Menstrual issues — such as heavy periods, irregular bleeding, or missed periods — are hallmark symptoms of polycystic ovary syndrome or PCOS. In fact, upward of 85 percent of women diagnosed with PCOS have some sort of issue with menstruation. It’s also one of the primary criteria used to diagnose this hormonal imbalance.

Yet, when these irregularities first emerge, it can be tempting to keep them to yourself and not mention them to others or even to your healthcare provider. Perhaps you believe heavy bleeding or missed periods are normal. Or, maybe you feel embarrassed and ashamed about what is happening. But it’s important to tell your healthcare provider.

Without proper intervention, you not only risk going undiagnosed and delaying treatment, but you may also find that you skip social activities, miss work, or start feeling sad or lonely due to your symptoms. If you’re experiencing abnormal bleeding, here’s what you need to know about its connection to PCOS, including how it might be treated.

Absent or Irregular Periods

Missing a period here and there can be normal, especially during the first years of menstruation. People may also miss periods because of stress, intense exercise, significant weight changes, or changes in their eating habits. Regardless of the reason, it can be worrisome to suddenly skip a month, especially if you’re sexually active and not trying to conceive.

If you’re consistently missing periods, there’s a good chance something else is going on. Amenorrhea, or the lack of menstrual periods, is often a sign of an underlying health issue like PCOS. In fact, about 30 percent to 40 percent of women who consistently miss their period have PCOS.

PCOS can also cause oligomenorrhea, which is the term for an irregular period. Typically, a period is considered irregular if you have gone more than 35 days between periods. You may also have oligomenorrhea if you only have four to nine periods a year. About 85 percent to 90 percent of women with irregular periods have PCOS.

If you are regularly missing your period, you may also be at an increased risk for infertility because you may not be ovulating like someone with normal periods. That said, you can still get pregnant even if you have PCOS. But it’s important to talk to a healthcare provider about how PCOS can impact fertility.

Heavy, Extended Periods

Heavy bleeding during periods is a common symptom of PCOS — and a really stressful and life-altering one as well. Not only can heavy periods be painful at times, but they also impact your quality of life. You may skip hanging out with friends, miss school or work, or change how you spend your time. Plus, leaking through a pad or tampon and staining your clothes can be embarrassing.

Heavy bleeding, which is also known as menorrhagia, affects 10 million women in the U.S. every year and represents more than 80 milliliters of blood (or 2.7 ounces) regularly throughout your period.

A normal period accounts for about 60 milliliters, or changing a pad or tampon every four hours in the first day or two. But with menorrhagia, you may be changing your pads or tampons every one to two hours throughout the duration of your menstrual cycle. You may also notice clots of blood and feel exhausted and mentally drained — especially if your period lasts longer than seven days. You are even at risk for developing anemia, a condition that results from a lack of red blood cells in the body.

Treatment Options

If you’re experiencing abnormal bleeding or irregular periods, your healthcare provider may recommend birth control. Both birth control pills (oral contraceptives) and hormonal intrauterine devices (IUDs) are effective ways to balance hormone levels. But you may have to experiment with different treatment options until you find one that works for you.

Your healthcare provider may also consider tranexamic acid, which helps slow heavy bleeding and may promote blood clotting. This medication can increase the risk of blood clots, especially if you’re already taking birth control pills. So, you need to weigh the risks and benefits.

Some people also consider surgery, especially if they have no plans to get pregnant. But this is a significant step that should be considered thoroughly. If your PCOS is causing anemia, you may also be given supplements to help boost your iron stores. And, some people use nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and diclofenac, to alleviate period pain.

You can also explore fertility drugs if you’re trying to get pregnant, as well as drugs to regulate androgens to limit hair loss and restore hair growth. Some people will also take medications to address insulin resistance or to help manage obesity.

Join the Conversation

On myPCOSteam, people share their experiences with PCOS, get advice, and find support from others who understand.

How do you handle missed or heavy periods each month? Let others know in the comments below.