Just like fingerprints, every person’s cycle is unique to them. A healthy period can look different for everyone. From person to person, it can vary in length of bleed, length of cycle, volume of blood, and symptoms before and during your period. With so much diversity in what can be “healthy”, it can be hard to tell when something is “unhealthy”. It’s good to have some knowledge around what the healthy ranges are, so you can tell when something is abnormal. When something is in that abnormal range, it’s time to book in with your practitioner who will do a further work up and find the root cause of the problem.
The first day of the menstrual bleed is marked as day 1. The entire cycle length is measured as the time from day 1 to the last day before next period. Generally, this is said to be 28 days, but it’s actually not all that common to have an exactly 28 day cycle every month. The normal menstrual cycle can be between 24 and 35 days in length. And in one person this can vary by up to 5-7 days and still be considered normal. When the cycle is shorter than 21 days it is called polymenorrhea, “poly” meaning many, and “menorrhea” meaning period. When the cycle is between 36 and 90 days it is called oligomenorrhea, “oligo” meaning few. When the cycle is longer than 90 days we call it amenorrhea, meaning absence of period. Polymenorrhea, oligomenorrhea, amenorrhea or a variation of more than a week between cycles are all worth a trip to your practitioner for further investigation. A workup, including bloodwork, can give us more information on the root cause of the irregularity and help guide our treatment choices.
The length and volume of menstrual bleed can be impacted by many factors including age, oral contraception, hormonal or copper IUD, perimenopause, growths in the uterus, and hormonal conditions. The typical duration of flow is 4-6 days, but some people may have a flow that is as short as two days or as long as 7 days. Any length of flow between 2 and 7 days is considered normal. The volume of blood lost on a single period is typically 30mL, but normal range is up to 80mL. Regular tampons and pads hold up to 5mL of fluid, and super can hold up to 12mL. Menorrhagia is the term commonly used to describe heavy menstrual bleeding. Menorrhagia occurs when over 80mL of blood is lost in one period or the period is longer than 7 days. There are many naturopathic treatment options for menorrhagia, a chat with your ND can help identify the one that would be best for you!
The menstrual cycle is divided into two halves, the follicular phase which encompasses the time for day 1 to ovulation, and the luteal phase which includes the time from ovulation to day 1 of the next cycle. Premenstrual syndrome, or PMS, is defined as recurrent moderate psychological and physical symptoms that occur during the luteal phase of the cycle. By definition, these symptoms stop within the first 4 days of the period and do not present in the follicular phase. If the symptoms you are experiencing do present outside of the luteal phase but are worse during the luteal phase, you may be experiencing premenstrual exacerbation of a different condition. Some of the most common PMS symptoms include irritability, fatigue, bloating, breast tenderness, body aches, anxiety, changes in appetite, headaches, and depression. PMS symptoms are distinguished from normal premenstrual symptoms by the way they impair daily activity. PMS will interfere with your ability to participate in your regular routines and may cause withdraw from social and professional activities. When PMS is severe, the luteal phase can be a very isolating time. Those who struggle with severe PMS may find themselves “cleaning up their messes” once they re-enter their follicular phase. This may be catching up on work you couldn’t complete, reconnecting with friends and colleagues that you distanced yourself from, apologizing to your friends or family for having a short temper, or literally cleaning up a mess that you didn’t have the energy for in your luteal phase.
If you are finding yourself struggling to complete your regular daily tasks in your luteal phase it may be time to seek treatment for your PMS.
Cramps and Pain
Pain that results from your menstruation is called dysmenorrhea. “Dys” meaning pain, and “menorrhea” referring to the menses. Despite them often being grouped together, dysmenorrhea and PMS are actually two completely separate conditions. Dysmenorrhea is characterised by crampy, colicky, pain in the suprapubic area that occurs during menstruation. It appears with the onset of bleeding, whereas PMS can appear up to two weeks before the onset of bleeding. Dysmenorrhea affects 45-95% of menstruating individuals, and despite the prevalence of this concern, it is not often addressed with primary care providers. Primary dysmenorrhea is pain that results directly from the shedding of the uterine lining and is typically the same from one cycle to the next. Secondary dysmenorrhea refers to pain that is caused by a different medical condition and is worsened by menstruation. Secondary dysmenorrhea will present as pain that is dramatically different from one cycle to the next. Generally, alcohol and smoking worsen dysmenorrhea and exercise improves it. If you notice your cramps are suddenly worse, and it cannot be explained by a change in diet or lifestyle, it would be a good idea to have a workup done to find the root cause.
It is also important to seek care if your pain is not improved with use of NSAIDs (Advil, Midol, etc.), extends beyond the lower stomach area, or is accompanied by dizziness, fainting or fever. It is also a good idea to talk to your practitioner if your pain prevents you from going to school, work, or social events. There are lots of natural treatment options available for dysmenorrhea, as NDs we do not want to let your period keep you from enjoying your life!
Article by Carmen Aguayo.