The Absent or Irregular Period & PCOS
Article #4 in a Women’s Fertility and Menstrual Health Series from Nourish & Breathe
The menstrual cycle flows month to month in a rhythm that is influenced and governed by so many varying factors that it is hard to list all the possibilities. However, it is true to say that an irregular period indicates that the hormones that orchestrate the monthly cycle have been impacted by an internal or external force and have changed their natural rhythm. And perhaps, almost certainly, it is not a sign that should be ignored.
PMS symptoms, as discussed in article #3 of this Women's Health Series, may be the first signs that something is not right with your cycle. If these signs are ignored you may end up with an absent or irregular period. Or, an irregular cycle can be the first sign to you that your health is imbalanced. You may be concerned about changes to your cycle and this may bring you into the naturopathic clinic at Nourish and Breathe.
Several mechanisms and influences can be affecting your cycle. A better understanding of what may be happening for you and how to correct the imbalance with naturopathic treatment, including everyday diet and lifestyle practices, is both beneficial and empowering for the road to healing and wellness.
THE HORMONES
The primary reproductive hormones include follicle stimulating hormone and luteinising hormone (from the pituitary gland), and the ovarian hormones oestrogen and progesterone. These hormones are orchestrated by a complex interaction between each other and other hormones, and secretion is stimulated or suppressed by feedback mechanisms, and the pulsatile secretion of higher hormones from the hypothalamus in the brain. These hormones regulate both:
ovarian function - the growth of the follicle and egg, ovulation and corpus luteum function; and
uterine function, the thickening of the uterine wall in anticipation of a pregnancy, and if this does not occur, the menstrual bleed.
And, in turn, their balance or imbalance will affect not only the monthly bleed and its symptoms and the regularity and quality of the menstrual cycle, but also our mood, our metabolic health, fertility, skin health, our general sense of well being.
When the menstrual cycle is absent or irregular, and has not been impacted by anatomical or genetic/chromosomal abnormalities then it is considered to be affected either by:
the disrupted release of hormones from the brain,
polycystic ovarian syndrome,
high prolactin hormone, or
premature ovarian failure.
So let us look briefly at each of these scenarios.
SUPPRESSION of HORMONES & STRESS
Firstly, and perhaps most commonly scenario that may affect the regularity of the menstrual cycle is Functional Hypothalamic Amenorrhea - this long name describes an interruption on the release of the first level of hormones from a part of the brain known as the hypothalamus. The release of these hormones may be suppressed in response to external or internal factors and are now not in sufficient quantity to stimulate the release of the next set of hormones down the line, and hence impact the growth of the egg in the ovary. There are a number of factors that may cause interruption to this flow, however, the number one cause of this interruption of the menstrual cycle is STRESS.
Both physical and psychological stress such that the body has an adaptive response to a deficiency of metabolic energy, i.e. the body goes into a preservation mode as the body has decided it does not have enough energy to operate a monthly cycle, or maintain the growth of a fertilised egg.
Physical stress involves either:
caloric restriction due to either weight loss, disordered eating ie nutrients to support a pregnancy, or,
excessive exercise, again the body has decided that there is too much stress on the body to support a pregnancy.
Psychological stress refers to both actual perceived and actual stressors that cause stress and anxiety. This negatively impacts the release of the reproductive hormones for the menstrual cycle flow.
POLYCYSTIC OVARIAN SYNDROME
Secondly, is the complex condition of polycystic ovaries, or polycystic ovarian syndrome (PCOS). There are many presentations of this condition and to varying degrees involves:
high androgen levels (70% of those with PCOS).
Disrupted metabolic profile - obesity or central adiposity, high blood pressure, and insulin resistance.
Elevation of other hormones: prolactin, anti mullerian hormone, cortisol, LH dominance
Disrupted thyroid function with higher antibodies.
PCOS seems to develop a life of its own interfering with the ‘normal’ interaction of hormones that regulate a regular and fertile menstrual cycle. Therefore those that come to clinic with PCOS and are looking for assistance to improve fertility, or simply to improve the symptoms that plague them every month, usually require a investigation to determine the driving factors and influences for their unique PCOS presentation. This will then guide the best treatment plan and strategy to be formulated. Persistence is also usually required to break through the metabolic drivers, or high androgen levels.
PROLACTIN
Prolactin is a hormone released from the pituitary gland in the brain and is not under control from higher levels or feedback mechanisms. However, high prolactin can be a major disruptor of the hormone pathways and must be addressed to restore balance to the other female hormones.
PREMATURE OVARIAN INSUFFICIENCY
Premature Ovarian Insufficiency is a term used to describe what may occur if it appears that ‘early menopause’ has occurred. That the ovaries are not responding to the stimulation of the hormones. Whether it is ‘early’ or a genetic occurrence. The age of menopause is always closer related, or, best indicated by the age of menopause of your mother. This can be a very enlightening conversation that you may be able to have, although for many it is not possible. A lot of understanding and ‘openness’ and willing to discuss their own menopausal transition is very dependent on culture, own experience, and even their health. But if it is possible, I do encourage discussions with your mother, or aunts or sisters. I can not express enough how often I hear comments like ‘I just found out mum had endometriosis, and she had never mentioned it before’. You must also remember that methods of investigations and understanding of conditions and disease states for the reproductive system has changed substantially over the past ten plus years.
This is the 4th article in the Women's Health Series. Article #2 outlined the Hormone Testing that may be necessary to undertake if you find yourself with an irregular or absent period. The hormone testing carried out provides very useful data on the pathology that is occurring, and what may be driving your unique case. This then helps guide the treatment program for you.
Please reach out anytime if you have any questions as to whether naturopathic treatment can be useful for you.