Last week my friend Maggie Chilton and I interviewed Lara Briden, ND for our podcast (The Ultimate Perimenopause Podcast). She is a fantastically knowledgeable naturopath practicing in Australia with an expertise in hormones. The quote above is from Lara, and I really love the idea of looking at the period as a way to learn about your overall health. What is your period trying to tell you?
What is a normal period?
Let’s begin with what is considered normal for periods. Here are some useful numbers and indicators:
- The usual amount of menstrual blood loss per period (not per day) is 10 to 35 ml. Each soaked normal-sized tampon or pad holds a teaspoon (5ml) of blood.That means it is normal to soak one to seven normal-sized pads or tampons (“sanitary products”) in a whole period. (Easier to measure if you use a menstrual cup!)
- A normal period also comes monthly, every 26-35 days. Shorter or longer cycles are often an indicator of hormone imbalance.
- Ideally a period comes with minimal pain, or just mild cramping that does not require pain-relief medication.
Period signs and how to interpret them:
Now let’s take a look at what your period might be saying Here are some period signs and what they can mean. (This is a short list and only just a start, there are many more indicators too)
1. Really heavy cycles
- Usually an indicator of estrogen dominance – meaning either high production of estrogen, slow detoxification of estrogen, or relatively high estrogen to progesterone ratio.
- Can be associated with the presence of uterine fibroids or adenomyosis.
- Worsened if you have a blood clotting disorder or hypothyroidism.
- Also more common if you are overweight (abdominal fat cells produce more of the estrone form of estrogen which can cause a thicker uterine lining).
2. Long cycles
- When the periods come far apart, meaning more than 35 days from each other this can indicate that ovulation is delayed. The most common causes of long cycles are irregular menstruation (most often related to polycystic ovarian syndrome) or low thyroid function (hypothyroidism).
- If this just happens occasionally, it can be due to stress or travel with time zones. Some women’s ovulation is very sensitive!
3. Irregular periods
- Irregular periods can be a sign of hormone imbalance – for example polycystic ovarian syndrome (PCOS). In this case there may be periods of time where they come on time followed by breaks of several months at a time.
- Periods can also become irregular in perimenopause and menopause, and during this time I would also expect to see signs like sleep disturbance, hot flashes or night sweats when the period is late.
- The last likely cause of irregular periods is that your body is under stress – stress from work, emotional stress, over-exercising stress, or under-eating stress. All of these can disrupt the normal rhythm of ovulation and cause a temporary irregularity.
4. Missed periods
- Similarly to irregular periods, the most common cause of missed periods is that your body is under stress: physical stress or emotional stress.
- Undereating or over-training with exercise can also cause missed periods, especially if body fat drops too low.
- After stopping hormonal birth control, especially if you have used it for over 5 years, it is very common to have missed periods for several months.
- Missed periods can also be a sign of menopause, or if you’re younger than 45 a sign of premature ovarian insufficiency where the ovaries have stopped working years before menopause is expected. (This is rare).
5. Painful periods
- Painful periods can be an indicator of overall body inflammation, and in this case will improve quite dramatically with a low-inflammation nutrition plan, regular exercise, and natural anti-inflammatories.
- The alignment of your uterus is a less known cause of painful periods. You can learn more about ‘displaced uterus’ and available treatment here: http://darouwellness.com/displaced-uterus-part-1/
- If pain is severe, and especially if several other signs are present like painful intercourse, digestive upset with menstruation, and pelvic pain during the week before menstruation, it may indicated endometriosis. (Read about endometriosis here: http://darouwellness.com/endometriosis-steps-treat/)
- Another condition called adenomyosis is another possibility for very painful period, which is more common in women over 40 years, especially if they have had a cesarian section. In this case pain gets worse with age, and there is also very heavy flow.
6. Light periods
- Very light periods are most often a sign of low estrogen levels, and means the uterus is not thickening very much. Some women simply have naturally light periods, or it can be a sign of a hormone imbalance. This is more common in women with lower body fat and in athletes.
- Another cause of very light periods can be a symptom of coming off low-dose oral contraceptives. In this case the estrogen levels are normal, but the uterine lining is not responding. This will often resolve on it’s own, and in rare cases can contribute to fertility difficulties.
7. Periods coming close together
- Periods coming more frequently, meaning less than 26 days apart are very common in women over the age of 40 especially through perimenopause. In this case the shorter cycle comes with a reduction in fertility.
- Shorter cycles can also come when periods are irregular, meaning ovulation is less predictable, and also during times of stress and with travel.
8. Spotting before your period
- It’s not uncommon to have occasional spotting during your cycle, and usually this happens due to a drop in hormones. If this happens just once in a while, there is no need for concern.
- Regular premenstrual spotting can indicate that progesterone levels are dropping early or there is what’s called a ‘short luteal phase’. Testing progesterone can help to confirm whether there is a hormonal explanation.
- Another common cause of spotting is endometrial polyps, or small growth inside the lining of the uterus. They may resolve on their own, or require a simple procedure to remove them if there are many or they are growing larger.
- And finally, spotting can happen with endometriosis or with uterine fibroids.
Two special circumstances
One thing to note, is that if you’ve just come off any form of hormone birth control (pill, IUD, ring), these signs of hormone imbalance may be temporary as your body adjusts to cycling and ovulating on its own. Similarly, at puberty there are many temporary signs of hormone imbalance (heavy flow, irregular periods, spotting), that in many cases will resolve over a year or two. If you’re in either of these categories, it doesn’t mean that there is nothing that can be done to ease your symptoms – please ask! There are many tools to support hormone balance.
Using these signs and learning more
The next step after listening to what your period is saying is usually some form of lab testing to confirm. This may include bloodwork to test for hormone imbalance, a DUTCH test to look at hormone detox pathways, or basal body temperature tracking to check for ovulation. Once we’ve understood fully what your hormones are doing, it becomes so much easier to treat.
Treatment for hormonal issues ranges from optimal nutrition for your particular circumstances, herbs or nutrients to support ovarian function, recommendations to detox hormones more effectively, and possibly bioidentical hormones to correct strong deficiencies.
If you feel that your period is trying to tell you something, let’s talk more!
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