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:
Too few or too many periods per year
Spotting or brown bleeding before a period
Very heavy (multiple pads/hour) or very light flow
Mid-cycle bleeding or bleeding after intercourse
Causes can be grouped into:
Hormonal: Estrogen too high or low, progesterone imbalance, thyroid issues, high prolactin, adrenal dysfunction
Structural: Ovarian cysts, fibroids, uterine or cervical polyps, cervical ectropion
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 polypsCervical 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.
Resources & Next Steps:Dr. Sarah and her team at Vera Health and Fertility can help evaluate and treat irregular cycles with a personalized, holistic plan. 📍 Westminster, Colorado 🌐 Schedule a consultation: verafertility.com 📧 Follow along: @verafertility on Instagram & TikTok
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