Clinical Library · Hormonal Health

Irregular periods & PCOS: a 7-point checklist before you panic

Two missed cycles and Instagram tells you it's PCOS. Sometimes it is — sometimes it's thyroid, prolactin, stress or a rebound from stopping the pill. Before you commit to a diagnosis, run this checklist. It's the same workup most Indian gynaecologists start with.

What counts as "irregular"

• Cycle shorter than 21 days or longer than 35 days.
• Cycle-to-cycle variation of more than 7–9 days.
• Fewer than 8 cycles a year (oligomenorrhoea).
• Missed periods for 3+ months (amenorrhoea).

A single off cycle after travel, illness or a stressful week is not a pattern.

The 7-point workup

Common non-PCOS causes worth ruling out

• Hypothyroidism — TSH > 4 with fatigue, cold hands, constipation. Easy to treat.
• High prolactin — often stress, sometimes a pituitary adenoma. Milky discharge is a red flag.
• Functional hypothalamic amenorrhoea — from under-eating, over-training or extreme stress. Cycles return when energy availability rises.
• Post-pill amenorrhoea — cycles can take 6+ months to normalise after stopping the pill. Not always PCOS.
• Premature ovarian insufficiency — hot flashes and missed periods before 40. Needs an FSH + estradiol test.

If the checklist points to PCOS

The evidence-based first-line stack is 40:1 myo:D-chiro-inositol + strength training + protein-forward meals. Add berberine and active folate for insulin-resistant PCOS, and vitamin D3 to sufficiency. Cycles typically start regularising in 3–6 months. Read the deep-dive linked below.

Educational only. This checklist is a starting point — a full diagnosis and treatment plan should come from your gynaecologist or endocrinologist.