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    Irregular Periods? Here’s What You Should Do

    By Dr. Laura Pipher

    Do you suffer from irregular periods, trouble losing weight, excess hair growth, or hormonal acne? You’re not alone. Today we brought in Dr. Laura Pipher, Naturopathic Doctor & Founder of HER Time Of The Month, to shed some light on why this may be happening, and what you can do about it.

    If you’re subscribed to Loti Wellness, you’ll see that our February box featured a 3-month free trial to Dr. Laura Pipher’s HER Time of The Month Program – a women’s health program & community tailored to your needs. So, if you’re interested in more advice beyond this blog around all feminine health topics, make sure you sign up for her program here.

    Dr. Laura Pipher

    Polycystic Ovarian Syndrome

    If your answer to all of the above was yes, you may be suffering from Polycystic Ovarian Syndrome (also referred to as “PCOS”). If you’ve never heard of the term polycystic ovarian syndrome, you’ll want to become familiar with it! Polycystic ovarian syndrome occurs in 5-10% of women, and in the United States, it is the most common cause of infertility.


    Often times I’ll see patients in my practice who either think they have PCOS after being told that they have cysts on their ovaries or have been put on birth control to “regulate their cycle,” and then told to come back to see them when they want to start trying for kids. Well, I hate to burst your bubble, but BOTH of these statements can be incorrect when it comes to getting a proper diagnosis and treatment plan for your PCOS.

    Getting A Diagnosis

    Did you know that you can have what’s known as “polycystic ovaries” and still not qualify for a diagnosis of PCOS?  I know, you’re probably wondering how that even makes sense, since polycystic ovaries is actually in the name.

    PCOS is a complex hormonal disorder and it is more of a metabolic dysfunction than anything else. This is why getting a proper diagnosis can be extremely tricky, and for some women can even take years. In an online survey of PCOS patients, many reported visiting three or more doctors before getting an official diagnosis, which took two years or more. I’m willing to bet that this time is actually longer than two years considering most women are given the birth control pill to treat their irregular periods and told to return when they want to start trying to get pregnant. This means that some women spend years on birth control thinking that it is improving their symptoms when it is actually working to cover them up.  



    Menstrual Cycle

    Why Is There Such a Delay in a Diagnosis?

     Since PCOS presents as a syndrome, the diagnostic criteria can be quite vague. There are three main factors to assess when looking for a diagnosis:


    1. Evaluating regular ovulation

    The main issue with PCOS is having an irregular period. This can be difficult to determine because regular periods do not confirm regular ovulation. The best way to identify whether or not you are ovulating each month is by doing a simple blood test evaluating progesterone at day 21 of your menstrual cycle (day 1 is when you bleed).


    1. Assessing androgens (male hormones)

    This is a key diagnostic feature in PCOS impacting between 60-100% with the condition. This can be determined by testing testosterone in basic bloodwork. It is important to get the proper bloodwork so that a diagnosis of PCOS is not easily missed.


    1. Looking for Cysts in the ovaries

    Finally, polycystic ovaries are a common feature seen in women with PCOS, thus its incorporation in the name polycystic ovarian syndrome. However, PCOS cannot be diagnosed OR ruled out with an ultrasound. This is because women can have cysts at certain times of the month, and this is completely normal!


    In fact, younger women will naturally have a higher number of follicles, thus a higher number of eggs. The international PCOS guidelines state that ultrasound is now not recommended in those within 8 years of the start of their periods. This means that if you got your period at 13 years old, an ultrasound cannot be used to diagnose your PCOS until you are at least 21 years old. If you had irregular periods, acne, trouble losing weight before the age of 21, you were probably put on birth control and not evaluated for a proper diagnosis.

    When It’s Not PCOS

    PCOS is a diagnosis of exclusion, which means that in order to solidify your diagnosis, we need to make sure there is nothing else going on. Some evaluations you should have done to help rule out PCOS include

    • Thyroid evaluations – Thyroid issues can impact your period making them irregular, heavy, or too light.
    • Diet & lifestyle – Hypothalamic amenorrhea can occur when you are under-eating, overexercising, or both. This leads to irregular periods (or no period at all). 


    Polycystic Ovarian Syndrome

    Conventional treatment options

    The first-line treatment from a conventional standpoint focuses on whether or not pregnancy or ovulation is “desired”. Now if you are a female, I would highly recommend everyone “desire” ovulation even if you are not trying to get pregnant. This is because ovulation is a key event that dictates our hormonal balance (so many other symptoms like sleep, sex drive, skin health & mood.)

    The rest of the treatment options are decided after this first question is answered. If you are not desiring ovulation or wanting to get pregnant, your first-line treatment option is hormonal contraception (ie. birth control). You are also recommended lifestyle modifications to reduce weight, given metformin if you are deemed to be insulin resistant, offered spironolactone for excess hair growth & acne (if the birth control didn’t work) as well as other topical medications to treat breakouts.

    Naturopathic Treatment options

    Fortunately, there are many lifestyle interventions that can help manage hormonal imbalances in PCOS.


    Here are 5  dietary tips for managing your PCOS symptoms : 


    Cinnamon 1-3g/d Research has shown cinnamon is equivalent to metformin for reduced LH, testosterone, and improved metabolic profile for women with PCOS

    Walnuts/Almonds | 1/2 cup – Research has shown this amount per day can help reduce bad cholesterol and androgens

    Flax seeds 1-2tbsp/d – Flaxseed is a phytoestrogen and can help balance estrogen and testosterone

    Spearmint& Flaxseed – A combination of these two for 30 days can result in a significant rise in progesterone, and a decrease in testosterone 

    Pumpkin seeds – Pumpkin seeds are anti-androgen (they reduce testosterone) and contain zinc which can support healthy skin and help treat acne

    The following diets have also been studied with respect to PCOS treatment

    Healthy Diet

    1.Mediterranean Diet

    The Mediterranean diet is characterized by high consumption of extra-virgin olive oil (EVOO), nuts, red wine, fruit, vegetables, and whole grains. One study found that the PCOS women consumed less extra-virgin olive oil, legumes, fish/seafood, and nuts compared with the control group. Further, despite no differences in energy intake between the two groups, the PCOS women consumed a lower quantity of complex carbohydrate, fiber, monounsaturated fatty acids (MUFA), and n-3 polyunsaturated fatty acid (PUFA), and higher quantity of simple carbohydrate, total fat, saturated fatty acid (SFA), PUFA and n-6 PUFA than the control group


    1. Ketogenic Diet

    The ketogenic diet primarily focuses on very low carbohydrates with high-fat content. One study looked at overweight women with PCOS and found that 12 weeks on the ketogenic diet reduced weight, insulin, cholesterol, and testosterone. It was also found to improve other hormone parameters in increasing progesterone and estrogen. 



    In a nutshell: PCOS is much more than simply having cysts on your ovaries and needs more than an ultrasound for proper diagnosis. Whether or not you plan on having children, ovulating is healthy, and going on the birth control pill only masks your PCOS symptoms. Being given the proper testing and being asked the right questions, in combination with a few simple lifestyle changes, can get your body on track and feeling good.


    If you are looking for options to help treat your PCOS head here to book your free discovery call.

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