149. Your Cycle Roadmap for Your 20s, 30s, and 40s

A 22-year-old and a 42-year-old can both have regular cycles and have completely different hormonal pictures underneath. What is normal for your cycle changes across your reproductive life — and most women are never told what to expect, what to watch for, or when something is worth investigating at any given age.

In this episode of Cycle Wisdom, Dr. Monica Minjeur builds a decade-by-decade roadmap for understanding your cycle across your 20s, 30s, and 40s. Through the stories of Priya, Melissa, and Judith — three women at different life stages who were each told their symptoms were normal when something was actually worth evaluating — you will see what becomes possible when cycle changes are taken seriously rather than dismissed.

You will learn:

• What healthy cycle patterns look like in your 20s, 30s, and 40s — and what changes are worth investigating at each stage
• Why a regular period does not confirm ovulation — and why ovulation remains the most important event in the cycle at every age
• How cycle charting creates a longitudinal health record that single lab draws and annual appointments simply cannot replicate

If you have ever been told your cycle symptoms are just normal for your age — this episode will help you decide whether to accept that answer. Learn more or schedule a free discovery call at radiantclinic.com

Transcript

Speaker 0:01

A 22-year-old and a 42-year-old can both have regular cycles and have completely different hormonal pictures underneath. What's normal for your cycle changes across your reproductive life,. Today, we're building a roadmap to help you know at any age if your cycles are normal. I'm Dr. Monica Minjeur, the host of Cycle Wisdom, where we help women and couples restore hormonal balance and reclaim their wellbeing through personalized healthcare grounded in clinical excellence. So we're gonna talk a little bit about three different women, each at a different chapter in their life today. Priya, who is 24 years old, Melissa, who is 33, and Judith, who is 41. Each had been told that her symptoms were normal for her age, and each had quietly accepted that answer, even when something felt off. Now, all three of these women, none of them knew each other initially, but all of them found their way to charting their cycles and to our clinic through similar realizations, and their questions deserved better answers than just, "That's how it is." So let's start off with Priya. Again, she was 24 years old, and her cycles were really variable. Sometimes they were 26 days apart, sometimes up to 36 or 37 days apart, and she was told that this was just normal for her. Now, the standard reality is that normal cycles are typically decided to be somewhere between 24 to 35 days apart. And so since most of her cycles fell within that time frame, she was just told that it was a bit of stress and that that was just normal for her. However, after working with her for a couple of months and doing some targeted lab work, we found out that her charting actually revealed she was inconsistently ovulating and in some cycles not ovulating at all. We were able to discern from her lab testing that she actually had an early PCOS, now called PMOS, pattern identified, and so correctly diagnosing her with this PCOS or PMOS helped her to have a better understanding of what was normal for her. Melissa, who was 33, noted that her cycles had shortened. She originally saw cycles every 30 to 32 days, and now they were shortening down to 25 to 27 days over the past two years. Her doctor originally told her this is a normal part of aging, nothing to see here, don't worry about it. But when we broke it down and identified what was going on from her charting standpoint, we found that her shortened follicular phase was actually causing the problems. So the time between her period and when she ovulated, that had become much shorter. So we did some additional evaluation to determine if she was having any problems with ovulation dysfunction, ovarian failure, or estrogen deficiency, and found that she actually was starting to have problems with her ovary dysfunction. So she was starting to go into this premature ovarian insufficiency. And so we worked together to treat that, to address her fertility goals, and to discuss what needed to be done in order to continue to preserve her fertility until the time she was ready to conceive. And finally, Judith, who was 41, had cycles that were fairly unpredictable in length, although they still happened about every 30 days. They were getting a bit heavier with each cycle, and she had worsening PMS. Again, she was told by her doctor that this was just a normal part of being over the age of 40, and welcome to perimenopause. In Judith's case, again, with cycle charting, we were able to identify she actually had a shortened luteal phase, so the time from when she ovulated until her next cycle began was getting shorter. Labs confirmed what we suspected, showing a declining progesterone level, as well as estrogen dominance, which explained the heavier periods. Now, although this is a very common sign that we see in perimenopause, it does not mean that she just had to live with it. And so we treated Judith's condition with some supplemental progesterone and continued to monitor her estrogen levels, having the discussion about when we would want to see her if things were worsening. The new reality here is that each woman left with a real understanding of what her cycle was telling her and a plan that was grounded in what was actually present, not strictly just set by some arbitrary guidelines of this many days of a cycle is normal. The reality here, if we take a bigger look and a step back, is that the female cycle is a vital sign. And like all vital signs, the normal ranges can shift across your lifespan. Unfortunately, most women receive almost no education whatsoever about how their cycle is expected to change across their 20s, 30s, and 40s. They learn what a period is, and then they're on their own. Cycle changes are oftentimes dismissed as normal parts of aging, or that's just how your body is, or that's how your mom's cycles look, or, yeah, that's how my sister experienced her cycles. Many times women are just being told to live with it, to deal with it, and that is not the right answer. We want you to be able to understand what is normal, what is not, and most importantly, to know that you do not have to suffer. Cycle charting across your lifespan creates a longitudinal health record, and those changes over time can start to become visible and actionable so that you can have a better idea for what is happening over time. Many women in their 20s are told, "Your irregular cycles are just because of stress." And while this can be true and can be a part of the story, if that inconsistent ovulation is persistent at any age, it warrants evaluation, even if you're under stress. Another common sign, like what our other patients were told, is that these cycles changing can just be a part of normal aging. And although this is sometimes true, things like a shortened follicular phase in your 30, especially if you're hoping for additional fertility, deserves additional evaluation early and quickly so that intervention can be started And the one that I hear the most often is that worsening menstrual symptoms, weight gain, hair loss, and heavy periods in your 40s are just perimenopause. There's nothing to do. Again, all of these symptoms have identifiable hormonal triggers and meaningful treatment options that can work together with your body and your unique situation to help improve your symptoms. So if I had it my way, if I could teach every woman what they needed to know about their cycles by decade, this is what it would look like. So in your teens and 20s, figure out what your baseline is. Your cycles should become more consistent after having some variability during your early teenage years. And typically, we would expect to see cycles ranging between 24 to 35 days. Most importantly, though, is to be able to clearly and reliably identify ovulation. Even if your menstrual cycle is happening regularly, if you cannot identify ovulation, there can still be problems present. So we also then, when we have identified ovulation, need to identify what is your luteal phase. So again, that time from when you ovulate until when your next menstrual cycle begins should be around 12 days plus or minus two. Now, anything that is outside of this normal is worth evaluating and especially if you are having other symptoms. So things like significant irregularity with your ovulation, with your luteal phase, with the cycles themselves, all of that deserves additional evaluation, even if you're not currently trying to conceive. If you're having really heavy bleeding, heavy pain, severe PMS, "I am missing school or work or life because of my periods," or if your periods just stop happening altogether, this is not just normal. These are signs that your body is saying there is something here worth evaluating. And although we know that at any age stress can impact what's going on with your cycles, the thing most commonly that's going to disrupt ovulation in your 20s is going to be undereating, overexercising, and chronic stress. Now, we're gonna talk a little bit more about what happens if you don't eat enough in next week's episode, so stay tuned for that. But this is not a reason to say it's normal, just if I'm not eating enough. And so we'll talk more about how we help to kind of pad yourself from some of those lifestyle changes, but ultimately, it is inevitable. You must get your diet, your exercise, your sleep, your stress right, or you are going to have issues with your hormones at any stage of the game So let's shift into your 30s. What changes during this time? Now, I know it's not popular to say, and I know people don't like to hear this, but your FSH, your follicle-stimulating hormone, begins to rise ever so slightly as your ovarian reserve starts to naturally decline. Now, oftentimes this can shorten your follicular phase, so moving up your ovulation, and lead to a shorter overall cycle length. Now, this does not mean that your fertility falls off a cliff at age 35 or some other arbitrary number in your 30s, but this gradual decline can be part of what's normal. However, it is worth evaluating if we're seeing a consistent trend, especially if you're trying to conceive. We want to make sure that that FSH is not increasing too quickly or inappropriately, and we also want to make sure that we're evaluating what's happening with your hormones after ovulation. So what's your progesterone level doing? Is it declining relative to your estrogen? Oftentimes, a declining progesterone can show up as increased PMS symptoms, mood changes, or premenstrual spotting. Additionally, thyroid dysfunction is more common in your 30s, and oftentimes cycle disruption is the first symptom we see. I oftentimes see in my practice that thyroid dysfunction can cause ovulation dysfunction, which can dramatically change the cycle length, the cycle regularity, and even subtle changes if your thyroid gland is working okay, but it can't get thyroid hormone to the cellular level, even that can cause significant major impactful changes. In fact, we've seen many patients in our practice over the years that all we need to do is treat their thyroid dysfunction, even if it's subclinical thyroid dysfunction, and it significantly improves ovulation and therefore improves the chances of fertility. And then the last section we'll talk a little bit about is what happens with your cycles in your 40s. Now, for most women, perimenopause begins, and perimenopause isn't a specific timeframe, but it typically is defined as something that spans up to seven to 10 years. For some women, it can begin as early as your late 30s, but it's really this timeframe in the seven to 10 years leading up to menopause, the time when your periods finally shut off. Now, classic perimenopausal changes would include kind of this fluctuating estrogen levels. This can go from too high to too low, and it can create timeframes where you have relative estrogen dominance, which can lead to things like weight gain and irritability and breast tenderness. And then sometimes your estrogen can crash out really quickly and can lead to some temporary menopausal symptoms, things like hot flashes or irritability. The other big hormone change that's happening here is the de- decline in progesterone. This is typically the most common thing we see happening for women in their 40s, and most importantly, these symptoms are not inevitable. Classic perimenopausal cycle changes we see with this progesterone decline include worsening PMS and heavier periods. Again, if progesterone is declining and we've got this unopposed estrogen, the lining of the uterine wall is gonna get thicker, and that will lead to heavier periods. You've got more that needs to bleed every time that you have a cycle come through. We also will notice oftentimes that you've got new or worsening anxiety or sleep disruption or irregular cycle length because we don't have enough progesterone to keep that luteal phase nice and stable. Again, I wanna stress here, symptoms are not inevitable suffering. Just because your friends are dealing with this in their 40s does not mean that you have to continue to suffer. We can identify the hormonal drivers of what's going on with your symptoms and respond by targeting hormonal support and lifestyle changes where necessary And what stays constant across all decades is that ovulation is the most important event in the cycle at every age, regardless of whether you're trying to conceive or not. Its presence confirms that hormones are functioning appropriately, not just having a menstrual cycle, because that menstrual cycle oftentimes can follow a cycle that you didn't ovulate at all, or it may just be a hormonal withdrawal bleed. If you don't have ovulation, its absence always warrants investigation, especially if it's happening cycle after cycle. Again, as I mentioned, any problems with heavy bleeding, pain, severe mood disruption, or cycle length consistently outside of that 24 to 35-day window deserves evaluation no matter what your age is. The nice thing about this is that cycle charting is a very consistent tool, and you can use those skills across all decades. The nice thing about this is it makes changes visible over time in a way that single lab draws cannot. We don't want to just be evaluating in s- teeny snapshots. We wanna look at that longitudinal charting data to help identify patterns and trends that a single visit or a single lab draw is not able to show us. I've seen this in real life in practice in women that have been charting their cycles for many years and sometimes decades. I have a couple women in my practice that are in their 40s that have been charting for the last 10 or 20 years, and we notice a significant, amazing longitudinal record of hormo- hormonal health. We see the changes in charting patterns. We see changes in ovulation, luteal phase changes, markers of PMS symptoms, or sometimes even the shifts that we can actually see from the onset of perimenopause. This charting helps women to bring more data to their provider. It's like when you bring in your blood pressure readings if you're being treated for high blood pressure. It gives us the tools that we need as healthcare professionals in order to make educated decisions about what needs to happen next So a couple commonly asked questions we get at any age. First of all, my cycle is regular. Doesn't that mean everything is fine? And ultimately here, it might be, but again, regular cycle length isn't the same as confirming ovulation has happened, you've got an adequate luteal phase, and you've got adequate hormone support to keep those normal cycles going. Charting adds a layer that a calendar view of just when your menses happens can't provide. Another common thing that we get asked, "Well, I'm not trying to get pregnant. I don't care about fertility. Why does ovulation matter?" And again, charting your cycles is about so much more than just identifying fertility. Being able to track your ovulation as a vital sign can help to alert you to health concerns that may manifest as changes in your hormones and your cycle well before your periods stop happening altogether. At what age should I start charting? We recommend as soon as possible. Now, maybe in the first few months or first couple of years that you're having your periods, it's hard to be able to identify ovulation, and that's incredibly normal. But even getting into the habit of starting to chart your cycles from the time that those periods start can create a good habit over time so that you constantly have an awareness of what's going on with your cycles. The earlier you establish this baseline and this habit, the easier it is to recognize when something changes and the more in tune you can be with trusting your body. Imagine if every woman understood that her cycle was a living record of her health, one that would change across her 20s, 30s, and 40s and into menopause in ways that were meaningful and readable. Imagine if she knew what to expect at each decade, recognized the signals worth investigating, and felt equipped to seek answers rather than assume that decline was just inevitable. We envision a world in which cycle literacy is treated as a lifelong skill, one that can give women the context they need at every stage to make informed decisions in order to advocate for themselves to improve health and promote fertility

Speaker 2 18:09

If you're ready to work with our elite team of healthcare professionals, go to our website radiantclinic.com to schedule a free discovery call and learn more about our package-based pricing for comprehensive care. We are currently able to see people for in-person appointments in our Cedar Rapids, Iowa clinic or can arrange for a telehealth visit if you live in many different states across the US. Check out our website for current states that we can serve medical clients, and let us know if your state is not listed to see if we can still cover you there as we are constantly expanding our reach. Please note that our fertility educators are able to take care of clients no matter where they live. Thank you so much for listening to this episode. Please share this podcast with someone in your life who would benefit from our services. Remember to subscribe to this podcast for more empowering content that I look forward to sharing with you on our next episode of Cycle Wisdom