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.