Many of us have complicated relationships with our menstrual cycles, but did you know that your menstrual cycle can actually be communicating whether your body is in or out of balance? In fact, the menstrual cycle has been coined the “fifth vital sign” in assessing a person who menstruates’ overall health status, alongside blood temperature, blood pressure, pulse and breathing rate. That says a lot about its importance!
Here’s What You Need To Know About Your Menstrual Cycle:
1) Despite what you’ve been led to believe, “normal” can be different for everyone
2) Just because you’ve experienced your menstrual cycle a specific way your whole life (aka debilitating pain every cycle) doesn’t mean it’s “normal”. Also, your symptoms may be telling you something and warrant your curiosity and attention.
So how do you know what’s normal? What should you be looking for? Come on this journey with me to find out!
Generally, I don’t like the word “normal”. If I’ve learned anything at all in my herbal medicine practice, I’ve learned that everyone is unique and we all have different “normals” when it comes to how our bodies work. While I do honor the uniqueness in all of us and think it’s super important to consider this in any good health protocol, I also think it’s important to identify areas of potential health concern.
Let’s talk about the range of what could be considered “healthy”, so we can identify when the body is raising a red flag and communicating that there may be an underlying imbalance in need of our attention and support.
Here are a list of questions you can be asking yourself to get a feel for what is considered a healthy and happy period, and what might be an indication of imbalance:
1. How Long Is Your Cycle?
Despite what we’ve been led to believe, not everyone has a 28 day cycle, and that can be normal! Anywhere between 26-34 days is considered an “average” cycle length. (1) Even still, there may be some variance in ”normal” here, especially if it’s always been the case for you. Generally though, when the cycle is shorter or longer than that, it can be considered “irregular” and may be an indication of an imbalance. If you skip periods completely for months at a time, that’s called amenorrhea. It’s a definite sign that there is an imbalance of some kind, and warrants more investigation. Important note- there are some well known cycle disruptors like stress, travel and illness that can play a role. Ever noticed during midterms or while you're taking a trip, you may skip a period? That's totally normal, especially if the next month it jumps back into a regular flow. Keep reading to find out some common menstrual cycle disruptors.
2. How Long Do You Bleed?
The length of the bleed can be anywhere from 3-7 days, and still be considered normal. Again, there isn’t a one size fits all for menstrual cycles! A big part of this is knowing what’s normal for you. Although, keep in mind- just because you’ve always experienced your periods one way (and it’s become totally normal to you), doesn’t mean that you should ignore it.
If you’re bleeding for 8 or more days, this can indicate anovulation (lack of ovulation) and can occur in polycystic ovarian syndrome (PCOS). For more on PCOS check out my blog post: A Natural Approach To Polycystic Ovarian Syndrome. Longer bleeds can also lead to anemia due to more significant blood loss, which can have it’s own health impacts. This leads us to the next question...
3. How Much Do You Bleed & Do You Spot In Between Periods?
A normal amount of blood is roughly 2 shot glasses full (30-80ml) over the course of your whole bleed, with small clots being normal as well.(1) This is much easier to measure with a menstrual cup! General rule of thumb, if you’re having to change your menstrual pad or tampon every 1-2 hours, or the amount of blood is so much that it interferes with your daily routines, you’re bleeding really heavily. (2)
Heavy bleeding (also known as menorrhagia) can be an indication of:
- Uterine fibroids
- Polycystic ovarian syndrome (PCOS)- PCOS can manifest as lighter periods too!
- Hormone imbalance
- Anovulation (lack of ovulation)
- Anemia- this isn’t the cause of heavy periods, but is rather the result of significant blood loss every month. Anemia symptoms can manifest as fatigue, low energy, shortness of breath, irregular heart beat (heart palpitations), cold extremities, chest pain and dizziness.
On the other hand, very light periods can be caused by a change in hormones brought about by stress, excessive or increased exercise, strict dietary restriction, being underweight, and could be a symptom of PCOS.(3) Also, it can be normal to experience slight bleeding around implantation when a fertilized ovum implants into the endometrial lining in the uterus. It can be mistaken for a light period, so it’s always good to take a pregnancy test where pregnancy is possible.
What About Spotting?
“Normal” spotting can occur during ovulation itself (some women experience this every cycle around day 14), and during implantation if pregnancy has occurred! Hormonal contraception is another common cause of irregular bleeding or spotting. In some cases, however, if you bleed in between periods, this could be an indication of underlying issues that may need attention. Spotting could indicate endometrial hyperplasia, which means the endometrial tissue in the uterus is being exposed to estrogen without progesterone to balance it out. This commonly occurs with anovulatory cycles (you have a menstrual bleed, but you didn’t ovulate). Other common causes for bleeding in between periods include: Pelvic Inflammatory Disease (PID),Dysfunctional Uterine Bleeding (DUB), uterine polyps, abnormalities of the cervix, conditions affecting the ovaries (eg: ovarian cysts) or metabolic imbalances like malnutrition or excessive weight loss. (4,5)
4. Do You Have Menstrual Cramps & Pain?
While menstrual cramps are super common and a bit of discomfort isn’t anything to worry about, intense menstrual pain is NOT something that should be “normalized”. I have friends and clients who’ve struggled with debilitating pain every single month their whole lives, and they’ve just accepted this as their reality because they don’t know it can be different! It doesn’t help that many doctors dismiss period pain as being “normal” and miss the underlying issue. In fact, cramps and intense pain could be signs of an imbalance needing attention, and further investigation is needed, especially if accompanied by some of the other menstrual issues we’re discussing here.
Painful periods (Dysmenorrhea) can be a sign of:
- Inflammation- prostaglandins (pro-inflammatory chemicals) are released by the uterus every month, and decreasing the “inflammatory load” through diet and omega 3 supplementation can be very helpful to reduce menstrual cramps (1)
- PCOS/ Ovarian cysts
- Pelvic Inflammatory Disease (PID)
It’s always a good idea to go get checked out in order to rule out any cause for concern with menstrual cramps, especially if it’s severe and interfering with your daily life.
For a more in depth look at dysmenorrhea and my herbal approach to tackling menstrual cramps check out my blog post Herbs for Menstrual Cramps & Painful Periods.
5. Do You Have Premenstrual Symptoms (PMS)?
Along with the hormone fluctuations that occur at the different phases of our cycles, it’s completely normal and natural to experience shifts to our emotional, mental and spiritual selves. Unlike the “hormonal crazy person” stereotype we’re fed about these fluctuations, there is actually an opportunity to work with these shifts in our favor in a balanced and grounded way!
If you haven’t checked out my article on Moon & Menstrual Cycles: How to Harness the Power of Your Cycle for Productivity & Rest, I highly recommend you do! I dive into the different phases of the menstrual cycle and how hormones at certain times of the month impact our moods.
While mild premenstrual symptoms can be considered “normal”, especially if they aren’t significantly impacting your day to day life, there are some PMS symptoms that may be sounding an alarm. What I consider a “PMS Red Flag”, is when the symptoms become disruptive to daily functioning leading to missed work, relationship conflicts, and/or seeking out pharmaceutical intervention (medications like contraceptive interventions- IUD or oral contraception, pain-relievers, anti-anxiety meds or anti-depressants), all of which come with their own side effects and implications.
PMS symptoms include:
- Emotional and mental shifts (irritability, impatience, weepiness, confusion, brain fog, forgetfulness, loneliness, restlessness)
- Cyclical headaches
- Breast tenderness, or breast lumps
- Bloating, fluid retention, cyclic weight gain
- Joint pain, backache
- Pelvic pain
- Appetite changes (cravings, increased, abnormal)
- Altered libido
A Note On Premenstrual Dysphoric Disorder (PMDD):
PMDD is a severe type of PMS characterized by severe irritability, unprovoked anger, anxiety and/or depression (1). This is PMS on a whole other level and seriously disrupts the person’s daily life and emotional/mental health. If you experience this, you may want to talk to your doctor, a trusted counsellor/psychologist, as well as a herbalist! Herbs can help to uplift the mood, balance the hormones, and support the liver in adjunct to other approaches.
What Causes PMS?
According to Dr. Aviva Romm the exact underlying cause of PMS isn’t known, however there are many current theories about what underlying issues may contribute to PMS. We can view our PMS symptoms as guideposts, guiding us towards the areas in our lives that may need some attention. These possible underlying contributing factors to PMS include:
- Hormone imbalances- related to estrogen, progesterone, prolactin, aldosterone and/or thyroid imbalances
- Imbalances with neurotransmitters and prostaglandins
- Stress- Leads to disruption in the stress cascade (Hypothalamus-Pituitary- Adrenal (HPA) axis) leading to cortisol imbalances
- Nutrient deficiencies- especially B6, vitamin E, vitamin A, calcium and magnesium
- Cultural and psychosocial factors- negative attitudes about menstruation, lack of self-confidence, personal history of sexual abuse, sense of disempowerment
To sum this up- If you have a few mild PMS symptoms that don’t really disrupt your daily life, then it may not be a cause for concern. However, if you have multiple premenstrual symptoms, they’re on the moderate to severe side and they’re leading to other physical and social consequences, then it may be an indication that there’s an underlying imbalance present.
Our Herbal Allies: How Can Herbs Support Menstrual Cycle Health?
Of course, if any of these questions sparked cause for concern, I recommend getting your doctor on board. It can be an empowering process to figure out what underlying factors are contributing to your menstrual cycle imbalances, so you can get back into a healthy groove with your cycle. The great news is herbs can be an incredible adjunct to getting your menstrual cycle back on track, not only by providing symptom relief, but by addressing underlying root causes.
Alongside appropriate dietary and lifestyle shifts, herbs can:
- Minimize heavy bleeding
- Decrease painful cramps
- Balance cycle length and duration
- Decrease PMS symptoms
- Modulate inflammation
- Balance hormones
- Address underlying causes of imbalances (balancing stress response, blood sugar balance, thyroid support, supporting deeper sleep, hormone detox and cycling through the liver, heal the gut lining and encourage proper digestive function)
Consulting with a herbalist can be an excellent way to support yourself on your menstrual cycle health journey, so you can gently and powerfully balance your hormones by bringing your body into its natural rhythm, with herbs!
Menstrual cycle tracking can be another powerful strategy to get to know your unique shifts and natural cycles. This can mean using a cycle tracking app, at the very least. But even better than that (and WAY more accurate!) is the fertility awareness method (FAM), which involves keeping track of and charting your cervical mucus and basal body temperature daily, along with any other shifts and symptoms. Working with a Fertility Awareness Educator can be awesome to learn how to do this, and means you can get your charts interpreted for that next level support. One of my favorite FAM educators is Chloe Skerlak. She’s fantastic!
Puberty & Menopause: Times of Natural Menstrual Cycle Fluctuations
There are some stages of menstruation that are naturally a little irregular- puberty and perimenopause. Both of these are characterized by a significant shift in hormones and can lead to many of the menstrual disruptions and irregularities we’ve talked about. So if this is your stage of life, there may be a little more of an explanation for the changes you’re noticing. However, it’s always good to rule out any cause of concern with your primary care doctor. You can also get support from a herbalist to support any of these shifts with botanicals, where appropriate, as a way to ease into these hormonal transitions more gracefully.
One More Thing!
If your cycle has become irregular in any way after getting your COVID-19 vaccine, you're going to want to read my article: How the COVID-19 Vaccine Affects the Menstrual Cycle- What We Know So Far.
I hope you got value from this article and understand the cues of your menstrual cycle a little more now! Our body is always speaking to us, we just need to listen ;)
To you and your brilliant body,
READY TO GET TO THE ROOT CAUSE OF YOUR HEALTH ISSUES, NATURALLY? BOOK A CONSULTATION WITH ME SO WE CAN DO IT TOGETHER!