Fertility, women's health
A thorough history of woman's menstrual cycle is something I always ask my patients in practice: whether they are tracking it for fertility, just getting it back post partum, or slowly losing it during menopause. Understanding our periods can tell us so much about our bodies and yet all too often I get woman who are unaware of the signs of irregular hormone imbalance and claim that everything is... well, fine I guess. When I start digging deeper, some admit to having such bad cramps they need to take time off work, some bleed between periods or have such a heavy flow they change a pad every hour. A period shouldn't be a time of suffering. Neither should the weeks leading up to it. Now I have to admit, there is no one fits all perfect period. Every woman will have a different cycle length and experience different symptoms. What is consistent for each woman though is important to evaluate because it's a window into what's going on with her hormones and the state of her general body.
The average length between periods should fall between 21-35 days and be consistent each month. A day or two difference isn't much to worry about, but if you're noticing that your cycle was 21 days one month, then 40 days the next, and then possibly one month skipped, this is a sign of irregular hormone balance and can either be caused by stress, dieting, or PCOS.
Length of Bleed
Anywhere from 2-7 days of bleeding is typical for woman. A period will start on the first day of a true bleed, as in the need for a liner or tampon. Some woman may experience bleeding between periods, after intercourse, for only 1 day or for over 1 week. These again are signs of hormone irregularities and possible issues with the endometrial lining.
Quantity and Quality of Blood
The amount of blood can be a large predictor of just how much lining is being shed during a period. Often woman who have very heavy flows and need to change even a super absorbent pad every hour will need to rule out estrogen dominance and conditions like endometriosis or iron deficiency as a possible cause. Heavy dark clots are also something that should be investigated. If on the other hand there is very little blood, this could be a sign of estrogen deficiency, often caused by menopause, smoking, dieting, and stress.
This may come as a surprise, but women should not be experiencing irritability before their period and intense pain during it! Excess pain during a period is another hallmark sign of endometriosis, fibroids, or inflammation and should be evaluated by your health care provider. Mild twitching and aches can be felt on the first few days, as blood loss is often that highest, but the pain itself should never be severe or debilitating. Some woman are so used to heavy painful periods that they assume it's the norm. I often ask patients if they require medication, such as Tylenol or Advil, and how many of them. If it's 8 a day to get by, it's too much. It is, however, common to feel a slight cramp in the middle of a cycle during ovulation, this can actually be a good sign that ovulation is occurring.
This isn't specific to a period per se, but to the overall health of a full hormonal cycle. In the first two weeks after day 1 of your period, estrogen is rising. This should be a state of happiness as estrogen is linked with serotonin and rising libido towards ovulation. Often you'll notice cervical mucous will be white and creamy. As ovulation approached, your body prepares to thin out this mucous in order for sperm to enter. Leading up to ovulation, you should notice that your cervical fluid increases and becomes thinner, clear, and more slippery - somewhat like egg whites. After ovulation, it will return to a thicker consistency.
This is again an indicator of ovulation. Temperature will fluctuate throughout the cycle, with it being the lowest before ovulation, spiking during ovulation, and then slightly higher after ovulation. If you track your temperature daily (best to be done first thing upon rising before eating or even brushing your teeth) and notice there is no spike or a very erratic fluctuation, this should be evaluated as well. This could indicate an issue with ovulation or even thyroid imbalance.
What if my period isn’t “normal”?
All too often birth control is used to try and "regulate" cycles. Unfortunately, birth control simply stops your body from producing these wonderful hormones and instead causes what is known as a fake bleed. Often times, woman will be on birth control for 10 years or more and then once stopping, their cycles can become irregular and conceiving may even be difficult. If you think your period pain and overall cycle could be improved, talk to your naturopathic doctor about safe, gentle, and effective ways to optimize your period health!