Episode #109: Restoring Your Cycle: Period Management for PCOS

4:32 – 15:55 Episode #26: PCOS and Period Problems

So many of the questions that I get about PCOS are period-related, not ovulating. Periods are irregular, not having a period. Periods are heavy or painful. Something always comes up about the period. So in today’s episode, we are going to be talking about all things PCOS period problems and of course, what to do about it.

You’re listening to the PCOS Repair Podcast, where we explore the ins and outs of PCOS and how to repair the imbalances in your hormones naturally with a little medical help. Sprinkled in. Hi.

I’m Ashlene Korcek

And with many years of medical and personal experience with the polycystic ovarian syndrome, it is my joy to watch women reverse their PCOS as they learn to nourish their body in a whole new way. With the power of our beliefs, our mindset and our environment, and the understanding of our genetics, we can heal at the root cause.

Welcome back to the PCOS Repair Podcast, where today we are talking about period problems. This may have been one of the very first things that you notice was off before you even were diagnosed with PCOS, maybe even as far back as high school. In this episode, I will cover what is a normal cycle and how to go about solving various types of period problems. So let’s get started. First of all, a normal cycle starts with a period. The first day of your period is considered day one of your cycle. Then approximately midway into your cycle, that’s like the halfway point. Usually somewhere after day eleven, around day 14 comes ovulation. This is when you could get pregnant as your body releases an egg that is waiting to be fertilized again. Ovulation usually occurs somewhere around day 14th because the average length of a cycle lasts anywhere between 21 and 35 days, that is a normal range. Women with PCOS, however, rarely have a regular auditory cycle, meaning that even if your periods are coming at regular distances apart, there is some form of irregularity happening in the hormone fluctuations during your cycle. And these hormone fluctuations are likely to affect your ovulation and your fertility.

Women with PCOS may miss periods or have fewer periods throughout the year, or their periods may come every 21 days, or even more often. Some women will have periods that last two weeks and then start again two weeks later. Then there are some women with PCOS who stop having their menstrual periods altogether. And this is where usually we call it an ovulation once they have gone three months without a period infrequent or irregular or prolonged menstrual cycles are the most common sign of PCOS. But what is going on and how can you treat these period problems? Just as with any symptom that we talk about here on the PCOS Repair Podcast, it all starts with your current primary root cause. You can learn more about that by taking the PCOS Root Cause Quiz by going to the nourishedtohealthy.com PCOS quiz. As you take the quiz. It’s going to look at what is going on overall inside of your body, what symptoms your body is demonstrating to help us better determine what is going on at the root of your PCOS. Now let’s take a look at the various period problems, what’s going on and how to fix them.

So, irregular periods can be anything from not ovulating having early ovulation, which is going to be a short Follicular phase, or late ovulation, which is going to have a short luteal phase, or having no periods at all, which is going at least three months without a period. Irregular periods are really common with PCOS or thyroid problems, and they are usually due to hormone balances and things such as too much insulin being present on a regular basis, SSH to LH ratio, testosterone coming off of birth control, nutritional disturbances, stress response, sleep disturbances, being overweight. These factors have a spiral effect. Each one plays off the other to increase inflammation to worsen the other symptoms. And so as you start to correct one of them, you start to reverse that spiral and you start to see an improving spiral as compared to a worsening spiral. Spiral is a much better word to use in this episode since we’re talking so much about cycles. Okay, so back to other period problems. Some women, in fact a lot of women with PCOS suffer from very heavy periods. But what does that even mean? Turns out I have heavy periods and I just thought that was normal.

I’ve never lived in anyone else’s body to have a reference point. So if you think your periods are heavy or you’re trying to tell your doctor that they’re heavy, sometimes it’s really helpful to have some quantitative data to go by. So you may have a heavy period if you find yourself using considerably more tampons or pads than normal, normal being they should last you more than 2 hours at a time without leaking. In other words, you should be able to trust in the security of your feminine hygiene product for at least 2 hours. If you are like I am and you are constantly worrying about if it is going to leak, you have a heavy period if you bleed through clothing or bedding on a semifrequent basis. Now, semifrequent only because we know our bodies right, like you’ve had a period before. So you know that if you’re prone to heavy periods, you better be kind of on the ball and not forget to change out your hygiene product. So if you have a problem of a surprise leak through, then you probably have a heavy period. Either a tampon or a pad by itself is not enough.

If you’re someone who requires using both of them because you need a backup method, then you probably have heavy periods. And then if you really want to know the quantitative amount so the actual measure of volume, then the normal period would usually have somewhere in the 30 to 40. Anything over about 80 ML is definitely considered heavy. So if you want to measure the volume, I recommend using a menstrual cup such as the Diva Cup, and then you can measure the output of your period for the duration. The only thing that can make a heavy period is even if you don’t have any of those above indicators that I just listed of what would make a heavy period. If you have a period that lasts enough days, you’re going to reach that heavy volume of menstrual flow just because it lasted more days than someone that had a very short duration of their period. Another period problem that I get asked a lot about is our painful periods. Now, while painful periods are common with PCOS, they’re even more common with something called endometriosis. Endometriosis and PCOS often go together. Hormone imbalance is going to make endometriosis even more prominent, meaning you can’t necessarily get rid of endometriosis, but having a hormone imbalance is going to really swing that estrogen and you’re going to have more symptoms if you’re having a lot of inflammation that goes right along with PCOS.

When you see the two of these combined, it can be really quite the double whammy. If you are experiencing pelvic pain during your periods or between periods, it’s really important to find out the root cause. There can be a number of different options available to treat these underlying conditions and manage your symptoms so that you don’t have to continue to suffer and rely on medications to get you through. If you have extremely painful periods, I really recommend talking to your doctor about endometriosis and seeing what they think based on their physical exam and other tests that they have run on you previously, or what maybe they want to consider running. Because while PCOS can definitely lead to more cramping and discomfort, and a heavy period in general, which is common with Pas, can be more uncomfortable, we don’t usually see as much debilitating pain that really impacts your daily life. Now, of course, there are always exceptions, but when we’re seeing that, I definitely don’t want to say, oh, you have PCOS, of course, you’re going to have painful periods because more than likely you have something else going on, possibly something like endometriosis or fibroids or other conditions on top of PCOS.

Just because we found one concern doesn’t mean we shouldn’t keep looking for others. But the good news is that even though neither of these conditions, PCOS or endometriosis, can be cured, they both respond very well to lifestyle changes to reduce inflammation and optimize health. And the even better news is that lifestyle changes go hand in hand. In other words, whatever you need to be focusing on your current primary root causes is going to assist both PCOS and endometriosis, and it’s going to benefit the symptoms of both. Okay, so how do we start managing all of this? So we have these period problems, what can we do about it? So the very first step in management is data. If you have information, it gives you a starting point, it gives you a conversation to have with your doctor. It gives you information on is it worsening. Is it improving? Are your periods indeed heavy? Are you appearing to be ovulating? Are you not appearing to be Ovulating? Like it gives you so much information to go off of. So the first obvious one that most people get is lab work, making sure that you have a full work up.

And if any symptoms change, I recommend retesting labs. The other thing that you’re always wanting to make sure when you’re testing labs, just like we talked about with The Endometriosis, you always want to be considering other health issues that may need medical attention. Just because we have previously tested our PCOS hormones and we didn’t show signs of insulin resistance, prediabetes or heart disease, that doesn’t mean that things can’t evolve. And so we want to make sure that we’re constantly monitoring them, constantly being at least every couple of years, or if symptoms change. And then we want to also log our cycle patterns and symptoms. So this is going to include everything from monitoring your basal body temperature and other indicators. Like if you have ways of testing your hormones through urine strips throughout your cycle, these are all information pieces that can be very helpful. Remember I was saying you can actually measure your period output that would go into this part, like getting that information. If you’re bothered by something, getting the data to back up what’s happening is really the first step. Then we go on to discovering why, which is where we look towards the root cause.

By taking the PCOS root cause quiz to help get a full picture of how your body is responding to its environment, you’re going to be able to see why and where it’s struggling so that you can address the problem head on. Then we start making the lifestyle adjustments. Begin making the lifestyle changes your body needs. You can learn more about those in episode four, which I will link to in the show notes below. And then that brings us back to data. So it’s kind of this constant loop we come back to. We looked at what was happening, the labs, the tracking, the body temperature, the hormone testing throughout our cycle, the looking for patterns, looking for lack of Ovulation for when Ovulation is happening, is it early, is it late? Then we look to how can we improve that our root cause? Then we come back to the data, continuing to monitor and track so that we can see what is and isn’t working, so that we can continually make adjustments accordingly. So there you have it, an overview of the problems that can affect your period, which can lead to difficulty getting pregnant or your period getting in the way of normal life.

If you have found this episode helpful, be sure to hit the subscribe button so that you are notified each and every week when the next PCOS Health topic becomes available. And if you have any questions about this episode or any of the other episodes of the PCs Repair podcast, I invite you to connect with me over on Instagram at Nourish The Healthy so that we can continue this conversation over there. And until next time, bye for now.

Did you know that studies of PCOS epigenetics have shown that our environment can either worsen or completely reverse our PCOS symptoms? I believe that although PCOS makes us sensitive to our environment, it also makes us powerful. When we learn what our body needs and commit to providing those needs, not only do we gain back our health, but we grow in power just by.

Showing up for ourselves.

This is why I’ve created a guide.

For you to get started.

My PCOS Fertility Meal guide can be found in the show notes below.

I want to show you how to.

Create an environment that promotes healing while still being able to live a life that you enjoy. This guide is completely free, so go get your copy now so that you can step into the vision that you have for your life and for your health.

16:00 – 33:56 Episode #42: A PCOS Hormone Storm

Have you ever noticed that out of the blue, your PCOS just goes haywire? I’m not saying that you didn’t have symptoms before, but all of a sudden, out of nowhere, things that used to work aren’t working. All of your symptoms or certain of your symptoms get drastically worse and you feel like you’re in freefall mode with your health, like there’s no rhyme or reason, you haven’t changed anything significant, but all of a sudden it has just gotten so bad. Now, maybe that’s a little overdramatic, but this is what I call a hormone storm. And today’s episode, we are going to be diving into what a PCOS hormone storm is and how to recognize it quickly, and most importantly, how to get yourself out of that free-fall hormone storm and back onto the stable ground with your PCOS, so let’s get started.

You’re listening to the PCOS repair podcast, where we explore the ins and outs of PCOS and how to repair the imbalances in your hormones naturally with a little medical help sprinkled in. Hi, I’m Ashlene Korcek, and with many years of medical and personal experience with polycystic ovarian syndrome, it is my joy to watch women reverse their PCOS as they learn to nourish their body in a whole new way with the power of our beliefs, our mindset, and our environment, and the understanding of our genetics, we can heal at the root cause.

Welcome back to the PCOS Repair podcast, where today we’re going to be discussing what I call a hormone storm. Yes, that is my made-up thing, I haven’t heard anyone else call it that. So if you mention that to your doctor, they’re going to look at you like, what? But if you have lived in a body with PCOS, which obviously you do, for any length of time, you may have experienced times where you just feel like your health is going out of control and you can’t figure out what is going on. It’s not all of the PCOS symptoms that I’m talking about. You may have had excess hair growth, your weight has maybe always been stubborn or difficult to manage, or maybe you have some acne, what I’m talking about is a few weeks ago, you seemed fine other than your normal PCOS symptoms and now all of a sudden your energy has tanked, maybe your acne has blossomed, maybe you’re gaining weight for no apparent reason because you haven’t changed anything in your life, maybe you’re no longer sleeping well, maybe you’re having crazy anxiety or mood swings, irritability, etc. So usually it could be all or one really prominent symptom standing out that is like you’re looking at yourself going, what is going on? Did I just get older all of a sudden or did I change something in my diet? What has happened to me? You may have heard me talk on previous episodes on how PCOS has this spiral effect on symptoms. We can spiral downward or we can spiral backward spiral upward. When I’m talking about a hormone storm, it’s like we go on supersonic speed on a downward spiral. When we think of all of our root cause hormones, we have to remember, and on a side note, this is why I do not really buy into the whole PCOS-type methodology. We have to look at all of the root causes hormones and how they play together. Cortisol being king really has a huge pull over so many of the other hormones, then we also have the whole insulin system, and then we have our reproductive androgen hormones. All three of these groupings, as well as some other ones in there that make up our metabolic and endocrine systems, they play together.

Yes, they have their own little microcosm of structure and uses, but they all listen to each other, so when one starts to move in a certain direction, as in not doing very well, the rest of them will start to cascade that way as well. So for example, maybe everything was going well, but you had a drop in estrogen, maybe this is because you crossed over a barrier over the last couple of months of being more premenopausal. You might still have a regular period. I mean, premenopause can start late 30s, right? So you have plenty of years still to have a baby. However, your body is starting to have a little bit of a drop in estrogen, that increases your insulin resistance, and all of a sudden you have this snowball effect across all of your hormones. You’re no longer sleeping well, which is leading to having you feel like you’re dragging throughout the day without realizing it, you’re reaching for foods that boost your energy, so those carbohydrate-rich foods because they do, they momentarily give you a boost and then your insulin is getting further and further and further out of control, so that’s one example, another example is where all of a sudden you are dealing with some stress that you may not even fully realize is there in your life. This happens a lot when we get busier, maybe we are rushing more throughout our day like we’re busy, but it’s not just the busyness, it’s like we’re always feeling slightly behind, and that takes a toll, we’re not ever feeling like, oh, I can just take a deep breath and let down for a minute. We’re just constantly next thing, next thing, next thing, next thing, and even though on the surface and even in our awareness, we feel like we’re handling it because things aren’t falling through the cracks yet, we’re still getting eight hours of sleep, we’re managing it, we’re managing our stress. That’s what we’re supposed to do. But we’re living in this constantly at full power mode in order to manage that stress and our body feels that. Do that for a couple of months, and after a bit, you have shot your cortisol, your insulin resistance goes through the roof and all of a sudden you are in a hormone storm. You can just see here how this all plays together and those are just two fairly simple examples of how I see that frequently in women that I work with.

Okay, so how do we recognize that this is what’s happening? And then more importantly, what do we do about it? So recognizing using it quicker is always better because we don’t have to go through as much of a negative spiral, we can recognize it quickly. But there’s no change in how we handle it depending on if we recognize it quickly or if it takes us three years to figure out what’s going on. We can just skip that three years of feeling awful. So basically, when you start to feel like your PCOS hormones have taken a turn for the worst, the frustrating part will be that you may go to your doctor and ask them to retest labs because you’re just sure that they are just absolutely falling apart and everything will still come back normal. That’s been one of the most frustrating things for me on my PCOS journey is that every time I see the doctor, my labs are normal, whether I feel like my PCOS is well handled or my PCOS is just tanking and for that reason, I asked them to check them once a year, but for the past several years, I don’t really get that hung up on what my labs are doing, I really focus off of my symptoms or I’m looking at specific things in my labs. Originally, I did have some abnormalities when I was diagnosed, but I have managed it naturally for so long now that none of my labs are abnormal. This really comes down to you know your body, you’re the only one that lives in your body and you’re the only one that can say, Hey, this is not normal for me and I need to figure out what it is that I’m currently doing or what’s currently going on in my environment that has created a hormone storm for my PCOS. I think the first step that you’re going to see when you recognize it is just as you are more in tune with your body when you start to say, Hey, look, this is starting to feel harder, and maybe you’re like, Okay, for a week, I’m going to see this, I’m going to keep an eye on it. A week or two in, you’re like, Okay, I don’t normally have this acne throughout the month or normally, I might have a bad night of sleep occasionally, but I’m having them very frequently, you can start to notice that certain things are not going as well. You don’t have to wait till all of them are not going well in order to recognize it quickly and you’re going to get better and better and better at this as you go. Here’s the thing. Although I am very skilled at managing my PCOS naturally at this point, having done it for many years and having all the experience that I have, that doesn’t mean that I don’t still have hormone storms. It just means that I recognize them very quickly and they don’t have a lot of time to brew into a full hurricane anymore. The reason why we continue to have hormone storms is because we’re aging. I’m approaching 40. When I first started managing my PCOS, I was 27. So there’s a huge difference in who I was and what I was capable of and what my body responded to at age 27 compared to now at approaching 40, my hormone levels are different as they should be, and my environment is vastly different. When I was 27, I was working full time, commuting in LA traffic, whereas now I’m mostly home with my three children.

Those are very different environments, and my PCOS requires different care in both of them, as well as the age factors. Different parts of the world, too. I now live in Oregon, which half the year is very dark, rainy, and cold. So there’s just a lot of what we feel like we are doing the same is actually quite altered until we really start to look at it and we’re like, Oh, you know what? I probably don’t get outside as much, and I probably could be vitamin D deficient now and so there’s just things where we do have things that change, and we need to constantly be looking at and keeping up with what’s going on with our body. So once you’ve recognized it, what do we do about it? We always want to start with, what are our symptoms indicating in the root cause? So like I mentioned, I may have some vitamin D deficiency. Is that the root cause or is the root cause something else? And that’s just playing something into it. So we really want to get down into the root cause of the root cause of the root cause. And this is something that I walk people through inside my programs and coaching because it’s very specific, but basically, you start with the PCOS root cause quiz. That gives you an idea of how you start listening to your symptoms and how they’re going to start at the big scale. That’s a fairly short quiz, but it gives you a really good idea of what category of root causes are we dealing with. Are we dealing with a stress response? Are we dealing with an insulin effect? Are we dealing with a hormonal or nutritional disturbance? Or are we dealing with an inflammatory response? When I am working with someone more closely in one of my programs, I have them go through a larger assessment that will group them into those four root causes. But once you get an idea of probably where your primary root cause is, we need to drill down a little further. Like I mentioned, all of these hormones are interconnected. So when we’re looking at what is going on, we want to take one step further back or even a couple of steps further back to see why. Are you having a hormonal disturbance, but it’s actually due to the fact that you are having a slight insulin effect with it? Or is it because you’re having a slight stress response with it? Or is it purely that you were doing overall pretty well, but when you went off of birth control, your body just didn’t handle that transition well? Your body didn’t turn on the hormones again at the level that they should have been. And now your hormones are in chaos and it can’t quite find itself. There’s different reasons why you are showing signs of a certain root cause. We need to back it in a little bit further. Then we may look at specific desired outcomes, or we may look at other specific symptoms that we may need to dive into a little bit further. Some people are dealing with a root cause and they’re frustrated because they don’t have a cycle. They’re trying to get pregnant and their periods aren’t regular or they’re absent completely. Then they’re looking at wanting to regain that cycle, but they are happy with the weight that they’re at. Others might be wanting to both lose weight and regain their cycle, or their cycles have been fine, but they’re looking to lose weight. Other people are really struggling with fatigue and energy or anxiety and irritability and so we need to look at not only where your root cause is, but what are the symptoms that you’re really struggling with. Because then we can look at what exactly your body is needing, and we can address that.

That brings us down to usually a very small handful of things that we need to change. Perhaps a certain supplement may be helpful, and certain types of foods we may want to avoid for a while. And most importantly, a lot of times this has to do with working where we’re at in our cycle and so working with, are we currently having a cycle? Where are we at in it? And maybe some additional labs, like I said, vitamin D that we may want to test, things like iron, things that could be a problem because we’re deficient in that we just may want to double check before we go down a whole rabbit hole of trying to figure out why we’re having low energy. So the exciting thing is that once we truly recognize that root cause and have dug a little bit deeper in to find any additional deeper root causes that are playing into why this hormone storm is happening, then we can start to take action and the cool part is that that action has a very quick turnaround for most people.

It’s amazing how if we can just get to that root cause, like the really true nugget of the root cause for each individual, which is the hard part because I know you’re like, Well, tell me what it is. It’s so independent for each person that the best I can do is… It’s the easiest, of course, when I’m working with someone one on one, but is to do it in a way where you learn how to do that and those are things where the PCOS root cause boot camp will be opening up again soon. That is a group program where you can learn what you need to do to find that and it will teach you to do it over and over and over and over because ultimately I want you to know how to do this at the drop of a hat when you feel like your body is in a hormone storm and the other way is when I help walk you through all these root causes and we’re looking at what is your current primary root cause, but are there any deeper root causes that are leading to that? And as you take that action, it can be a small thing where you just change a little bit of how you’re eating, how you’re moving, how you’re handling your stress, a couple of mindset shifts.

It can be really small things, and it may even just be one or two of those things that make all the difference, and the reason it can be such a small little thing that makes the difference is chances are you are handling your current primary root cause. But all of a sudden, something that created a negative cascade because all of these root cause hormones are interconnected. So let’s say you were dealing with the insulin effect and you were taking care of it really well and then all of a sudden a hormone storm comes out of nowhere and you’re like, I’m doing all the right things. What is wrong? Well, somewhere in your stress response, something wasn’t working. And so because you already have the insulin effect more or less cared for, we can just go in, address that deeper root cause, make some changes, and you’re on an upward spiral to better health. That is something that is so exciting to see women experience and it’s even more exciting and exhilarating when you experience it for yourself, where you felt like everything was going crazy and you have this scare, this fear, this belief that you hope isn’t true, that this is just the way it’s going to be like you’re just going to get worse and worse and worse, and there’s nothing you can do about it because you think you’re doing all the right things. You’ve done everything that has helped before, and all of a sudden it’s not working and so now you feel like, oh, crap, my whole health is broken and there’s no way to put it back together again at least that’s how I have felt in previous years when this has happened to me and I’ve had to reshape up all the ways that I look at things and get to a deeper and deeper and deeper root cause, and that’s where I think a lot of these times we feel like, okay, well, it’s simple. If you have an insulin effect, you just need to eat low carb, it’s not necessarily that simple and sometimes we’re eating too low carb, or sometimes we’re not eating as low as we think we are, or we’re eating low carb, but we’re not getting enough nutrients. I mean, the little nuances of this are definitely frustrating and a little general here, I wish I could be more specific, but it’s so person by person, and learning to get in touch with your body is the most important thing here.

So as a quick recap, when you feel like your symptoms have taken a nosedive like you feel like you’re freefalling in PCOS hormone chaos, step one is always reevaluating your root cause. You may have felt very in touch with your root cause previously, and all of a sudden your body is telling you, you need to reevaluate it. You might need to dig a step further, you might need to look at it a little bit differently. But ultimately we need to get re-in touch with what are our symptoms telling us about what’s going on in our metabolic and endocrine root cause hormones. We take that step to dig a little bit deeper into them, once we have a good understanding of what’s going on, we start to take action. Now, I want to remind you, having a good understanding of what is going on is not an excuse to research and study and not take action. Sometimes the best way that we discover what’s going on is by taking a little action and doing some trial and error. For example, if you feel like, okay, my health has taken a nosedive, I’m doing the right things for my insulin effect root cause, but it’s not working.

Sometimes we have to do a little trial and error to see what the root of the root cause really is, and that might look like intentionally doing some things to help us de-stress. That may look like intentionally really taking a look at, are we doing the nutrition that we think we’re doing. Because sometimes we’ve been at it for long enough that we’ve slid a little bit back to old habits and not even really realized it. Those are all ways that we can take a little bit deeper look into our root causes while not getting caught up in the, I need more information, I need to learn more before I start taking action because a lot of times taking action is what helps us learn. We just can’t get discouraged when it takes a little while for that action to make sense. And then we start to see the storm calm, we start to see the sun come back out, and we start to see our hormones get back to where we used to be, and likely better because you’ve put that love, care, and nurturing focus back into your health, which in and of itself is going to do wonders for the way you feel, your stress, your body sense of being cared for and heard in your ability to feel amazing and thrive in your body.

So there you have it, my friend. I know you probably haven’t heard of it before, but when I say the word hormone storm, I bet you can relate to exactly what I’m saying when it comes to your PCOS.

If you have found this episode helpful, I hope you hit the subscribe button so that you get notified each and every week when a new episode of PCOS Health becomes available. And until next week, I would love to connect with you and answer your questions over on Instagram. Just send me a DM @nourishedtohealthy, and I can either respond to you in the DM or create a Reel or a Post to help answer your question. Because if you have a question and you’re brave enough to ask it, there are hundreds of other women out there that have the same question and will benefit from your response. We can keep it 100 % anonymous, it’s not about tagging you or anything like that because I know that can feel a little bit vulnerable when it comes to your health. We can keep a conversation going on the DMs, but also it helps me to create content that you find helpful.

So until next time, find me over on Instagram @nourishedtohealthy. And until next week, bye for now. Did you know that studies of PCOS epigenetics have shown that our environment can either worsen or completely reverse our PCOS symptoms? I believe that although PCOS makes us sensitive to our environment, it also makes us powerful. When we learn what our body needs and commit to providing those needs, not only do we gain back our health, but we grow in power just by showing up for ourselves. This is why I’ve created a guide for you to get started. My PCOS fertility meal guide can be found in the show notes below. I want to show you how to create an environment that promotes healing while still being able to live a life that you enjoy. This guide is completely free, so go get your copy now so that you can step into the vision that you have for your life and for your health.

39:59.8 – 1:00:57.5 Episode #45: PCOS Period Repair

The first step when trying to get pregnant with PCOS is to make sure that you are having a healthy ovulatory cycle. Now, I know that sounds super obvious, but this is the step that gets skipped over so many times. It’s what leads to what we talked about a few episodes ago, that infertility cycle of insanity, because we jumped ahead of ourselves and never asked why and figured out what was going on with the ovulation. In today’s episode, we are going to focus on how to repair your period, how to repair your cycle, and all the steps and considerations based on your current primary root cause and looking at that domino effect that is going on leading to period dysfunction and cycle dysfunction and ultimately leading to the infertility that you may be struggling with. So without further ado, let’s get started.

You’re listening to the PCOS Repair podcast, where we explore the ins and outs of PCOS and how to repair the imbalances in your hormones naturally with a little medical help sprinkled in. Hi, I’m Ashlene Korcek, and with many years of medical and personal experience with polycystic ovarian syndrome, it is my joy to watch women reverse their PCOS as they learn to nourish their body in a whole new way. With the power of our beliefs, our mindset, and our environment, and the understanding of our genetics, we can heal at the root cause.

Welcome back to the PCOS Repair podcast, where today we are going to go through the considerations and the steps of how to repair your period. If you’re having no periods, if you’re having irregular periods, if you’re having regular periods where it’s being difficult to pinpoint ovulation, or even if you are just having no luck getting pregnant and you feel like something’s just a little bit off in your cycle, even if you’re meeting those metrics of under 35 days or ovulation close to 14 days, even if you’re in that zone but you feel like, Okay, I’ve been on hormonal birth control, I went off hormonal birth control, and though everything appears to be working like clockwork, I’m still not getting pregnant. Even if that’s the case, this episode and the steps that we’re going to go over are going to be super helpful for you. So let’s get started.

Now, like with anything else, it all starts with understanding your root cause and then looking a little bit further into the root of the root, of the root of that cause. If you’ve been on birth control, you may need to go in and repair and restart and love up on your natural hormones after they have been suppressed with synthetic hormones for any length of time. If you are dealing with the insulin effect or systemic inflammation, or if you’re dealing with a stress response, whatever those root problems are, we need to even take it one step further usually and just make sure that your lifestyle is supporting a healthy cycle. It’s important to remember that symptoms of our period, of our menstrual cycle, they’re the tip of the iceberg, so to speak. What we’re looking at is what is leading to an absent period, what is causing our cycle to be irregular and why are we not ovulating or why is our ovulation not leading to a pregnancy when we think we’re timing everything just right? The reason that this is so important is that if we just start throwing more medication, so medication such as Letrozole or Clomid, which is intended to force an ovulation or strengthen an ovulation, if we just throw that type of medication at a dysfunctional cycle, we are in a sense making it more dysfunctional. If we don’t know where we’re at in our cycle, we are swimming upstream instead of swimming in the stream of our cycle or helping our cycle to create its natural rhythm and flow again.

If you are slightly irregular or everything is regular and you’re not far from a normal cycle, then sometimes these medications do the trick. But for most women with PCOS, we know PCOS is a hormone disorder. For the most part, this is something where there is more going on under the surface and where someone who doesn’t technically have PCOS, they may have a symptom sequelae after going off of birth control, but they don’t truly have PCOS. Those medications work really well, but it makes this type of scenario a little cloudy because when it comes to PCOS, there is true hormone disturbance down deep in the root causes. Those need to be addressed before other things are going to be very successful, which is why a lot of women go on to, after having several cycles, maybe a couple of Clomid and then a couple of Letrozole, and after almost a year of trying these medications, then they’ll be moved on to IUI or IVF. Now, it’s not that these don’t work, but it’s important to look at why is it not working. It’s not that these medications aren’t helpful but if we don’t, first of all, look at what is happening in our cycle and why it’s not working the way it should be, although it’s fine to start adding in some of these medications, I would recommend that it is so much better to at least start to create a healthy cycle.

Get a few months under your belt of nourishing and caring for your body to help it recover from whatever root cause you have going on. Then if you’re still not pregnant, consider going down the path of fertility treatments, medications, procedures, and so forth. The period is really obvious. It’s the thing that we see each month or we are hoping to see each month if you’re currently having absent periods. It’s easy to think that the period is the main event of the cycle. But truly, in order to know if you’re having a healthy cycle, it’s really all about ovulation. If your hormones are in the first part of your cycle, so that would be your follicular phase from day one of your period, so once your period starts, you enter menstruation as well as the follicular phase of your cycle. In this phase, your body is preparing and maturing an egg to be released at ovulation, and then we switch to the second half of your cycle. We have our period, which starts our follicular phase, then we have ovulation, typically right in the middle of a cycle, somewhere between days 14 and 17, depending on how long your cycle is.

Then we enter the second phase, which is the luteal phase. You may think that the important part here is that we get all the way to the middle part and then we just have this boring two-week wait. But each of those phases is equally important because in the first half, we are preparing both our endometrial lining as well as we are preparing a follicle and maturing it to become an egg. Now, if the egg is then fertilized, we need to have a nice thick endometrial lining for it to implant into, and then we need to have high enough progesterone levels to hold that endometrial lining and to sustain the pregnancy until our body can form a placenta, and then it will take over housing the embryo and the baby as the baby continues to grow. In that first phase, we have FSH rising, and then just as we are getting close to ovulation, we have this LH is released, we have a big spike of LH, it releases the follicle, and then hopefully, again, we sustain and have implantation in the beginning of pregnancy. In order to repair our periods, we need to have strong ovulation.

It takes a little bit of time. When you think about how long it should take in order for all of this to work. If you go off of birth control and hormonal birth control, it takes three months to mature an egg to the point of where the follicles turn this month. When we think about timing, we need to be at this recovery of our period for a minimum of three months to really even get that first shot at getting pregnant. I think even just that understanding of how long this takes to occur. Now, some people do get pregnant faster, and it depends on what birth control you were on, depends how your body responded to the birth control and so forth but typically, say you’re starting from ground zero, your body needs to start preparing follicles to become eggs, it’s going to take a minimum of about three months and then even every single month, you have somewhere in a 20 % chance of getting pregnant, even if you have an ovulation, even if even if you time everything perfectly, there are other hormones and things at play in your cycle that may not line up quite right to successfully get pregnant and that’s why it’s normal for it to take a little while and we don’t want to overly jump to I’m not getting pregnant, therefore, I need to go on fertility treatment. Not a bad idea to maybe start having that conversation with your doctor, but it’s ultimately your choice when you’re ready to do that. We talked about FH and LH and how FH is rising in that first phase of your cycle, in your follicular phase, maturing an egg, and then right before ovulation, you’ll have an LH spike so that it can release an egg, ovulation can occur. Now we enter that second phase, the luteal phase. But what are some of the other big players in the hormones that we have going on in our cycle? This is going to include estrogen and progesterone. Now, estrogen is the big player in that first phase of your cycle, your follicular phase. This is where your body is going to feel energized, and powerful. You may feel more assertive. You may feel more awake and energetic and ready to go out and make things happen. During this phase, you may also feel you feel stronger in your workouts. It’s easier to wake up.

You actually may have a little bit of a hard time sleeping sometimes because you’re on this power mode. Our estrogen is our power hormone. It makes us feel all sorts of confidence. Now, everybody, of course, has their own levels of this, but this is the time to think of yourself. This is the time in your month when if you’re paying attention, you will typically feel more powerful. The second phase, your luteal phase when everything is going normal, and again, I should say that with the first phase, this is what it would feel like if you had a healthy cycle if your estrogen levels were healthy. Then in the second phase of your cycle, your luteal phase, your progesterone is the ruler of the cycle or this phase of your cycle. This is your feel-good connector hormone. This is the hormone that makes you relax, calm, and engaged in what you’re doing. It’s like your type B versus your type A. If you think of the first half of your cycle as more Type A, your second half is more Type B. However, if your progesterone your own levels are low, which is very common in women with PCOS, you are going to feel really off.

Instead of feeling like you’re peaceful, happy, relaxed, in the moment type B place of your cycle, you may feel completely on edge, anxious, and really not sleeping well because your body is missing enough hormones to help you relax, to help you feel at ease. As we think about those two phases of our cycle and we think about repairing our cycle, of course, nutrition is really important. In the first half of our cycle, we can be a little bit more strict with our nutrition. The second half of our cycle, we may want to be a little bit less rigid because, again, we’re more type B in the second half of our cycle. That doesn’t mean going out and eating the comfort food and all the junk. What I mean by that is that this may be a place where healthy carbs have a little larger place, whereas, in the first half of our cycle, we may be able to be a little bit more aggressive with our healthy eating endeavors. Both phases, protein is really important. Both phases, healthy fats is still really important because hormones need healthy fats to be produced by the body and to be manufactured, so we don’t want to skimp on the healthy fats.

But in that second half of the cycle, that’s where some healthy carbohydrates, like having some quinoa or some whole grain rice or some oatmeal may be a little bit more appropriate, as well as a little bit more fruit, a little bit more vegetables, paired with your proteins and healthy fat still. Then when we think about our fitness, that powerful phase in the first half is really where we want to make gains. You’re going to feel more energetic, you’re going to feel more powerful. You typically have a better recovery. And of course, as you’re going through your workout regimen, it doesn’t have to be, I only do this in the first half and I only do this in the second half. I used to feel like that’s what people were trying to say. And what I have found to be really helpful for me, because I don’t know if you can relate to this, but I feel like I have been able to achieve different levels of fitness that have surprised me over my life. But my baseline fitness, it is hard for me to get moving, not just like I’m not liking it. I feel heavy, I feel like my legs are like cement blocks.

And so it is frustrating to me to stop and start. I feel like I lose ground really quickly if I’m not consistent with my exercise, and so for me, the idea of only exercising one way in the first two weeks and then changing up how I exercise in the second two weeks is very stressful to me. So here’s how I think about it. And the ultimate takeaway is really learning to listen to your body in those two phases and what I try to do is I plan my more intense and powerful workout in the first part of my cycle. I also know that when I’m in that first half of my cycle, so I’m in the estrogen is the ruler and it’s in the follicular phase of my cycle, this is where even if I’m feeling a little uninterested today, this is where I push. This is where I push my speed with running. It’s where I push my distance with running. It’s where I push the resistance that I’m lifting and so forth. Now, in the second phase of my cycle, I do have days where I actually feel really good and energetic, and I attribute that to probably my progesterone is in a good place.

However, this is where if I am feeling at all tired, I will slow down. If I feel at all fatigued after a workout, I dial it back. Think about it. If you were trying to train for a race, just as an example. The first half of your cycle is where you do your fast, intense, and interval running, and you push your speed, and you push your distance. Then that second half of your cycle, you’re looking at doing a nice, gentle, scenery jog more for your mental health than for pushing the progress. Now, if you were, say, training for a race, practically speaking, in my sense and what I do is I spread out my training protocol. So if it says that you’re going to train for eight weeks, I’m probably going to train more for 12 weeks, and I’m going to have more weeks where I put in, this is not where I’m pushing my distance, this is not where I’m pushing my speed. I am listening to my body in this phase. It doesn’t mean I can’t go for a run, but I’m going to enjoy the scenery and I’m going to be out there for the purpose of getting fresh air and getting my blood flowing and feeling better and not for forcing myself to run an extra mile than I did last week.

I hope that makes sense when you think about how you’re going to approach your fitness in the various phases of your cycle. Now, when we think about estrogen being the ruler in the first part of your cycle and progesterone being the ruler of your second phase of your cycle, what keeps these two hormones healthy? With estrogen, having a good balance in your insulin is really important. If you have an insulin effect, definitely you’re going to want to pay attention to this. But no matter what your primary root causes, all humans have insulin. If we’re alive, we’re using insulin. In that first part of our cycle, we don’t want to be having hyperinsulinemia or high glucose or out of control in our glucose and insulin system. We want them to be in a really nice, healthy metabolic state. This is going to be where we really want to focus on not having those refined carbohydrates. I didn’t say cut carbs, I said refined packaged junk carbohydrates, vegetables, amazing, healthy, healthy carbs, amazing. Your body needs them, especially if you are working out and especially when you’re trying to boost fertility. We don’t want to restrict anything too hard.

Otherwise, our bodies will feel stressed. It’s not about restricting all carbohydrates, but this is the phase where we want to do a lower glycemic effect on our diet. Okay, second phase, we have progesterone. Progesterone is destroyed by stress, which is a mean little trick of nature because during an infertility journey, I don’t know anyone who’s not on edge and a bit stressed during that two-week wait. However, cortisol tanks progesterone. So what helps us to stop cortisol? And this is a hormone called oxytocin. Oxytocin is our hormone that cancels out cortisol. We can’t be in flight and flight mode if we are in relaxation, happy, everything is good mode. They just cancel each other out. How do we override that for a result? You can look up more, and I’ll include a list in the show notes as well, but to name a few, things that improve oxytocin are all of your connector relationship-type things. So spending more time with your partner, petting your pet, or really connecting with your pet. When we connect with someone, we relax. Have you ever felt really stressed out and then someone that cares about you gives you a big hug?

Even if at the moment you don’t want them to touch you, but they’re a safe person and they give you a hug, and all of a sudden you just feel the stress like let down? That is an example of cortisol raging and then oxytocin taking over. During this two-month wait, I encourage you do the self-care, the massages, the extra time with positive relationships, so friends and family that lift you up, that lead you feeling warm and fuzzy inside. If you have a pet, make sure you get those extra pet snuggles. If you have children already hugging your child, cuddling up, and reading a book, these are things that boost oxytocin. Special time with your partner, getting out on a date where you engage with each other, where it’s not about fertility, where it’s just about connecting as a couple. Extra fun time in the bedroom, I know sometimes we think, Okay, we did that, ovulation already happened but having an orgasm is a really good way to boost oxytocin. But all of those things that make us connect, feel loved, feel close to somebody, they all cancel out cortisol, and they’re really important.

We can do these things for ourselves, too. Taking a long shower or hot bath, all of those things that help us to unwind, meditate, listening to music, deep breathing, doing yoga and connecting with our breath, getting out into nature and taking some deep breaths, and letting the sunshine hit us, or getting that fresh air and being present in that moment. Those are all ways where we can instantly take cortisol and crush it. During that two-week wait, very important, it’s going to help you to boost your progesterone, care for your progesterone and keep cortisol at bay. It’s not about saying, Oh, just don’t stress, just relax and it’ll happen. But this is where there is a little bit of truth in that. But there are actionable ways that we can deal with the stresses in our lives while at the same time telling cortisol that we are safe, that everything is okay, that we’re not going to worry about that right now, we can get to that worry later. Also, just when you are thinking about your schedule, if you can, life is life, we have to continue on moving forward. But if you can, lighten your schedule during this time.

Give yourself a little extra time when you’re driving somewhere so that you don’t always feel like you’re just rushed. Try to be five minutes ahead where you can sit back and enjoy the moment as compared to feeling like you’re five minutes behind where you just need to rush everywhere that you go. Those are all things that your hormones are going to thank you for in these two phases of your cycle. Okay, so a quick recap here. The first two weeks starting day one is your period. The first two weeks you’re in your follicular phase. Then your LH spikes, we have ovulation and we move into the LH. We move into the luteal phase. That first phase, the ruler is estrogen. The second phase, we want the ruler and oftentimes with PCOS. Typically, our estrogen is okay. But if we want to love up on our estrogen because again, this is the precursor, it is setting up how our cycle goes, we want to really make sure that our insulin is in check, which to do that, you have to keep our glucose in check. Then as we roll into that second phase, we want progesterone to be the ruler.

Oftentimes with PCOS, our progesterone is low. This is what leads to difficulty getting pregnant, and holding on to a pregnancy, especially in the first trimester. We want to really love up on the progesterone, and we went over how to do that. Then just as a side note, the reason you’re probably listening to this episode is that your hormones are a little unbalanced and so we may not see this perfect pattern that I’m describing, that is what we are working to. What I recommend women do is lean into those feelings, those actions, and let your body relax into them as it creates its own rhythm and gets a handle on its own rhythm again. Then, of course, we have the question of what if I don’t have a period? How can I get started? You can do a couple of things. One, you can chart how you’re feeling, sometimes you will notice clear patterns after listening to this that you actually are feeling some of these things. You can do hormone testing. We are going to dive into functional lab testing in a couple of episodes, but you can have something called a Dutch test.

The best one is a Dutch cycle mapping test to see really where you’re at in your cycle and what’s going on in your cycle. They can be a little bit hard to interpret and they’re not something that’s covered by insurance. They’re not something that your medical doctor typically orders. If you have questions about those, feel free to DM me on Instagram and we can go over that, But the point is that you’re going to want probably figure out where you’re at in your cycle. And if you’re not interested in doing additional testing right now, do your best to start where you think you would be. Typically, we have some degree of, okay, even if you were on birth control a few months ago, march it forward and start leaning into where that would be if you’re taking over-the-counter ovulation predictor kits, which I don’t highly recommend because it’s going to probably give you false information. But you may start to see that there is a place where LH starts to rise a little bit. That’s going to be somewhere near the middle of your cycle. That’s going to give you some information about where your body is trying to be, even if it’s not quite making it.

As an example, I was having really long periods. My periods were somewhere between 45 and 60 days for quite a while during my infertility journey. I didn’t know any better, so I thought the LH was the best way to go. I didn’t realize that with PCOS, we often have elevated LH and make those kits not very precise. But if I was trying to figure out where I am in my cycle, I was having a period, so that would be day one. It just said it would be 60 days till my next one. What I would do is I would say, okay, day one of the period, and then middle, we switched to phase two during that LH beginning to rise, although I never get a full surge. Hopefully by loving up on the estrogen and then loving up on the progesterone, then hopefully we would start to see that my cycles would shorten and shorten and shorten because I’m doing all of the getting my daily movement, getting my good nutrition, practicing the self-care, especially leaning into it that second half of that cycle and honoring the two different phases that I go through.

If you’re not having a cycle at all, you may start to see that you’re having a little bit of an up and down with your LH if you took all the counter population kits. Also, a really good way to do that would be something like Meera or Ovusense to start to see if you can see some patterns. Ovusense would be taking your temperature daily to see if you’re seeing any patterns there. Then Mera would be to check your hormones and see if you’re having any semblance of a cycle, even though it’s not enough to see you really working. Do you have a little bit of an underlying cycle going on? Then, of course, you can do a Dutch cycle mapping lab where you do an entire month of urine tests at home and then you let them dry and you send them back in on these little papers and they give you a bigger analysis of what’s going on with all of your hormones throughout your cycle to give you a window into what’s happening. Then you can use that to start your calendar forward of where you would be in your cycle. That way you’re not just blindly trying to figure out what’s happening.

Again, typically, ovulation will come before your period starts. In order to have ovulation, it takes a few months to get those eggs going, and it can take a few months for this to happen. I want to set your expectation that this shouldn’t just happen two weeks or four weeks after you start making changes. It can take a little while. When you think about, we’ve talked about finding your own path to PCOS health episode a few episodes back, we talked about how you can intentionally put yourself in the driver’s seat of when you’re going to be ready to do certain things and what’s your next step and knowing that timeline of how long things are expected to take is very helpful in sitting back and relaxing and enjoying the journey and not feeling like, wait, it’s not working yet. I know there’s a lot of details in repairing your period, and although we covered the big picture of it here in this episode, I created a resource to go along with this episode so that you can see each step laid out, you can see the pictures, the diagrams, and get a little bit better feel for how to actually take action as you repair your period and your cycle.

The link for that, of course, will be in the show notes below, but be sure to grab your free copy of the Period Repair Kit so that you can get started taking some of these actions and leaning into caring for your cycle confidently and learning more about the symptoms that you would feel and all the things related to repairing your period. Make sure you grab your copy. Again, the link will be on the show notes page when you head over to the episode web page, so be sure to head over there. Be sure to connect with me over on Instagram. I’d be happy to help send you the link over there as well. All right, so be sure to grab your copy of it. It’s free. It’s just going to help you walk through in a more visual step-by-step manner what we’re talking about today in this episode. So there you have it, my friend. I hope you found this helpful in understanding how your cycle is working or should be working and how to help repair your cycle if it’s not working optimally and ultimately making your cycle healthier and stronger for better ovulation, boosting those hormones.

And even if you are not trying to get pregnant, this episode is going to help you have that better cycle health, which is the visible part of what’s going on deeper in our hormones. And I challenge you to during that second half of your cycle, see how much loving on yourself you can do to how much you can boost that progesterone. And this is the enjoyable part of PCOS healthy lifestyle is to really give yourself a reason why you need to book that pedicure and let yourself have a little bit more downtime and relaxing. Not just Netflix watching, but really let yourself unwind, maybe taking a hot shower or a hot bath or taking a little bit of time to do some yoga or sit in quiet, connecting to your breath or going for an evening walk and just letting life slow down a little bit. I’m guessing it’s going to become your favorite part of your cycle because you get to have that excuse, not that we need one, but you get to have a reason to make it a little bit more about you and enjoying and taking the time to get calm and connect with yourself again and the people that you love.

With that, if you have any follow-up questions, you know where to find me. I’m over at @nourishedtohealthy on Instagram, and I just love connecting with all of you in the DMs. Make my day to get a message from you, so please don’t be shy. Feel free to head over to Instagram @nourishedtohealthy and slide into my DMs to let me know your questions, your thoughts. Anything that you thought was an amazing takeaway from today’s episode, I would love to hear from you and until next week, bye for now.

Did you know that studies of PCOS epigenetics have shown that our environment can either worsen or completely reverse our PCOS symptoms? I believe that although PCOS makes us sensitive to our environment, it also makes us powerful. When we learn what our body needs and commit to providing those needs, not only do we gain back our health, but we grow in power just by showing up for ourselves. This is why I’ve created a guide for you to get started. My PCOS fertility meal guide can be found in the show notes below. I want to show you how to create an environment that promotes healing while still being able to live a life that you enjoy. This guide is completely free, so go get your copy now so that you can step into the vision that you have for your life and for your health.

1:01:01.10 – 1:20:06 Episode #94: PCOS and Menstrual Irregularities

One of the biggest problems with PCOS is our menstrual cycle. Irregular periods, heavy periods, some people talk about painful periods. I want to go through today and just talk about PCOS and your menstrual cycle, the irregularities that we see, what they mean, what to do about them, where to get started, and to help you navigate what’s what’s going on there. So with that, let’s dive into PCOS and your cycle.

You’re listening to the PCOS Repair podcast, where we explore the ins and outs of PCOS and how to repair the imbalances in your hormones naturally with a little medical help sprinkled in. Hi, I’m Ashlene Korcek, and with many years of medical and personal experience with polycystic ovarian syndrome, it is my joy to watch women reverse PCOS as they learn to nourish their body in a whole new way. With the power of our beliefs, our mindset, and our environment, and the understanding of our genetics, we can heal at the root cause.

Welcome back to the PCOS Repair podcast, where today we’re going to be talking about all things PCOS and your menstrual cycle. In order to fully understand the abnormalities of a cycle when you have PCOS, we need to start with what is actually going on in a normal cycle. Typically, we think of there being four main aspects or phases, parts of the cycle. We, first of all, start with day one, which is where we have our first bleed. The first day that we notice any bleeding, that’s day one of your cycle, and we would call that the menstrual phase or the period. That typically lasts for anyone somewhere between three and seven days. Should be fairly consistent flow with maybe a peak in the middle, so it starts maybe a little slow, gets a little heavier, and then tapers off. It’s fairly normal. The amount of flow is such a difficult question for people to know, but for the most part, you should be needing to change out a medium to heavy pad or tampon every couple hours at your heaviest flow. There’s been times where I would feel a super plus tampon in 30 minutes, that is extremely heavy flow. That would be what we would consider abnormal heavy but when you have a normal that’s heavy, sometimes it doesn’t feel extra heavy. I would say somewhere in the ballpark of if you’re having to be aware of your pad or tampon and you’re using an appropriately heavy, as in probably heavy, maybe not heavy plus, but just heavy, if you’re having to be aware of needing to change that before 2 hours.

If you feel like you can’t leave the house and go 2 hours without needing to change that, you’re probably having a heavy period. Now, if you have that for half a day on your heaviest day, and it’s borderline what I’m talking about there, that’s probably borderline normal, especially if that’s been normal for you since the very beginning. If you feel like your period has changed in heaviness, that’s something to pay attention to as well. Has it gotten lighter over time, heavier over time, longer in days, things like that are worth noting. They’re not always important as far as being significant, but they are worth at least paying attention to. Okay, so first part, we have the bleeding part. As that is happening, we have a rise in FSH. As our FSH rises, our follicular stimulating hormone, it is basically telling our follicles on our ovaries to start developing. We’ll have several follicles begin to develop, and the one that begins to take the lead will then become the dominant one. The other ones will reabsorb, and that will become the egg that will be ovulated that month. Then we have the follicular phase. We had a period, it leads into the follicular phase.

The follicular phase goes all the way up until we have an LH surge about mid-cycle. That LH surge signals our ovary to release that matured ready follicle as an egg, and that egg then goes and hopefully joins with some sperm and becomes an embryo and will implant in the uterine lining. Then it will, hopefully through enough progesterone, that it will also be contributing to. Our progesterone should be rising at this point. As that progesterone rises, if we did have conception, so we created an embryo, if the embryo implants and there’s enough progesterone, then pregnancy will occur. Pregnancy will be sustained until the embryo creates its own placenta and so forth, and then will become its own entity, and the progesterone levels become a little bit less important. That would be if you got pregnant. Now, if you did not get pregnant, so the LH surges, the egg is released, and you did not get pregnant that month, maybe you weren’t trying to get pregnant that month, you were trying not to get pregnant that month, then what’s going to happen is your progesterone, hopefully is still high enough to maintain a substantial luteal phase, should be about the second half of your cycle.

Ideally, give a 28-day cycle, ovulation should be happening right around 14 days, and then you should have another 14 days from ovulation until that progesterone and estrogen drops signaling the lining of the uterus to shed. That uterus lining is called the endometrium. As the estrogen and the progesterone are rising throughout your cycle, that lining gets nice and thick and cushy and ready for an implanted embryo to keep it nice and secure and housed. So it gets nice and thick. Then when there is no viable embryo, then when the estrogen and progesterone drop, your body will shed that lining and start fresh the next month. That’s a normal cycle.

What is going on in an abnormal cycle? First of all, let’s talk about what are some of the symptoms that we would have of an irregular menstrual cycle, and then we can go through what’s happening with each of those. First of all, what about irregular? Irregular could be anything that’s less than 21 days, more than 35 days, or completely absent, never having started, or you don’t have a period unless you take some medication. Those are all different ways that women will present with irregular periods but essentially, if you’re having cycles that are coming too frequently or are taking too long to come, we consider it too long at about 36 days, but that could even be months in between cycles. What is happening there? Oftentimes here, what’s happening is that we don’t have enough change in our LH surge. We’re not having a follicle develop, we’re not getting a good enough LH surge to ovulate and then we’re not getting the rise in the progesterone and estrogen, so we’re also not getting the drop in progesterone and estrogen that signals our body to shed that uterine lining. If we have something that is keeping our uterine lining really small like an IUD. Even the copper or the Mirena IUD sometimes will keep our lining of our uterus small enough that we won’t have a cycle, specifically when it has the hormone with it. The Mirena or the Skyla or any of the progesterone-based IUDs tend to keep that uterine lining nice and thin, when that happens, we tend to not have the shedding or the period. So birth control can cause that, but also just a lack of ovulation can cause it to go longer because your body is essentially waiting.

We didn’t progress to the next stage. Say we had a period, so maybe you’re having periods every three months. So say we have a period, the FSH hormone may be elevating, but we’re not getting a good dominant follicle, we’re not getting an LH surge, maybe our LH is already elevated because of root cause hormones, our body is not detecting that like, all right, LH went up. Let’s release that egg. What we get is we get these several mature follicles that just keep maturing on the ovary, and we get this polycystic ovarian look on ultrasound, but we’re not seeing ovulation. If we don’t see an ovulation, our body is just waiting. It’s like, Okay, I’m waiting, waiting, still waiting. Then at some point, our uterine lining may get heavy enough that it just sheds on its own, or it may spot a little bit to shed, or you may not have any spotting or period at all for months because if you’re estrogen and progesterone low, you’re not getting that thickened endometrial lining, so it’s just a stalemate.

Other reasons that we can have irregular periods is because maybe we have really high estrogen, and so our endometrial lining is getting very, very thick, but we’re not actually ovulating, but we’re having an overflow bleed but that’s not going to come on a routine through a cycle. It’s going to be like it builds up enough and then it spills over. It’s going to come at a more variable timing. The other thing that can happen is that if we are having really light or really heavy periods, that can be an indication, again, of that endometrial lining being that we’re going too thick or too thin, or that we’re going too long in between. We may have heavier periods if we’re having longer cycles. You can see where all of that would be happening.

When it comes to pain with our menstrual cycles, typically this is not specifically PCOS-related. We hear them in combination so much that we tend to think that they are. There can be some hormonal effects that make us be more crampy, but a lot of times it has to do with some degree of endometriosis going on as well. If you’re having pain with your periods, it may definitely be worth having your doctor explore that a little further to see if something in addition is going on. The cysts of PCOS are really not painful, they don’t rupture the same way as an ovarian cyst can. A true ovarian cyst is a single cyst, and it’s very different than PCOS. That can happen to people who have PCOS, it can happen to people that don’t have PCOS. It’s a separate problem. That’s worth noting as well.

What’s going on in our bodies that is creating these symptoms? First of all, if we are having high LH, this can be a cause of testosterone being high. It can create an up our LH ratio with our FSH. When that ratio isn’t correct, our body doesn’t get that difference between FSH, stimulating a follicle, and then LH, telling it when it’s time to release it and finish maturing one, that conversation isn’t happening correctly because the levels are off. That can occur due to high testosterone. It can occur due to androgens released from the ovaries. What can happen is different things in our body, such as stress, such as food, such as our environment, can stimulate things that tell our ovaries to produce more androgens in the form of testosterone, primarily. This can come from various forms of our body not processing stress well, not processing inflammation well, not providing our body with foods that keep our insulin low. That doesn’t have anything to do with insulin resistance. It just has to do with the presence of a lot of insulin, which has to do with the foods that we’re eating, that stimulates our ovaries to produce androgens, when that happens, it can throw off our LH balance and we can really mess up our ovulation, so when we mess up our ovulation, over time, our progesterone goes lower and lower, stress levels lower, our progesterone, lower and lower, perceived stress on our body because of nutrition issues, because of exercise, sleep deprivation, our busy schedules, all of these things can really have an effect on those hormones and at each point in the cycle, if the next thing doesn’t happen, it’s almost like… I use this analogy, I think, in week’s episode, I mean this in a very different way but if you line up a bunch of dominoes and it’s like the symphony requires one domino to push the other one over so that the next thing can happen and the next thing can happen in a cycle, it’s almost like you put the dominoes too far apart and they couldn’t hit each other, so the next one didn’t go. You have this stall out and we don’t complete the process, and that leads to these symptoms.

How do we navigate fixing that? Well, the problem, I think, in a lot of therapies is that we go about diagnosing, do you have irregular periods? Very rarely does anyone look further into that beyond maybe ordering labs that include that top of pyramid labs that we just talked about, the FSH, the LH, the progesterone and the estrogen, maybe some testosterone and we may look at those to see if they’re out of balance but the problem is that when we see whether or not those are out of balance, the problem goes deeper. If we’re not looking at those deeper root cause hormones or we’re not looking at the symptoms that those deeper root cause hormones would create, such as different cravings, such as different energy levels, such as looking at maybe our levels of stress or what our body may be perceiving as stress because of the way that we’re eating or exercising or sleeping or working or whatever it is that we’re doing. We don’t have a very clear view as to why those hormones are out of balance.

We can see that our cycle is not working correctly, we can see that maybe we have low progesterone or we have a high LH-FSH Ratio. We don’t, in medicine, do a very good job at diving into the why. Then if we didn’t dive into the diagnostic and the root cause medicine of it very well to get a very holistic picture of what’s going wrong here, then when we jump to our treatment methods, we’re going to jump to things like, provera, let’s induce a period, or let’s put you on the pill so you have regular periods, or let’s say we did go far enough to diagnose you with PCOS, let’s give you some metformin to reduce your risk of type 2 diabetes and maybe reduce your insulin response. These are all things that they may give you, but at the same time, it’s not that they’re wrong or that they’re not helpful, but they’re addressing the top of a pyramid problem without going deeper into what’s going on on a holistic level in our bodies, in our environment, with our cycles, with our metabolic hormones, our endocrine hormones that are deeper, that are all affecting what’s going on in these top of pyramid, symptom-inducing suppressing hormones.

I want to also, as we talk about treatment, include in this conversation that there are some things we want to keep in mind. One of the reasons why your doctor may recommend including something like Provera in your health regimen, is that if you go long, long, long periods of time without shedding your endometrial lining, so without having a bleed and without changing out the lining of the uterus, that endometrial lining, those cells can get old, they don’t refresh themselves, they’re not rejuvenating themselves, and they become at higher risk of developing cancer. This is not something that is going to happen if you don’t have a period every single month. It is well-researched that you do not need to have a period every month for safety but this is something where it’s like if you’re never having a period and you are going years without having a period, you should probably think about having some provera every couple of months. My approach with this with clients is that while we need to keep that in the back of of our mind, as long as it hasn’t been six years since you’ve had a period, if it is, then maybe we should have some provera and then start the healing process but for the most part, when I’m working with clients, if they’re talking about provera with me, they’ve been on it off and on, and their doctor has them on about, usually every three months. That’s what I typically see in women is that they’re being recommended Provera every three months if they’re not having a period, and they’re not otherwise on birth control.

What I recommend with that is that go to your doctor and you see how long you can go without it with the idea that you are actively adjusting your lifestyle to try and induce a period naturally, and you would like to have as much time as possible between Provera to induce a period as possible. Typically, what I’ve seen back from doctors when clients talk to their doctor about this is that they’re like, Oh, that’s fine. You can go like six months or so, but we just don’t want you to go indefinitely, and so we have you on a regimen, that way, it gives us enough time. Typically, we can start inducing natural periods as long as they have even one natural period every couple of months, which happens relatively quickly in a healing journey to start getting some periods back.

Even if they’re not as regular and ovulatory as we want them to be, they’re at least returning. When that happens, we’re able to start not doing Provera at all because just like you would have had Provera every three months, now at least you’re having a natural period every three months, and we can get rid of that altogether. That’s something, though, that I do want to bring up. There’s a reason your doctor is doing that. I’m not suggesting that you don’t do it, but there are ways of talking to them about it and getting a timeline of what their comfort is with how long you go between it when you’re trying to induce a period naturally, your lifestyle changes. With that, being able to advocate for yourself when it comes to medical treatments for irregular periods and period problems is really important and understanding how your cycle should work and what your options are, are just the start of that. And then knowing how to bring up these conversations and If you need help with that, that’s something when I work with my clients, we talk very much about, I am not a replacement for their physician. I am working with them on lifestyle changes, working with them to help also talk to their doctors and ask questions so that their health is being addressed, along with their natural holistic approach to their PCOS wellness as well.

In conclusion today, I think it’s really important to understand that the point of this episode is that when we have a healthy normal cycle, our hormones are fluctuating throughout. If we have one area that gets a hang up, then all of a sudden we start to see these symptoms come up but those symptoms can be the same, and there can be many different things going on underneath. We can try to just gloss it over with something like birth control. We can try to dig a little deeper and diagnose someone with PCOS but even then, we need to dig deeper into what’s going on in those metabolic hormones, what’s going on in our lifestyle that’s leading us to struggle so much so that we can take a holistic approach, a well-rounded approach to our entire lifestyle, our mindset, our stress management, our nutrition, our sleep, our exercise, and all the things that are going to help us to let our body rebalance those hormones, repair our cycle.

Then as we repair our cycle, ovulation will return as it feels like all of those things are coming into place. Ovulation is the last thing that tends to show back up, that’s something to keep in mind, too. If you’re feeling like, Okay, my period is coming back, but I’m still not getting pregnant, there can be a few more things that need to be tweaked, a little bit deeper healing that needs to happen because ovulation is something that is a lot more finicky and a lot less ready to return than just the bleeding each month.

With that, if you have any questions, you know where to find me. I’m over on Instagram @Nourishedtohealthy. I do have a resource for you about PCOS period repair, and I will include that in today’s show notes, it’s a nice PDF download that walks you through, gives you some visuals about how a normal cycle works and how to go about beginning to repair your PCOS cycle from a more natural standpoint. I will provide the link for that so you can go and grab a copy in the show notes. Until next time, bye for now.