Irregular cycles have two main midlife causes: perimenopause OR PCOS. Treatment differs sharply.
Cycle irregularity can mean perimenopause (cycles lengthen, eventually stop) или PCOS (cycles длиннее 35 days, anovulation). Workup distinguishes the two.
Perimenopause: typically 40s. PCOS: persists from teens but can worsen в 30s-40s. Both share insulin resistance contributions.
All options below are real published treatments. Evidence-level reflects current clinical guidelines (NAMS / ACOG / Endocrine Society). Cost ranges are starting price estimates от $US public sources.
Monthly cost
$5-$50 generic
Side effects
nausea, breakthrough bleeding, breast tenderness
Regulates cycles + reduces bleeding в both conditions. Use в perimenopause limited by VTE risk over age 35 если smoker.
Contraindications: Smoker over 35, history of VTE, migraines с aura
Providers offering this: pandia health, tia womens health
Monthly cost
$20-$80
Side effects
mood changes, breast tenderness
Days 14-28 each cycle к induce regular withdrawal bleed + protect endometrium. Useful когда estrogen levels still adequate.
Providers offering this: midi health, alloy womens health
Monthly cost
$5-$20 generic
Side effects
GI upset, diarrhea, B12 depletion long-term
Off-label для PCOS. Improves ovulation в ~⅓ of women + reduces insulin resistance. Required если obesity или impaired glucose tolerance.
Providers offering this: allara, pollie pcos specialist, curio wellness pcos
Monthly cost
$0
Side effects
minimal
Even modest weight loss restores ovulation в many с PCOS. Combined с med therapy.
Onset age (PCOS typically teens; peri typically 40s), accompanying symptoms (PCOS: acne/hirsutism/insulin resistance; peri: hot flashes/sleep changes), и labs (peri: rising FSH/LH ratio normalizes; PCOS: anti-mullerian hormone elevated, LH:FSH ratio >2).
Last verified 2026-06-01. Treatment guidelines update — confirm с your clinician.