As someone with PCOS, you might’ve missed your periods many consecutive months in a row.
If this happens, there’s some steps to take so that you’re decreasing your risk of a condition called endometrial hyperplasia.
Endometrial hyperplasia, essentially, is an overgrowth of your uterine lining because it’s not being shed. This leads to abnormal and uncontrolled growth of these cells. This, in turn, may predispose a small percentage of people to endometrial cancer (down the road, especially if left unchecked).
In PCOS, the hormonal and metabolic issues can lead to no or irregular ovulation. This lack of ovulation or irregular ovulation means missed and irregular periods.
What this means is that we have exposure to our hormone estrogen (which causes the uterine lining to grow), but we don’t have exposure to progesterone (which is only made after ovulation and helps to stabilize and mature the uterine lining).
Enter: Progesterone Withdrawal Challenge
This is when we give you progesterone or a progestin (a compound that looks similar to progesterone and acts like progesterone in the uterus) for 7-10 days (typically orally).
Once your course of hormone meds are done, you should get a bleed around a week later.
In a natural unmedicated menstrual cycle, progesterone drops in the second half of your cycle and causes the destabilization of your uterine lining which leads to a period.
This hormone medication will do something similar–when it’s there, your body kind of thinks it’s the second half of your cycle, and then when we take the hormone away, a bleed will ensue.
PCOS and missing periods
If you have PCOS and it’s been >3-4 months since your last period (and you’re not pregnant), it’s best to reach out to your doctor to discuss a progesterone withdrawal challenge.
At the same time, make sure to start working with your healthcare team on improving the hormonal and metabolic dysfunction we see in PCOS so that you’re improving your PCOS and overall health.
You’ll find detailed narratives and practical tools like this in “The Period Literacy Handbook”. Go grab your copy! There’s a full chapter on PCOS (Chapter 19). I’m also accepting new patients on a rolling basis if you’re looking for individualized support with your polycystic ovary syndrome.
