womben, meet menses
Before we can begin to discuss what might go “wrong” with a period, we really ought to know
What even is a normal period?
Now in the realm of women’s health and menstrual cycles, normal is a fairly relative term. Despite the tired notion that "every cycle is 28 days long and therefore you must ovulate on day 14”, this is simply not the case at all. Each woman has her own flow, her own innate cycle and her intricate dance of hormones. It is for this reason that you are really your best informative when it comes to your menstrual cycle. If you say something is different or off, I believe you because you know your body best.
It is also important to make a distinction between normal and common; just because a symptom is common does not mean it is normal and something that you must endure.
Here are some general markers when it comes to a normal cycle:
Your period arrives every 21-35 days; this can vary a little month to month and that would be considered normal
Teenagers can cycle up to every 45 days and this is normal as their bodies are still adjusting to their new cycle
You bleed for 2-7 days and overall, you do not lose more than 80 mL of blood (this is tricky to know but a typical tampon holds 5 mL so as long as you are under 16 saturated tampons, you’re in the clear)
Your first day of bleeding (a full flow, not spotting) is known as “day 1” and it indicates that you have started a new cycle
You might skip a period here or there and this is nothing to worry about especially if you were under high stress or were ill
The blood is a darker red ( but not burgundy)
The colour of period blood is useful in diagnosis of traditional Chinese medicine patterns
There can be some clots but they are the size of a dime or smaller
You absolutely might have some mid-cycle spotting or cramping (AKA mittelschmerz) - this is not anything to be alarmed about and is an indication that you have ovulated
Your cervical discharge varies throughout the month
Your period may be painful however this is a common symptom, not necessarily a normal symptom
Cyclical acne (a few bumps that come and go) is common
Typically, once you ovulate, you should expect your period ~14 days from then as the luteal phase is believed to be fixed; it is only ever 14 days long. I - however - disagree as I have seen cases where the luteal phase is longer. Modern medicine does not have the answers to this however traditional Chinese medicine certainly does and this is why I prefer to approach women’s health through both of these lenses.
As a reminder: For those who are on birth control, you are not secreting your own hormones and - therefore - you are not having a true bleed; instead you are experiencing a withdrawal bleed
When to seek naturopathic care:
Missed periods become a norm
Period pain is affecting your quality of life or is requiring heavy dose medications
Irregular periods
Libido is low, mood is on a roller coaster and breast tenderness is a given every month
Acne that is ever-present or cystic and affecting your quality of life and/or self-esteem
You are gaining weight despite eating and exercising the same
Hair changes; growing hair in new places or losing hair
You’re spotting quite often especially after intercourse
Your period came and never left
Your periods are becoming heavy and you are experiencing “flooding”
There are lots of clots and they are big (size of a loonie or larger)
You have any other period concerns or are unsure if you are ovulating
Before we bleed…we must ovulate
It is common for patients with wonky, irregular or missing periods to exclaim “I just want to bleed and end this emotional rollercoaster already!” but before we can bleed, we really must ovulate. Below is a quick peak at what is happening in your body from day 1 through to ovulation to the grand finale: the shedding of the uterine lining.
The process of ovulation and bleeding is orchestrated by your brain, your guts and your ovaries. Hence why when you present with hormonal imbalance symptoms, the well-trained practitioner is going to ask you questions about your liver health, your gut health and bowels as well as your hormones. I often say, hormonal imbalance is a representation of something going awry upstream (at the liver, the HPA axis, the bowels for instance).
Created by Dr. Brittany Wolfe, ND
Welcome to the first half of the cycle: The FOLLICULAR Phase
DAY 1-OVULATION: You are currently bleeding. Rest as much as possible and treat yourself with kindness.
Your brain is already ramping up for your next cycle by releasing pulsatile secretions of LH and FSH. These hormones will then communicate with your ovaries and encourage them to prepare the next batch of follicles (soon to be egg!). One of these follicles will become bigger than the rest and will be released at ovulation.
Estrogen is slowly rising thanks to a little encouragement from LH and FSH and the dominant follicle. Estrogen begins to build the walls of the endometrium; these walls are the ones that we “shed” when we are bleeding. One of the many roles of estrogen is to build a nice cushion of endometrial tissue for implantation of a fertilized egg (soon to be baby!)
Now we are passing through to the second half of the cycle: The LUTEAL Phase
Estrogen continues to rise until it reach its peak and this dramatic increase tells the brain that it is time to shoot out high levels of LH in order to release the egg to the fallopian tube (to ovulate!). This spike in LH is known as the LH surge. Now our biggest follicle will be released from the ovary and it will travel down the fallopian tube and into the uterus where it becomes the corpus luteum (hence the luteal phase). If you were interested in conception, this egg would be fertilized to create a fetus. Regardless of your intentions, the corpus luteum has one critical job: it secretes progesterone.
The corpus luteum is key for progesterone production.
You might have heard by now that progesterone can be hard to come by (especially in relation to its counterpart, estrogen) and that a progesterone deficiency can make you moody, bloated and give you headaches. There are lots of reasons that your progesterone may be lacking and - not to worry - we will touch on them all in the future. But for now, I want you to know that our very good friend the corpus luteum secretes progesterone and also some estrogen for us!
Progesterone should steadily rise in the second of the cycle and then estrogen will come back in the picture. Yes, estrogen is bimodal; it spikes twice during the menstrual cycle. If the corpus luteum has not been fertilized, it will begin to break down and, as a result, progesterone and estrogen levels will decrease. This decrease in hormones causes menstruation.
Once we begin to bleed, we find ourselves back at day one and the cycle begins all over again.
What I hope you realize the most from this blog post is this….
Normal is a relative term
Just because a symptom is common does not mean it is normal
Before we bleed, we ovulate
We get progesterone through ovulation and the production of the corpus luteum
When you are on day three of your current cycle, your amazing body is already orchestrating your next period
Your hormones are doing different things at different phases of your cycle…and so naturally, you will feel different as these normal shifts occur. Further to that, you will need to support your body in different ways based on your ever-changing cycle. We will talk about this concept in the future.
Estrogen builds the walls of your endometrium and progesterone keeps ‘em there OR estrogen is the bricks, progesterone is the mortar
Next in our women’s health journey, we will chat about the concept of estrogen dominance (a well-touted diagnosis) but what does it really mean? How do we know if we have it? And how can we influence our estrogen levels in our day to day life? The answer is likely a lot more simple than you think. Stay tuned!
