Irregular menstrual cycles are a common complaint I see in clinic especially when a woman has decided it’s time to try for a baby. Prior to this, it is not unusual for women to ‘manage’ their irregular cycles with some form of contraception such as the oral contraceptive pill. Unfortunately using artificial hormones to “regulate” your cycle does nothing to resolve the underlying causes and is really only masking the issue. (The same thing could be said for using hormonal contraception to address acne or period pain but they are topics for another blog).
So, what does a normal menstrual cycle look like?
A normal menstrual cycle is, on average, 28 days (but anything from 21-35 days is normal). It should be largely pain free and uneventful. It should not disrupt your enjoyment of life or ability to function at the top of your game.
Some variations from the norm can happen occasionally (a particularly stressful month for example), however your cycle should remain pretty much the same from month to month.
The length of your cycle is measured from the first day of your menstrual bleed (day one) and you count until the day prior to your next menstrual bleed. Your period can be 2-7 days (most women bleed for 3-5 days) and again should be fairly similar from month to month. Most women will have a couple of “heavier” days and the rest are lighter (typical total blood loss is around 50ml).
Ovulation is the key to a normal menstrual cycle. In a healthy woman with a 28 day cycle, ovulation usually takes place around day 14, however this can vary from woman to woman and therefore it is vital to understand if and when you ovulate to either assist with conception or avoid unwanted pregnancy. Note: it is normal to have the occasional annovulatory cycle (i.e. you haven’t ovulated that month) and it is possible to have a period without having ovulated.
Your menstrual cycle is under the influence of the key reproductive hormones oestrogen, follicular stimulating hormone, luteinising hormone and progesterone.
So, a predictable, pain free and effortless period is what we are aiming for. Anything else is a clue that something is not quite right. Think of it as a monthly evaluation of your current health status.
When is having an irregular cycle normal?
There are times in your life when having an irregular menstrual cycle is normal. These include:
After your first period (menarche)
It can take months to years for a young woman to establish a regular cycle. This is because the hypothalamic-pituitary-ovarian axis (HPO Axis) is still developing. It is estimated that the HPO axis can take up to 10 years to properly mature. This axis is basically the communication pathway between your brain and your ovaries that sends signals to produce your reproductive hormones. Unfortunately I see so many young women who have been prescribed the pill during their teens because their irregular cycles were seen as abnormal when in fact it was just part of their normal maturation which lends itself to gentle dietary and lifestyle support.
When ceasing hormonal contraception
After a woman has been on hormonal contraception it can take some time to establish a normal menstrual cycle (especially if they started contraception at a young age before their cycle had established its rhythm). It can be really helpful to prepare your body prior to ceasing hormonal contraception to minimise any side effects caused by the sudden withdrawal of synthetic hormones during these initial months. You can do this by consulting a naturopath and getting appropriate nutritional supplementation (if required) to support normal hormone production. What I do will depend on what your hormonal health was like before you started contraception. It’s a big clue to what it will be like now.
After giving birth and breastfeeding
For some women their periods return as early as 12 weeks after giving birth. For others, they may take many months to over a year for a period to return. The return of your period and the regularity of your cycle depends on many factors such as whether you are breastfeeding, how frequently you’re breastfeeding and even whether or not you’re still doing night feeds.
That’s why it is important to consider what contraceptive methods you want to use after giving birth as ovulation will come before your period returns and therefore, you could find yourself pregnant again sooner than expected if you are not careful.
One of the earliest signs you’re approaching menopause is changes to your menstrual cycle. For some women they may find their menstrual bleed changes or the length of their cycle changes. It may get shorter or longer and you may skip periods all together. This is called peri-menopause.
What are some of the other causes of an irregular cycle?
There can be a variety of reasons why your cycle might be irregular but they largely all stem from an imbalance of hormones resulting in changes to when or if you ovulate.
You need the right hormones in the right amount at the right time!
The most common reasons for an irregular cycle are as follows:
Ongoing, chronic stress can wreak havoc with your hormones. This is because of another communication pathway called the hypothalamic-pituitary-adrenal axis (HPA axis) which is very closely linked with your HPO axis. As you can see both communication pathways go via the hypothalamus and the pituitary.
High levels of stress can result in changes to the signals being sent by your hypothalamus to your ovaries and may interrupt hormones that regulate your cycle. When you consider that stress hormones are a signal to your body that you are “in danger”, your brain will also recognise that having a baby is not appropriate and therefore may alter hormonal signals that can disrupt your cycle.
Poor detoxification of hormones
Your liver and bowel do an amazing job of removing toxins and waste that you ingest, inhale and absorb in your day to day life. These organs also have to remove metabolic waste products, basically the end products of our normal bodily processes that keep you in tip top shape. Some of these metabolic products are hormones such as oestrogen and progesterone.
The toxic burden on your liver and bowel however has increased in recent decades due to industrialisation and the sheer number of chemicals in our food, clothing, furniture, household cleaners, plastics etc. etc. Add in a poor diet and poor lifestyle choices and you’ve got a liver and bowel having to work extremely hard to keep your body ticking over in good health.
Sometimes if the liver isn’t able to break down waste into products that can be excreted, you can end up with an accumulation of certain hormones which can disrupt the delicate balance of reproductive hormones needed for ovulation and a regular cycle.
Being underweight or overweight
You need to have a healthy amount of body fat in order for your body to produce hormones, including reproductive hormones. Too little body fat and your body can’t produce hormones and therefore you will not have a regular menstrual cycle (or perhaps stop menstruating completely for a time). And too much body fat can interfere with your hormone production leading to an imbalance that can disrupt your menstrual cycle. Achieving a healthy weight is important to achieve a healthy cycle.
An underlying medical condition
Sometimes an underlying medical condition may be the cause of your irregular cycle. These conditions may include and are not limited to; thyroid disorders, pituitary disorders, poly cystic ovarian syndrome, uterine fibroids, endometriosis, pelvic inflammatory disease and premature ovarian failure (when the ovaries of a woman under the age of 40 don’t function properly).
Therefore, it is always important to have irregular menstrual cycles assessed. Sometimes hormone testing may be necessary, and in other cases simple diet and lifestyle changes are all that’s required to regain a normal menstrual cycle.
What can you do to understand and regulate your menstrual cycle?
Basal body temperature charting and cervical mucus charting
These two tracking tools are very useful in identifying patterns of ovulation, including whether or not ovulation is taking place. Both of these methods work well together, particularly for those women with irregular cycles. A naturopath can talk you through these charts and evaluate your charts after each cycle.
Hormone panels can be done to determine your hormone levels at various times in your cycle. The timing of hormone tests is important though, which is why for women with an irregular cycle, using the above charts proves useful in identifying the best time to test.
Ensure your liver and bowel are working at their best to remove hormones
You can do this by ensuring your diet includes lots of plants and lean protein. These provide important nutrients and fibre for detoxification processes to take place and sufficient excretion of waste products.
A naturopath can guide you with dietary and lifestyle changes to ensure your detoxification pathways are supported.
Reduce your stress levels
Relaxation seems to come up in almost every one of my blogs and for good reason. Managing your stress levels is important for all aspects of your health including your reproductive health.
Find an activity you enjoy, for example; yoga, meditation, drawing, having a bath, walking in nature, watching the clouds pass…..etc. This will help your body de-stress.
If you need some support to reduce your stress levels there are some fantastic herbs your naturopath can prescribe to support your HPA axis.
Make sure you are eating well
Your body requires a variety of nutrients to carry out its normal processes. Likewise, the production of your hormones requires lots of vitamins, minerals, protein, complex carbohydrates and healthy fats. Therefore, eating a well rounded wholefood diet is essential for healthy hormone balance.
Changing your diet can take time so that you form good habits that are lifelong, rather than adopting the latest craze in diets and relapsing back to your old ways. Also, not every diet suits everybody, so if you need help assessing and changing your diet, speak to your naturopath about a tailored dietary plan that is suitable for you.
See a naturopath
There is so much that can be done via diet, lifestyle and selected nutritional and herbal supplements to “normalise” your menstrual cycle. They key is to understand the drivers of your cycle and symptoms and then come up with relevant and appropriate solutions.