50. Cycle Length Matters

Join Dr. Monica Minjeur on Cycle Wisdom as she celebrates the podcast's first anniversary and delves into the nuances of menstrual cycle length. In this milestone 50th episode, Dr. Minjeur discusses the importance of understanding and regulating cycle lengths for overall health and fertility. Featuring patient stories and practical advice, this episode offers insights into addressing cycle irregularities, whether they are too short or too long, and highlights the critical role of progesterone. Tune in for expert guidance on achieving natural, healthy menstrual cycles.

Transcript

Monica: 0:01

Welcome back to Cycle Wisdom, where we empower women to restore natural menstrual cycles to improve health and promote fertility. I'm your host, Dr. Monica Minjeur, and I'm so glad you are listening today. I would like to start off today by thanking you for your support as we celebrate the Cycle Wisdom podcast being one year old this week. This is our 50th episode. And as of this recording, we have reached over 10, 000 downloads since we started in July of 2023. I am so grateful for the opportunity to provide education regarding natural menstrual cycles and fertility with all of you. And I would love for you to share this podcast with others who need to hear these messages. Now if you could take just a quick moment to pause this episode and leave us a review or even just add some stars so others can find us, I would be so thankful. Just take a quick pause. I'll be right here waiting for you to come back. I look forward to the next year on this adventure of continuing to empower you to know more about how to achieve natural menstrual cycles and promote fertility. I'm planning to host many more guests over the next year to expand our horizons a bit more into areas that are new to me. I am also looking for your suggestions for new podcast topics to make sure I'm talking about things that interest you. If you have a great idea you would like me to talk more about or to find an expert who can share more with us, please send an email to hello at radiant clinic. com and I'll add your idea to my list to research. So now let's get on to episode number 50 for today. On today's episode, I'm going to be talking about how you can impact the length of your menstrual cycles. We'll start off with talking about what is a normal cycle length and how to know if you have anything to be concerned about. I will discuss further what to do if your cycles are too far apart, too close together, and how you can make a difference through understanding what is happening with your cycles. So as always, let's get started with a patient story about a past client of mine who we'll call Kendra. Now Kendra was getting her period about every 21 to 22 days each cycle. And initially this didn't bother her too much. But after she got married and started trying to have a baby, she knew she needed to do something to evaluate this further. Her OB doctor had recommended putting her on birth control to get her cycles to be a bit farther apart. However, when Kendra explained to her doctor that she was trying to get pregnant, they told her she didn't really have any other options and she should just try to achieve a pregnancy and let them know if they didn't have any luck after a year of trying. Now luckily her sister had been seeing me as a patient for some similar issues and sent Kendra our way to see me for further evaluation. As always, we started off with having her chart her cycles because I was especially curious about when she was ovulating in relationship to these short menstrual cycles. Once we were able to see a more clear picture of her charting patterns, I ordered lab work timed to her cycles for further evaluation. Kendra's lab results showed that she was quite deficient in progesterone, which was causing her to have a shortened luteal phase. Now again, that luteal phase is the time from when you ovulate until the first day that your next menstrual cycle begins. Once we had figured out the cause of her short cycles, it was very easy to make the proper recommendation of adding in progesterone timed to when it should naturally be increasing in Kendra's cycles. This had the direct and immediate effect of lengthening out her luteal phase the very first cycle she began the medication, and her cycles now began to be about 28 to 30 days apart. She went on to conceive a pregnancy naturally once her cycles were in the right range with the support of progesterone. Now, another important point with this is that had we not corrected the progesterone deficiency prior to pregnancy, Kendra would be at an increased risk of miscarriage because she was already going into early pregnancy with levels that were too low. And when your progesterone levels are too low, it can lead to troubles with placental development and implantation. So this is why it's so important not to ignore an irregular pattern and why you should work to find the root cause of those abnormalities instead because we can really impact other things down the road even if you're not trying to get pregnant at the time. So let's talk a little bit more about what a normal menstrual cycle looks like. So when we look at the strict criteria or definitions as far as what normal is within the realm of a menstrual cycle, there can be some variability depending upon whose guidelines you follow. But in general, we're looking for cycles that are happening at least 25 to 35 days apart. Anything less than that is going to be considered a short cycle. Anything longer than 35 days is going to be considered a long cycle. As far as your bleeding pattern, we're looking for bleeding or actual menstrual flow of no more than seven days. We should not see any significant spotting or brown bleeding prior to the onset of the flow of menses and we should not be seeing more than two to three days of brown bleeding towards the end of your menstrual cycle. The other thing that's really important as we noted in Kendra's case is that it's not enough just to say how frequently are your cycles happening. We also want to be looking for that luteal phase to be normal. So again, that luteal phase from the day that you ovulate, so the first day after ovulation, Until the first day of your menstrual cycle, that's your luteal phase. Now, different charting methods for fertility awareness have different recommendations as far as what's normal, but if we look at most of them out there, we're going to say a normal luteal phase is anywhere from nine to 15 days. Most of the time we're going to be optimizing that and really looking somewhere between 12 to 14 days. Anything much shorter than that and we can have some concerns for progesterone deficiency. Anything much longer than that and we worry about some other ovulatory defects. So let's talk a little bit as far as what a short cycle is or a short luteal phase. Now a short cycle doesn't always mean you have a short luteal phase and this is why it's important to be charting to know when ovulation occurs. Most frequently when we see a short cycle, so anything that is less than 25 days between the first day of flow of bleeding from month to month is going to be considered a short cycle. And most of the time we're going to see that that's because of a shortened luteal phase, so the time from ovulation until menses. However, sometimes we do see that a short follicular phase can cause that, and that doesn't always mean there's anything abnormal, but we do want to identify where the issue is. Sometimes we'll see that lab evaluation in these short cycles can be completely normal. Sometimes we can see that a woman is not actually ovulating and most commonly we're going to find some sort of progesterone deficiency especially if there's a shortened luteal phase. Now the most frequent thing that we're going to do in order to try and fix this is to correct the underlying problem. So again, determining what is the underlying problem is going to help direct that treatment course. Frequently, we end up providing progesterone support in order to help lengthen out that luteal phase. And again, it's very important to make sure this is timed with the cycle because we want to be augmenting what naturally should be occurring, which is an increase of progesterone at the time after ovulation. Now, if instead the luteal phase is normal, but it's that follicular phase that is short, you may need help with some estrogen support or treatment for an ovulation dysfunction. So again, it's really important to understand when are you ovulating because that helps determine what is the reason or the cause for that shortened cycle, as well as helps point to the direction that we need to go when we're looking for lab evaluation and treatment course. Now, on the flip side, if we're talking about long cycles, these are going to be defined as anything that is greater than 35 days between the first day of actual flow of bleeding from cycle to cycle. Now in some women, long cycles may end up being multiple months between cycles. When we look at lab evaluation and charting, we oftentimes will see anovulation, so somebody is not ovulating when they have long cycles. Other common abnormalities we find with long cycles may be thyroid dysfunction. Typically this is going to show up as an underactive thyroid. And the other thing that we can see is excessive androgen levels. So think about your elevated testosterone levels, DHEA, androstenedione. Often times we're going to see these excessive androgen levels go along with PCOS, which is one of the common causes for having these long cycles. Now, although PCOS is one of the most common things I see when I evaluate a woman that has long cycles, We also can see troubles with hypothalamic amenorrhea. So meaning you have a problem with the hypothalamus causing you to not have cycles. This can often be triggered from eating disorders, people who are underweight, or if you're not getting enough caloric intake in people who are extreme athletes or maybe they are college athletes, somebody who is very, very active and is expending more energy than what they are taking in for calories on a regular basis. Now again, the correction for these long cycles is going to be to fix the underlying problem. So first of all, looking at the lab work, looking at the charting, identifying what the underlying cause is, and then working together with the woman to say, Hey, let's get your cycles back on track. Okay. Okay. Whether that means we need to trigger a withdrawal menstrual bleed with progesterone, we need to help stimulate ovulation to occur, if there is a thyroid dysfunction, it may include thyroid supplements and or medications, and if the problem is that they are underweight or not getting enough calories in, to work towards gently increasing their weight and or their net caloric intake. Sometimes this can also mean that we are recommending athletes are cutting back on the intensity of their exercise in order to help their menstrual cycles return, because if this goes on long term, having long cycles and chronic anovulation can actually lead to increased problems when you get older with osteoporosis. with certain types of cancers and with really long term effects and impacts on your fertility. So although some women say, hey it's great, I don't have a cycle all that often, we know that the long term health implications of that are not great. So we really want to focus on getting those regular cycles back. The last thing I want to talk a little bit about today is unusual bleeding when it comes to your menstrual cycles. Now this is going to be defined as anything that is bleeding more than seven days or if you're having bleeding at times that aren't within that first seven days of your menstrual cycle. So whether that means some ovulation bleeding or, uh, even spotting or whether that's some bleeding or spotting that's happening before the onset of an actual menstrual flow, Now, the evaluation we do for this is really going to be dependent upon your time frame. And so we can kind of separate this out into two general categories. One is going to be hormonal causes. So typically if you're having that pre menstrual bleeding or spotting, that's going to be a progesterone deficiency if that onset is prior to menses. The other time we'll see this is that if you have an estrogen dominant situation. So last week's episode, we talked about the different reasons that you can have estrogen dominance, but that can lead to some prolonged menstrual bleeding. If you're having an actual menstrual flow, that's greater than seven days. Now, other reasons that we can have unusual bleeding can be anatomic causes. So most often this is going to show up during ovulation or during the actual menstrual cycle itself. So again, depending upon the underlying cause, that's going to help us work towards correcting the underlying problem as that fix. So if there is a hormonal imbalance, we're going to work to treat that estrogen dominance or the progesterone deficiency, depending upon the cause of that unusual bleeding. If there is something going on from a standpoint of uterine polyps or adhesions, you may need surgical intervention in order to treat that underlying cause of the bleeding. If there is a chronic inflammation or infection going on in the uterine lining, we call that endometritis and that can sometimes require some antibiotics in order to take care of treatment for that. And then the final thing we'll talk about is that you can have actual inflammation of the cervix itself. itself. Now this can also be called a cervical ectropion and we treat that in the office with silver nitrate to help reduce the inflammation, to help those cells to heal and to correct that underlying ectropion, in which cases the unusual bleeding oftentimes will resolve. So again, that unusual bleeding doesn't always mean that we should just go on birth control. It means we need to do more to figure out the underlying cause and correct that cause, whether it's hormonal. or whether it's anatomic or sometimes you've got a little bit of both going on. Imagine if you could work to find the underlying cause of your menstrual cycle length abnormalities and then treat that root cause appropriately to improve your health and promote fertility. If you're ready to work with our elite team of healthcare professionals, go to our website, radiantclinic. com, to schedule a free discovery call with me and learn more about our package based pricing for comprehensive care. We are currently able to see people for in person appointments in the Cedar Rapids, Iowa area, or can arrange for a telehealth visit if you live in the state of Iowa or Illinois. Thank you so much for listening to this episode. Please share this podcast with someone in your life who would benefit from our services. Remember to subscribe to this podcast for more empowering content that I look forward to sharing with you on our next episode of Cycle Wisdom.