Have you ever missed a period? If so, you probably recognize the wish to somehow peer into your insides and figure out what on earth is going on.
Pregnancy is always a possibility. But for many of my patients, they’re not pregnant (and irregular periods may be its own kind of exquisite torture if they’re trying). It feels impossible to predict when the next period will come. Even in women who aren’t actively trying to get pregnant, having irregular periods can range from a slight nuisance (beach vacation timing) to a potential for extreme embarrassment (white pants, anyone?).
Doing a quick search online typically turns up the phrase PCOS. This stands for polycystic ovarian syndrome, which seems just as mysterious as its acronym. Though PCOS affects 10% of women, it’s a diagnosis of exclusion. That means all other causes need to be ruled out before you can say your irregular cycles are due to PCOS.
These other causes include the following (stay tuned for more posts on each of these in detail!):
- thyroid imbalances. This is relatively common and is usually because of autoimmune attack on the thyroid gland. Thyroid hormones affect so much in the body, including periods, fertility, and miscarriage risks. Blood testing to look at thyroid function is how it’s diagnosed.
- high prolactin levels. Prolactin is the hormone that helps with milk production during nursing. But there can be a myriad of reasons why it may be elevated in women who aren’t postpartum. Another easy blood test can be done to rule this out.
- hypothalamic insufficiency (another fancy pants phrase). This is when the brain isn’t producing sufficient signaling to allow regular ovulation. Why this happens is variable but it can be related to nutritional, physical, or emotional stressors.
- low egg number. Since we are born with all of our eggs, we know their numbers go down throughout our lives, ending in menopause. As we approach our late 30s and 40s, this may be more pronounced.
Before you drop everything and rush to your GYN, please know that each of these may be more or less likely in each of us, and so some of these diagnoses may not be pertinent to you.
I’ve been told I have PCOS …. how did I get that diagnosis?
Adding to the confusion of PCOS is the fact that there are multiple different ways to diagnose it. You heard me right — not even the doctors could agree on one set of criteria, though the hallmarks are all included (just in varying importance).
Typically, a woman needs to have at least a couple of the following, though the specifics vary depending on the criteria used:
- irregular periods.
- evidence of a male and female hormone imbalance. This can be manifested:
- clinically (with dark hair growth in a male pattern) and/or acne, or
- in the blood, with high male hormone levels.
- classic ultrasound findings.
- multiple small follicles (the fluid filled structures in the ovary that contain the egg), or
- a large ovarian volume when measured on the scan.
When should I see a doctor if I think this is what I have?
- If you haven’t had a period for more than 3 months
- If you are considering or actively trying to become pregnant
- If you are having very heavy bleeds when you finally do get a period
- My two cents: even if none of the above applies to you but you are curious about your irregular periods, go in! Knowledge is power.
If you have PCOS, you are not alone. The silver lining (I feel like there is a feminine product pun in here somewhere) is that PCOS has multiple different management options, including many integrative medicine ones! I’ll be addressing this in future posts.
And hopefully with these techniques, you’ll soon be experiencing Periods Coming On Schedule instead (ha).
I am a USC-trained Reproductive Endocrinology & Infertility physician with a boutique practice in Orange County, CA. I am also a Fellow in Integrative Medicine at the Andrew Weil Center at the University of Arizona, a FEMM Fellow at the Reproductive Health Research Institute, and serve as Associate Clinical Faculty at UC Irvine. My goal is to radically reimagine my field by focusing on whole body methods to identify the root cause and heal reproductive issues, like fertility, miscarriage, and abnormal cycles. I do this through integrative medicine practices coupled with traditional REI techniques, all while avoiding aggressive procedures. I’m grateful to have been selected for multiple years running as a Southern California Super Doctor and Rising Star, Orange County Physician of Excellence, and Top Doc in Pasadena. I am a Healthcare Task Force member for Life Perspectives, a leader in education, research, expertise and support after reproductive loss; serve on the Advisory Board for Pre-Health Shadowing, a non-profit that makes discovery of different medical specialties accessible to students; and have been an invited guest at multiple conferences and podcasts as well as an author of book chapters and multiple articles. I am excited to use an integrative medicine lens to educate about women’s issues!