If you’ve lost your period (or it’s gone a bit MIA), you might be wondering… Is it PCOS? Is it HA? How do I even tell the difference?
Both conditions mess with your menstrual cycle, but they’re very different in terms of causes, symptoms, and treatment. And knowing which one you’re dealing with is so important—because the way you manage them is basically the opposite.
So, let’s break it down.
Different Physical Presentations
One of the biggest giveaways is how your body feels and looks.
- PCOS: Often comes with symptoms like acne, oily skin, unwanted hair growth (on the face, chest, or stomach), and sometimes hair thinning on the head. You might also notice weight gain or difficulty losing weight.
- HA: Typically seen in those who are under-eating (especially carbs and fats) and/or over-exercising. Many people with HA have a leaner body composition, but you can have HA at any size. Other signs? Feeling cold all the time, low energy, poor recovery from workouts, and a reduced libido.
Different Causes
This is where things really start to separate.
- PCOS: A hormonal condition often driven by insulin resistance (though not always). It can also be influenced by genetics, stress, inflammation, and gut health. Importantly, PCOS is not caused by over-exercising or under-eating.
- HA: Caused by a lack of energy availability—basically, your body isn’t getting enough fuel to support normal hormone function. This can happen due to restrictive eating, excessive exercise, high stress, or a mix of all three. It’s your body’s way of saying, Hey, I don’t have enough resources to support reproduction right now.
Different Blood Test Markers
If you’re not sure which one you’re dealing with, a few key blood tests can help:
LH:FSH Ratio
- PCOS: Often has a high LH to FSH ratio (typically >2:1).
- HA: Low across the board—low LH, low FSH, low oestrogen.
Androgens (Testosterone, DHEAS, Androstenedione)
- PCOS: These are elevated, which can drive symptoms like acne and hair growth.
- HA: These are low or normal because your body has essentially down regulated hormone production.
Estrogen & Progesterone
- PCOS: Oestrogen is usually within normal range, but progesterone stays low due to lack of ovulation.
- HA: Oestrogen is very low, which can lead to bone loss and other health issues if not addressed.
Fasting Insulin & Blood Glucose
- PCOS: Often shows high insulin and/or insulin resistance.
- HA: Typically low to normal, since this isn’t an insulin-driven condition.
Different Treatments
This is why getting the right diagnosis matters—because what works for PCOS could make HA worse, and vice versa.
PCOS Treatment
- Focus on blood sugar regulation—this might mean reducing refined carbs, prioritising protein, fibre, and healthy fats, and strength training to improve insulin sensitivity.
- Managing stress, optimising gut health, and getting enough sleep also play a huge role.
- If insulin resistance is a big factor, supplements like inositol can be helpful (always check with a health professional).
HA Treatment
- The main focus? Eat more, exercise less. Specifically, increasing carbs and fats, reducing high-intensity workouts, and prioritizing rest.
- Stress management is key because your body needs to feel safe to restart your period.
- Many people find that gaining some weight is necessary for recovery (even if their BMI is already “normal”).
So… Which One Is It?
If your period is missing, but you’re struggling with acne, excess hair growth, or insulin resistance, PCOS might be the culprit.
If you’re under-eating, over-training, and constantly cold or exhausted, HA is more likely.
And here’s the tricky part: Some people get misdiagnosed with PCOS when they actually have HA, because their ovaries appear “polycystic” on an ultrasound. But ovarian cysts alone don’t equal PCOS—you need the hormonal imbalances too.
If you’re still unsure, getting blood work done (with a practitioner who understands both conditions) can give you a clearer answer.
And if you have either of these conditions (or both, because yes, you can have them both) a dietitian is a health professional who can support you in making the diet and lifestyle changes required to manage your condition.
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