IRREGULAR CYCLES

The Chinese and Western Medicine View and Treatment
 

Irregular cycles are a common issue, with many women likely not reporting them to their Dr. This means that we are unable to know just how many people suffer with this issue. 

However, research carried out in Lebanon reported that 59.4% of the women they studied experienced irregular cycles [1]. Another study of students in Saudi Arabia reported a 27% rate of irregular cycles, possibly related to academic stress [2].

What is an Irregular Cycle?

An irregular cycle is a menstrual cycle that is unpredictable in terms of when it will arrive, and it will either arrive earlier or later than it usually should.

This means that the timing of the cycle is out of sync compared to a standard cycle of around 28 days, and it will either be early or late and is not regularly timed or predictable.

Western Medicine View:

An irregular cycle in western medicine is a cycle that is not within the standard range of 22-35 days. You’ll see shortly that Chinese medicine defines this slightly differently.

Western medicine finds that irregular cycles can be due to a variety of issues or dysfunctions of the body such as:

• PCOS
• Ovarian Cysts
• Endometriosis
• Fibroids
• Anovulation
• Diminished Ovarian Reserves 
• Endocrine issues such as: Thyroid, Pituitary, Hormonal disturbance or disease.
• Menopause
• Medication – prescribed medical drugs, some of which delay ovulation
• Herbal medicines – if not correct for your health balance 
• Supplementation – if not correct for your health balance 
• Changes in body weight – too much weight gain or too much weight loss 
• Exercise – too much or too little
• Lifestyle 
• Diet
• Irregular eating

Through a selection of medical tests or investigations, it’s possible to find out whether any of the above issues are present. 

Blood tests, Ultrasound Scans and some cycle tracking such as BBT (basal body temperature) charting can help identify underlying key issues.

Check out my test list here, that explains when to do hormone and thyroid tests in your cycle.

You can also access a talk here that I gave several years ago on how to understand BBT chart patterns.

Herbal medicine and supplements, if self-prescribed or incorrectly prescribed by a practitioner, can also cause irregularity of a cycle. 

Important: Please do not self-prescribe supplements or herbal medicines, and if you are working with a practitioner please monitor your cycles and report if they become more irregular.

Chinese Medicine View:

Irregular cycles are often called ‘chaotic menses’ in Chinese medicine, as they have a chaotic and unknown quality in relation to the timing of when they will arrive.

The term ‘irregular’ is a western term to describe any cycle frequency that is not consistently between 22-35 days. 

This includes short and long cycles and cycles that appear randomly at any time. Irregular is, therefore, a term that western medicine uses to describe any abnormal length of a cycle.

In Chinese medicine, we see each of these cycles as being different, which allows us to be more focused on the underlying causes of each one. 

The ‘irregular’ western medicine category is divided into the following 3 cycle groups in Chinese medicine:

1. Early cycles – that arrive regularly earlier than they should
2. Late cycles – that arrive regularly later than they should 
3. Sometimes early, sometimes late cycles – that arrive irregularly earlier or later than they should – and there is no regularity or predictability to their timing.

Point 3 above is the true definition of an ‘irregular cycle’ in Chinese medicine, as the other two cycles, short or long, are still regular in their timing and arrival.

Interestingly research has shown that rates of infertility were higher in women with cycles that arrive irregularly (point 3 above), compared to cycles that are short or long but arrive regularly [3].

To keep this post a bit simpler I’ll refer to all 3 cycles under the description of ‘irregular’ – as there are some crossovers within them.

Any irregularity of a cycle changing by more than 3-4 days of arriving earlier or later than usual should be reviewed, as this can impact the possibility of pregnancy.  

The 2 Key Factors That Regulate A Cycle:

Cycle regularity is based on 2 key factors:

1. The length of the follicular phase (first part of your cycle before ovulation), which determines when ovulation happens 
2. The length of the luteal phase (the part of your cycle after ovulation)

Both of these phases are involved in creating the overall length and timing of your cycle. And both are vital for getting pregnant and having a healthy pregnancy. 

We want to see at least 12 days in each phase (follicular and luteal) ideally. 

This means that the shortest cycle length should be 24 days.

Any less than 12 days in each phase, results in insufficient time for the necessary processes to complete their actions properly.

Issues mostly start to arise when cycles are reduced or increased by more than 3 days (compared to a 28 day cycle) according to clinical studies [4]. 

If a cycle is more than 3 days shorter, longer, or irregular then one or more of these phases will be disrupted, which may reduce the possibility of pregnancy.

Short Cycles:

A short cycle will be due to either the follicular or luteal phase being too short – and sometimes both phases are too short in the same cycle. 

A short cycle is defined as being less than 24 days in total, but a short phase (follicular or luteal) is anything less than 12 days for each phase.

A short follicular phase creates an early ovulation, which means an egg may be released before it is mature enough for healthy fertilisation, implantation, or pregnancy.

A short luteal phase reduces the possibility of implantation, which typically takes between 6 to 12 days [5] – and may stop pregnancy from happening.

Long Cycles:

A long cycle is caused by the follicular phase being too long, with ovulation being later than CD19. Many medical references talk about ovulation being okay up to cycle day 21, but my clinical experience has shown differently. I, therefore, prefer to aim my client’s cycles towards a CD18/19 ovulation at the latest. 

An ovulation on CD19 with a normal 14 day luteal phase would result in a cycle being 33 days or more in length.

A later ovulation indicates a reduced follicle response, to stimulation by FSH, or an interference with FSH production and release due to endocrine issues such as Hyperprolactinemia. 

A delay in releasing the egg may potentially reduce the egg’s energy or physical quality resulting in a poorer egg being released. This could reduce the possibility of a healthy pregnancy.

A long luteal phase past 18 days is usually only seen in pregnancy, or when certain medications have chemically altered the progesterone balance.

Irregular Cycles:

A truly irregular cycle, Sometimes Early Sometimes Late, is a combination of both the short and long cycles I’ve described.

There will be either shorter or longer follicular and/or luteal phases in each cycle. Sometimes the cycle will be long with a late ovulation, and other times it will be short with early ovulation. Sometimes it may be normal ovulation timing, with a short luteal phase.

All of these variations disrupt the natural balance of the cycle, and this should ideally be restored to a regularly timed cycle.

Identifying which type of cycle you have is key to treating it.

I always recommend BBT charting to help track the phases and identify where ovulation takes place so that you can diagnose where the issue is in the cycle.

Need some FREE support?

If you’re not already in my Facebook Group, where I help our members diagnose their BBT and cycle balance, join me here.

Chinese Medicine Diagnosis:

As you may know, if you’ve read my many other posts on Chinese medicine health patterns, there are a selection of patterns of imbalance that can present in your health presentation.

Typically for short, long or irregular cycles, there are 3 key patterns of imbalance that we recognise in Chinese medicine:

1. Qi deficiency – meaning that there is a reduced level of energy and internal function/activity of the body for all of the processes to be properly carried out. This results in a hypo (underactive) situation, where your body struggles to complete processes easily. You can read more detail about this pattern and foods to use to balance it here.

2. Blood deficiency – meaning that there is a reduced quality of blood. Nutrients, energy, hormones and many more components of your body are transported around the body to cells (including egg cells) via the blood. A weakness in the quality of the blood and it’s circulation will negatively impact the regulation and delivery of vital nutrients and hormones to the required areas. This can reduce egg quality, along with causing disruption in hormonal balance along with many other issues. The same is true for male fertility with disruption to the sperm health. You can read more about this pattern and foods to use to balance it here.

3. Qi and/or Blood stagnation – which indicates that there is a lack of circulation of the Qi (vital energy) and Blood around the body. These patterns can each exist alone but are often-times present together. This results in delayed ovulation, as the follicles are unable to receive the proper delivery of nutrients and energy they need. PMS, pre-ovulation issues, and circulatory issues and diseases (Endometriosis, PCOS, Fibroids, Cysts, painful periods, clotted periods, Hyperprolactinemia and more) all relate to these patterns of stagnation. To read about foods and tips for Qi and Blood stagnation go here.

4. Heat – which is a concept in Chinese medicine of a type of internal over-stimulation. Typically we see early ovulation if there is too much heat, but if the heat damages the fluid balance (blood and other important fertile fluids) then the fluids deplete and ovulation is delayed. Read more about Heat here.

To properly understand which patterns are affecting you, a detailed Chinese medicine fertility health assessment is crucial. 

This will find the root cause and balance and reveal which patterns are involved in your situation.

My favourite quote that I’ve shared in many previous posts outlines this:

“There is nothing better than knowing the root cause” 

Lu Buwei – famous Chinese medicine physician that lived 2300 years ago [6].

Treatment with Chinese and Western Medicine

Western Medicine Treatment:

Western medicine treatments for irregular, short or long cycles are typically not helpful when you are trying to conceive.

The main approach is to use hormone treatment to try and regulate a cycle, typically with the use of the birth control pill. As you may know, the pill has also been associated with irregular cycles once it’s use has been stopped – so this could be a risky strategy for many.

As more than 99% of my clients are 40+, the option of using the pill to stop a cycle, and then restart it, doesn’t offer much help as it will create a time-period where getting pregnant isn’t possible. The loss of time related to this type of therapy means that it doesn’t suit many people on a fertility journey.

Until western medicine finds a fertility friendly way of regulating cycles, my advice is to consider the experienced use of Chinese herbal medicine.

Chinese Medicine Treatment:

Classical Chinese Medicine (NOT “Traditional Chinese Medicine – TCM”) has been treating fertility and gynaecological issues for the past 1500 years.

My experience with hundreds of clients over the past 22+ years has shown that irregular cycles are in most cases changeable – and important to address to create the foundation for a healthy pregnancy.

On average it takes me between 3-9 months to regulate cycles, with most people seeing positive changes within the first 2-months.

Addressing any health issue, including irregular cycles, needs to be approached in an individualised way for optimum results.

This requires a clear understanding of your root health balance and the patterns of imbalance that are presenting.

With a detailed health assessment, we can find the patterns of imbalance that relate to the cycle issue you have.

Once this root cause is established, then a treatment program can be created for you based on the underlying aspects that your body needs help with. 

Once you address the root cause and the cycle changes, your chances of a healthy pregnancy increase – for natural and IVF conception and pregnancy.

The main treatment in Chinese medicine for regulating cycles is herbal medicine – and not acupuncture.  This is because most people’s health imbalance that causes irregular cycles, is linked to the above mentioned deficiency patterns.

Acupuncture can be used but should take a secondary role in the treatment of irregular cycles that relate to deficiency patterns – as it does not have the ability to increase Qi or Blood quality. 

Irregular cycles may develop into other menstrual irregularities such as heavy bleeding, prolonged periods, or abnormal uterine bleeding – spotting or bleeding between the normal time of menstruation.

Treating and regulating cycle length and disorders of ovulation will increase your chances of having a healthy pregnancy.

I recently received this message on Facebook from a client on my program, which prompted me to write this post:

“This month was my first EVER 28 days cycle ❤ compering to 60 and 90 days previously. I find this quite amazing. Thank you for your hard work Andrew! 🌱🌱🌱” Michelle, 39.

This is the first time in her life at 39 years old that she has had a regular cycle.

We found her root cause and worked to balance her health, and within 3 months her cycles started to regulate. 

As I write this she is 20-weeks into her pregnancy, after more than 12 years of trying to conceive, including failed IVF cycles and thyroid disease (hypothyroidism).

Need some help too?

If you’d like help and are interested in joining my program, book a free chat first to make sure it’s right for you: Book FREE chat here

References:

[1] Prevalence and pattern of menstrual disorders among Lebanese nursing students – N. Karout, S.M.Hawai  and S.Altuwaijri http://www.emro.who.int/emhj-volume-18-2012/issue-4/article-07.html 

[2] Prevalence of menstrual problems and their association with psychological stress in young female students studying health sciences – Rafique and Al-Sheikh: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885123/ 

[3]  Small CM, Manatunga AK, Klein M, et al. Menstrual cycle variability and the likelihood of achieving pregnancy. Rev Environ Health. 2010;25(4):369-378. doi:10.1515/REVEH.2010.25.4.369 

[4] Lum KJ, Sundaram R, Buck Louis GM, Louis TA. A Bayesian joint model of menstrual cycle length and fecundity. Biometrics. 2016

[5] Wilcox AJ, Baird DD, Weinberg CR (1999). “Time of implantation of the Conceptus and loss of pregnancy”. New England Journal of Medicine.

[6] The Annals of Lu Buwei, 3rd Century BCE (Stanford University Press – translated by K, K and Riegel – 2000) 

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