Why the Long Cycle? What you need to know about PCOS.

By Quilla Watt – Integrative Naturopath


Irregular periods. Acne. Excess body hair. Obesity. Difficulty conceiving.

These are signs of Polycystic Ovarian Syndrome (PCOS). It’s a common condition, affecting up to 21% of women of reproductive age. Yet only about 30% actually get diagnosed. Some women don’t realise there’s an issue with their long cycle until they have trouble getting pregnant. Other women might get popped on the pill to regulate their cycle without the cause being fully understood. Plus, diagnosis is a little tricky – there isn’t a single test for PCOS, and other conditions need to be ruled out.

Why should we care about PCOS? Because it’s the most common cause of female infertility. Seventy-five percent of women who don’t ovulate and experience infertility have PCOS. And, early diagnosis and management of PCOS decreases the risk of developing Type 2 Diabetes or heart disease later in life.

So what are the main features?

The main features of PCOS are long cycles (lasting more than 35 days) or no periods at all; polycystic ovaries (seen on ultrasound); and high androgens. Androgens are the hormones that give “male” characteristics like increased body hair, deeper voice, and more muscle mass. It is also common to see obesity, insulin resistance and raised blood sugar levels in women with PCOS.

What do we need to know? When I see a patient with a long cycle, or if she has already been diagnosed with PCOS, I have a list of things I want to know:

  • Is there insulin resistance? High insulin pushes the body to make more androgens. With many PCOS patients, weight loss and blood sugar regulation through diet and exercise can be the best tools to regulate the metabolic madness we see in PCOS.
  • Was the pill on the scene? Some women stop the oral contraceptive pill and do not get their period back for months (sometimes years!). In these cases, something as simple as Vitex can help switch on the hormonal signalling you need to have a period.
  • Is prolactin high? High prolactin suppresses ovulation. About 75% of women with absent periods will have high prolactin. It’s a good idea to see your GP and investigate why prolactin is high before treating it.  
  • Is thyroid function ok? It’s a good idea to consider low thyroid function in PCOS, especially if prolactin is also high.
  • Is there low-grade inflammation? We can answer this question with blood tests like ESR and CRP. We know from research that women with PCOS have low-grade inflammation, which stimulates polycystic ovaries to produce androgens.

You can have poly-cystic ovaries without having PCOS. Wha…..? Yeah, I know. I love it when things are simple like that. Not. 

PCO is more common than PCOS, with up to a third of women of childbearing age having polycystic ovaries on ultrasound. But these women have none of the hormonal imbalances, can have perfectly normal periods and no difficulty conceiving.

What’s the take away message? If your cycle is longer than 35 days, or your period doesn’t come at all (and you aren’t pregnant!)– talk you your integrative GP or naturopath and find out why.