By Dr. Shawna Darou, ND
Have you ever been told to take hormonal birth control to manage your period issues? The pill, or other hormonal birth control is routinely prescribed for issues such as:
- painful periods
- irregular cycles
- heavy periods
- ovarian cysts
- perimenopause changes
- spotting between periods
I admit that there are some cases where this is appropriate, but in many cases there are lots of things we can do to get to the root of the problem. It is important to recognize that hormonal contraceptives are not fixing the problem at all, they are simply masking it.
If you have difficult periods, irregular periods, heavy periods or extreme PMS, these are simply signs that there is an imbalance somewhere in the body. Consider the idea that your body is trying to tell you something, rather than needing to get rid of a symptom quickly. In fact, many people view the menstrual cycle as a vital sign – a health marker that provides important information about your overall health.
Interestingly, the naturopathic approach to treating period problems rarely has to do with adding more hormones. Your ovarian hormones are interconnected with many other systems: blood sugar regulation, thyroid function, adrenal / stress hormones, digestive function, liver detoxification pathways, optimal nutrition and nutrient levels, sleep quality and more. In fact, by treating the underlying cause you can permanently fixing your periods, rather than temporarily covering up symptoms.
If we take a more holistic approach, we want to look ‘upstream’ and try to understand where the imbalance is that creates difficult periods. For example what is the source of inflammation that creates painful periods; what is causing estrogen dominance to make the flow excessively heavy; or how to support the body’s detoxification pathways to clear hormones more effectively.
For most period issues, start here:
- Lab testing: If you’ve read a few of my blogs, you know I’m a big fan of lab testing. We need to accurately learn about hormone levels first, and depending on symptoms this will include bloodwork on day 2 or 3 of the cycle, and day 21. (These dates are counted day 1 = the first day of significant menstrual flow, not spotting). Bloodwork may include: Estradiol, Progesterone, Prolactin, LH, FSH, Thyroid panel, am Cortisol, DHEA, Testosterone, fasting glucose and insulin. A second step may include DUTCH (dried urine hormone testing) to learn about the specific pathways of estrogen metabolism, which is especially indicated in cases of estrogen dominance.
- Cycle tracking: Tracking your cycle is just as important as lab testing – we can learn about hormone balance, ovulation timing, and other signs that may direct us to the cause of your hormonal issues. Start by tracking the basics: the first day of your period, and the duration of flow. You can then add other notes about cyclic symptoms like headaches, spotting, mood-swings, breast tenderness and more.
Once we understand whether or not there is a hormone imbalance, and levels of surrounding hormones (adrenal, thyroid, insulin), we can dive right into treatment.
Top areas to address for better periods:
1. Insulin / blood sugar regulation
Chronically imbalanced blood sugar levels, and a diet too high in simple carbohydrates and sugar can lead to insulin resistance, which is associated with hormone imbalances such as polycystic ovarian syndrome (PCOS). Imbalances in blood sugar levels will also make PMS symptoms worse (mood, bloating, food cravings especially), and cause irregular menstruation. A nutrition plan that supports optimal blood sugar balance can have a profound impact on hormone balance.
2. Inflammation and immune system balance
Inflammation in the body often leads to pain, and this is a key to addressing menstrual cramps and more severe mood changes with your period. Inflammation can be addressed by adjusting your diet especially, identifying food intolerances and anti-inflammatory supplements such as fish oils and turmeric. If your periods are extremely painful and difficult and you suspect endometriosis, inflammation is the key area to address, as endometriosis is now classified as an inflammatory disorder that is affected by hormones, not the other way around.
Stress in interesting in that it can affect many hormones: lowering progesterone levels and causing more PMS, affecting thyroid function causing cycle length irregularities, reducing estrogen detoxification causing further estrogen dominance, and affecting the hypothalamus-pituitary-ovarian axis causing ovulation, and in extreme cases stopping periods all together. Addressing stress hormones is always an important step in restoring hormone balance. One way to look at this is that stress turns up the volume on any type of imbalance in the body, especially hormones.
Consistent poor sleep quality, or lack of sleep also impacts your hormones by changing melatonin production and affecting stress hormones. When sleep is chronically disrupted, ovulation is affected, along with egg quality, stress hormone balance and blood sugar regulation. As you can see, a lack of quality sleep can cause a domino affect with other systems too.
There are many key nutrients required for a healthy menstrual cycle, and a diet lacking in vegetables and fruits, nuts and seeds and sufficient protein intake may be to blame. Your body especially needs sufficient B-vitamins, especially vitamin B5 and B6, magnesium, calcium, vitamin D and zinc to maintain a regular menstrual cycle and to minimize PMS symptoms.
6. Gastrointestinal health
This one is not intuitive, but the link between gut health and hormone balance can be profound. In fact women with endometriosis also often have chronic digestive disorders, and by addressing the gut we effectively reduce menstrual pain and inflammation. Rebalancing digestive flora, specifically clearing out yeast and cutting out sugar is also a key treatment for premenstrual syndrome too. When the gut is functioning more optimally, there is much more effective breakdown and elimination of excess estrogens, meaning lighter and less intense menstrual cycles.
Since all of your hormonal systems are interconnected, imbalances in thyroid function will always cause changes in your menstrual cycle. An underactive thyroid for example, usually lengthens the menstrual cycle to more than 30 days, causes heavier flow, more PMS and can impact fertility. Treating the thyroid can address all of these issues.
8. The right amount of exercise
Exercise can be an interesting factor for hormone balance, as there is a happy middle-ground here. Overexercising can also be detrimental as it puts extra stress on the body and can cause periods to become lighter or stop, especially if your body fat is also low. Regular moderate-intensity exercise is especially importantin cases of polycystic ovarian syndrome and heavy periods. Exercise effectively improves insulin sensitivity and period regularity, and dropping excess body fat will reduce heavy menstrual flow.
9. Environmental toxins
There are many estrogen-mimicking chemicals, for example bisphenol A, phthalates and parabens which we can have high exposure to through plastics, water bottles, canned foods and personal care products. Supporting liver detoxification to help process extra estrogens, and of course reducing exposure can impact your hormone balance. These exposures make an especially big impact at puberty, and can have a cumulative impact on your hormonal health.
In conclusion, if you are on hormonal contraceptives for the main purpose of managing or regulating your period, please consider that this is not treating the underlying causes, and that with a systematic approach of treating both your hormonal system and surrounding systems, we can effectively restore balance.
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