Are your menstrual cycles getting longer, becoming unpredictable, or disappearing altogether? While 28 days is often considered the standard, your cycle doesn't have to be exactly 28 days to be healthy. But when periods consistently arrive late or become increasingly irregular, the bigger question is often: Why isn't ovulation happening normally? In this episode of Function Over Fix, Dr. Tim Augustyniak breaks down four major mechanisms that can interfere with ovulation: polycystic ovary syndrome (PCOS), hypothalamic suppression, thyroid dysfunction, and elevated prolactin. He explores how these systems interact and the potential roles of blood sugar regulation, insulin, chronic stress, nutrition, exercise, and hormone metabolism. You'll also learn how hormone bloodwork and specialized testing such as DUTCH can provide different types of information—and why laboratory findings must be interpreted alongside symptoms and clinical history. Most importantly, we discuss practical ways to start understanding your menstrual cycle: tracking your periods and ovulation, examining your eating habits, supporting adequate nutrition, improving sleep, managing stress, and avoiding excessive training. The goal isn't simply to produce another period. It's to understand what may be interfering with normal reproductive function and what you can do to support it long-term. Research & Resources 1. 2023 International Evidence-Based Guideline for the Assessment and Management of PCOS Comprehensive clinical guidelines covering PCOS diagnosis, irregular menstrual cycles, androgen excess, insulin resistance, metabolic considerations, and treatment strategies. https://integration.asrm.org/practice-guidance/practice-committee-documents/recommendations-from-the-2023-international-evidence-based-guideline-for-the-assessment-and-management-of-polycystic-ovary-syndrome/ 2. American Society for Reproductive Medicine — Current Evaluation of Amenorrhea (2024) Clinical guidance covering absent or irregular periods, pregnancy testing, thyroid dysfunction, prolactin, ovarian hormones, and hypothalamic-pituitary causes of menstrual dysfunction. https://www.asrm.org/practice-guidance/practice-committee-documents/current-evaluation-of-amenorrhea/ 3. Endocrine Society — Functional Hypothalamic Amenorrhea Clinical Practice Guideline (2017) Explains how inadequate energy availability, excessive exercise, psychological stress, and changes in hypothalamic signaling can disrupt ovulation and menstrual cycles. https://www.endocrine.org/clinical-practice-guidelines/hypothalamic-amenorrhea 4. American Thyroid Association — Thyroid Function Tests An overview of TSH, T4, T3, and thyroid testing, including how thyroid hormones are regulated and interpreted. https://www.thyroid.org/thyroid-function-tests/ 5. Endocrine Society — Hyperprolactinemia Clinical Practice Guideline (2011) Clinical guidance on elevated prolactin, medication-related causes, pituitary disorders, and the effects of hyperprolactinemia on reproductive function. https://www.endocrine.org/clinical-practice-guidelines/hyperprolactinemia 6. DUTCH — Dried Urine Test for Comprehensive Hormones Information about urinary hormone and metabolite testing, including estrogen, progesterone, androgen metabolites, and cortisol/cortisone assessment. This is a testing-provider resource rather than an independent clinical guideline; the added clinical value of individual metabolite measures varies. https://dutchtest.com/ Instagram: @dr.tim.augustyniak Facebook: Facebook.com/dr.tim.augustyniak Threads: @dr.tim.augustyniak YouTube: @flourishfwc X: @flourishfwc Website: flourishfwc.com Follow Function Over Fix for future episodes, and share this episode with someone who may find it useful. When you stop blindly listening and start asking why, everything changes.
