Welcome back to the *PCOS Repair Podcast*! Today, I’m excited to share a very common scenario I hear from the women I work with who have PCOS. I’ll start by sharing one of my patient’s experiences—with her permission—and then highlight some of the common pitfalls women encounter from their teen years into their 30s, which collectively contribute to the challenges we see with PCOS. Let’s dive in!  

I want to share the journey of my patient, Janel. I didn’t meet her until her late 20s, but she came to me because she hadn’t had a natural period since stopping birth control. Since puberty, she had always had semi-regular periods—a pattern that’s very common in PCOS. Her cycles were regular enough that she didn’t feel the need to see a doctor, but just when she started to worry about her period being late, it would arrive. This often looked like cycles ranging from 35 to 40 days, or sometimes a couple of months with a 32-day cycle, followed by a three-month gap. By the time she considered making an appointment, her period would return.  

Because of this irregularity, Janel started birth control in her late teens after being diagnosed with PCOS. Her doctor prescribed it to regulate her cycles, and since she wasn’t trying to conceive at the time, she went along with it. She remained on birth control for about 10 years, stopping at age 27 when she and her partner were ready to start a family.  

After stopping birth control, her period never returned. At the six-month mark, she saw her doctor. Given her history with PCOS, they retested her hormones and, without waiting for her cycle to regulate naturally, moved forward with fertility treatments. She was given Provera, which triggered a withdrawal bleed, but her cycle didn’t regulate on its own in the following months. She was then prescribed Provera along with Letrozole for six months. Each month, she experienced a withdrawal bleed, but pregnancy didn’t occur.  

After six months, feeling frustrated and still in the dark about whether or not she was ovulating, Janel decided to take a break. She wanted to see if she could recover her hormones and regain a natural cycle. This is when she started exploring alternative options beyond Provera and Letrozole, which led her to me.  

While her ultimate goal was pregnancy, her immediate priority was to restore her natural cycle without medication. She felt like something was wrong with her body and was stressed about not knowing what was happening with her cycle. This is a situation I see frequently.  

Fast forward three months into our work together, Janel was having regular 28 to 30-day cycles. Not perfectly clockwork, but very consistent—about as regular as we can expect when managing PCOS. Regaining a cycle so quickly was a huge milestone. From there, we continued working toward pregnancy, but just having a predictable cycle was an incredible sign of progress. It reassured her that her body was functioning well and that she was on the right track.  

Why Does This Happen?  

This is such a common scenario—where mild irregularity before birth control turns into a complete hormonal disruption after stopping it. Unfortunately, conventional medicine offers very few tools to support natural cycle recovery. This is where we need to take a step back and focus on repairing the cycle, optimizing fertility, and improving overall hormone health.  

A regular menstrual cycle is a key indicator of hormonal health, so the first step is understanding *why* cycles become irregular. Irregular periods don’t just happen randomly—there’s always an underlying hormonal imbalance. Identifying the root cause is crucial, but testing can be difficult when cycles are inconsistent. Since many hormone tests depend on cycle timing, it can be tricky to interpret results accurately.  

One of the best tests available is the DUTCH test. There are two versions: the standard DUTCH test for those with relatively regular cycles and the DUTCH Cycle Mapping test for those who haven’t had a period at all. The cycle mapping version provides a full month of hormonal data, offering insight into ovulation timing, whether it happened early or late, and overall hormone patterns. Insurance doesn’t typically cover these tests, making them somewhat expensive, but they can provide invaluable information.  

If a DUTCH test isn’t an option, conventional blood tests can still provide useful insights. However, results should always be interpreted with an understanding of where you are in your cycle—whether you’re in the follicular phase, around ovulation, or in the luteal phase. Without that context, hormone levels can appear misleadingly high or low.  

How Do We Recover a Missing Period?  

Once lab work is done, the next step is determining the primary root cause of hormonal dysfunction. Some women have one dominant root cause, while others have multiple factors at play. Identifying these allows us to tailor lifestyle changes to support hormone balance effectively.  

When it comes to restoring cycles, two major factors make the biggest impact: **stress management and nutrition.** Exercise is important for PCOS health, but stress and nutrition tend to influence cycle recovery the most. Stress management isn’t about eliminating stress but rather learning how to respond to it in a way that supports hormonal balance.  

If you’ve been on birth control and your period hasn’t returned, it can feel incredibly frustrating—like nothing is working. But time and time again, I’ve seen that committing just **four months** to focusing on root causes, emotional well-being, and nutrition makes a huge difference. Most women see at least one or two periods in those first few months, and by six months, cycles often become more consistent.  

For those trying to conceive, six months can feel like an eternity. But without a regular cycle, pinpointing ovulation is nearly impossible. The best way to track ovulation is by monitoring your cycle with tools like **Mira** (which measures hormone levels in urine) or **BBT tracking** (which tracks basal body temperature). While BBT tracking is sufficient for most women, Mira provides additional hormonal insights throughout the cycle.  

The DUTCH test, on the other hand, offers retrospective insights—it won’t help with real-time ovulation tracking but is useful for understanding broader hormonal patterns. If you’re not having a period at all, it typically means you’re not ovulating, making pregnancy impossible without intervention. This is why many fertility treatments involve a cycle reset with Provera, followed by ovulation induction with medications like Clomid or Letrozole.  

The Best Approach to Fertility with PCOS  

While Clomid is effective, it often loses effectiveness after three to four months, which is why Letrozole is now more commonly used. However, these medications work best when the body is already in a state of balance.  

This is why I *highly* recommend taking a pause before jumping into fertility treatments. A few months of prioritizing hormone health can significantly improve fertility outcomes. I know that waiting feels unbearable when trying to conceive, but investing just four to six months in hormone recovery often leads to better, more sustainable results.  

Janel’s story is a perfect example. She always had irregular periods, but birth control masked the underlying issue. When she stopped taking it, her hormone feedback loops were completely disrupted. Instead of relying solely on medication, she focused on metabolic health, endocrine balance, and restoring her natural hormone cycle. Now, she has the option to try naturally or, if she chooses to use Letrozole again, she’s in a much better position for success.  

Final Thoughts  

I hope this episode gives you a clearer picture of the steps involved in cycle recovery and fertility optimization with PCOS. When we panic about missing periods and rush into fertility treatments without addressing the root causes, we often create more frustration. But by taking a step back, supporting our bodies, and allowing time for healing, we can set ourselves up for better results—both for natural conception and assisted fertility treatments.  

If you found this episode helpful, be sure to subscribe so you never miss a new release. And if you have any questions, I’d love to hear from you! Send me a message on Instagram—I always enjoy connecting with you.  

Until next time, bye for now!