Why Is My Period Missing? Understanding Absent & Irregular Periods with PCOS

Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders, affecting up to 10% of women of reproductive age. One of its hallmark symptoms is irregular or missing periods, medically known as oligomenorrhea (infrequent periods) or amenorrhea (absence of periods for three or more months).

If you're wondering why your period is missing, this blog post will break down the possible causes, the role of PCOS, and what you can do to restore a healthy menstrual cycle.

Why Do Periods Become Irregular or Absent in PCOS?

PCOS affects the menstrual cycle primarily due to hormonal imbalances. The key hormones involved are:

1. Elevated Androgens (Male Hormones such as testosterone) – Women with PCOS often have higher levels of testosterone and other androgens, which can disrupt ovulation and cause irregular cycles.

2. Insulin Resistance – Up to 70% of women with PCOS have insulin resistance, which contributes to higher insulin levels, driving the ovaries to produce excess androgens.

3. Impaired Follicle Development – The menstrual cycle depends on the development and release of an egg (ovulation). In PCOS, follicles (fluid-filled sacs in the ovaries) often fail to mature, preventing ovulation and leading to missed or irregular periods.

4. Low or Imbalanced Progesterone – After ovulation, the body produces progesterone, a hormone that regulates the cycle. Without regular ovulation, progesterone levels remain low, leading to cycle irregularities.

5. Not Eating Enough – One of the most common reasons for absent or irregular periods in my clients with PCOS is under-eating. This includes skipping meals, eating too few calories, or not consuming enough nutrients to support healthy hormone function. Chronic under-eating can disrupt signals between the brain and ovaries, making ovulation irregular or stopping it altogether.

   
   

How to Know If Your Period Is Irregular or Missing Due to PCOS

Signs of an Irregular or Absent Period with PCOS:

Cycles longer than 35 days (normal cycles range from 21-35 days)

Fewer than 8 periods per year

Skipping periods for 3 or more months (amenorrhea)

Experiencing light, heavy, or unpredictable bleeding

Difficulty tracking ovulation or noticing ovulatory symptoms

If you experience these symptoms, it's important to discuss them with a healthcare professional who can assess your hormone levels and rule out other potential causes.

Can You Get Your Period Back Naturally?

Many women with PCOS can restore regular cycles by addressing underlying hormonal imbalances. Here are clinically-supported strategies that can help:

1. Optimize Insulin Sensitivity

Balanced Blood Sugar Levels – Eating meals rich in protein, fibre, and healthy fats can help stabilize insulin levels and support hormone balance.

Supplementing with Myo-Inositol – This natural compound has been shown to improve insulin sensitivity and restore ovulation in women with PCOS. Read my blog post on inositol to find out more.

Regular Movement – Exercise, particularly resistance training and moderate cardio, helps improve insulin sensitivity and may help regulate menstrual cycles.

2. Reduce Androgen Levels

Spearmint Tea – Some studies suggest that spearmint tea can help lower androgen levels and improve menstrual regularity. Studies used two cups of 100% spearmint tea per day.

Omega-3s – Omega-3 fatty acids may reduce inflammation and androgen levels, promoting cycle regularity. Natural sources of Omega-3 include walnuts, chia seeds, flaxseeds, and oily fish such as salmon and mackerel.

3. Eat Enough & Prioritize Nutrient-Dense Meals

Regular Meals – Skipping meals or restricting calories can signal to your body that it’s under stress, which may further suppress ovulation. Having less than three meals a day will also make it harder to ensure you consume all the vitamins and minerals your body needs to function at its best.

Sufficient Protein & Healthy Fats – These nutrients help stabilize blood sugar levels and support reproductive health.

Key Micronutrients – Iron, zinc, magnesium, and B vitamins are particularly important for menstrual health. A well-balanced diet should be sufficient to meet your needs. However, if you are vegetarian/vegan, you should supplement with Vitamin B12.

4. Manage Stress & Improve Sleep

Chronic Stress & Cortisol – High stress hormones (cortisol) can worsen PCOS symptoms. Practicing yoga, mindfulness, and deep breathing can help regulate the stress response and support hormonal balance.

Quality Sleep – Poor sleep disrupts hormone levels and insulin regulation. Aim for 7-9 hours of quality sleep each night.

5. Consider Targeted Supplementation

Vitamin D – Deficiency is common in women with PCOS and is associated with menstrual irregularities. During autumn and winter months, when the sun’s UV rays are not strong enough, it is recommended that everyone takes a vitamin D supplement containing 10mcg (400IU). In summer, aim to get 15-20 minutes of sun exposure per day.

Actions to Take to Help Restore Your Cycle:

1. Ensure you are having 3 balanced meals a day and possibly 1-2 snacks if needed.

2. See every meal as an opportunity to add more nutrients – add nuts/seeds (healthy fats) and extra portions of veg/fruit.

3. Aim for a good source of protein with every main meal.

4. If you are vegetarian/vegan, consider taking a B12 supplement.

5. Consider adding an inositol supplement to your daily intake.

6. If you do not consume oily fish and other sources of Omega-3 regularly, an Omega-3 supplement may be beneficial.

7. Assess your relationship with your phone – ‘mindless scrolling’ has been linked to increased cortisol levels and disrupted sleep patterns.

If your period remains absent for three or more months, or if you experience excessive bleeding, severe pain, or other concerning symptoms, consider consulting a healthcare provider.

Missing or irregular periods can feel frustrating, but with the right diet, lifestyle, and targeted support, many women with PCOS can successfully restore a regular menstrual cycle.

If you’re struggling with absent or irregular periods, remember that you’re not alone, and support is available. Small, sustainable changes can make a significant impact on your hormonal health over time.

References

Azziz, R., et al. (2016). "Epidemiology and pathogenesis of polycystic ovary syndrome." Nature Reviews Endocrinology, 12(4), 219-231.

Dunaif, A. (2020). "Insulin resistance and the polycystic ovary syndrome: Mechanism and implications for pathogenesis." Endocrine Reviews, 41(5), 559-578.

Escobar-Morreale, H. F. (2018). "Polycystic ovary syndrome: Definition, aetiology, diagnosis, and treatment." Nature Reviews Endocrinology, 14(5), 270-284.

Teede, H. J., et al. (2018). "Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome." Human Reproduction, 33(9), 1602-1618.

Joham, A. E., et al. (2022). "Polycystic ovary syndrome in young women: What have we learned?" Current Opinion in Endocrinology, Diabetes and Obesity, 29(1), 15-24.