In the fertility awareness world, it is no secret that we advocate for the medical community to consider the menstrual cycle a vital sign of health. Often sequestered to that aisle in the drug store or murmurs in the bathroom, periods have long gotten a bad rap. We’re learning now that not only do periods open a previously hidden door of new understanding into women’s well being and health, but healthy and balanced cycles have recently been linked with living longer. Finally, the PR for periods may be getting a long-overdue overhaul.
A landmark prospective cohort study out of Boston, published in the British Medical Journal this past August, found an association between irregular and long menstrual cycles* in adolescence and adulthood with a greater risk of premature mortality (described as death before the age of 70 years old) .
This association between menstrual cycles and premature death was independent of body mass index (BMI) and was present with or without signs of PCOS, endometriosis, or uterine fibroids. This indicates that hormonal disorders alone are not the culprit behind early death, but rather an indication that the lack of regular ovulation and menstruation could be the root of this association.
This is huge. It means if hormonal disorders are effectively treated, and regular ovulation is supported for women of reproductive age, then women with hormonal disorders can reap long-lasting health benefits just as well as women without such disorders.
The connections between irregular cycles, teenage birth control use, and early death
In an even more striking finding, the same study discovered an increased risk of early death among women who used oral contraceptives during their teen years, specifically between the ages 14-17.
This indicates two really important things that fertility awareness advocates have been positively shouting about for years: First, that having a regular, balanced period matters for a woman’s current and future health. Second, how the pattern of fertility cycles unfolds in a young woman’s early years matters.
It’s a sad irony that teens younger than 17 are more likely to be put on the Pill—or any other form of hormonal contraception—due to long or irregular periods, rather than for the express purpose of contraception. But irregular periods are more than merely annoying, and are thought to be a sign of something far more serious: a disrupted hypothalamic-pituitary-ovarian (HPO) axis. A disturbed HPO axis is associated with “non-communicable diseases, including ovarian cancer, coronary heart disease, type 2 diabetes, and mental health problems, through mechanisms probably related to a disrupted hormonal environment, chronic inflammation, and metabolic disturbances.”
While irregular periods can be normal in the beginning years of puberty, there should be a progression over time to more regularity. In the case that a young girl experiences irregular periods that don’t progress toward maturation, this is often a sign of some type of hormonal imbalance.
But what does this have to do with birth control? As we’ve discussed at length before, hormonal contraception doesn’t regulate anything about a woman’s cycle, but rather, it shuts down the all-important HPO axis. So instead of having a true menstrual period each month, a girl or woman on birth control has a false hormonal withdrawal bleed every month.
The missing link in irregular periods: Metabolic syndrome and hyperinsulinemia
It isn’t entirely clear why irregular periods are linked with premature death, but researchers are beginning to hypothesize that irregular and long menstrual cycles are strong predictors of a condition known as hyperinsulinemia . That’s a fancy word for too much insulin—the hormone that regulates sugar—in your blood. Now it’s a question of what came first, the chicken or the egg: Did increased insulin cause irregular cycles or did irregular cycles cause increased insulin?
It’s no secret that modern diets are high in sugar, and that modern living is abundant in stress. Either one of these two things can wreak havoc on the endocrine system; together, they can cause a veritable firestorm in our bodies. Insulin resistance, when women have a much higher threshold of how much insulin is needed before their body recognizes it, is becoming the norm. And it has even been hypothesized that this condition could be cross generational . This means that your great grandmother’s diet could have had an effect on your DNA, and insulin levels, even today. Wild. High insulin levels have been long thought to play a critical role in cancer, diabetes, and cardiovascular disease. And, in case you were wondering, cardiovascular disease is the top cause for premature death in women, and cancer and diabetes are a close second and third.
What can be done?
Before you get too down about this, consider that we do have a chance to rewrite our future generation’s DNA. It starts with the menstrual cycle. Women young and old can chart their menstrual cycles with a fertility awareness method (FAM), which can reveal cycle irregularities or hormonal imbalances that a FAM-aware doctor can help treat with restorative reproductive medicine.
Rather than putting a hold button on these issues, as hormonal contraception does, we have the option to teach teens how to chart their cycles which gives them an empowering relationship with their body as well as a family planning tool for when they need it. But more importantly, their cycle charts serve as an invaluable diagnostic tool helping them to know and manage their health risks, and alerting them to get the help they need when it matters most.
This is another reason medical professionals should learn more about fertility science and include information on cycle charting in their practice. If medical practitioners have enough knowledge about cycle charting and include menstrual characteristics as a vital sign of health, young teens can navigate cycles (regular or irregular) and utilize both complementary and conventional medicine to reduce future risk of adverse health outcomes.
*Irregular and long cycles can be considered normal in transitional seasons such as early puberty, post birth, during breastfeeding, and perimenopause.
When this article refers to fertility awareness methods (FAM), or natural family planning (NFP), we are referring to Fertility Awareness-Based Methods, evidence-based methods of cycle charting which can be used as effective forms of natural birth control when learned by a certified instructor.
 Wang Y, Arvizu M, Rich-Edwards J et al. Menstrual cycle regularity and length across the reproductive lifespan and risk of premature mortality: prospective cohort study. BMJ. 2020:m3464. doi:10.1136/bmj.m3464
 Wei S, Schmidt M, Dwyer T, Norman R, Venn A. Obesity and Menstrual Irregularity: Associations With SHBG, Testosterone, and Insulin. Obesity. 2009;17(5):1070-1076. doi:10.1038/oby.2008.641
 Fusco S, Spinelli M, Cocco S et al. Maternal insulin resistance multigenerationally impairs synaptic plasticity and memory via gametic mechanisms. Nat Commun. 2019;10(1). doi:10.1038/s41467-019-12793-3
Last updated January 16, 2021.