• Pinterest
• X
• ShareCopied to clipboard

How to Get Regular Periods with Polycystic Ovary Syndrome (PCOS): A Functional Nutrition Guide

I recently polled my instagram broadcast channel on what topic they’d most like more information about and how to get more regular periods with PCOS was one of their top choices. (Weight loss was their first choice- you can read my articles about that here How to Lose Weight with PCOS)

One of the main symptoms of PCOS is irregular periods and though it’s not the case for everyone, most women with PCOS will have issues maintaining regular periods. This is due to a variety of the underlying factors involved in PCOS: hormone imbalances and root cause metabolic issues.

In this article, we’ll cover why we deal with irregular periods and the best strategies for getting a regular period with PCOS using principles of functional nutrition.

PCOS and menstrual health

We know that PCOS can cause irregular periods, but why?

There are several reasons PCOS can prevent regular periods and they begin with hormone imbalances.

In PCOS, we produce too many androgens (traditionally male hormones) like testosterone and/or DHEA and these increased androgens alter the delicate signaling of the menstrual cycle.

Here’s a graphic that illustrates the differences between PCOS cycles and regular cycles.

In PCOS, androgen production increases levels of follicle stimulating hormone (FSH) which encourages our ovaries to make more follicles (you might have heard them called eggs).

Higher levels of insulin can also alter the delicate signaling in the brain, leading to higher than normal levels of luteinizing hormone (LH) which is the hormone that triggers your ovaries to ovulate.

When you combine too much testosterone with too much luteinizing hormone, you get an ovary that continues making lots of small follicles that never develop and never release. These are the cysts in polycystic ovary syndrome: they’re just undeveloped follicles.

How often do you ovulate with PCOS

Some women with PCOS may still ovulate occasionally but irregularly. If you get a period every couple of months but just don’t know when to expect it, this may be the case for you. In these cases, hormone imbalances are delaying ovulation but not fully preventing it.

However, for many women with PCOS, and especially those with longer cycles, there likely isn’t any ovulating happening.

Now, why does this matter? Well, ovulation is key for the production of progesterone. Progesterone is the hormone that stabilizes the uterine lining and helps grab onto it. When we make enough progesterone, the drop in hormones at the end of the cycle can successfully trigger our uterus to shed our lining.

Progesterone is produced from the place left in the ovary when we ovulate. It’s called the corpus luteum and it’s only from here that we can get the progesterone we need.

When we don’t get that necessary progesterone, there’s no signal to our endometrial lining to shed and thus, no period.

Irregular PCOS cycles: Progesterone and Estrogen Dominance

Progesterone is the natural balance to estrogen. In PCOS, we don’t tend to have much at all due to very infrequent ovulation and this means that we often become estrogen dominant.

Estrogen dominance can contribute further to our lack of ovulation by confusing signals even more. It can make periods heavy and uncomfortable and is one risk factor that increases the more than 2.7 fold risk of endometrial cancers in PCOS.

There are many receptor sites for progesterone throughout our bodies. It can play some really cool roles. For example, progesterone is a muscle relaxant and helps our brain produce more GABA (the anti-anxiety neurotransmitter) which helps with sleep and reducing stress hormones, along with less anxiety.

Getting a regular period in PCOS is very important. Preferably, we would do this naturally through diet and lifestyle changes. With the right approach, this often works! But in some cases we may need some help from pharmaceuticals as well, which we will discuss at the end of this article.

As a survivor of endometrial cancer myself, I want to alert you to these very real risks of irregular periods with PCOS and make sure that you stay in contact with your healthcare team. Remember to take care of yourself!

Why regular periods matter for PCOS

Regular periods with PCOS matter for a lot of reasons. Here’s just a few of the main ones:

• Lowered risk of endometrial cancers (2.7 fold increased risk in PCOS)
• Stronger chances for fertility
• Indicator of better overall health
• More progesterone (better sleep, less anxiety)
• Less painful and heavy periods
• More balanced hormones and reduced symptoms

Strategies for regular periods with PCOS naturally: overview

To get more regular periods with PCOS naturally we need to focus on a few key areas: blood sugar regulation, reducing inflammation, and addressing root causes. Let’s talk about each of these and help make sense of them.

Blood sugar regulation

The single most common reason for irregular periods in PCOS is high insulin levels.

High insulin levels (hyperinsulinemia) and insulin resistant are key root causes of PCOS symptoms and are the most common trigger for high androgen levels.

Insulin is a hormone that directly triggers the ovaries to make more testosterone. Even if you don’t suspect insulin to be part of your PCOS picture, you still will benefit greatly from balancing your blood sugar.

Functional Nutrition for PCOS PCOS Self Assessment Quiz and Guide- PCOS diagnosis Quiz

It is irregularities in blood sugar that cause the most frequent delays in PCOS ovulation and since the menstrual cycle is so delicate, keeping sugars steady is very important for keeping hormones balanced.

How to balance blood sugar for more regular periods with PCOS

Balancing blood sugar is an art and one that has to also include looking deeply at your unique PCOS root causes. There is much to be said about this topic alone!

But, there are some main pieces of advice I tend to give clients when first working on their blood sugar and I find them very effective.

Eat high protein

The most helpful thing you can do to start balancing blood sugar is adding more protein to your diet. Protein can help reduce insulin and blood sugar spikes naturally.

Protein keeps you full longer, helps you release sugars slower and prevents your body from making as much insulin in response to meals.

Aim for 4 oz per meal at minimum, or about the size of the palm of your hand. For reference, half a large chicken breast is about 4 oz.

Need help with protein? I’ve got a whole guide to this here. The Ultimate Guide to Protein for PCOS.

Limit starch and added sugar for more regular periods with pcos

When we consume any kind of carbohydrate, our body will break down that carbohydrate into a sugar called glucose. Glucose is the fuel for our bodies and also gets stored in our muscles and liver as a form called glycogen.

When our storage space is full, our body stores extra glucose as fat. This happens because glucose raises our blood sugar and rises in our blood sugar lead to more insulin production. It is the insulin production that contributes to the hormone imbalances we discussed earlier.

One strategy for reducing insulin spikes is to reduce blood sugar spikes by reducing the amount of foods in our diet that cause those spikes.

So, we might look to limit the amount of added sugars in our diet. We might also seek to lower the overall amount of starches or carbohydrates.

Starchy carbohydrates from whole foods sources like banana, sweet potato, and whole grains can be very helpful parts of a PCOS friendly diet but you still may benefit from reducing the overall amount.

This recommendation varies greatly depending on your activity level, but in general, aim for 30g of net carbohydrates or less per meal. Net carbohydrates is the total carbohydrates of a food minus the fiber count.

Add more fiber

Speaking of fiber, fiber is the unsung hero of getting regular periods with PCOS and balancing blood sugar. Just like protein it slows the release of sugars from the blood stream. But it also has the added benefit of helping us focus on more whole and unprocessed foods since these tend to be higher in fiber.

High fiber diets are very helpful for gut health and reducing inflammation.

Aim for about 30g fiber per day. I like to divide this up with meals.

Pro tip: if you eat most of your carbs from whole foods sources like legumes and whole grains, you’ll likely get enough fiber and meet your protein goals as well.

Reduce Caffeine

Caffeine is a trigger for blood sugar spikes because it releases cortisol, one of our bodies key stress hormones. This can then force the body to release sugars we’ve been storing in our muscles and liver, called glycogen.

Many women with PCOS rely heavily on coffee and even energy drinks to help them get through the day. PCOS fatigue is no joke but forcing our body to have energy when it really doesn’t can also have negative consequences. Top Signs of High Cortisol and Adrenal Dysfunction in PCOS

When trying to balance blood sugar and get more regular periods with PCOS, limiting caffeine to the equivalent of one cup of coffee per day is helpful.

Switch to Matcha

One of the best ways to support your PCOS stress hormones and blood sugar and still get caffeine is to switch from coffee and energy drinks to matcha. Matcha is a powerful antioxidant with many health benefits for PCOS but one of the best parts of drinking matcha is the slow and steady release of caffeine.

Matcha has natural stoppers on it’s caffeine release which help your body adjust to it better and reduce the stress induced blood sugar spikes that can be caused by other caffeine sources.

Here’s my article on matcha for PCOS and you can also shop my favorite matcha here. Use my code AMBERFISCHER for a discount.

Exercises for balanced pcos blood sugar

Balancing blood sugar to get more regular periods in PCOS typically won’t work without adding some additional physical activity.

Exercise helps burn off some of the energy consumed during the day and reduces your bodies need to produce insulin.

More daily movement

We tend to think about exercise in terms of when we can go to the gym but one of the more effective helpers for blood sugar is getting more movement throughout the day.

Try setting a timer on your phone or smart watch to remind you to get up every hour. I usually walk around, grab some water and do some stretching for about 5 minutes. Not only does this keep my fresh for work, it balances my blood sugar.

Strength training for balancing blood sugar in PCOS

At least twice a week, I recommend doing strength training for PCOS. Heavier weights are best here to get the most benefit. Strength training has tons of benefits for PCOS but one of the best is it’s ability to keep you insulin and blood sugar levels in check and rev your metabolism long after you’re done with your workout.

In fact, the benefits of strength training last for the next 72 hours! If you’ve never tried strength training, give it a shot, it really helps!

Supplement for blood sugar regulation and more regular periods with PCOS

Sometimes diet and lifestyle changes to help PCOS aren’t quite enough on their own and we can speed and support the process of getting more regular periods with PCOS by adding in specific supplementation.

While there are tons of supplements that benefit PCOS and finding the ones that work for your unique PCOS root cause issues is most helpful, the supplement below is well-studied for improving blood sugar balance and helping with more regular periods in PCOS.

Inositols: getting regular periods with PCOS

The inositols myo and d-chiro inositol are the best studied forms of inositol for PCOS. Inositol is something your body naturally produces in response to eating certain vegetables. In PCOS, we often are deficient and supplementing can be helpful.

Studies have shown improved menstrual regularity with inositol supplementation in PCOS.

The key to doing inositol well is to ensure you’ve got the ideal 40:1 ratio of myoinositol to d-chiro inositol. Studies with different ratios or with myo or d-chiro inositol alone have not shown the same benefit.

I recommend this inositol for PCOS.

Reducing inflammation: How to Get Regular Periods with PCOS

Another way we create too many androgens in PCOS is by way of increased levels of chronic inflammation in our bodies. This is a common underpinning of PCOS and another one of the main “root causes” I discussed earlier.

Inflammation can be triggered by a number of things including medications, nutrient deficiencies, digestive issues, food sensitivities and gut health problems. Solving inflammation can be complex but increasing anti-inflammatory foods is the first step in improving the overall levels of inflammation.

Decreasing inflammation will help decrease testosterone production which will help with period frequency and more ovulation.

Foods to decrease inflammation and get more regular periods in PCOS

Decreasing inflammation: antioxidants

The best foods to reduce inflammation are the foods that are highest in antioxidants, polyphenols, and other plant components that increase our nutrient stores and feed our beneficial gut bacteria.

Antioxidants help with inflammation by reducing oxidative stress, a main cause of inflammation. You see, part of our natural detoxification process involves breaking many foods down into something called Reactive Oxygen Species (ROS). These are “oxidants”. When we have enough antioxidants to neutralize the oxidants, everything is good. But often in PCOS, we don’t have this balance. The excess levels of ROS lead to something called oxidative stress. This is where a lot of the inflammation we deal with comes from.

By and large, improving our inflammation means more plant foods in the diet. This is because plant foods are naturally the highest in antioxidants.

We want to try to incorporate two main categories of these foods for the best return on our investment: foods high in resveratrol and foods high in folate and vitamin C.

Foods high in resveratrol and anthocyanins are foods that are usually more blue in color- think blueberries, dark grapes, even dark chocolate.

For foods high in folate, think deep green foods like spinach, kale, and other leafy greens.

All of these foods will be naturally higher in vitamin C, a key antioxidant.

Decreasing inflammation: Healthy fats and fish oils

Another food key for reducing inflammation and oxidative stress is healthy fats. Particularly key are fish oils from fatty fish like salmon, cod, and sardines. Aim for at least three servings a week of these kinds of fish to improve your levels of omega 3 fatty acids which are highly anti-inflammatory.

You may also want to increase your levels of monounsaturated fats from sources like high quality olive oil and avocado oil. These kinds of fats are more prevalent in diets like the Mediterranean diet and have been shown to have many beneficial health properties, including reducing inflammation.

Stress management for more regular periods with PCOS

Managing stress with PCOS is an important part of overall health in the syndrome, but also in regulating periods.

Overactive stress hormones like cortisol or DHEA-are one of the root cause issues in PCOS and can increase both insulin resistance and inflammation.

Managing stress means incorporating techniques that reduce cortisol, a main stress hormone. There are many ways to do that which I discuss in this article Top Signs of High Cortisol and Adrenal Dysfunction in PCOS

For the purposed of getting more regular periods in PCOS, I’d recommend a daily mindfulness practice as one of the most effective tools for less stress hormone imbalance.

Some options for mindfulness include guided meditations, prayer, journaling, gratitude practice, yoga, and breathing exercise (I particularly like box breathing!).

If possible, aim for 15-20 minutes daily to see the most benefit.

Acupuncture and more regular cycles in PCOS

Another effective tool for improving menstrual cycle regularity in PCOS is acupuncture.

This is an intervention I frequently suggest when my clients are trying to conceive since it can be very helpful for improving chances of conception. But if regular cycles are the goal, we definitely have evidence to support its use.

Studies have shown increased menstrual cycle regularity in PCOS and improvements in LH levels and other hormones when consistently incorporating acupuncture.

When I was trying to conceive, I went to a fertility focused acupuncturist every week for several months. During that time, I listened to guided meditations by Circle and Bloom. I found this time very helpful for keeping me calm and balanced through the ups and downs of the fertility process and I now have a 4 and a half year old son who is absolutely the light of my life.

I interviewed my fertility acupuncturist for an episode of An Amber a Day, you can listen here if you’re interested in her perspective on acupuncture for PCOS.  Her advice was to pursue acupuncture as frequently as possible and with regularity and consistency.  The consistency piece is really key with trying to get regular periods with PCOS because it’s going to take time for hormones to rebalance and it’s the consistency of the intervention that helps create that change.

The same could really be said for nutrition too- it’s better to do one thing really well and really consistently for PCOS than a hundred things without consistency.

Importance of sleep for regular pcos cycles

Another key component of both reducing stress/inflammation AND blood sugar is sleep.

For some reason, sleep seems to be something that many people discount.  It seem so simple- how could a few extra hours of sleep per week really make any difference to hormones?

The answer lies in the way our bodies work with and without sleep and what sleep is really for.

Sleep is our bodies reparative time- it’s when we heal, when we recuperate and recover.  When we sleep well we have more balanced moods and cravings.  Our livers do the majority of their work while we sleep as well, so sleep is crucial for detoxification.

When we don’t get enough sleep, our body struggles to heal and recover and kicks up stress hormones that increase cravings.  Our blood sugar becomes more volatile and our insulin levels increase.  All of this leads to increased symptoms.

As someone with PCOS who has also dealt with adrenal dysfunction, I know that sleep may sometimes elude us even with our best efforts.  However, there are a few important basics that many of us neglect and that will help improve the quality of your sleep.

Basics for quality sleep in PCOS

Sleep in a cold, dark room.  The ideal sleeping temperature is about 65 degrees for most people with a heavier blanket.  You want your room very dark, as dark as you can get it.

Good sleep starts with good preparation- always start winding down for bed with ample time.  In most cases, 1-2 hours before bedtime is enough to relax the mind and body and support good sleep.

Try creating a consistent bedtime routine that you can follow every night.  Here’s mine:

My bedtime routine for PCOS

Around 8 p.m. I switch off the TV, computer and any other sources of blue light.  I always keep a blue light filter going on my phone as well- you can usually find this in your phone’s settings.

By 9 p.m. I stop all forms of stimulating social media.  For me this means no more instagram or tiktok.  I usually stay on my phone but only do calming apps like pinterest and youtube.  The key is to almost have a boring experience- you don’t want any real stimulation, positive or negative.

By 10 p.m. I start my skincare routine and then change into my pajamas.  I’ll usually read a book or watch an ASMR video to feel extra sleepy and try to have lights out by 11 p.m.  I sleep until 7:30 every morning and aim for 8-9 hours of quality sleep.

I also spend time in direct sunlight during the day which helps tell my body when to get sleepy and balances my circadian rhythm for the night ahead.

Supplements to reduce PCOS inflammation

Fish oil and CO-Q-10 are both supplements that can help reduce PCOS inflammation and help you get more regular periods with PCOS.  Fish oils work by increasing anti-inflammatory omega 3 fatty acids which are often deficient in American diets and especially in PCOS.  Omega 3 fatty acids have a soothing effect on the gut lining and reduce oxidative stress.

Co-Q-10 on the other hand helps support mitochondrial health.  The mitochondria are the energy makers of our cells and represent one of the main sources of inflammation in PCOS.  Typically, we have issues with our mitochondrial health which means that our body doesn’t have the resources to make the energy it needs to accomplish all the important cellular tasks it needs to do.  You can read more about this here A Root Cause PCOS Approach- Priority Pyramid for PCOS

A great supplement to support this is a fish oil and co-q-10 blend.  Pairing them together helps them be absorbed better and also means extra benefits without having to take extra pills.  This is a favorite of mine. 

Vitex for regular pcos cycles

One tool I typically use in my nutrition practice to help improve menstrual cycle regularity is vitex.

Vitex agnus-castus, also called chaste tree berry is an herb grown from a tree with beautiful blue flowers.  I actually have one in my backyard in south Texas!

Vitex has long been used for it’s hormone altering properties.  In fact, medieval monks used to take vitex regularly because they believed it supressed libido (hence, chaste tree)

The reason for this, and why it can be so effective for PCOS is because vitex helps the body produce more quality estrogen and progesterone.

When trying to get regular periods with PCOS, I will have my clients use a strong vitex supplement (like this one) for the first 10 day of their menstrual cycle.  This extra push helps tell the body to select a follicle and grow it to maturity.  From there, the body often follow suite by ovulating and a period occurs a few weeks later.

When the period starts, we start the vitex over again and continue this cyclical vitex for the next six months or so.

If there are completely absent or irregular periods, I’ll usually just do 10 days out of every month cyclically and this often helps to shrink the time between periods.

Addressing root causes to get more regular periods with PCOS

Vitex can work very well in the right person but it’s important to remember that no one supplement or diet trick will get your periods regular in PCOS unless you are also addressing your root causes.

The root causes of PCOS symptoms differ person to person but always center around a combination of insulin resistance, inflammation and stress hormone imbalances.

There are important methods to a balanced diet approach to PCOS that I can’t go fully into during this article but I do cover and help make simple in my PCOS Foundations course.  I highly recommend this as a first step and many times just following the advice in this course alone can lead to more regular periods.

I have received many messages telling me that PCOS Foundations helped women get their periods back and they found it very simple, thorough, and informative.  Here’s more on PCOS Foundations.

Pharmaceutical methods of regulating menstrual cycles in pcos

There are a few pharmaceutical methods employed to help regulate PCOS cycles.

As a nutrition professional, I fully believe that lifestyle changes should be the first approach to PCOS management but sometimes we need help from more conventional methods.

Metformin for more regular periods

Metformin has some decent evidence to support it helping with cycle regularity in PCOS- this is mostly due to it’s ability to regulate insulin and blood sugar levels.  Some studies have found inositol more effective than metformin for this purpose but I have also had clients who combined them with good results.

Oral birth control

Probably the most frequently used method to regulate cycles in PCOS.  Oral birth control works by suprressing the body’s natural hormones  with synthetic hormones.  It regulates the cycles but only as a bandaid approach.  After stopping birth control, cycles typically go back to irregular.

That said, birth control can be important in certain cases, especially if you ever dealt with issues like endometriosis or endometrial cancer.  Birth control is currently going through a bad reputation time, and for good reason as it has numerous side effects.  However, it can be protective in a subset of women with PCOS and sometimes it is the best option.  Consult with your doctor on this one, for sure.

Cyclical Progesterone

One little known method of supporting regular cycles in PCOS is something called cyclical progesterone therapy.

Typically a bioidentical form of progesterone will be taken for 10 to 15 days out of every month.  This mimics the natural menstrual process of progesterone production and helps your body shed it’s lining.

For the right person, cyclical progesterone can be very helpful, although it is another bandaid approach.

In my case, due to my endometrial cancer I was not able to regulate my cycles naturally due to safety concerns but oral birth control was also very hard on me physically and emotionally.  Cyclical progesterone helped keep my lining healthy and I tolerated it much better.  In fact, I felt amazing on it!

I used cyclical progesterone for a few years while waiting to pursue fertility post cancer treatments and I highly recommend if you are a higher risk woman with PCOS that you ask your doctor about this as an option.

What if you don’t have regular periods but don’t want to go on birth control?

I’m often asked about options if a woman is being told to go on birth control but doesn’t want to.

Assuming it’s safe to do so (there are no major risks for endometrial cancer, for example) you could consider asking your doctor for something called Provera.

Provera is a progesterone prescription pill that can be used to flush the uterine lining.

When I’m working with clients on lifestyle changes, many of them don’t want to go on birth control because they want to see if their body can restore it’s cycles naturally and birth control would mask this.

With their doctors help and permission, we will sometimes rely on provera for a while as we try to regulate cycles more naturally.

How to get more regular periods with PCOS

Well, this was a whopper of an article!  Congrats to you for making it to the end and I hope it was helpful.  To recap, here’s what we’ve learned to get more regular periods with PCOS

1. Focus on blood sugar
2. Reduce inflammation
3. Incorporate Stress Management
4. Potentially try acupuncture
5. Get quality sleep
6. Address your root causes (here’s the link for PCOS Foundations again)
7. Consider Vitex
8. Pharmaceuticals may be part of your picture

Good luck in your hormone balancing journey and I wish you the very best success in getting regular periods with PCOS.

• Pinterest
• X
• ShareCopied to clipboard