112. Irregular Periods: What Your Body Is Trying to Tell You

Irregular periods aren’t random—they’re your body’s way of signaling that something deeper may be going on. In this episode of Cycle Wisdom, Dr. Monica Minjeur unpacks the most common causes of irregular cycles, from PCOS and thyroid dysfunction to stress, hypothalamic amenorrhea, and more. Through Nora’s story, you’ll see how cycle charting plus timed labs uncover hidden issues that “normal” tests often miss. Discover how identifying the real cause of cycle changes can restore balance, improve fertility, and bring clarity to your health.

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Transcript

Speaker: 0:02

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're listening today. What if your irregular periods weren't random at all, but your body's way of flagging exactly where your system was struggling. Today we're going to map out the most common reasons that cycles go off track and how cycle charting plus timed labs can help to differentiate if you are having stress or hypothalamic amenorrhea or PCOS or thyroid dysfunction and other causes, so you can stop guessing and start fixing things. So let's get started, as always, with a patient story that we'll call Nora. Now Nora came to me. She was a NICU nurse and she had cycles that ranged anywhere from 24 to 55 days. She had been noticing some problems with acne along her jawline and had been noticing that when she was working the day shift, she had energy crashes in the afternoon, she started second guessing herself and tried to pay attention to her schedule because she did rotate and have different shifts that she worked. So she thought, is it my schedule? Is it my thyroid? Is it my adrenal glands? Is something really broken? After a visit to her OB doctor, they drew a lab test that checked her thyroid and she was told Your thyroid is normal because your TSH is fine. They gave her the suggestion to go on birth control pills in order to regulate her cycles, but she wanted answers, not just suppression. So she came to see us at our clinic. Okay, as always, we got her started with cycle charting and identified that she had a long variable phase of her follicular phase, which is the time between when her menstrual period stopped until the next time of ovulation. She occasionally had cycles that showed that she wasn't ovulating. Our next step was to get some timed lab testing done, and we evaluated her labs both in the early part of her menstrual cycle as well as again, about a week after she had ovulated. What we found is that she actually had some significant thyroid dysfunction despite her normal TSH lab tests that had been done. In fact, she had developed some thyroid antibodies showing autoimmune dysfunction. We also found that she had some metabolism issues with some high insulin levels and focused on really helping to restore her hormone levels because she did have some low progesterone levels after ovulation. So the reality was there was no one thing that was causing the irregular cycles. There were actually multiple factors that needed to be addressed. We worked together to pay attention to what was going on with her diet, her exercise levels. Added in some supplementations as well as prescription strength medications to help get ovulation happening on a regular basis. Again. Now, not only was Nora having cycles that had stabilized to about 30 to 35 days apart, but her energy levels were better, her mood was improved, and she said it finally makes. Sense because I measure the things that are going on in real time, and I can track my cycles every month to make sure that I'm aware of what's going on. So let's look at the big picture here, and we'll kind of talk through the most common causes of irregular cycles and how each of them looks a little bit different. So for the sake of this discussion, we need to start with understanding what are regular cycles. So regular cycles we typically classify as a cycle that's anywhere between 28 to 35 days apart. And we count a cycle from the first day of your actual flow of bleeding to the next day of your actual flow of bleeding. When we discuss bleeding, we talk about a flow that happens that to be seven days or less. Now some women have some spotting that happens before that. Some have some spotting or brown bleeding that happens at the end of that. But really we're focused on that overall flow being seven days or less. Now, bleeding patterns also become important when it comes to the diagnosis for these pieces, but for the sake of this discussion, seven days or less of bleeding with cycles that are happening 28 to 35 days apart. So one of the most common reasons for irregular cycles is PCOS or polycystic ovarian syndrome. Now, we discussed a lot about this in last week's episode number one 11, so you can go back and listen to Maya's story from there. But clues that PCOS may be playing a role are generally going to be longer cycles, typically happening even more than 40 days apart, or sometimes what's. Seems to be a complete skipped cycle, so up to 60 to 90 days or more between each cycles. Women with PCOS often also have signs of high androgen levels, high testosterone, so things like acne, facial hair growth. They may also have insulin resistance, can also have problems with their weight, and may have ultrasound findings of enlarged or polycystic ovaries on ultrasound. Now again, not all of those features have to be present for a diagnosis of PCOS, but it is one of the more common reasons that we see irregular cycles happening. Another common finding that we can see with irregular cycles is thyroid disorders. Now this may be underactive or it may be overactive, but generally these cycles are happening farther apart, and oftentimes they are heavier cycles, so more bleeding. We also are gonna be looking for other clues of thyroid dysfunction, so things like cold intolerance. So I'm feeling cold all the time, or maybe you're losing a lot of hair. Constipation can also be really common to find with signs of low thyroid function, or if you're having hyperthyroidism, so high thyroid function, you may notice diarrhea, heart palpitations, or anxiety. In many, many cases, TSH or thyroid stimulating hormone can be completely normal and misses autoimmune disease like we noticed here in Nora's case. Again, it's incredibly important to have a complete thyroid evaluation done so that we can understand the nuances not only of the thyroid gland production, but how your body is converting that thyroid hormone to the active form that binds to your cells, because this can make all the difference when it comes to irregular cycle. Another very common reason that we find irregular cycles is if you have excessive stress. Now, this can be emotional stress, but also maybe physical stress. So things like, I'm exercising too much and not eating enough foods. I've had a significant weight loss, intentional or otherwise I'm having troubles with my sleep or major life stressors. Things like. A move or a family death or a new job. All of these things can theoretically delay ovulation from happening, which can cause irregular cycles. So things that may show up as far as stress would be as if you're not having much cervical mucus or frequently not ovulating. We can also see a low or normal luteinizing hormone and follicle stimulating hormone and a feeling of. Troubles with sleep where you're feeling wired but tired, so maybe you're having frequent overnight awakenings, things that would trigger or identify that your cortisol or your stress levels are higher. Other common causes for irregular cycles may be elevated prolactin levels. Now, if your prolactin levels are elevated significantly, this can actually stop your periods from happening altogether. Now, high prolactin levels typically are from pituitary masses that are located in your brain, and so this can also mean that you have excess prolactin, which is. Responsible for milk production. So some women actually notice that their breasts are producing milk even if they're not pregnant or breastfeeding. And this is a clue or a sign that you wanna pay attention to if you may be struggling with high prolactin levels. If these micro adenomas are causing problems, they also can get enlarged and cause headaches or even visual changes if they can get really big. So high prolactin levels can cause irregular cycles, even at lower or moderate levels. Other times that we can have irregular cycles can include perimenopause transition, or premature ovarian insufficiency. Now, clues that this may be what's going on, oftentimes are gonna be cycle variability added to other menopausal or premenopausal symptoms. So think things like hot flashes or night. Elevated follicle stimulating hormone, low estrogen levels, and low progesterone levels that can fluctuate. For more information on this, go back and check out episode number 1 0 6 where I talk about thriving in the transition of perimenopause, because this gives a great overview as far as what are the other symptoms to watch for when it comes to perimenopause. And then the final two categories. One would be if you are coming off of the pill or postpartum or breastfeeding. Now this is typically going to be a temporary suppression of ovulation, and sometimes it just requires a bit of time and charting to confirm a return of normal ovulation. But this can absolutely be a part of that normal transition. And then the final thing that can cause irregular cycles would be endometriosis, fibroids, endometritis, chronic illness. Medications, things that can cause actual anatomic changes and need to be differentiated. Is this a true menstrual cycle or is there some other cause of irregular bleeding that might be happening? So even though we have the same symptom of irregular cycles, there's very different mechanisms. Timing, context, and understanding of the lab evaluation, as well as the charting signs that we see that make all the difference in the world. So our focus with restorative reproductive medicine is not just to throw the birth control pill or some other form of suppression at any cycle that is irregular. It is so critically important that we map out your cycle, understand what's going on from the charting standpoint, and start to log your other symptoms that you're seeing along with it. Because this gives us so much information and data to be able to understand the why your cycles are irregular, as well as help us to understand what we need to do about it. Again, as we have discussed over, and again, it's so important to make sure that we're doing that full lab evaluation. Again, episode number one, 10 goes into depth as far as what should be done. For anybody that has irregular cycles. We want to make sure that we're targeting every piece from the hormone standpoint to thyroid, to adrenal gland function, to metabolic and insulin resistance, to understand what are we dealing with and how do we get that clear diagnosis. In many cases, we also want to evaluate with an ultrasound. This helps us to evaluate for things not only like PCOS, but also to rule out any other structural factors that may be causing issues. Things like excessive thickening of the endometrium or the uterine wall lining. Things like irregularity to your cysts or your ovaries that may be happening, or things like polyps or fibroids that may be causing excessive bleeding. And then when we can see all of those pieces together, the charting, the labs, the ultrasound, then, and only then can we understand what is your specific diagnosis and reason for those irregular cycles. The other thing that I would add in here that we evaluate often with irregular cycles is brown bleeding. Now, as I mentioned, that bleeding pattern that can happen typically should be just a normal flow, and we define a normal flow as something that requires a menstrual product, something like a tampon or a pad or a cup or a disc to be utilized to manage that flow. And many women experience what we call brown bleeding or light bleeding or spotting. That happens either before that flow starts or right at the tail end of it. And in many cases, this is not considered normal. It can be from hormone dysfunction, it can be from thyroid dysfunction, it can also be from chronic inflammation or a chronic infection. And all of these things need to be evaluated to have a better understanding for what we need to do to evaluate your health. And specifically how this may impact your fertility if this is playing a role. So I can't underscore enough. It's not just about the timing between each cycle, but also what that bleeding pattern shows us. So how can you advocate for yourself if you have an irregular cycle? First and foremost, please don't accept just being put on birth control or some type of hormonal suppression. This does not fix the underlying problem, and in many cases it can mask other symptoms and signs that maybe your body is trying to tell you, Hey, something is not right here. So always work towards timed cycle lab testing. Look for things like insulin resistance, insist upon a full spectrum thyroid evaluation, including antibody levels, because so often as was Nora's case, we find that this plays an important role, not just for your overall health of your menstrual cycles, but long-term health as well. Okay. We always want to audit your cycles to say what is going on from a standpoint of my exercise, my energy levels, how am I making sure to incorporate regular exercise, but not too much, and making sure that we're adding in that ultrasound evaluation to assess for any anatomic or structural abnormalities, especially if you are having heavy bleeding or cycles that are happening closer together. And then most importantly, once we have been able to identify the underlying diagnosis, instituting treatment that is appropriate for your diagnosis, and making sure to have significant and frequent follow up with labs, reevaluation of your charting and making sure that your treatments are structured specifically to your unique needs. Always working towards regulating those cycles in a way that not only helps you to feel better, but also helps to promote long-term health and fertility. Imagine if instead of having irregular cycles that left you confused, you finally had information to empower you to understand what was going on. Your charting can tell a more clear story, especially when your labs are drawn on the right days and you have a plan that is matched to why your cycle is irregular, not just a prescription or a bandaid that masks those symptoms. Imagine your period becoming a monthly check-in that has a better reflection of your overall health. No more mysteries. This way forward is possible, and if you are struggling with irregular cycles, I can't wait to work with you to uncover that mystery and have a clear path forward to your specific diagnosis and a treatment strategy that not only empowers you, but helps to improve your health for the long term.

Monica: 15:27

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