The Hormone Cafe

In this episode of The Hormone Café, Dr. Sarah Pederson, holistic OB-GYN and founder of Vera Health and Fertility in Westminster, Colorado, discusses irregular bleeding. She explains what counts as an irregular period, the possible causes—from hormonal imbalances to structural issues—and how to properly evaluate and treat irregular cycles.

In This Episode, You’ll Learn:

💡 Definition & Differential Diagnosis

• Normal cycles: 24–35 days, varying by no more than 3 days per cycle.
• Signs of irregular bleeding:
  1. Too few or too many periods per year
  2. Spotting or brown bleeding before a period
  3. Very heavy (multiple pads/hour) or very light flow
  4. Mid-cycle bleeding or bleeding after intercourse
     
• Causes can be grouped into:
  1. Hormonal: Estrogen too high or low, progesterone imbalance, thyroid issues, high prolactin, adrenal dysfunction
  2. Structural: Ovarian cysts, fibroids, uterine or cervical polyps, cervical ectropion
  3. Blood-related: Genetic or acquired clotting disorders (e.g., Factor V Leiden)
     

🩺 Workup of Irregular Bleeding

• Hormone testing: Estrogen, progesterone, LH, FSH, thyroid hormones, prolactin, testosterone
• Cycle mapping with urine tracking (e.g., Mira, NEDO) and blood work at multiple points in the cycle
• Ultrasound: Assess ovaries, uterine lining, fibroids, cysts, or polyps
• Pelvic exam and cervical check, including vaginal swabs for infections
• Endometrial biopsy for uterine health or infection
  

🌿 Treatment & Management

• Nutrition & Lifestyle: Foods and supplements to support hormone balance; tailored to whether estrogen, progesterone, or other hormones are high or low
• Medical Interventions:
  • Bioidentical hormones to correct estrogen or progesterone imbalances
  • Medication or surgery for ovarian cysts, fibroids, or polyps
    Cervical treatments (e.g., silver nitrate) for ectropion
  • Antibiotics or probiotics for infections
• Monitoring & Tracking: Chart cycles to ensure interventions are effective; cycle mapping helps identify hormone shifts and empowers long-term management
  

Key Takeaways:

• Irregular periods are not “normal” and often signal underlying hormonal, structural, or blood-related issues.
• Comprehensive evaluation—including hormone testing, imaging, and pelvic exams—is essential to identify causes.
• Treatment can include lifestyle changes, supplements, medical interventions, and monitoring.
• Balancing hormones and achieving regular cycles may take 3–6 months, but long-term consistency leads to improved health and well-being.