Episode 10: Being fat doesn’t cause irregular cycles
Episode Summary:
In this episode of Fat and Fertile, I'm shedding light on the misconception that being fat causes irregular menstrual cycles.
I discuss the importance of proper diagnoses, challenging stereotypes, and emphasize the need for inclusive research and healthcare that goes beyond assumptions about body size.
Tune in to learn more about the real factors that can impact reproductive health.
What to Expect from the Podcast
Listeners will learn what constitutes a "normal" menstrual cycle, actionable steps for managing irregularities, and how to advocate for better healthcare. Nicola also provides practical tips for supporting the nervous system and tracking cycles effectively. This empowering episode encourages listeners to reject harmful stereotypes, seek the care they deserve, and navigate their fertility journeys with confidence and self-compassion.
Highlights
Debunking the Myth: Fatness and Irregular Cycles
What is Considered "Normal" for Menstrual Cycles
Actionable Steps for Managing Irregular Cycles
Links and Resources
Nicola’s book, Fat and Fertile
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Hey, my lovely Welcome to fat and fertile the podcast. I'm Nicola salmon, fat positive fertility coach and author of the book fat and fertile. I'm obsessed with helping folks navigate getting pregnant in an anti fat world on this podcast, we'll explore the complexities that fat folks face when you want to grow your family. If you want to support this podcast, I would love for you to share it on social media or leave me a review on your podcast app. Are you ready? Let's dive in. You. Music. Hi, my lovelies, and welcome to a new episode of fat and fertile. Today, we are going to be talking about cycles, and specifically irregular cycles, because there seems to be this myth going around that being fat causes irregular cycles. So we are absolutely going to smash that myth today, and I'm going to give you lots of information that is going to mean that you can go out there and advocate for better health care, because blaming irregular cycles on your body size, on your weight, is unethical and totally not evidence based, I want you to have the best healthcare possible. So we're going to deep dive today into what irregular cycles means when you're fat and what we can do about it. So the first thing we're going to look at is what actually an irregular cycle is, there is so much misconceptions and misinformation around how our menstrual cycle should look. What's too much bleeding? What's enough blood? How long should they be? So we're going to start with the basics, and we're going to have a little look into what is, quote, unquote, normal and what we should be having further investigations to look at. I have always had irregular cycles. I was diagnosed with PCOS when I was 16, and I have had irregular cycles since I first started menstruating when I was 13, and they varied massively. So for a long time, I was on the oral contraceptive pill, which we're told regulates our cycles, but what it actually does is just forces you to have a bleed. It's not a period. It is just a bleed, and it isn't the same as having a period, and it isn't mimicking the way that your body hormones into play every month. It's not a real period. It's not a real bleed when you're on the oral contraceptive pill, and what it is just doing is masking any problems, any possible things, symptoms that are going on, which is useful to know right now, my cycle varies from about 35 ish days to going up to like 9800 days. It can vary massively, and I have a real sense now of what has a positive impact on it, and I will, of course, happily share that with you a bit later on. But when we're talking about what a typical menstrual cycle looks like, it is normally somewhere between 25 to 32 ish days, there is real natural variation in what a cycle should look like. 28 days is what you're here banded about as the normal. But there is a lot of natural variation in what's normal for you, and I would not worry at all if your period is pretty regularly between 25 and 32 days like that is pretty normal and really nothing to worry about. If your cycle is consistently much longer than that, if you notice that it varies from month to month, quite significantly more than like five days every month, then that might start to become a sign of something not working in The way that you'd want it to, also the something that's really useful to know is which part of your cycle is irregular, and this is such powerful information when I began to understand exactly how my menstrual cycle was working. So the the normal. Way that folks talk about menstrual cycles is we use day one as the first day of full bleed. So not the kind of spotting, not the sometimes folks will have like brown spotting or red spotting or pink spotting. We're not counting that. What we're counting as day one is the day of full flow, when you need to be wearing a sanitary pad or having other protection, using tampons and cup underwear, whatever your preferred choice of menstrual product is. But that's the kind of day one and the irregular part of your period of your cycle, sorry, is from day one until when you ovulate. That is the part of your cycle that varies if you have irregular periods then, and there's lots of things that can impact that. So stress is a massive impactor of when ovulation occurs, and then once you've ovulated, a time between ovulation and your next period is usually pretty consistent. There's not many things that will impact that timeframe. Sometimes it can be a little bit short, and normally we want 12 to 14 days in that part of your cycle, and if it's a little bit short, then looking at supporting your body with progesterone supplements can be useful. But the first part from day one to ovulation is the part that is more than likely going to be the bit that is irregular. I normally will bleed for two to seven days. That's kind of the common amount of time that you will be bleeding at the beginning part of your cycle. And how much blood varies massively from person to person, 30 to 40 mil, which is obviously really hard to measure when you're using period pants or sanitary towers, that is a kind of average, but if you are constantly needing to change your pad or your tampon every hour, that is something that needs looking at. That is something telling you that something is not right, and no matter what your GP says about heavy bleeding being normal, that's not okay. If you need to be changing your menstrual products every hour, that is not okay. And it's the same with pain, if you're in mild discomfort, that that can be considered quite normal, but if it's disrupting your life, and if it is meaning that you have to stop going to work for a day, or you can't do the things that you love for one to a few days every single month, if it is having a massive disruption in your life, then that is not normal, and it is not acceptable to be fobbed off at the doctor just saying that that kind of level of pain or that kind of level is bleeding is normal. It is not and it is not acceptable that they are not providing you with healthcare in order to support that. So I really just think that's an important piece of the conversation is to normalize what is normal and what what needs further attention, what needs further support from our healthcare system, because historically, those needs have not been met. So a regular menstrual cycle is, you know, like 25 to 32 ish days, totally dependent on you typical bleeding time, two to seven ish days. And we want, you know, we want bleeding and we want if we have pain, it does not impact your life, it does not have a massively negative impact in your day to day life. Because if it is having a massively negative impact that then we want to access further healthcare and support in order to look at it. So that's what an irregular menstrual cycle is the opposite of that. So something that doesn't look like that, and that could look like really heavy bleeding, that could look like it's just super long. Every time that could look like it varies month to month like massively changing how long it is. And also, if it's entirely absent, that counts as amenorrhea, which kind of comes under the umbrella of irregular menstrual cycles. So we've been told that fat causes irregular menstrual cycles. I'm sure if you're in a fat body, you either thought that or been told that if you suffer from irregular cycles. But that is not true.
What we know about a regular menstrual cycle is that it's caused by a variation in the hormones, and those are our reproductive hormones. So those are estrogen, follicle stimulating hormone, FSH, luteinizing hormone, LH, and progesterone. Those are the four key hormone. Means that control and manage the menstrual cycle, and there are several kind of quite common conditions that can impact and vary those hormones over the month, which can then cause irregular cycles. Probably the most common one is polycystic ovarian syndrome, or PCOS, which is what I was diagnosed with at 16. But there are other medical conditions that can impact it, such as thyroid function issues, and we know that dress has a huge impact on something called the hypothalamus, the pituitary, ovarian access, which is basically three parts of your body, so the hypothalamus and the pituitary, which are in your brain, and the ovaries, and they converse, they communicate in your body, and that is what regulates hormone production. So we know that if that axis, that function of your body, is impacted, that will absolutely have a knock on effect on hormone production. Also, different medications can impact menstrual cycles, and then for folks who are later on in life, perimenopause and menopause can lead to irregular menstrual cycles. So it's important that we really understand that there's lots of different things can be at play here, and none of them are about being fat. The only fat adjacent part of this, I would say, is the stress that doctors may put you under through weight stigma so that the way that they treat you, the way that society as a whole treats you being a fat person in the world that we live in can lead to increased levels of stress, and that is the only fat adjacent thing that can be impacting menstrual cycles when we're looking at all of these different things that cause irregular menstruation. So why are we told that fatness causes irregularities within our menstrual cycle, like, Where does this come from? And there are a few reasons which I'm just going to kind of touch on, because I think it's important to get context about why this happens, so we can fight back around it and actually influence the care that we receive, so that we're not just put in this kind of pocket of, oh, being fat is gonna cause this, and therefore, ergo, weight loss is going to fix it. Because that is just not true. So the first one is around stereotypes and anti fat bias that exists within our society, like we have this, the stereotype that's perpetuated that tells us that our body size is the reason that we have health issues, and that includes menstrual problems. And we have this narrative that assumes that being fat is inherently unhealthy or problematic, and then that naturally feeds into this idea that, of course, if your fat, that's going to impact your reproduction and your reproductive health. So that is kind of one of the foundational reasons why we have this idea that being fat causes menstrual irregularities. The second is more about the research now there is a massive research bias in the way that we look at Fat bodies already, like that is there is a huge bias because research is only as good as the people who are doing it. And we all live in this soup that is diet culture. We all live in a world where thinness is valued and fatness is demonized. And researchers aren't separate from that world. They exist in that soup too, and have their own biases, of course, including weight bias. So historically, our research has always been biased towards understanding health and studying health and deciding what is normal, and fat bodies are often excluded from that. So the majority of research is done on thinner bodies, and if it is done on fat folks, it's often done with the lens of, oh, these people are unhealthy. So we should look at, you know, medicalising their bodies and understanding their disease pathways. It's never done with just more of an idea of, this is a distribution of what human bodies look like. So we should make sure we include them all in our research. That doesn't really happen. So there's a lack of research and representation, and of course, that perpetuates the stereotypes and assumptions that we have around fatness and reproductive health. And when we have these researchers doing this research, the next thing that happens is so often they will go against like medical research, 101, On and misinterpret or misrepresent correlation. So correlation is this idea of when one factor goes up the other factor also goes up at a similar or same rate. And while we can see that they are related, what we absolutely cannot do is say that one causes the other either, either way. We cannot say that one causes the other. A great example that I love to talk about is ice cream sales and sunny days. We know that as the sunshine comes out and it's more sunny, there's gonna be a higher rate of ice cream sales, right? Like that makes sense, but we cannot say that ice cream sales causes the sun to shine. Like that is just totally nonsensical, and we can see that that makes no sense. So we know that correlation does not imply causation. And while there may be a higher prevalence of conditions, these conditions, like menstrual imbalances within fat folks, it doesn't not mean that there is a direct causation between fatness and the irregularities. That is just bad science. So we've got the stereotypes, we've got this biofilm medical research, we've got this misinterpretation or misrepresentation of correlation. And then finally, it's the oversimplification of health. It's so common that, especially within like reproductive health, and for folks with uteruses that
it's oversimplified, we look at it and we say, Oh, well, it must be, because this person is fat, that they're having problems or complications. And if you're a fat person who's ever been to the doctor, you will likely have come across this simplification yourself for any kind of health condition. You can go in with a cold, with a broken finger, and the doctor will just say, Oh, it's because you're fat. No further test treatment, no further test needed, no further treatment required. You just need to go away and lose weight, as if by magic. They have these X ray eyes that can tell exactly what is going on in your body without asking any questions, purely based on their assumptions. So, yeah, this is why we have this myth, this idea that being fat causes irregular cycles. And it's so problematic because it means that people aren't diagnosed for conditions which they may have, and that leads to delays in their healthcare. It leads to delays with accessing any tests or treatments that they might need, and it encourages folks to go away and follow the medical advice of dieting or weight loss, which can often cause more harm than good, this episode of fat and fertile is proudly sponsored by supported the 12 month community program that offers the support you truly deserve, compassionate, respectful, evidence based, and above all, led by you. It provides a safe haven where you can feel validated and acknowledged amidst the prevailing inequality and anti fat bias that often accompanies fertility. Care. To learn more, visit the link in our show notes, or send me a message on Instagram at Fat positive fertility. Now let's get back to the show. So let's have a little look at what could be going on if you have an irregular cycle, if you're listening to this and you have an irregular cycle, then it's really helpful to rule things out, rule certain things out that might be going on so that you can get access to the health care that you might need. And obviously, I understand that it's not as simple as going into the doctors and going, Hey, can I have all these tests? Sometimes doctors will help and be wonderful and helpful, and sometimes they won't. I'll have other podcasts soon, more about advocacy and more about having these difficult conversations. But for now, I'm just going to share a little bit about what you might need to ask for, what that might look like, what kind of things you want to rule out just to get the best health care you can. And obviously I appreciate that it isn't as simple as just go in and get these tests done. So the first one is PCOS, which I've already mentioned, a polycystic ovarian syndrome. Now this is a metabolic and hormonal condition, so it impacts both your hormones and your metabolism, and can come in lots of different flavors, with lots of different symptoms in varying degrees. Sometimes you'll get some symptoms, but not others. For me, my PCOS looks like I have excess hair, so I have hair that grows on my. Chin on my stomach, on my breasts, thick hair on my legs and arms, just lots of hair. Really. I had acne a lot when I was younger, and more now, so I am noticing that I'm getting thinning hair on my head. Obviously, a regular cycle, and that's something that's always been apparent for me, but those are kind of the main ones. But other people can, you know, experience more generalized symptoms as well, which is really hard to attribute necessarily to PCOS, but things like higher incidence of depression, fatigue, it can impact you in a lot of different ways. And obviously, if you're having irregular cycles, it can lead to making it more difficult to get pregnant because you're not ovulating as frequently, and it can be much harder to pinpoint when you are ovulating to get pregnant. So that for PCOS. The general diagnostic criteria that's most widely accepted is called the Rotterdam criteria. And there are three things that you need to have checked. And if you have two, two out of three of these things, then you can have the kind of official diagnosis of PCOS. So that is irregular cycles, which, if you're listening to this, probably you already have. And the other two are a blood test, which tests your androgen or testosterone levels. So testosterone is a type of androgen, so like a hormone, and if they're high, that is another indicator that you have PCOS. And finally, you can have an ultrasound scan, which looks at your ovaries, and what they're looking for is, they call this, but they're not really cysts. They are little immature follicles that your body just doesn't absorb like normally, they will be absorbed in somebody without PCOS, but your body just decides any of them there. So you have lots of, they call it like a pearl necklace. So it's lots of little, little immature follicles around your ovary. So again, that's another indication of PCOS. So if you suspect you might have that, then those the two types of tests to ask for something that is super common for fat folks, is that doctors will give them a diagnosis of PCOS without doing these tests and without doing their due diligence of diagnosing someone properly. So it's definitely worth if you've been given a diagnosis, checking that this has been done properly, and they're not just assuming you have a condition based on your body size. The second is a thyroid disorder, most commonly hypothyroid, which is where you have lower thyroid hormones in your so your thyroid is underactive. It's not producing enough. And that can be tested by looking at your thyroid hormones and also your thyroid antibodies. One of the thyroid disorders, something called Hashimotos, is caused when your thyroid antibodies are super high, and it basically attacks your thyroid and your other thyroid hormones can appear normal because your body is trying its best to kind of stave off this attack from the antibodies, and it will appear normal. It appear normal, and then all of a sudden, it will be decimated. So if possible, it's worth getting your thyroid hormones and your thyroid antibodies checked, especially around fertility, they recommend that the main hormone that they treat, that they test is called TSH, or thyroid stimulating hormone, and that should be below 2.5 for folks who are wanting to get pregnant. There are different limits based on different populations, but the who the World Health Organization have given the advice that for folks who want to get pregnant, 2.5 is what it needs to be under, something else which is really useful to understand as a diagnosis, and something which is not commonly picked up within our healthcare system, is something called hypothalamic amenorrhea. And this is something which you may which doctors may recognize in a different type of population. So people like athletes, people who have a really high, like external stressor of exercise on their bodies. What can happen is that that can stop your periods because of a psychic physiological stress on your body. Basically, if you do, like, tons and tons and tons of exercise, it can lead to this calorific imbalance within your body which stops your periods. And it's quite well recognized within, like, the sporting community. But I think. That I think it's much more common than just within that specific community. And especially, I think for fat folks who are maybe on significantly reduced calorific loads or increasing exercise to a form of like, you know, maybe becomes a little bit obsessive, which is so understandable and can happen really easily when the doctor is constantly telling you that you need to lose weight in order to get pregnant, and of course, you'll do anything you want you can to get there. I think it can be really common to fall into these patterns of causing this cycle physiological stress on the body with a reduced calorie load and increased exercise.
And that can be looked at by looking at kind of, I think, inflammation markers. But there's a really useful book by a person called Nicola Rinaldi. I can't just remember the top of my head what it is called. I think it's called no period now what? But I'll link to it in the show notes. That's a really, really useful kind of I'd also like, almost like hypothal hypothalamic amenorrhea Bible. So I definitely recommend reading that. If that's something that sounds familiar, could be ringing alarm bells for you. But like I said, I'll pop that in the show notes so you can have a link to it. And then the other one is endometriosis. This is something that is notoriously under diagnosed. It's really difficult to get a diagnosis for because we have historically not done much research on this, because it's something that affects folks with uteruses. And I think the last paper that I saw quoted on this with some wild number that it takes, like seven to eight years to be diagnosed with endometriosis from when you start the process. So for endometriosis, they I think they need to do some kind of La proposcopy to see if they can visualize it within your uterus and the surrounding tissues, but yeah, then the main signs of that are heavy periods, painful periods. Those are kind of the two risk factors. And also something that's quite common is other kind of signs of inflammation, so things like IBS can go often with endometriosis and other kind of inflammation disorders. So again, something to ask your doctor about if you have really painful, heavy periods, or if you have a sense that that might be something going on for you. So those are kind of the differential diagnoses of what we should be looking for if, if irregular cycles is part of your pattern, and what to do so if you've recognized something within that within yourself, if you don't have a diagnosis for your irregular cycles, this is kind of my like, best advice into what, what your next steps are, what you can do to support yourself in Getting pregnant, the first would be seeking a proper diagnosis if possible. And I know that it's not always possible. I know that that kind of thing is not always available, but if you are able to seek a proper diagnosis and get some tests and treatment, then to figure out why that's happening for you, that can be really important and powerful moving forward. The second one is to to the best of your ability, is to track your cycle. And there are many different ways that you can do this. I'm going to talk about tracking cycles in the next podcast, so watch out for that. But you can do that with external devices like temperature tracking. You can use devices to measure hormones in your urine, and you can also do it by tuning into what your body's telling you, so looking for key signs and symptoms, which again, we'll discuss next time around, what that looks like for you, which I think can be really powerful, especially getting a sense for yourself of how your body responds in each different part of your cycle. And then the final tip, idea of what to do with irregular cycles is to find what works for you in terms of supporting your nervous system. And this can look a multitude of different ways. So many things work well for different people, but some ideas that folks I've worked with have used well that I've used that work well are things like movement, if that feels accessible to you right now, weight lifting, body weight, stuff like things like that, can be really helpful. Things like cold water exposure can be really good. I found that really helpful in my own practice, whether that's cold water swimming, or whether that's just having a five minute cold shower or even just splashing your face with cold water, that can be quite interesting. There's lots of different body practices that help with regulating your nervous system. You might be familiar with some like. Yoga and Pilates, also tai chi, chi, Gong, gentle, stretching and moving whatever is accessible to you, but also things like finding care within your support system. So getting really good hugs from people, if you're a hugger, talking to people, processing things in that way of seeking support, laughing, finding joy in things, singing out loud. All of these things are really helpful at regulating another system. It's just about finding what works for you, dancing, moving your body, anything that you that brings you joy in your body, that brings you a sense of peace, of calmness, of finding that regulation can be really useful. So in conclusion, I want you to take away from this, more than anything, that being fat does not cause irregular periods. Sure, there are things that are adjacent to being fat that conditions that one of the side effects is being fat or putting on weight that cause irregular cycles, but being fat does not cause them. There are lots of diagnoses that will can explain your irregular cycles and ways to help you regulate them, but you need to have those diagnoses before you can make the impact that would be helpful. So if you're able to do that, if you're able to find someone who can help you in diagnosing what's going on, that is really useful, and if you have a regular cycles, there is things that you can do to support that, to track that, to help support that, with your own support and self kindness that you can offer to yourself, And that can look so many different ways, depending on what suits you and what's important to meet your needs. I hope that's been helpful. Thank you so much for coming and joining me today. I'd love to know what you think. I'd love to know your experiences. So please do drop me a message on Instagram at Fat positive fertility. Let me know what your experiences with irregular cycles and what's helped you and please, please, continue to advocate for yourself with your healthcare professionals, to do your best to get the treatment that you absolutely deserve, navigating getting pregnant in a bigger body. Take care. Thanks so much for joining me today for fat and fertile. If you want to learn more about how to have a fat positive facility journey, then I'd love for you to check out my book fat and fertile, how to get pregnant in a bigger body. It's available everywhere via Amazon, so just search in your Amazon store for fat and fertile, or click in the link in the show notes See you next time you.
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