Irregular Periods- what to recommend?

[SimoneS]

Hi Everyone,

I am working on a nutrition counseling assignment and am trying to find the best information to give to my "client"  She has had irregular periods for some time now, but has not been on the pill.  She does exercise, which I know can affect cycles, but not obsessively, Moderate stress, not trying to get pregnant... 

I have found lots of great information about PMS alleviation, but not as much about missed periods. Specifically, I am hoping to figure out which foods and supplements would be helpful.  (She probably won't go to the doctor unless it seems to be life threatening, which I can relate to)  I've been poring though every book I have, thinking it should be an easy answer, but have found myself stumped.   

Any information is very much appreciated!

Thank you
Simone

[jodi f.]

You haven't given a whole lot of information about your client that would prove helpful: Age--Is it possible she's entering peri-menopause?; Weight--Is she severely underweight or has she gained or lost a significant amount of weight over a short period of time?; Diet---Does she eat a lot of refined carbohydrates?

Also, what do you mean by irregular periods? Does she bleed regularly but with long or short cycles? Is she missing periods, and if so, how many? Some irregularity may just be her "normal", since there's a wide range among women of what's considered regular cycles.

What immediately comes to mind to me are the biggest factors affecting menstrual cycle regularity: stress (you sure it's not affecting her?) and polycystic ovary syndrome (PCOS), which usually involves insulin resistance and interestingly, doesn't always involve cysts on the ovaries. Many PCOS sufferers are obese, non-ovulatory, have increased body hair and sometimes acne. But not all women with this condition fit this profile---not at all---which means medical testing is important. Check some of the PCOS websites and online forums.

Another reason I think she'll (hopefully) want to see a doctor is that menstrual irregularity can also be caused by pituitary tumors, which while not immediately life-threatening, would be easier to deal with early rather than later in the process.

If you feel like presenting us with more of her diet, lifestyle, medical history information, and anything else you feel is relevant, please do so. But for a real diagnosis, she'll need some testing.

If you're needing to get to diet/lifestyle recommendations for her right away, I'd suggest making blood-sugar regulating/stress management recommendations. I'd also want to be certain she wasn't eating any endocrine-disrupting foods such as commercial meat and dairy. And even her produce should be mainly organic because many of the pesticides we use affect aromatase, the hormone that regulates how we convert hormones to other hormones. This can lead to increased production of either testosterone or estrogen. I imagine she wants to minimize this kind of risk as much as possible.

Keep us posted if you can.

[SimoneS]

Thank you so much Jodi.  I was so relieved to see a response from you- you always have such great information! 

Some more information about her: She's 30 years old, overweight (178 / 5'4") And has been eating a primarily vegetarian diet.  Hardly any refined carbs if at all- mostly vegatables, some soy products (unfermented- which I don't think is a great idea*)  Maybe a little bit of commercial dairy, in the form of greek low fat yogurt.  (also not a great idea, and I've suggested alternatives in her meal plan) All in all, way better than the average SADer.  One thing that pops into my head is that her vegetarian diet is lacking healthy fats, but she hasn't been following this diet as long as her periods have been irregular.  I suppose healthy fats can always be lacking though...   

Her diet history has varied greatly.  She tends to go through phases where she eats really well, and then falls off the wagon and binges on sugar and unhealthy fats.  The impression I get is that she's on the right path this time, and very proactive about getting herself healthy (She also recently quit smoking) As far as health history, I don't believe she has ever had any issues.   

By irregular, I mean that she misses her periods often.  I think she gets them, on average every 2-3, maybe 4 months.  It's hard to say if stress could be the main culprit.  She's a 2nd generation astrologer, so VERY aware and affected by how any home stress can turn a Cancer into a basketcase.  I'm not sure how much of that she's internalizing. 


Thanks again!
Simone

* I know the Bauman community doesn't shun soy, and suggests it is eaten in moderation.  For me though, when I combine how it's affected me, many articles I've read, and several practitioners I've spoken with who I greatly respect, I am anti-soy that hasn't been fermented. 

[SimoneS]

I forgot an important detail:  She recently started taking phytoestrin, which was recommended by her mother.  It's basically soy isoflavones and several herbs that I know are commonly recommended for women (black cohosh, etc)  It looks like it's intended for women who are menopausal, so I'm baffled as to why someone her age would be taking it... 

[jodi f.]

Most women in our culture sure don't need more estrogen, especially if they're overweight, and she's quite heavy. Sounds like she's guessing at what's going on and throwing supplement darts at it. I call this pin-the-tail-on-the-donkey nutrition, where you've got a virtual blindfold because you've done no testing, and you hope your supplement hits its mark. I can generally talk clients out of this by explaining that the result, or lack thereof, may not warrant the expense. BTW, I'm with you on the soy issue, and soy isoflavones scare me a little.

OK, so she doesn't want to go to a doctor. What about ordering some inexpensive labs online? Direct Labs (directlabs.com) offers very low price labs, both the standard variety and some functional testing. Bauman Nutrition, in fact, has their own page of offerings on this site. Their thyroid panel is the right one and the price is right, too. Low thyroid function can cause both weight gain and hormonal imbalances, so she may want to consider this panel. If she has a little money to spend, some standard labs could help you understand her issues. Also, if she gets some out of reference range readings, maybe that would encourage her to see a doctor. (I'm assuming that she doesn't want to see a doctor at least partially because she doesn't have insurance or money?) If she's not wanting to see a doctor because she doesn't like Western medical care, maybe you can simply tell her that getting a diagnosis doesn't mean she needs to take drugs. A diagnosis, while not necessary, may speed her recovery, simply because you'd know what her issues are.

If she isn't opposed to having some testing done, a Fasting glucose with a Fasting Insulin can help you understand her blood sugar regulation. You can also give her the Hypoglycemia questionnaire for this. There are some people who are exquisitely sensitive to carbohydrates, even unrefined ones, including whole grains. Also, vegetarianism may not be providing her with enough protein, which is a necessary component for the manufacture of hormones. And, it looks like smoking can cause her condition (see http://www.womentowomen.com/menstruation/irregularperiods.aspx).

For other tests, a hormone panel would be useful, but she'd want a doctor to look at it.

But, really, the bottom line for you is what kind of recommendations to make for this client, even if she doesn't get to a doctor or do any testing. Have you asked her what makes her "fall off the wagon" and binge on sweets? You may find some good personal or nutritional information there. This used to happen to me in my vegetarian days because my protein and fat intake was so inadequate. So, your wondering about her fat intake may be quite right on. Have you asked her many questions about these irregular periods? Was there something that triggered them, something emotional or physical or environmental?

If this was me, and with only the information you've given me, I still say a stress and blood sugar management diet: Building direction. Clean food. Is it possible that she would eat some fish or chicken just for a month, to see how that made her feel?  Very small amounts of whole grains and starchy veggies. Lots of colorful veggies. Boosters. Replace the nutrients sapped from years of smoking. See if she's willing to reduce the unfermented soy.

You can't make her do anything she's not willing to do, but maybe you make some reading recommendations for her. www.womentowomen offers gentle, easy to read information on all aspects of women's health. She may like their newsletter. If she's truly proactive, she may end up needing more than nutritional counseling.

Good luck.

[SimoneS]

Thank you so much for all of that information- SO helpful.   

She actually has health insurance, but isn't a fan of western medicine.  (which I can relate to)  Getting tests done as you suggested is a great idea.  I think thyroid issues could definitely be the issue, considering she eats well and exercises- One would think she could lose weight, but it seems to be an uphill battle for her.  According to the metabolic type survey, she seems somewhere between a slow and balanced metabolizer...  She was vegan on and off from the time she was 5...  Makes me worry about how much soy has gone into her body over time, as well as a lack of healthy fats overall.  I have forwarded her lots of good information and links,  so she can do some reading and move forward in an educated manner. 

Thanks again! 

[ErinL]

Simone,
I agree with Jodi's comprehensive recommendations, and while you're doing testing, working with her diet can really help give her a good foundation upon which to build her health. What stands out for me is that she's not currently, nor has she been in the past, eating enough fat and protein.  Calculate how many grams of protein she needs per day and ensure she's getting a good portion of that at breakfast. It's possible to do this with plant protein, but I agree with Jodi, that to re-balance her body, she may need to add some animal protein. Share with her a chart showing her where her protein is coming from in grams from standard dietary sources. This will help her to be more aware of the foods she needs to add in at every meal and how much/many she needs of them.
Remember, hormones are made from protein so she needs enough of this valuable macronutrient just to be able to make her hormones.

[jodi f.]

I completely agree with Erin's recommendation, and showing her a chart is a great idea. It's always nice to have something easy to read and comprehend.

This brings to mind a conversation I just had with a former overweight vegetarian. Most overweight people I encounter are very sensitive to carbohydrates--sometimes even to whole grains--and in order to derive enough protein from vegetable foods, one is almost certainly eating a heavy dose of starchy carbohydrates. There's generally a lot of talk on this forum about the "high protein" grains, quinoa and amaranth. But even these are predominantly starchy carbohydrate.

I also completely agree with Erin's suggestion of optimal protein at breakfast. There are studies showing this can greatly aid weight loss because it helps ensure steadier blood sugar levels further into the day. At your client's weight, and with her irregular menses, I'd bet on insulin resistance and probably PCOS, and the key here is blood sugar balance.