Ladies, your period should be largely pain-free, come at regular intervals and should not be excessively heavy. And it should almost catch you by surprise due to a lack of premenstrual symptoms.
In other words your period should not disrupt your life and you shouldn’t have to plan your days around your cycle.
We’ve written previously about a normal menstrual cycle and irregular cycles but now I want to address some of the factors behind other issues that frequently arise with the female menstrual cycle.
What goes wrong with your menstrual cycle?
It is estimated that at least 1 in 3 women suffer from PMS severe enough to impact their lives. PMS symptoms may start a couple of days before your period but for some women they can last for the entire second half of your cycle (after ovulation). They usually dissipate within a day or so of your period starting.
PMS may include one or more of the following:
Mood changes are the most commonly reported symptoms in our clinic. Specifically this can present as grumpiness, irritability, anger, anxiety, a short fuse or impatience. Or maybe you become more emotional, bursting into tears or feeling overwhelmed at the drop of a hat.
Bloating, fluid retention or sore breasts are another common symptom. Some women will go up a dress size for a week or more every month.
Acne flares or breakouts are often due to hormonal changes premenstrually but can also be exacerbated by inflammation and diet.
Cravings for certain foods…chocolate and cakes seem to be particularly popular
Pain in the abdomen or lower pelvic region or pain in the form of pre-menstrual migraines
Brain fog or forgetfulness
Insomnia and fatigue which can exacerbate mood changes, cravings and cognition
Pain (aka dysmenorrhea)
The majority of women will experience some period pain with their bleed. The fortunate ones experience a mild discomfort in the hours leading up to the commencement of their bleed and then perhaps for a few more hours whilst others will have pain so severe that they are bed-bound for days.
Pain may be in the form of a dull ache or a sense of dragging and fullness or it could be in the form of cramp-like pain. Generally pain is in the lower abdomen but sometimes women will experience lower back pain and even pain extending down the legs.
There are two classifications of dysmenorrhea. Secondary dysmenorrhea is period pain that is the result of an underlying condition such as endometriosis which is thought to affect 1 in 10 women whereas primary dysmenorrhea is the term given to period pain where there is no identified underlying condition.
Heavy periods (aka menorrhagia)
For most women, their period lasts between 3 and 7 days with some of these days having only some light spotting. The average loss of blood is approximately 50ml and for these women, there is no particular impact on daily activity or nightly sleep. Generally, they only need to change a tampon or pad every couple of hours on the “heavier” days and can get through the night uninterrupted as their flow generally slows overnight.
However, many women experience menorrhagia, or the loss of more than 80ml of menstrual fluid (even losing up to 500ml in rare circumstances). Heavy periods may be the result of an underlying condition such as the presence of fibroids but it can also be triggered by hormonal imbalances or low iron levels.
These may be the result of annovulatory cycles (i.e. no ovulation that month), hormonal imbalances, an underlying condition like PCOS (which is estimated to affect up to 15% of women) or even increased stress. Read irregular cycles for more detail.
Transition to menopause
Perimenopause is the time leading up to your last period (menopause). This is a time of fluctuating hormones that can result in significant changes to your “normal” menstrual cycle. Your cycle can fluctuate in length, get heavier or more painful and you may experience hot flushes or increased PMS-type symptoms. If you want to know more about this time in a woman’s life read the pesky perimenopause or menopause.
What’s behind all these menstrual problems?
There are many causes or triggers of all these menstrual problems and sometimes it might be a combination of more than one. In my clinic, I often see women who have been put on the pill in their teen years when their problems started. The pill masks the problem, then they come off the pill in their 20s or 30s only to find that the symptoms return with a vengeance. Unfortunately, unless they address the underlying causes the symptoms will likely remain until menopause.
So, what are the common drivers?
Imbalance of key sex hormones
Our sex hormones (think primarily oestrogen and progesterone in this instance) should be made on demand in varying amounts throughout our menstrual cycle. Once they have served their purpose for that cycle our bodies break them down and eliminate them (i.e. detoxification and elimination).
Oestrogen’s primary job is to aid ovulation and prepare the uterus to receive a fertilised egg. (Our production of oestrogen declines dramatically through menopause and beyond). Beyond fertility, oestrogen is also important for healthy bones and muscles, cardiovascular health, brain function, sleep and metabolism. But you can have too much of a good thing. Oestrogen may also promote inflammation and growth. We see the symptoms of fibroids and endometriosis as worsening under the inflammatory effects of too much oestrogen. This is especially the case when our body’s own detoxification processes are slow to remove unwanted oestrogen.
Progesterone should be made during the second half of your cycle if you have ovulated. Besides preparing your uterus for the possible arrival of a fertilised egg, progesterone also performs a number of vital functions. It has a calming effect on your mind, helping with mood and sleep. It is also anti-inflammatory.
If you have not ovulated you won’t make progesterone. Even if you have ovulated sometimes your progesterone levels are insufficient to achieve the desired calming effect or other hormonal changes can interfere with its function.
Learn more about your reproductive hormones here.
Your hormones should not be looked at in isolation. They all interact with each other like a beautiful, harmonious orchestra playing in perfect tune and sync. But it only takes one “instrument” to be slightly off-time or out of tune to throw out the whole sound and instead of beautiful music you just have “noise”.
Elevated blood glucose due to dysfunction in the hormone insulin may lead to increased inflammation which can affect oestrogen and testosterone production and exacerbate inflammatory conditions.
Increased stress in your life results in the increased production of the stress hormone, cortisol. Cortisol is made from many of the same ingredients (called precursors) as your sex hormones. In times of stress your body will prioritise cortisol over your sex hormones. (In addition to the hormonal effects, stress may also impact your temperature regulation, making you more prone to hot flushes or chills).
Problems with thyroid function (especially hypothyroidism) affect the production of thyroid hormones which can interfere with progesterone, resulting in increased PMS symptoms or irregular periods. (And hypothyroidism may also contribute to poor digestion and detoxification).
Detoxification and elimination
Inadequate detoxification (by the liver) can result in poor clearance of hormones leading to accumulation of excess hormones (particularly oestrogen) which may be the underlying cause of heavy periods, fibroid growth or endometriosis.
Dysbiosis or an imbalance of bacteria (our microbiome) in the digestive tract can affect detoxification and elimination of waste (including toxins) and can lead to inflammation.
Other factors that can affect your digestive processes include alcohol, some pharmaceutical medications, stress and a diet lacking in vital nutrients.
Too much abdominal fat
There are many possible causes of inflammation. We’ve already mentioned some of these but another common cause is carrying a bit too much adipose tissue (fat) around your abdomen. This particular type of fat is known to promote inflammation and oestrogen production.
An overload of toxins coming from your diet or environment
We’ve written previously about the role of toxins in our health but I want to make specific mention of particular toxins called “endocrine disrupting chemicals”. There are numerous studies linking these chemicals to problems of hormonal dysfunction in both males and females. EDCs may be found in plastics, cleaning products, personal care products, some food additives and certain pesticides.
These are all triggers that can be reduced with simple treatments and diet or lifestyle changes. There’s no need to suffer in silence and nor should you have to.
The naturopathic approach to dealing with menstrual problems
In rectifying your menstrual problems, be prepared for it to take a few cycles, especially if we are working on successful ovulation as it takes approximately three months for an egg to fully mature.
Our naturopathic approach is to provide symptomatic relief through targeted nutritional and herbal remedies specifically chosen to address your individual symptom picture. We have numerous tools in our tool kit.
While doing this, we also seek to address all the underlying drivers of your symptoms. So depending on what is going on for you, this might include working on your detoxification and elimination pathways, balancing hormones, reducing inflammation and addressing the drivers, reducing stress and improving your resilience, all the while ensuring your diet and lifestyle are supportive of healthy hormonal balance.