What could be causing my constant cramps and late period, given my history of regular menstrual cycles, recent weight loss, insulin resistance, and current medications including levothyroxine and myo-inositol D-chiro, after recently stopping Adderall (amphetamine and dextroamphetamine)?

Constant Cramps with Late Period: Pregnancy Must Be Ruled Out First

You need an immediate pregnancy test—this is the single most important step, as pregnancy is the most common cause of missed periods with cramping in reproductive-age women, and your insulin resistance increases pregnancy risks. 1

Immediate Diagnostic Steps

First-Line Testing (Do Today)

• Urine or serum β-hCG pregnancy test is mandatory before any other evaluation 1
• If positive, urgent obstetric referral is needed given your metabolic risk factors 2

If Pregnancy is Excluded

• Measure LH, FSH, and estradiol levels to assess ovarian function and evaluate for PCOS exacerbation 1
• Your insulin resistance and PCOS history make hormonal disruption highly likely 2, 3

Most Likely Cause: Medication-Induced Menstrual Disruption

Your recent Adderall discontinuation, combined with ongoing testosterone exposure (if applicable) and metabolic stress from the glutathione reaction, has likely disrupted your hypothalamic-pituitary-ovarian axis. 1

Contributing Factors in Your Case

Metabolic and Hormonal Disruption:

• Insulin resistance directly correlates with menstrual irregularities, particularly amenorrhea (absence of periods) 3, 4
• Women with amenorrhea show 78% prevalence of insulin resistance versus 35% in those with regular cycles 3
• Your recent weight loss may have further disrupted hormonal balance, as minimum body fat is required for ovulation 5

Medication Effects:

• Levothyroxine can cause menstrual irregularities as an adverse effect 6
• Recent medication changes (stopping Adderall, glutathione reaction) create stress that disrupts the hypothalamic-pituitary-ovarian axis 1
• Any exogenous testosterone exposure would directly suppress ovarian function and delay menstruation 1

What Your Constant Cramping Means

Cramping without menstruation suggests your uterus is contracting but the endometrial lining hasn't developed properly to shed, likely due to anovulation (lack of ovulation). 7

• This differs from primary dysmenorrhea, which occurs with menstruation 7
• The constant nature (rather than cyclical) points to hormonal imbalance rather than prostaglandin-mediated menstrual pain 7

Management Algorithm

Step 1: After Negative Pregnancy Test

Cycles >35 days apart are abnormal and require evaluation—do not dismiss a 10-day delay as "normal variation." 1

Step 2: Hormone Assessment Results Guide Treatment

If LH/FSH ratio is elevated (>2:1) with low estradiol:

• This confirms PCOS exacerbation 2, 1
• Optimize myo-inositol and D-chiro inositol dosing (you're already taking this correctly) 2
• Consider metformin addition if not already prescribed, given your insulin resistance 3, 4

If estradiol is very low (<30 pg/mL):

• Discontinue or reduce any testosterone exposure immediately to allow endogenous estrogen recovery 1
• Consider transdermal estradiol with cyclic oral progesterone for more physiologic hormone delivery 1
• After estrogen rebuilds the endometrium, progesterone withdrawal will induce menses 1

Step 3: Address Metabolic Risk Factors

Your weight and insulin resistance significantly impact menstrual function:

• Being overweight doubles the odds of prolonged menstrual cramping 8
• Weight optimization improves both insulin sensitivity and menstrual regularity 5, 4
• Continue levothyroxine as prescribed, but ensure TSH is optimized (thyroid dysfunction worsens metabolic issues) 6

Critical Pitfalls to Avoid

Do not start combined oral contraceptives without full evaluation—they may worsen insulin resistance and bone health in your metabolic context 1

Do not continue any testosterone supplementation at current doses without investigating its impact on menstrual function 1

Do not assume this will resolve spontaneously—women with irregular cycles have significantly increased 15-year risk of diabetes (HR 1.73) and pre-diabetes (HR 1.33) 4

Do not use alcohol for cramping relief—while it may decrease cramping occurrence, it increases duration and severity when pain is present 8

When to Seek Urgent Care

• Severe, worsening abdominal pain (concern for ectopic pregnancy even with negative initial test) 1
• Heavy bleeding when period finally arrives (may indicate anovulatory bleeding) 2
• No period within 2 weeks despite intervention (requires progesterone challenge test) 1

Your combination of insulin resistance, recent medication changes, and metabolic stress creates a perfect storm for menstrual disruption—aggressive evaluation and treatment of the underlying hormonal imbalance is essential to prevent long-term metabolic complications. 3, 4