What should your period be like?
Your period should arrive every 21 to 35 days, or up to 45 days if you’re a teenager. It should arrive without premenstrual symptoms, without pain, and last anywhere from two to seven days of bleeding. Over those days, you should lose a total of 50 mL (or about three tablespoons) of menstrual fluid; more than 80 mL is excessive. Of course, you’ve probably never measured the actual volume of your menstrual flow. You can estimate it by counting the number of menstrual products: one regular pad or tampon holds 5 mL or about 1 teaspoon, so 80 mL equates to about 16 filled tampons over all the days of your bleed.
Learn to know your cycle
To determine the length of your cycle, start counting from your first day of heavy bleeding your heaviest flow. Call this “Day 1”. Do not count the days of light spotting that come before your heavy day. Your spotting days are not part of this cycle, but rather the final days of your previous cycle.
Your period is irregular if it comes more often than every 21 days or less often than every 35 day— or if it does not come at all. An irregular period can be due to several different things including a medical condition, so please check with your doctor for a diagnosis. Based on her assessment, she may diagnose you with one of the two most common reasons for irregular periods: polycystic ovary syndrome (PCOS) or hypothalamic amenorrhea.
PCOS is the state of having irregular periods because of elevated androgens (male hormones) and possibly insulin resistance. It also often presents with the symptoms of acne and facial hair.
Hypothalamic amenorrhea (HA) is the loss of periods due to undereating, either undereating generally or under eating carbs.
In some ways, the PCOS and hypothalamic amenorrhea are quite different—almost opposite. PCOS can be driven by too much sugar, and hypothalamic amenorrhea is caused by too little food or carbohydrate.
In other ways, the two conditions are similar enough that your doctor might mistakenly say you have PCOS when you really have hypothalamic amenorrhea. For example, take care that your PCOS diagnosis was not based on an ultrasound. Polycystic ovaries can occur with PCOS, yes, but they also occur with hypothalamic amenorrhea. One study concluded that relying on ultrasound for diagnosis can result in hypothalamic amenorrhea being misdiagnosed as PCOS.
The treatment for PCOS is to reverse the underlying problem with insulin by reducing sugar in your diet and taking magnesium. The treatment for hypothalamic amenorrhea is to eat more.
Your period is heavy if you lose more than 80 mL of menstrual fluid (16 fully soaked tampons), or if your period lasts for longer than seven days. A heavy period can be caused by medical problems such as fibroids (benign growths of the uterine muscle), endometriosis (a painful condition in which tissue similar to uterine lining grows in the pelvis), or adenomyosis (a condition similar to endometriosis in which tissue similar to uterine lining grows in the uterine muscle), so please check with your doctor. Once she has ruled out other causes, your doctor may conclude that your heavy periods are “hormonal,” which means they’re caused by “unopposed estrogen” or cycles in which you did not ovulate and make progesterone — the period-lightening hormone. The treatment is to identify why you’re not ovulating and correct that, if possible. Common causes include insulin resistance and PCOS, as well as stress and perimenopause. Avoiding cow’s dairy can also substantially lighten periods.
A little pain is normal if it occurs during the first day or two of your bleed and is mild enough that it can be relieved by ibuprofen. More severe pain can indicate fibroids, infection, or endometriosis, so please see your doctor. Normal period pain can be improved by avoiding junk food and cow’s dairy or by supplementing magnesium and zinc, which work by reducing prostaglandins.
Premenstrual syndrome (PMS)
Premenstrual symptoms include irritability, headaches, and sugar cravings before your period. PMS is common so it’s easy to think it just goes with the territory of having periods – but it doesn’t. With the right natural treatment, PMS can become a thing of the past. No irritability. No headache. No cravings. It is possible!
The best way to improve PMS is with the supplements magnesium and vitamin B6, which work by boosting levels of GABA, a calming neurotransmitter in the brain. You can also support your calming hormone progesterone with the herbal medicine Vitex, which has been shown in some studies to be effective for the premenstrual symptoms of irritability, fluid retention, and breast pain.
The pill is not a solution
The pill can mask only period problems. For example, it forces a withdrawal bleed, which reassures you that you’ve had a period when you really haven’t because pill-bleeds are not periods. A real period is a bleed at the end of a natural ovulatory cycle (a menstrual cycle that includes ovulation as the main event). A pill-bleed is the bleed induced by stopping contraceptive drugs which are similar, but not identical, to your own hormones. There is no medical reason to bleed monthly on the pill.
Why you should track your monthly report card
Your fertility is the expression of your health. When symptoms such as moodiness, weight loss or gain, acne, anxiety, difficulty sleeping, etc. cause lifestyle changes, it’s time to investigate what may be causing them. This is where charting your cycle sheds invaluable light.
The knowledge is literally inside us. All we have to do is learn how to listen.
Tune in to your menstrual health with kegg — the intuitive fertility tracker that assesses the electrolyte levels of cervical fluid to detect your fertile window and period up to 7 days in advance.
Lara Briden is a Christchurch naturopath and the author of the bestselling book Period Repair Manual: Every woman’s guide to better periods.