What Causes Irregular Periods? The Root-Cause Guide for South African Women

Irregular periods are one of the most common concerns women bring to functional and integrative medicine clinics. For some, it’s a few days’ difference each month; for others, periods might disappear for months, come twice in one month, or change in flow and symptoms unpredictably.

While many conventional explanations stop at “it’s hormonal,” functional medicine goes deeper, asking why your hormones are off in the first place. In this guide, we’ll explore the real root causes of irregular cycles, how they connect to your whole-body health, and practical steps you can take to restore your rhythm naturally.

First, What Counts as an “Irregular Period”?

In functional medicine, a healthy menstrual cycle typically:

• Lasts between 24–35 days (from the first day of one period to the day before the next starts)
• Has consistent cycle length month to month (give or take a day or two)
• Bleeding lasts 3–7 days
• Comes without excessive pain, flooding, or large clots

An irregular period means your cycle falls outside these norms, either in timing, flow, or symptoms, for more than a couple of months. It’s important to note that occasional irregularity from illness, travel, or stress is normal. But when the changes persist, it’s a sign to dig deeper.

Why South African Women Shouldn’t Ignore Irregular Periods

In South Africa, many women assume irregular cycles are “just part of life”, especially in busy seasons or during perimenopause. Unfortunately, ignoring the pattern can allow underlying health issues to worsen over time, affecting fertility, mood, bone health, heart health, and long-term disease risk.

Functional medicine views irregular cycles as your body’s way of saying something is out of balance, often far earlier than other symptoms appear. Addressing the cause early can prevent years of frustration and improve your overall well-being.

The Root-Cause Approach: Listening to Your Body

The root-cause framework teaches that your menstrual cycle is like a monthly report card for your overall health. Hormones are chemical messengers, and their production, breakdown, and balance depend on multiple systems, including your brain, thyroid, gut, liver, and adrenal glands.

When any of these systems struggle, your menstrual cycle will reflect it. That’s why simply taking the pill to “regulate” your cycle might mask symptoms but doesn’t correct the imbalance.

The 7 Most Common Root Causes of Irregular Periods

Let’s look at the most common reasons cycles go off-track, based on both clinical experience and the functional medicine lens.

1. Stress and Cortisol Imbalance

Chronic stress — whether from work, relationships, finances, or even unrelenting busyness, increases your production of cortisol, your main stress hormone. High cortisol levels can:

• Suppress ovulation (leading to longer or missed cycles)
• Shorten your luteal phase (the time after ovulation before bleeding)
• Cause heavier or lighter flow than normal

High cost of living, long commutes, and safety concerns can contribute to daily, low-grade stress that your body interprets as a reason to conserve energy and reproduction is often the first thing to slow down.

What helps:

• Daily stress reduction practices (walking, journaling, breathwork)
• Adequate sleep
• Adaptogenic herbs (Ashwagandha, Rhodiola, Holy Basil)
• Gentle, consistent exercise instead of intense, exhausting workouts

2. Polycystic Ovary Syndrome (PCOS)

PCOS is one of the most common causes of irregular cycles globally and in South Africa. It’s driven by a combination of insulin resistance and higher levels of androgens (male hormones).

Typical cycle patterns:

• Long cycles (35+ days)
• Skipped periods
• Unpredictable ovulation

Other signs: acne, unwanted hair growth, weight gain (especially around the middle), and difficulty losing weight.

What helps:

• Balancing blood sugar through diet (low glycaemic index eating)
• Strength training for insulin sensitivity
• Key nutrients like inositol, magnesium, and chromium
• Targeted herbal and supplement support

3. Thyroid Dysfunction

Your thyroid controls metabolism — which includes your menstrual rhythm. Both hypothyroidism (low thyroid) and hyperthyroidism (overactive thyroid) can cause irregular or absent periods.

Common signs of low thyroid include:

• Fatigue
• Weight gain
• Feeling cold
• Dry skin
• Hair thinning

In South Africa, iodine deficiency is less common due to iodised salt, but autoimmune thyroid conditions (like Hashimoto’s) are on the rise.

What helps:

• Full thyroid panel testing (TSH, Free T3, Free T4, antibodies)
• Selenium-rich foods (Brazil nuts, sunflower seeds)
• Ensuring adequate iron and vitamin D
• Treating underlying autoimmunity

4. Perimenopause

Perimenopause — the transition before menopause — can start as early as the mid-30s. Hormone levels, particularly estrogen and progesterone, begin to fluctuate more wildly, leading to:

• Shorter cycles
• Heavier bleeding
• Skipped months

What helps:

• Supporting adrenal health (since your adrenals take over hormone production post-menopause)
• Stabilising blood sugar
• Gentle phytoestrogens (like flaxseeds) for balance
• Tracking symptoms to differentiate normal transition from other conditions

5. Extreme Dieting or Over-Exercise

Your body needs enough energy and nutrients to maintain reproductive health. When calorie intake is too low or exercise is too intense, ovulation can stop (amenorrhea).

This is common among athletes, dancers, and women following extreme weight-loss programmes.

What helps:

• Eating balanced meals with protein, healthy fats, and complex carbs
• Allowing rest days between workouts
• Checking iron, B12, and vitamin D levels

6. Post-Pill or Contraceptive Changes

Many women experience irregular periods after stopping hormonal birth control. This is because synthetic hormones suppress ovulation, and your body needs time to restart natural cycles.

What helps:

• Supporting liver detoxification (cruciferous vegetables, hydration, sweating through exercise)
• Tracking ovulation with basal temperature or ovulation strips
• Herbal allies like chasteberry (Vitex) to encourage regular cycles

7. Underlying Medical Conditions

Other conditions that may cause irregular periods include:

• Uterine fibroids
• Endometriosis
• Pelvic inflammatory disease
• High prolactin levels

These require proper medical evaluation to ensure safe and effective treatment.

How Functional Approach Restores Your Cycle Naturally

At Ask Dr Olz, we approach irregular periods by:

1. Investigating the Root Cause
   Comprehensive lab testing and health history review.
2. Balancing Hormones Naturally
   Nutrition, targeted supplements, herbal support.
3. Supporting Detoxification
   Optimising liver and gut health for proper hormone clearance.
4. Addressing Lifestyle Foundations
   Sleep, stress management, movement, and emotional health.

When to Seek Help Immediately

See a healthcare provider if you experience:

• Bleeding that soaks a pad/tampon every hour for several hours
• Missing periods for 3+ months (outside pregnancy)
• Severe pelvic pain or cramping
• Unexpected bleeding after sex
• Symptoms of anemia (dizziness, extreme fatigue)

Your Next Step: Take Back Control of Your Cycle

You don’t have to live at the mercy of unpredictable cycles. At Ask Dr Olz, we combine functional medicine, natural treatments, and advanced hormone testing to help women across South Africa restore balance and feel like themselves again.

Book your virtual consultation today and get a personalised plan to regulate your cycle naturally.

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📅 Book your appointment now — Let’s uncover the root cause of your irregular periods and create your step-by-step path back to balance.