From lifestyle changes to medical treatment — options mapped to each cause.

If the cause is perimenopause

Perimenopause itself cannot be stopped, but its impact on cycle regularity can be managed.
Options include:

• Low-dose combined oral contraceptives — regulate cycles, reduce heavy bleeding, and relieve hot flashes simultaneously

• Progestogen-only pill or hormonal IUD (Mirena) — particularly effective for heavy perimenopausal bleeding; IUD can reduce bleeding by ~90%

• Hormone therapy (HT/HRT) — most effective for hot flashes and vasomotor symptoms; less typically used for cycle regulation alone

• Non-hormonal options — tranexamic acid (reduces heavy bleeding), NSAIDs (reduce flow and pain), SSRIs/SNRIs (hot flash relief)

If the cause is thyroid dysfunction

Hypothyroidism is treated with daily levothyroxine (synthetic thyroid hormone). Most women seetheir cycles normalise within a few months of achieving stable thyroid levels. Hyperthyroidism may be treated with anti-thyroid medication, radioiodine, or surgery. Both conditions are highly treatable and cycle restoration is expected with appropriate management.

If the cause is PCOS

Management is tailored to the individual's goals. For those not seeking pregnancy, combined hormonal contraceptives regulate cycles and reduce androgen effects. Metformin is sometimes used to improve insulin sensitivity. Lifestyle modifications — particularly weight management and reducing refined carbohydrates — can restore ovulation in some women. For those trying to conceive, ovulation induction medications are available.

If the cause is fibroids or polyps

Small, asymptomatic fibroids may require no treatment beyond monitoring. For symptomatic fibroids causing heavy or irregular bleeding, options range from hormonal suppression (GnRH agonists, hormonal IUD) to minimally invasive procedures (uterine artery embolization, endometrial ablation) and surgical removal (myomectomy or hysterectomy for severe cases). Polyps are typically removed via hysteroscopy in an outpatient procedure.

Lifestyle factors that support cycle regularity

Several evidence-based lifestyle measures reduce hormonal disruption across causes:

• Stress management — mindfulness, cognitive behavioural therapy, sleep hygiene, exercise all reduce cortisol load

• Maintaining a healthy weight — significant weight change in either direction disrupts the hormonal cycle

• Regular moderate exercise — 150 minutes of aerobic activity per week supports hormonal balance; note that excessive high-intensity training can suppress ovulation

• Alcohol reduction — alcohol raises oestrogen levels and disrupts sleep, both of which affect cycle regularity

• Adequate sleep — sleep deprivation elevates cortisol, which suppresses GnRH and disrupts ovulation timing

Read more: Menstrual cycle changes and management — Let's Talk Menopause ↗