Treatment and management

Irregular or no periods

With PCOS, high levels of androgens (male-type hormones) and insulin can disrupt your monthly cycle of ovulation and periods. This means your periods may be irregular or stop altogether.

The average menstrual cycle is 28 days, but ‘normal’ cycles can range from 21 to 35 days.

An irregular cycle is defined as:

• eight or fewer menstrual cycles per year
• menstrual cycles shorter than 21 days
• menstrual cycles longer than 35 days.

For teenagers, an irregular cycle might mean periods:

• are longer than 90 days (more than a year after periods have started)
• are shorter than 21 days or longer than 45 days (between one and three years after periods started)
• have not started by the age of 15.

When menstrual cycles lengthen, ovulation can stop or only happen occasionally.

Healthy lifestyle

A healthy lifestyle is the most effective approach to managing PCOS symptoms, including irregular periods. A healthy lifestyle includes eating a balanced diet, maintaining a healthy weight, being as active as possible and reducing or stopping harmful habits such as smoking and excessive drinking.

Learn more about how physical activity and diet can help improve PCOS symptoms.

Medicines

Your doctor might recommend different medicines to re-establish regular periods.

Hormonal contraception

Depending on your symptoms and health, your doctor may suggest:

• the combined oral contraceptive pill (the Pill)
• progesterone, which stimulates the uterus and induces bleeding
• hormonal implants
• vaginal contraceptive rings
• intrauterine devices (IUDs) that contain progesterone.

The oestrogen and progesterone in hormonal contraception override your body’s menstrual cycle.

The Pill reduces the production of hormones such as testosterone and other androgens (male-type hormones), which may improve symptoms such as excess hair.

Hormonal contraceptives may have some side effects.

For example:

• mood changes
• weight gain or loss
• bloating
• breast tenderness
• irregular bleeding.

There may also be some risks, especially if you smoke, have high blood pressure or are extremely overweight.

Metformin

Metformin reduces insulin resistance and the production of androgens in the ovaries. It is more likely to benefit women with PCOS who have a heavier weight.

Metformin is not as effective as the Pill at making periods more regular. But it has a more positive effect on cholesterol levels and insulin than the Pill. It also helps with weight loss and reduces the risk of diabetes in people at high risk. Metformin has few serious side effects.

In some cases, Metformin can also improve how the ovaries work, re-establish regular periods and increase fertility.

It is important to discuss these medicines, their side effects and risks with your doctor before making any decisions.

Hair and skin conditions

Excess hair on your face and body, scalp hair loss (alopecia) and acne are symptoms of PCOS.

Many women feel distressed by these visible symptoms, but you can try different treatment options.

Excess hair

You can wax your excess hair, use laser hair removal or electrolysis. Laser hair removal is more likely to reduce hair growth over time, but you need regular treatments which can be costly.

Some dermatologists specialise in laser hair removal for women with PCOS. They can recommend the best treatment for your hair and skin type.

Scalp hair loss

You can use minoxidil (sold as Rogaine and Regaine) to prevent hair loss. The liquid or foam is massaged into your scalp. Some dermatologists prescribe minoxidil tablets. Side effects include scalp dryness and itchiness.

Acne

You can treat acne with creams or gels that reduce pore blocking, oil production and inflammation. Ask your doctor which products they recommend.

Dermatologists may prescribe isotretinoin to help with acne. This should only be prescribed for women who are not trying to get pregnant, as the medicine can cause birth defects. Side effects include dry skin and eczema.

It is widely accepted that diets with a high glycaemic load (GL) contribute to acne. Glycaemic load is the effect of carbohydrates on blood sugar levels. A high-GL diet can increase oil production in skin cells, causing acne. The Australasian College of Dermatologists recommends a low-GL diet to help manage acne.

Learn more about eating a balanced diet.

Medicines that reduce androgen production

Certain medicines reduce the production of testosterone and other androgens in the body, which may improve symptoms such as excess hair, scalp hair loss and acne.

For example:

• the oral contraceptive pill
• anti-androgen drugs
• spironolactone (sold as Aldactone)
• cyproterone acetate (sold as Androcur)

As with all medicines, there may be risks and side effects, so it’s important to work with your doctor to find the best treatment for you.

Stress, anxiety and depression

Stress, anxiety and depression are common in women with PCOS. These conditions are often overlooked and left untreated. But emotional health is just as important as physical health.

Symptoms of PCOS, such as excess hair growth and acne, can make some women feel self-conscious, reduce their self-esteem and affect their body image and mood. If you get help to manage your physical symptoms, it may improve your emotional health.

Body image is the way you think or feel about your body. Many women with PCOS feel less physically attractive. This can be difficult to cope with emotionally.

Also, the process of getting a diagnosis and living with a condition such as PCOS can be distressing.

These factors may cause stress, anxiety and depression. But there are things you can do to take care of your emotional health.

Having a healthy lifestyle (a balanced diet and physical activity) is an effective way to improve your mood and reduce negative feelings. There are also many natural and complementary therapies you can try.

But if you have constant and extreme negative feelings and thoughts that stop you from doing everyday activities, see your doctor. They may refer you to a counsellor or psychologist for support. In Australia, you can get Medicare rebates for seeing a psychologist.

If counselling and other therapies aren’t working, talk to your doctor about medicines that may help.

In this short video, psychologist, Dr Leah Brennan, talks about common experiences for women with PCOS, including anxiety depression and body image. Download the video transcript (DOCX 100KB).