Life Stages

• Adolescence: wider variation for 1–2 years post-menarche as axes mature.
• Postpartum: lactation suppresses ovulation; cycles return gradually.
• Perimenopause: ovulation becomes sporadic; flow and symptoms fluctuate.

Functional Patterns

• Anovulatory cycles: bleed without ovulation—often erratic.
• PCOS-like: irregular cycles with acne/hair changes or insulin resistance signs.
• Hypothalamic: under-fueling, weight loss, over-training, high stress.
• Endocrine-driven: thyroid or prolactin shifts; sometimes medication side-effects.

Common Symptoms

• Unpredictable cycle start dates, very light or very heavy flow.
• Breast tenderness, bloating, mood and sleep changes.
• Acne or hair changes; weight or energy shifts.
• Pelvic cramps or discomfort.

See a Doctor If

• Missed periods for 3+ months (not pregnant).
• Bleeding so heavy you soak through protection hourly for several hours, or clots larger than a ₹10 coin.
• Bleeding between periods or after intercourse.
• Severe pain, fever, foul discharge, or signs of anemia (fatigue, dizziness).

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Hormone & Metabolic

• Infrequent ovulation (PCOS-like), insulin resistance.
• Thyroid imbalance (slow or fast); elevated prolactin.
• Perimenopausal ovarian variability.

Lifestyle & Environmental

• Sleep loss, shift work, high stress.
• Under-fueling, rapid weight change, or over-training.
• Pelvic heat exposure; endocrine-disrupting chemicals.

History & Exam

• Cycle calendar (length, flow, pain, inter-cycle spotting).
• Stress, sleep, diet, activity, weight change.
• Skin/hair, galactorrhea, thyroid cues, pelvic tenderness.

Core Tests (Case-by-Case)

• Cycle days 2–5: LH, FSH, estradiol; ± androgens if indicated; TSH ± FT4.
• Luteal progesterone: ~7 days after ovulation (or 7 days before expected menses).
• Prolactin: repeat if borderline; interpret with context.
• Ultrasound: cavity and ovarian morphology when irregularity persists.
• CBC/ferritin: if heavy bleeding or fatigue suggests anemia.

Ovulation Confirmation Options

• Basal body temperature trend (sustained rise after ovulation).
• Mid-cycle LH kits or symptom tracking (cervical mucus, ovulation pain).
• Timely luteal progesterone level.

Principle: Test only what changes decisions. Align timing; avoid scattershot panels that don’t guide action.

Daily Foundations

• Sleep: 7–8 hours; fixed wake time; screens off 60 min before bed; cool, dark room.
• Meals: consistent timing; balanced plates (vegetables, quality proteins, whole grains/legumes, healthy fats); earlier, lighter dinners.
• Movement: 150–210 min/week moderate cardio + 2 strength sessions; 10–15 min post-meal walks.
• Stress care: 10–15 minutes/day of breathwork; extend exhales.
• Heat & toxins: laptops off lap; breathable underwear; avoid microwaving in plastic; ventilate solvents/paints.

Weekly Rhythm

• One no-phone walk or meal daily; 1–2 restorative sessions (yoga, stretching, massage as advised) weekly.
• Evening wind-down routine 20–45 minutes, every day.

Check-ins & Follow-up

• Week 4: review sleep, meal timing, steps, stress score (0–10), flow notes.
• Week 8: adjust training windows; confirm ovulation evidence.
• Week 12: reassess cycle regularity; plan next steps if still erratic.

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Follicular → Ovulation

• Energy often higher—schedule tougher workouts and complex tasks.
• Support hydration and balanced carbs around training.

Luteal

• Prioritize sleep; maintain protein-rich snacks; stabilize meals to reduce cravings.
• Dial down intensity if PMS symptoms flare; keep walks and mobility.

Heavy or Painful Days

• Favor gentle movement, heat-pack to lower abdomen as comfortable.
• Ensure iron-rich foods if bleeding is heavy; discuss testing if fatigue persists.

Dinacharya & Ritu-charya

• Fixed sleep/wake, mindful meals, gentle morning movement.
• Adjust for seasons—cooling routines in heat; warm, easy-to-digest meals in cool/dry months.

Therapies When Indicated

• Soothing head/neck therapies to reduce stress load and improve sleep.
• Pelvic-calming approaches and guided breath for Apāna Vata balance.
• Panchakarma-based work only with physician advice and timing.

Create Your Integrative Plan

If Trying to Conceive

• Track ovulation signs; time intercourse in the 4–5 days before ovulation and on ovulation day.
• Repeat cycle tracking for at least 3 cycles to see patterns.

If Avoiding Pregnancy

• Do not rely on irregular cycles alone—use a reliable method.
• Cycle awareness is helpful but should be paired with an effective contraceptive strategy.

Myth

• “Irregular periods always mean infertility.”
• “Only one hormone is to blame.”
• “Teens and perimenopause shouldn’t be irregular.”
• “More tests always equal better answers.”

Fact

• Many women conceive after restoring ovulation rhythm and lifestyle foundations.
• It’s usually a network: sleep, stress, thyroid, prolactin, insulin, and ovulation timing interact.
• Some irregularity is expected at these life stages; persistent or severe change deserves evaluation.
• Choose tests that change decisions; align to cycle timing.

How long until I see change?

Energy and sleep may improve within 2–4 weeks; cycle patterns typically respond across 8–12 weeks of consistent habits.

Can stress alone cause irregularity?

Yes—particularly with sleep loss and shift work. Pair stress care with regular meals and movement.

Do I need an ultrasound?

It’s helpful when cycles remain erratic, bleeding is heavy, or pelvic pain/spotting occurs. Your clinician will advise timing.

What about supplements/medicines?

This page is educational and does not name any medicines. Your plan is personalized after evaluation.

Dr. Megha Yadav

BAMS — Female Infertility & PCOS/PCOD

Focus: cycle-timed diagnostics, PCOS patterns, perimenopause planning, integrative routines synced to your life.

Consult Dr. Megha

Dr. Ranjeet Singh

BAMS, DMR — Male Infertility & Sexual Health

Supports partner evaluation and couple-centric planning when fertility is the shared goal.

Consult Dr. Ranjeet