What causes irregular periods with PCOS?
If you’re reading this article, you’re most likely wondering why all your gal friends seem to be having regular periods while yours seems nowhere in sight. Or maybe you’ve recently gotten curious about your hormone health and have a hunch that your irregular periods are a sign that something could be out of balance.
And you’re right! Periods are such an important marker of health that it has even been coined our fifth vital sign. Unfortunately, society has associated periods as something “gross” and thrown into the category of “TMI”, and yet they represent everything beautiful, powerful, and extraordinary about the female body.
So if you’re experiencing sporadic periods and not sure where to start when it comes to supporting regular cycles, I’ve got you!
The importance of a regular period
It may be tempting to think that a missing or irregular period is a perk rather than a problem. “Less bleeds throughout the year? Count me in!”... right?
In fact, often times many women don’t take the time to address an irregular period until they are trying to get pregnant and realize that it’s pretty challenging to do so if you have no idea where you are in your cycle. That is because
Fewer periods = Fewer instances of ovulation = Fewer chances of egg fertilization aka getting pregnant!
However, having a regular period is just as important for someone who has no interest in getting pregnant. When you are cycling regularly, meaning, moving through the ebbs and flows of estrogen, progesterone, and testosterone throughout the month, you get to reap the benefits of healthy hormones that drive better energy, stable moods, quality sleep, glowing skin, and a strong libido. Healthy hormones also regulate your appetite and fire up that metabolism which minimizes cravings and supports a healthy weight.
If you’re not cycling regularly, chances are your estrogen, progesterone, and testosterone are out of balance, which will also manifest through energy crashes, poor satisfaction with food, and more instances of anxiety and/or depression, all of which are common symptoms associated with PCOS.
Defining irregular periods
Now before you assume you have regular or irregular periods, it is important to define what actually qualities a regular period.
A healthy regular cycle is defined as a cycle that ranges between 26-35 days. These are the days from the first day of your period to the first day of your next period. Minor fluctuations within this range are normal and do not require any concern or intervention.
Irregular periods that persistently fall outside of the normal range can fall under one of two categories:
Amenorrhea: Specifically Secondary Amenorrhea which is when periods are absent for more than three to six months.
Oligomenorrhea: Which is the medical term for having less than six to eight periods per year.
Both are experienced within PCOS and can be addressed through nutrition and lifestyle changes which we will discuss later in this article. If you’re unsure whether or not you fall under the criteria of regular cycles, Ammehorea, or Oligomenorrhea, you can easily get started by simply marking the date of the first day of your period on a calendar or using a Period Tracking App.
For some women, it may also be important to track your Basal Body Temperature which will determine if and when you ovulate. This is because someone women with irregular periods experience breakthrough bleeding. Breakthrough bleeding occurs when the lining of the uterus destabilizes and prematurely sheds. Although this can look like a period, it is important to understand that a true period is one that follows ovulation.
NOTE: If you are on hormonal birth control, your “regular” bleeds are NOT regular periods. Hormone birth control suppresses ovulation, thus serving as a contraceptive. Therefore, the bleed that you get on a monthly basis with hormonal birth control is a medication-induced withdrawal bleed rather than a true period that follows ovulation. Unfortunately, many women with irregular periods are prescribed hormonal birth control as a means of “regulating” their periods. However, the reality is that the pill is merely serving to mask the symptom of an irregular cycle.
Top 3 causes of irregular periods with PCOS
Insulin Resistance
50-70% of women with PCOS have high insulin levels, better known as Insulin Resistance. The following numbers are indicative of insulin resistance.
Fasting glucose >99 mg/dL
HA1c >5.7%
Fasting insulin >10 IU/mL
Insulin is the "key" that allows glucose (or sugar) to enter into the cells and be used for energy. In the case of PCOS, the cells do not respond well to insulin. So your body then tries to compensate by pumping out more insulin hoping to get a response. This leads to excess insulin as excess glucose hangs out in the blood and outside of the cells, drivin up poor satisfaction, chronic cravings, and poor energy levels.
However, excess insulin not only affects your appetite but is the catalyst for many of your hormonal woes. The following graphic demonstrates the downstream effects insulin has on your sex hormones that manifest themselves through your PCOS symptoms, specifically with irregular periods.
Inflammation
Inflammation in the body is a natural mechanism that indicates our body's immune system is at work. It signals the body to fight off sickness and heal, and as it does, inflammation can then subside. However, women with PCOS have been shown to experience a chronic pro-inflammatory state. When the body is under chronic inflammation, it is forced to prioritize mechanisms that work to extinguish this acute stressor while deprioritizing mechanisms of growth and development. In other words, the body attempts to protect itself and signals, “Now is not the time to grow a baby!” which leads to delayed ovulation and irregular periods.
Chronic stress
Although stressors are often defined seen as circumstantial such as with career pressure, relationships, or finances, stressors also come in physical, emotional, and mental forms. A chronically stressed state communicates a lack of safety in the body. Similar to what we discussed with inflammation, the body then compensates by placing certain physiological systems on the back burner while working to prioritize survival. Stress is also incredibly energy expensive, meaning it can deplete the body of essential nutrients that support healthy hormones and regular cycles. A lack of essential nutrients like B vitamins, magnesium, and sodium force the body to be “choosy” with mechanisms it can support.
Other causes of irregular periods outside of PCOS
Although irregular periods can be a sign of PCOS, there are many other causes of irregular cycles outside of the qualifications of PCOS such as thyroid disorders, hyperprolactinemia, and in the case of pregnancy or breastfeeding. If you suspect PCOS, it’s time to have a conversation with your doctor so that you can be clear on the treatment options that are available to you.
And if you have been diagnosed with PCOS and experience irregular periods, know that you CAN experience healthy and regular cycles, and hormonal birth control and Metformin aren’t your only options. By offering your body the nutrition and lifestyle changes it needs, you can support healthy hormones that help you feel your very best.
