PCOS: Log Your Cycle and Symptoms for the Doctor

Your last period was two months ago, the one before came after five weeks, and at the appointment it all shrinks to "pretty irregular". For suspected PCOS, those gaps over months are exactly what counts, along with your skin, hair and mood. In Sam's cycle tracking you log each bleeding day with its flow, and Sam counts your cycle lengths from shortest to longest, so you are not counting back through a calendar. Acne, hair loss and fatigue go in the symptom diary.

What does your doctor need to know about your cycle?

The cycle comes first. The 2023 international evidence-based PCOS guideline defines when cycles count as irregular. The limits depend on how long ago your first period was:

• first year: irregular cycles are part of puberty, says the guideline; a heavy bleed still needs checking
• one to three years: cycles shorter than 21 or longer than 45 days
• three years until perimenopause: cycles shorter than 21 or longer than 35 days, or fewer than eight a year
• from one year on: any single cycle longer than 90 days

When cycles like these show up, the guideline says PCOS should be considered. A bleed normally shows that a new cycle has begun, explains InformedHealth.org from the German institute IQWiG. That holds as long as you are not pregnant and not on hormonal medication that suppresses the cycle. So a cycle runs from the first day of one bleed to the first day of the next.

In your log, the first day of each bleed matters most. Add how many days it lasted and how heavy it was. Most periods last three to seven days, the same source says. Keep spotting between periods on its own line. A log over months says more than one over four weeks. A single long cycle can last more than two months. Do not wait for that, though. Start today, add what you remember, and book the appointment now. You can see a doctor with a few entries or with no log at all.

An invented example, not a real person and not a benchmark:

Under the guideline's definition for more than three years after the first period, cycles 2 and 4 are longer than 35 days. Cycle 4 also passes 90 days, a reason to get checked soon (see below). Whether your cycle is irregular in the medical sense is for your doctor to say. Do not postpone an appointment because your own numbers look fine.

What else belongs in the log besides bleeding?

The guideline asks clinicians to check for signs of raised male hormones. These are acne, female pattern hair loss and excess facial or body hair, called hirsutism. They should take unwanted hair growth and hair loss seriously, however mild these look. Many women remove such hair, which makes the signs look milder at an examination, the guideline notes. Your own account is considered highly valid. So note:

• Acne: where, how bad and whether it comes and goes.
• Hair on your head: whether it is thinning.
• Hair on your face or body: where it grows and how often you remove it.
• Start and pace: since when, and whether it grew slowly or quickly.
• Thick, dark patches of skin on the neck or armpits, which the NHS lists as a possible sign.
• Fatigue and mood: low mood, anxiety, mood changes.
• Sleep: whether you snore, wake up unrefreshed or feel very sleepy in the day.
• Medication: everything you take, hormonal medication included, with start and stop dates.

Start and pace matter because signs that are new and severe, or quickly getting worse, need further investigation, according to the guideline. That rules out other causes.

Mood and sleep belong on the list too. The guideline recommends screening all adults with PCOS for depression and anxiety. The WHO also names eating disorders and a negative body image. Obstructive sleep apnea is more common with PCOS, independent of BMI. So the guideline asks about snoring together with waking unrefreshed, daytime sleepiness or fatigue. More in sleep apnea: what to log for your sleep doctor.

Hormonal medication goes on the list for a practical reason. On combined oral hormonal medication, male hormones in the blood are very hard to assess reliably, the guideline says. AMH can come out lower as well. Such products suppress the normal cycle. A bleed on them is a withdrawal bleed, usually lighter than a period, says the German family-planning portal familienplanung.de. Do not change your medication without talking to your doctor. For a full list, see what to include on a medication list.

And weight? PCOS is not only a condition of people with higher weight. Germany's federal health portal says 50 to 80 percent of women with PCOS are overweight, so many are not. The guideline names the raised type 2 diabetes risk "regardless of age and BMI". It sees weight as one indicator of health among several. Clinicians should seek permission before weighing.

Which features do the guidelines use for a diagnosis?

For adults, the international guideline needs two of three features, once other causes are ruled out:

• signs of raised male hormones, seen as hirsutism or measured in the blood
• a cycle disorder, usually shown as irregular cycles
• polycystic-looking ovaries on ultrasound, or a raised AMH level

The German S2k guideline, written by the German Society of Endocrinology with other medical societies, uses the same rule, according to the Deutsches Ärzteblatt. It accepts a high AMH level as a criterion. The WHO uses the same two-of-three rule but names only ultrasound as the third feature. For blood tests, the international guideline names total and free testosterone.

AMH is not needed when irregular cycles and signs of raised male hormones are already present. It should never be the only test and should not yet be used in adolescents. Age, weight, hormonal products and the day of your cycle all affect it.

At diagnosis, the guideline also calls for a check of glucose metabolism. It is repeated every one to three years, depending on risk. The oral glucose tolerance test is named as the most accurate. Which tests make sense for you is your doctor's call.

Is PCOS becoming PMOS, and why does this page still say PCOS first?

On 12 May 2026 the Lancet published the result of a global consensus process: polycystic ovary syndrome becomes polyendocrine metabolic ovarian syndrome, or PMOS. Five German medical societies welcome it, among them those for endocrinology, diabetes and gynecology. Their joint statement of 26 June 2026 gives these reasons:

• The structures seen on ultrasound are small follicles, not cysts.
• The condition involves hormones and metabolism, with a raised risk of type 2 diabetes and heart and vascular disease, among others.
• Up to 70 percent of those affected are undiagnosed.
• The old focus on the ovaries alone has added to stigma.

A three-year transition is planned, and the societies suggest writing "PMOS (formerly PCOS)" until then. The NHS has already renamed its page.

We still put PCOS first because it is most likely the term you know and searched for. Both names mean the same condition, and you may hear either at your appointment.

How do you prepare for the first appointment?

The NHS says to see a GP if you think you might have PMOS. The same applies if symptoms affect your everyday life, work or relationships. A GP may arrange blood tests and an ultrasound scan, which the NHS offers only to people over 18. They may refer you to a gynecologist or an endocrinologist. What to bring:

• your cycle log, on paper or as the Cycle report from Sam
• notes on skin, hair, mood and sleep, with start dates and changes
• a medication list including hormonal medication, with start and stop dates
• earlier lab reports and letters from other doctors
• your questions, for example: Which tests make sense for me? Does my hormonal medication affect the blood results? When will my glucose metabolism be checked?

Earlier lab reports can go in Sam's Health Vault. With your consent, Sam reads the values from the report. Glucose, HbA1c, cholesterol and ALT are among the values Sam matches by name. Testosterone, LH, FSH, AMH and estradiol are not. For those rows, name, value and unit stay as printed, plus the first reference range your lab printed. For every value with a printed range, the value card shows "High", "Low" or "In range", worked out against the first printed range only. For rows such as testosterone, LH or FSH it is not an assessment of your results, and it can be wrong, for example if your lab prints separate ranges for women and men. Check the values against the original. What the values mean is for your doctor to discuss with you.

To describe symptoms briefly, use the doctor appointment checklist for a chronic condition. If you have felt brushed off before, read when your doctor does not take your symptoms seriously.

When should you not wait for the appointment?

A heavy period should be checked by a doctor. Germany's federal health portal names two signs. You often need to change a pad or tampon after only one to two hours, or you pass many thick clots. The NHS also lists severe period pain and bleeding between periods or after sex as reasons to see a GP.

Ask for an urgent GP appointment if new thick, dark hair suddenly starts growing on your face and body. The same applies if your voice is getting lower or your muscles bigger, the NHS says. Per the guideline, signs of raised male hormones that are new and severe, or quickly getting worse, also need further tests.

If you go longer than 90 days without a bleed, get it checked by a doctor soon. If you could be pregnant, do not wait that long: the MSD Manual names pregnancy as the most common reason periods stop in women of childbearing age. It gives more reasons to see a health professional. Among them are three missed periods, fewer than nine periods a year and a sudden change in pattern.

If dizziness, shortness of breath or a racing heart come with heavy bleeding, get medical help the same day. The federal portal lists these as possible signs of more severe anemia. In the UK, contact NHS 111. If the breathlessness is severe, skip this route and call your local emergency number.

Call your local emergency number (112 in the EU, 999 in the UK, 911 in the US) for:

• severe breathlessness, where you are gasping or cannot get words out
• sudden, very severe pain low in the abdomen together with dizziness or fainting
• fainting with chest pain or a racing, pounding or irregular heartbeat
• fainting while exercising or while lying down
• fainting with a serious injury or with a seizure (shaking or jerking)
• fainting where you do not fully recover, or have difficulty speaking or moving afterwards
• someone who is not breathing, or who cannot be woken within a minute, after fainting
• bleeding that cannot be stopped

Do not wait for these to pass. If you have thoughts of harming yourself, call your local emergency number or a crisis line. Samaritans answer free on 116 123 in the UK, day and night. In the US, call or text 988, free and open around the clock. Sam replaces neither an emergency call nor an examination.

What does Sam keep, and what stays on paper?

In cycle tracking you pick the flow for each bleeding day: spotting, light, medium or heavy. Under "How it went" you pick from fixed answers how the bleeding affected your day, such as "Changed my plans". Sam counts spotting separately and keeps it out of the period. Sam brings in bleeding days that are already in Apple Health when you open cycle tracking, as long as you have allowed Apple Health access, going back up to two years. Days with a flow level are brought in; days without a level and spotting from Apple Health are not. Missed days you add later. Once you have logged two periods, the "Your cycles" card shows your cycle length and the days of your period. If a whole period is missing, two cycles merge into one long one.

The Cycle report is a PDF of your whole record: cycles recorded, cycle length, bleeding days per period and days of bleeding between periods. Where they apply, it adds the rows "Cycles outside 21-35 days" and "Periods longer than 8 days". The 21 to 35 day range is fixed. It takes neither your age nor the time since your first period into account. Sam does not classify any cycle as regular or irregular. The report itself notes that the counts are self-reported minimums. What they mean is for your doctor to interpret.

The symptom diary has Acne, Hair loss, Fatigue, Low mood, Anxiety and Pelvic pain, each rated mild, moderate or severe. You can also reach it under "Also noticing" in the cycle sheet. Mood changes and Snoring are logged as present. There is no entry for unwanted hair growth; add it as your own symptom under "Other". Each symptom gets one entry per day, with no time of day and no note field.

You create the monthly report yourself, from the 1st of a month for the month before. It shows symptom days on a calendar and your five most logged symptoms. It needs notifications allowed, Apple Health access and the question about your conditions answered. From the second report on, you also need a log of how you felt on at least 15 of the last 30 days. Symptom entries do not count toward that.

Paper keeps where hair grows, how often you remove it, when something started and anything in your own words. What else Sam shows for this condition is on the PCOS page.

Log your cycle and symptoms in Sam and bring the Cycle report

You walk in with counted cycle lengths instead of "pretty irregular", with no adding up the night before.

• Instead of flicking through a calendar: you log each bleeding day with its flow, and Sam counts cycle lengths and bleeding days, with spotting kept apart.
• Instead of a note in your bag: you tap acne, hair loss or low mood per day as mild, moderate or severe, and unwanted hair growth as your own symptom.
• Instead of loose notes: you take the Cycle report as a PDF, and the monthly report you create yourself shows your symptom days.

Sam counts only what you log or import from Apple Health and does not diagnose; times of day and free notes stay on paper. More on the PCOS page.

Try Sam for free

Sam is a wellness companion, not a medical device. The app does not diagnose, treat, cure or prevent any condition or health state. Always consult qualified professionals for medical decisions.

Related reading

• Which doctor for PCOS: GP, gynecologist or endocrinologist?
• PCOS blood test: which labs doctors check and why
• Symptom diary: paper template or app?
• Sleep apnea: what to log for your sleep doctor
• Medication list for your doctor: what to include
• Doctor appointment checklist for a chronic condition
• When your doctor does not take your symptoms seriously

Sources

Updated: October 2026

• Teede HJ et al.: International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2023, summary (PDF). Monash University with ESHRE, ASRM, the Endocrine Society and ESE (recommendations 1.1.1, 1.2.1, 1.2.6, 1.3.3 to 1.3.7, 1.5.1 to 1.5.6, 1.9.1 to 1.9.10, 1.10.1 to 1.10.2, 2.2.1 to 2.2.2, 3.6.4)
• Teede HJ et al.: Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process. Lancet 2026;407:2329-2339, published online 12 May 2026 (read: PubMed record)
• DGE, DAG, DDG, DGGG and DGPAED: Joint statement on the international renaming of PCOS to PMOS (PDF, German) (26 June 2026)
• Deutsches Ärzteblatt: New guideline on polycystic ovary syndrome published (German) (13 August 2025; report on the S2k guideline AWMF 089-004, whose full text we could not open in the AWMF register)
• WHO: Polycystic ovary syndrome, fact sheet (22 January 2026)
• NHS: PMOS (reviewed 30 June 2026), Hirsutism (reviewed 18 August 2025), Heavy periods (19 September 2024), Shortness of breath (30 January 2024), Fainting (17 August 2026), Ectopic pregnancy (23 August 2022)
• German Federal Ministry of Health, gesund.bund.de: Polycystic ovarian syndrome (PCOS) (as of 23 June 2021) and Heavy periods (German) (as of 5 February 2026)
• InformedHealth.org (IQWiG): How does the menstrual cycle work? (German edition) (updated 23 February 2022)
• familienplanung.de: Withdrawal bleed (German)
• MSD Manual, consumer edition: Absence of menstrual periods (German edition) (fully reviewed August 2025)
• Samaritans: Contact a Samaritan (call 116 123, free, 24 hours)
• 988 Suicide and Crisis Lifeline: 988lifeline.org (call or text 988, free, 24/7)