Irregular or stopped periods: PCOS, or premature menopause? What the tests show
Irregular or stopped periods are often due to PCOS, but not always, and simple tests tell the difference. In PCOS the AMH level is usually normal or high. An AMH that is almost zero, with very high FSH and LH, points instead to premature menopause, where the ovaries stop working early. An ultrasound scan completes the picture.
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This video is in Konkani; the guide on this page is in English.
In this short video, Dr Mayur Pai describes a patient he saw recently. Her periods had become irregular and then stopped, and she had been treated for PCOS for years without improvement. The tests showed something quite different. The lesson is for every woman with irregular periods: be sure of the cause before treatment goes on for years.
What happened in this case?
A young woman in her early thirties came to us because her periods, irregular for a long time, had now stopped for two or three months. She had no child and was hoping to have one.
For several years she had been treated elsewhere for PCOS (polycystic ovaries), but her periods had not improved, and she came to us feeling frustrated. Dr Pai is clear that he is not telling anyone to give up Ayurvedic or any other treatment they trust. His point is simpler: when treatment for PCOS is not helping, it is time to check whether PCOS is really the cause.
Which tests were done?
We looked at her reports and did three special blood tests, along with an ultrasound scan:
- AMH (anti-Mullerian hormone). It gives an idea of how many eggs are left in the ovaries, the egg reserve. It does not measure egg quality. See low AMH explained.
- FSH and LH. These are hormones the brain sends to the ovaries. They give extra information that helps the doctor understand what the problem really is.
- Ultrasound. The scan shows the ovaries and the size of the womb (uterus).
What did the results show?
Her AMH came back at about 0.02. Dr Pai stresses how different 0.2 and 0.02 are: 0.02 is almost zero. Her FSH and LH were both very high.
Together, these results meant that, young as she was, her ovaries had already stopped working, and her periods had stopped with them. This was not PCOS. It was premature menopause.
The ultrasound added a second important finding. Her womb had become small. It had started to shrink towards what doctors call infantile size, the size of a child's womb. The womb needs the hormone oestrogen, made by working ovaries, to keep its normal size, so when the ovaries stop, it can slowly shrink.
How is PCOS different from premature menopause?
Both can cause irregular or missed periods, which is why one can be mistaken for the other. Inside the ovaries, though, they are almost opposites.
- PCOS. The ovaries hold many small follicles, each with an immature egg. The eggs are usually there; they are simply not released on a regular schedule. AMH is usually normal or high, and FSH is usually in the normal range. What PCOS looks like on the scan is explained in PCOS: causes and ultrasound.
- Premature menopause. The ovaries stop working early, before the age of 40. Doctors also call this premature ovarian insufficiency. Very few eggs remain, so AMH is very low. The brain keeps sending more FSH and LH to ovaries that no longer respond, so these levels rise, and the periods stop.
A low AMH on its own does not mean menopause. Many women with a low AMH still have regular periods and release an egg each month. In this case it was the whole picture together: periods stopped, AMH almost zero, very high FSH and LH, and a small womb on the scan.
What can be done for her now?
Dr Pai explained her position to her clearly and honestly:
- Her own eggs. With her periods stopped and almost no eggs left, IVF with her own eggs is very unlikely to work now.
- The womb first. The first step is to try to bring the womb back to its normal size. For this, she will take tablets for three to six months.
- No promises. Whether the womb recovers is not in the doctor's hands. As Dr Pai puts it, it is up to nature.
- If it does recover. If her womb returns to a normal size and her periods come back properly, treatment with donor eggs may then become an option for her.
Why does an early, correct diagnosis matter?
Dr Pai's lesson from this case is about time. Years went by on treatment for PCOS, and by the time the right tests were done, her periods had stopped and her womb had become small. The egg reserve does not come back once it is used up. An early, correct diagnosis gives a woman the most time to understand her situation and make her choices.
When should you ask for these tests?
Ask your doctor about them if:
- your periods are irregular, or have stopped for a few months, and a pregnancy test is negative
- you have been told you have PCOS, but after some months of treatment your periods are no better
- you are trying for a baby and your periods are irregular
- women in your family have had an early menopause
These are simple blood tests and a scan. PCOS is common, and a low AMH does not always mean menopause, so there is no need to fear the worst. The aim is to be sure of the cause. If you do have PCOS and want a baby, read can you get pregnant with PCOS?
Where treatment happens
This guide is by Dr Mayur Pai, MBBS, MS (Obstetrics & Gynaecology), a fertility and laparoscopy specialist. Pai Hospital in Goa has its own operating theatre and its own IVF laboratory, so your blood test reports, scan and treatment plan are looked at together by one team that sees the whole picture. More of Dr Pai's talks in Konkani are on our Konkani fertility videos page.
Questions, or ready to book?
If your periods are irregular or have stopped, send a WhatsApp message to +91 95185 02773 with your situation and any reports you already have, such as AMH, FSH, LH or scan reports. Your first online consultation is free (one session). Consultations are by appointment, so please call Sheetal at our fertility reception on +91 95459 20817 to book a time. This article is for education only and is not personal medical advice; please consult your doctor about your own situation.
Your questions
Are irregular periods always caused by PCOS?
No. PCOS is a common cause, but not the only one. A thyroid problem, a high prolactin level, a big change in weight and, less often, premature menopause can also make periods irregular or stop them. Blood tests and a scan show which it is.
Which tests tell PCOS apart from premature menopause?
An AMH blood test, FSH and LH blood tests, and an ultrasound of the ovaries and womb. The doctor reads them together, with your age and your history, never one number on its own.
Is AMH high or low in PCOS?
Usually normal or high, because PCOS ovaries hold many small follicles. An AMH that is almost zero is not what PCOS usually looks like, so it needs a closer look.
What does an AMH of 0.02 mean?
It is almost zero, which means very few eggs are left in the ovaries. Dr Pai stresses that 0.2 and 0.02 are very different results, so read the decimal point carefully, and have the report read with your FSH, LH and scan.
Does a low AMH mean I have reached menopause?
Not on its own. Many women with a low AMH still have regular periods and release an egg each month. Premature menopause is suspected when the periods have stopped, AMH is almost zero and FSH and LH are very high, all together.
Can a womb that has become small go back to its normal size?
In the case Dr Pai describes, tablets are being given for three to six months to try. He is frank that whether the womb recovers is not in the doctor's hands; it depends on nature, and no one can promise it.
Or call +91 95185 02773
This page is for general education and is not personal medical advice. Treatment depends on your own examination and reports, so please speak to a doctor about your situation. We do not carry out or offer sex determination of any kind.