnosed with PCOS, but my Dr. said it’s different bc it’s my progesterone that isn’t high enough. She said it can be managed through diet and exercise, but I’m still struggling with hormonal imbalances.

  83. Do you have any advice for me?
    I’ve never taken the pill and I’ve always had a normal weight. I’m 26, have had acne since I was 12 and it never went away, skin & hair is extremely oily, lost at least half of my hair over the last ~7 years, also noticed more hair growth in lots of places but on my head. Got diagnosed with hypothyroidism in 2012, been taking Thyroxin since then, never noticed a change. Was so sure it must be high testosterone, but all my blood tests are normal, been to many doctors but noone could (or wanted to) help me. Ultrasound of my ovaries showed more follicles on one ovary, according to the doctor “it could be a mild case of PCOS”, should try inositol, vitex and a low carb diet. Just read on here though that low carb might make it even worse. Been taking all sorts of supplements (Magnesium, Vit D, Zinc, B12, Inositol…) for months but nothing changes. Doctor also said that she can see that I ovulate (and I’m pretty sure that I can feel ovulation every month). Cycles are around 33 days, sometimes longer.
    I really don’t know what to do anymore.

  84. I was diagnosed with PCOS recently. According to the criteria, I have it: acne, multiple follicles on ultrasound, and high DHEA-S. But I don’t know if I trust the diagnosis. I have NEVER had trouble staying at a healthy weight; if anything my cycles are shorter than average rather than longer; the high DHEA-S may be caused by my very stressful job; and multiple follicles may be due to spironolactone.

    Background: I’m 30. I was put on BC pills when I was ~15 because of painful periods. Switched to Mirena IUD ~5 years ago (periods got lighter but did not disappear, cycles averaged 25 days). I got my IUD removed ~18 months ago. Cycles since then have ranged from 21-28 days and have not been heavy or very crampy.

    Six months ago: I started 100mg/day of spironolactone for acne.

    Four months ago: Heavy mid-cycle spotting started. I started tracking my cycle using sympto-thermal methods at the same time as the spotting, and determined that I wasn’t ovulating (but was still having bleeds every 21-28 days).

    Two months ago: After more mid-cycle spotting, my gynecologist agreed to run some tests. Testosterone total normal (20), DHEA-S high (394), multiple follicles on ultrasound, TSH normal. We decided to cut the spironolactone dose to 50mg/day, so we’ll see if testosterone (and/or DHEA-S) goes up when I get re-tested in a month. I also started magnesium and zinc supplements.

    Past two months: I have ovulated both cycles since I started magnesium/zinc and we cut the spironolactone dose in half

    Next month: I’m getting DHEA-S and testosterone total re-tested. My gynecologist also ordered a comprehensive metabolic panel (fasting), hemoglobin A1C, lipid profile, and prolactin. Is there anything else I should ask for? Should I ask for insulin and/or luteinizing hormone? Cortisol?

    I do know my hormones are out of whack and need to be addressed, I’m just not sure if it’s really PCOS. Based on your book I think if I DO have PCOS, it’s Adrenal PCOS. But it’s hard to know because I don’t know if I was ovulating or not before I started the spironolactone, and I don’t yet know how the spironolactone is affecting my other levels.

  85. I stopped taking the progesterone-only birth control pill almost two years ago and since stopping have had mild acne, greasy hair and hair loss (especially in the last two months) along with stomach issues, anxiety and mild depression. I get very fatigued also. I have been to the GP who dismissed my issues as she thought they were only mild and when I mentioned these issues being to do with stopping the pill she didn’t take much notice. I have since been to many other GPs but no one has taken me seriously. Could these effects be post-pill PCOS and how long are they likely to last? I have tried so many different supplements. Previously before taking the pill (which I took for around 2 years) I had perfect skin and hair and no issues with my health. I have been vegetarian my whole life. Could you give your input? Thank you.

  86. Hi there! I feel this article is so relevant to me right now…I have come off the microlevelen pill after 15 years (treatment for endometriosis) and no period 4 months on. Ultrasounds show multiple follicles and enlarged ovaries but blood tests are normal. It constantly feels like I am ready to have a period (bloating, cramps, acne and visible cervical fluid etc). My dr wanted to put me on metformin but I am hesitant to treat this as PCOS so quickly…do you have any advice on how to address this? I see a specialist in a months time as I am TTC and am nervous they will try to get me to treat this as PCOS! Thank you!

    • Hi Angela, I have a lot of info on hypothalamic amenorrhea vs PCOS (I’m an HA specialist) – with no period for for months after bcp, I would definitely consider HA as a possibility. You can download chapter of my book that goes through this in detail for free at https://bit.ly/NPNWHAvsPCOS.

    • Four months is still early days coming off the pill. It’s common and normal to not ovulate straight away after stopping an ovulation-suppressing drug (the pill). Since already you’re seeing fertile mucus, you’re getting close to a period. The thing to worry about is probably the return of endometriosis symptoms. If you haven’t already, please check out my book Period Repair Manual and also my post Endometriosis: 5 natural treatments that really work.

  87. I have excess facial hair and acne and have not taken birth control pills. I’m 42 and it started when I was 13. I attribute it to hypothyroidism and being part Ashkenazi jew, which if you have any of that heritage is a guarantee for excess hair (it even lists it under hirsutism). Some women are hairier than others due to their DNA and some are hairy due to other autoimmune illnesses that effect cortisol levels like Cushings. There are also androgenic “like” diseases that are under the PCOS umbrella, that arent’ “technically” PCOS 🙂

  88. Thank you for this post! I read that BMJ study with interest and hoping they revise the guidelines for diagnosis of PCOS soon. I discovered you after I was given my own post-pill PCOS diagnosis (I didn’t have excess androgens) and had been told by a fertility specialist that I would never have a baby naturally. The fact that I had had regular periods pre-pill was ignored. I read your book and worked with a naturopath and now have a naturally conceived 6 month old. Unfortunately the PCOS diagnosis is still following me and I feel like I am constantly battling medical professionals about it, except ironically an endocrinologist who was very sensible and aware of overdiagnosis. Thank you for all the work you’re doing in this area.

    • When it comes to PCOS, endocrinologists are definitely the ones to talk to. They have a much better understanding than gynecologists, which makes sense given PCOS is an endocrine disorder, not a gynecological condition.

  89. Thank you! PCOS seems complicated, but interesting to read about. Do you have any advice for a girl with mild ideopathic hisutism, acne and hairloss? My breasts have all but disappeared too, without weightloss. Doctors find nothing wrong with me or my hormones…


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