“Irregular menstruation is not a female hormone problem. It is very much likely an insulin problem.”
— Dr. Andrea Salcedo
In a landmark conversation hosted by Tamzyn Murphy of the Nutrition Network, board-certified gynecologist Dr. Andrea Salcedo revealed why we may need to completely rethink our approach to abnormal uterine bleeding (AUB), fibroids, and even menopause.
Her new study, The Uterus as an End Organ: A Preliminary Study of Insulin Resistance and Abnormal Uterine Bleeding, published in the journal Menopause, is a bold call to shift the paradigm from hormones to metabolism.
And the implications—for patients, clinicians, and the future of women’s health—are profound.
The Uterus as a Metabolic End Organ: A New Framework
What does it mean to call the uterus an “end organ”?
In medicine, end organs are the final receivers of damage from systemic disease—like the kidneys in diabetes or the heart in hypertension. Dr. Salcedo argues that the uterus deserves the same classification, especially in the context of metabolic dysfunction.
“The uterus is made of smooth muscle cells, the same cells found in blood vessels,” she explained. “It’s essentially a large vascular organ—so when inflammation hits, it suffers just like the heart or kidneys do.”
That inflammation, she says, can be driven by chronic hyperinsulinemia—elevated insulin levels due to insulin resistance, often years before blood sugar levels even become abnormal.
This understanding reframes common gynecological conditions—like heavy periods, fibroids, and irregular cycles—not as isolated hormone issues, but as manifestations of deeper metabolic problems.
Heavy Periods Aren’t “Normal”
One of the biggest wake-up calls from the Live was just how normalized abnormal bleeding has become.
“A normal period is 3 to 5 days long and should involve only 30 to 60 milliliters of blood,” said Dr. Salcedo. “That’s about two shot glasses. If you’re changing a pad every hour or bleeding more than five days—you’re not just unlucky, you’re showing signs of potential metabolic distress.”
The problem? Most women—and many clinicians—don’t recognize these symptoms as pathologic. They’re dismissed as “just part of being a woman.”
But Dr. Salcedo warns that when AUB becomes normalized, so does ignoring a red flag for systemic disease.
Insulin Resistance: The Missing Link
Dr. Salcedo’s cross-sectional study compared women with AUB to those with normal menstrual cycles. The results?
- Women with AUB had significantly higher fasting insulin levels
- A fasting insulin above 10 mIU/L was associated with three times higher risk of AUB
- Even “normal-weight” women with AUB showed signs of metabolic dysfunction
And here’s the kicker: When adjusted for obesity, the insulin-AUB link weakened but didn’t disappear.
“Obesity and insulin resistance work together—co-dependently,” she explained. “We see this in lean women too, particularly those with PCOS or high stress and poor sleep. Their insulin levels might not be sky-high, but their bodies still show signs of metabolic inflammation.”
Why Your Period is Your Vital Sign
Tamzyn put it perfectly during the interview: “Your menstrual cycle might just be the most overlooked vital sign in women’s health.”
Dr. Salcedo agreed.
“I can learn so much from just two questions,” she said. “Is your cycle regular, and is it heavy? Regularity reflects ovulation—and thus insulin function. Heaviness reflects inflammation. The menstrual cycle gives us both an endocrinologic and inflammatory readout.”
This makes it clear: A woman’s cycle isn’t just reproductive—it’s metabolic.
Metabolic Mayhem in Menopause and Perimenopause
While much of the focus was on reproductive-age women, Dr. Salcedo emphasized that metabolic factors play a huge role during perimenopause and menopause, too.
“If you’re going through menopause with severe hot flashes, mood swings, or sleep problems—these aren’t just estrogen issues. They’re often signs of underlying inflammation and insulin resistance,” she said.
Obesity, especially visceral fat, worsens vasomotor symptoms by producing estrogen-like compounds (estrone) and inflammatory cytokines. This explains why women with higher adiposity often experience more intense menopause symptoms.
The Contraceptive Mask: Hidden Health Risks
What about women on the pill?
Combined hormonal contraceptives regulate the bleeding pattern—but not the underlying cycle.
“Bleeding on the pill isn’t a real period,” Dr. Salcedo clarified. “It’s a withdrawal bleed from the lack of hormones in the final week. You can’t use it to assess metabolic health.”
In other words, hormonal contraceptives might offer relief—but they can also mask warning signs of dysfunction, delaying appropriate investigation and intervention.
Strategies for Managing AUB and Menopause Symptoms
Dr. Salcedo’s approach isn’t anti-medication. She’s a full-scope gynecologist who performs surgery, prescribes medication, and supports nutritional intervention. But she’s clear: metabolic health comes first.
Her practical strategy includes:
1. Lowering Carbohydrates to Reduce Insulin
“Therapeutic carbohydrate restriction is often the first and most effective step,” she explained. “It lowers insulin, reduces inflammation, and supports weight loss—especially around the abdomen.”
2. Optimizing Sleep and Stress
“I always ask, ‘Do you like your husband?’” she laughed. “Because stress matters. Cortisol drives insulin, which drives inflammation.”
3. Testing Insulin, Not Just Glucose
She recommends fasting insulin as a critical lab for patients with AUB or suspected PCOS—even if blood sugar is normal. This can flag dysfunction long before HbA1c rises.
4. Using Continuous Glucose Monitors (CGMs)
For patients who are data-driven, CGMs or glucometers can be empowering tools to learn how foods affect glucose—and indirectly, insulin.
5. Lifting Weights to Build Muscle
“Muscle is a glucose sink,” she said. “It’s an endocrine organ in itself. Lifting weights helps you store more glycogen, reduces circulating glucose, and improves insulin sensitivity.”
6. Nutritional Support
She also uses nutrient-dense foods, omega-3s, cod liver oil, and vitamin D as part of a holistic anti-inflammatory protocol.
Menstrual Cycle as the Red Flag for Metabolic Dysfunction
If there’s one message to take away, it’s this:
“Irregular, heavy, or painful periods should not be ignored. They’re not just hormone issues. They’re often the first visible sign of metabolic dysfunction—years before prediabetes or cardiovascular disease is diagnosed.”
This is the real-life application of what the Nutrition Network teaches through its Medical Certification Path and Women’s Health Training.
Join the Movement to Revolutionize Women’s Metabolic Health
Dr. Andrea Salcedo is not just a gynecologist—she’s a leader in a growing field of metabolically-informed women’s healthcare. Her work reflects a powerful integration of conventional gynecology with therapeutic nutrition and metabolic insight.
She’s also a proud graduate of the Nutrition Network’s Medical Certification Pathway, a comprehensive professional training for clinicians ready to transform how they approach insulin resistance, chronic disease, and women’s health.
Want to practice like Dr. Salcedo?
Start your journey with the Nutrition Network Medical Certification Pathway, and don’t miss the Women’s Health Training for more cutting-edge, evidence-based content like this.
It’s time we stop dismissing women’s symptoms—and start decoding them.Because your period is more than a cycle.
It’s a message.
