That’s On Period – Part 2 – Irregular Periods

By Dr. Olivia Watkins, ND

In part 2 of our series on PMS symptoms, irregular periods, painful periods, and abnormally heavy periods, we are discussing irregular periods. You’ll learn about the types of irregular periods, their symptoms, and some ways to treat them naturally.

Irregular Cycles

I’ve broken this down into three different categories:

• Amenorrhea, which means the absence of a period
• Polymenorrhea, meaning having a period frequently, a cycle that’s 21 days or less
• Oligomenorrhea, which is having an infrequent cycle, one that’s 35 days or longer

How to Count Your Period’s Cycle Days

Before we get into those different descriptors, I like to talk about how we count our periods, or cycle days, and understand what’s going on there. Many apps are available now that help us count the cycles, but it’s good to understand what we are counting.

Whenever you’re thinking about your period, the first day you start bleeding is cycle day one. That’s the first day of your cycle, and then you count from there.

Let’s say you started bleeding on the 16th; so that’s cycle day one. Saturday, which is the 17th, cycle day two, and we keep counting from there until we start our period again. This is how we can tell our cycles 28 days or 35 days or 33 days. This is how you count your cycles.

Amenorrhea Causes

We classify amenorrhea as the absence of a period for three or more months in a woman with regular periods or a woman who has a history of irregular periods going six months or more without a period. There are five major classifications or five different ways that this could happen.

1. Disorders of the vagina or the uterus. These can be anatomic abnormalities or even genetics that can cause the organs to develop differently and cause the body to not have a regular period.
2. Disorders of the ovary. These are issues with the actual ovaries themselves. PCOS is a prevalent condition that I see in practice.
3. Disorders of the pituitary gland. Imbalances between some of those endocrine hormones that Dr. Turner was talking about in our Hormones 101 article. LH and FSH are two hormones that we look at whenever we look at periods, fertility and menopause. TSH, a thyroid hormone, and then prolactin, is a hormone that we see with elevated periods that are typically irregular. This is a stress hormone, which usually indicates that we need to help that person or patient with their stress management.
4. Disorders of the nervous system. Issues with the hypothalamus, that part in the brain that signals the rest of that cascade.
5. And stress.

Then there are other causes. Pregnancy will, of course, cause our periods to cease. Excessive exercise or low body fat, we see this with our gymnasts, with our bodybuilders, with our extreme athletes. We need fat to make our hormones; cholesterol is the first starting point in making our hormones. So if we have low fat in our diet and low body fat, then we’re not making those hormones to have a period to start all of those different processes. That excessive exercise keeps that body fat low, so they tie into each other. And, of course, eating disorders will cause nutritional deficiencies and low body fat; we see that again there. Medications, substance abuse, chronic illness, and contraceptives can all cause periods to be absent.

PCOS

PCOS is a syndrome that can look so different and is very common, but the main thing about this picture here is it’s showing you the different cysts within the ovary. So on the left side, you can see the inflamed ovary is larger than the other side, you see those cysts there, which are cysts for when the ovaries try to ovulate, but they weren’t able to, and then it creates cystic ovaries.

PCOS Symptoms

Some symptoms that we see with poly-cystic ovarian syndrome:

• Pelvic pain
• The cystic ovary. So here we take an ultrasound to look at the ovaries and see if those cysts are there.
• Acne
• Cystic acne, usually around the chin and on the back.
• Headaches
• Infertility
• Heavy bleeding
• Irregular menses. Sometimes patients get their periods monthly, and sometimes they go months without a period.
• Weight gain
• Imbalances in blood sugar are also very common with PCOS.
• Hair growth

Why Are These Things Happening?

These things are happening in PCOS because of hormonal imbalances. With PCOS, there are so many different variants, so many different things that could be happening, and that’s why I like to use these graphs to discuss what those overlapping things can be.

The primary way that we diagnose PCOS is the Rotterdam criteria:

1. Irregular periods.
2. High androgens. So high DHEA, one of those hormones made in the adrenals that we talked about earlier, is converted into testosterone. Typically testosterone and DHEA are elevated in PCOS, so we see cystic acne, irregularities in the periods, and some of that hair growth.
3. And then the multiple cysts.

This is the most popular criteria. But again, not every person with PCOS will present this way.

PCOS Risks

We see some psychological issues that occur due to PCOS, including depression and anxiety, . Increased negative body image can occur from weight gain. We also see low self-esteem, eating disorders, and overall poor quality of life as far as the reproductive realm.

When the ovaries have cysts, and you have irregular cycles, it can eventually lead to infertility, which can be stressful later in life.

Metabolic imbalances, insulin resistance, is something PCOS can cause, resulting in obesity and dyslipidemia, which is lipids or cholesterol which are out of normal limits.

We also see pre-diabetes, diabetes, or even cardiovascular risks. This is why when we’re working up PCOS, we must get a comprehensive history on the patient so that we can assess all these different areas to see if the person has an irregular cycle, where is it coming from, how do we best support and treat them moving forward.

PCOS Treatment

We start by treating the whole person; that’s one of our naturopathic principles. We don’t want just to treat the symptoms. We want to treat the root cause, and we want to treat the whole person. We work on treating their stress, treating the weight if they’re overweight, treating insulin resistance or diabetes. Some of the ways we treat PCOS is by:

• Focusing on the diet: making sure that this person is on a whole foods diet, whole grains, fruits, vegetables, nuts and seeds, and fish. Adequate protein and fat are essential.
• Exercise: exercise is vital, especially if we’re dealing with someone who does have excess weight gain or obesity in their picture.
• Botanical nutritional supplementation: once again, herbs are super, super helpful whenever we treat imbalances within the cycle and our hormones.
• Birth control: birth control is really popular in the conventional world in treating some PCOS symptoms. We like for our patients to have all of their options and be really informed to make the best choice for themselves.

These are just a few of the things that we do for PCOS; this treatment plan looks completely different depending on the person. I could see three women with PCOS, and their treatment plans will all look different because it is individualized to that specific person and what their presentation looks like.

Risks of Amenorrhea

What are the risks of not having a period? I hear very often whenever women don’t have a period, and they’re happy about it because usually, our periods suck; it’s not a fun time. But there are consequences to going without a period.

Estrogen is essential for a host of reasons: it is important for our bones, it is important for protecting our heart in our vessels, estrogen is important for maintaining our uterus and making sure that the lining is healthy, and it’s also important for keeping our cycles regular. If we do not have a period, we do not have those monthly fluctuations of estrogen and progesterone doing what they need to do. This puts you at a higher risk of stress factors and osteoporosis. This is why when women hit menopause and have a decrease in their estrogen, they’re at a higher risk of osteoporosis and stress factors.

Cardiovascular disease is another risk that increases in women who have had a history of irregular periods or absent periods. Endometrial hyperplasia is estrogen continuing to grow the uterine lining. Periods are so healthy because we grow that lining every month, and then when the estrogen and progesterone decreases, we lose that lining. If we’re not having that play and hormones, that lining just continues to grow. And that can be problematic. And then, of course, infertility is another risk of amenorrhea.

Polymenorrhea

Polymenorrhea is having a period every 21 days or less.

Some of the causes of polymenorrhea are:

• Hormonal imbalances between estrogen and progesterone.
• Uterine fibroids
• Uterine polyps, cervical polyps, or any growth within the uterine or the ovarian spaces can cause bleeding in between the period or cause you to have more periods.
• Infections in the uterus or the cervix
• Any blood disorder, if there are any genetic predispositions for clotting disorders, then you won’t be able to have that normal clotting process and will bleed more often.
• Hypothyroidism
• Stress
• Contraceptives, whenever women start on new contraceptives or change contraceptives, sometimes there’s this middle space of periods being more frequent. That’s because your body is beginning to acclimate to the new hormones.
• Malignancy, so cancer is another sign or condition that will cause polymenorrhea.

If you have several periods where they are 21 days or less, I urge you to speak to someone about it because that is not normal, even if it is your personal normal. Periods should be 28 to 35 days.

Oligomenorrhea

Oligomenorrhea is infrequent periods. This is usually 35 days or more without a period, again hormonal imbalances between estrogen, progesterone, prolactin, excessive exercise, and that low body fat will see that periods become more and more infrequent, nutritional deficiencies, if we’re deficient and we don’t have those micronutrients that our body needs for thyroid, adrenal, our digestion, our periods will reflect that, stress, and contraceptives will cause periods to be infrequent as well.

Treatment for Irregular Cycles

How do we treat irregular cycles? We always try to address the root cause, why is the irregularity happening, is it estrogen, is it progesterone, is it the thyroid, is it the adrenal? We have to address the root cause first, to bring some balance back into the system. We do that by getting a full history using labs or even using imaging.

Some other methods for treating irregular cycles:

• Herbs, we love herbs here at Living Wellness; as naturopaths, they are the superstars in our treatments. Herbs are so gentle but powerful at the same time.
• Diet is very helpful in treating irregular cycles.
• Stress management.
• And using oral contraceptives or birth control can help treat some of the conditions that we see with irregular cycles.

If you’d like to discuss natural treatments for irregular periods, schedule a free brief meet and greet with one of our naturopathic doctors by calling 480-588-6856.