Irregular Periods? Find out about the 5 top causes and what you can do about it

June-2022

Experiencing skipped periods can be confusing, frustrating, and worrisome. The impact of menstrual disorders can affect a patient’s quality of life especially when it leads to other associated problems, such as infertility and hormonal or metabolic disturbances. Patients often receive limited conventional support and are typically offered the oral birth control pill to regulate their periods, which is a simple bandaid solution that does not address the root of the issue.

There are several causes of missed periods or no periods at all, and most of the time the cause is hormonal in origin. Find out below about 5 top causes that cause skipped periods and learn about how a naturopathic doctor can support you in achieving menstrual cycle regularity:

1. Caloric deficits (Overexercising & Underfuelling)

Overexercising occurs when someone exercises too frequently, intensely, or for too long. Exercise itself does not cause menstruation to stop; rather, it’s the mismatch between energy expenditure and energy consumption that can affect menstruation. Amenorrhea, or the absence of a menstrual period, can be a sign of exercise-induced anorexia due to energy deprivation.

Underconsumption of calories can lead to a body mass index (BMI) that is too low which can result in anovulation. Anovulation is the term that refers to the absence of ovulation, which is a major cause of skipped periods. Conversely, an elevated BMI and obesity are risk factors for irregular periods or no periods (amenorrhea).

2. Stress

Chronic stress can negatively affect the hypothalamic-pituitary axis (HPA). Sustained elevation in cortisol, our stress hormone, can suppress reproductive hormones and lead to irregular periods. High stress can also result in light, heavy, or non-existent periods.

There are great stress-reducing activities located close to my clinic in Burlington, Ontario including the Stillwater Float Centre and Poweryoga Canada.

3. Perimenopause

Symptoms of perimenopause can start 8 to 10 years prior to menopause. The average age of menopause in Canada is 51 years old, so it is not abnormal to see symptoms of perimenopause start in a woman’s early 40s (and even late 30s!) such as irregular periods, hot flashes, night sweats, insomnia, vaginal dryness, heavier menstrual bleeding, and heightened PMS symptoms. Labs may not be helpful, as it takes years for perimenopause to be reflected in labs well after symptoms start. Initially, estrogen levels may increase, followed by a rise in FSH and a drop in estrogen. The medical diagnosis of perimenopause is typically made on symptoms alone.

Naturopathic doctors play an integral role in helping improve the quality of life of patients in perimenopause. There are several evidence-based nutrients like vitex and calcium that may help reduce associated symptoms, as well as bioidentical hormone therapy including progesterone and estrogen which can be prescribed by naturopathic doctors in Ontario.

4. Thyroid

Hypothyroidism is an interesting cause of delayed or skipped periods and may fly under the radar if the patient does not have major symptoms of hypothyroidism. It may not be TSH (thyroid-stimulating hormone) itself that causes delayed periods but rather the impact that elevated TSH and elevated thyroid-releasing hormone (TRH) have on other hormones, particularly the hormone prolactin. Prolactin can suppress additional hormones like testosterone, LH FSH, and GnRH release, all of which may affect the menstrual cycle. Elevated prolactin is a common finding in hypothyroidism and is a cause of delayed or skipped menses.

Testing these hormones in blood work is straightforward. Naturopathic doctors regularly requisition blood work including hormones to identify the root cause of a patient’s skipped periods.

5. Polycystic ovarian syndrome (PCOS)

Polycystic Ovarian Syndrome (PCOS) is an endocrine-metabolic disorder and is a major cause of hypo-ovulation or complete loss of periods. PCOS is a common condition that causes 70 percent of anovulation cases (where someone does not ovulate). Hormonal dysregulation is thought to be the cause of PCOS, in particular, elevated insulin and testosterone, hypersecretion of LH, and reduced FSH.

Naturopathic doctors have many tools to support patients with PCOS. For example, N-Acetyl-Cysteine (NAC) has been shown to have similar benefits as metformin for improving pregnancy rates, promoting ovulation, and improving menstrual regularity in women with PCOS. Similarly, myo-inositol has been shown to significantly reduce testosterone and promote ovulation in patients with PCOS.

If you are experiencing skipped or no periods, it’s always important to seek help. There are some risks involved with having amenorrhea (no periods), including endometrial hyperplasia, as well as ramifications of hormonal irregularities on metabolic and endocrine health. Working with a naturopathic doctor is an excellent first step to help you determine the cause of your menstrual irregularities and get you set up with supportive treatment.

Dr. Dominique Vanier is a naturopathic doctor in Burlington, Ontario with a focus on digestive health and hormones. As a regulated health provider, she is registered to see patients in Ontario both virtually (online) and in person.