Category: Menstruation

by Marcelle Pick, OB/GYN NP

Why did I miss a period? Why was my flow so heavy this month? Is there something wrong with me if my periods don’t have a regular pattern? These are some of the questions and concerns I have heard from patients at my clinic over the years. It can be frightening to notice sudden changes in your menstrual cycles with no good explanation.

It’s important to remember that “regular” doesn’t mean the same thing for every woman. Some have a cycle that arrives every 21-28 days like clockwork. Others may have a shorter or longer cycle that isn’t quite as predictable. So to judge whether a period has become irregular, you first need to know what is normal for YOU.

Often, an irregularity is nothing to worry about. One or two missed periods over the course of a year is probably not a cause for concern. But if your cycles are more unpredictable than that, it’s time to take a closer look. When you can’t find a consistent pattern, you may be at the beginning of perimenopause, have a disturbance in the hormonal chain of events that impacts menstruation, or you might be pregnant.

There are numerous factors that might be behind irregular periods. If several of these factors are present, there’s an even higher likelihood that you will experience some disruption in your natural cycle. Some of these factors include:

• Significant weight gain or loss. Both low body weight and obesity can cause a change in your menstrual cycle. Eating disorders such as anorexia or bulimia can also be behind this disruption. Poor nutrition has an impact – if you aren’t getting the nutrients you need, your body lets you know.
• Over exercising. Regular exercise is good for your overall health, but when you overdo it, your body reacts. Endurance athletes like marathon runners often experience missed periods.
• Excessive substance use. If you are regularly filling your body with toxins through smoking, drug use, excessive caffeine intake, or alcohol use your menstrual cycle may suffer.
• Hormonal imbalances. Whether related to increased stress, perimenopause, or Polycystic ovarian syndrome (PCOS), if your hormones are not properly balanced your periods might not be regular.
• Medications, including heavy duty treatments like chemotherapy. Birth control medications have a big impact on your cycle, whether they cause lighter or heavier flow, skipped periods, or no periods at all.
• Uterine abnormalities. Differences in your uterus – for example, fibroids, cysts, polyps or endometriosis, can cause changes in your periods.
• Pregnancy or recent childbirth, miscarriage, or D&C. Many women will also not resume normal periods until they have stopped breastfeeding.

Because so many things could be behind a change in your cycle, it’s important to talk to a health care practitioner if you are experiencing irregularity. If missed periods are a sign of a larger condition – whether pregnancy, hormonal imbalance or disease, it’s important to know what to do to best support your body and find your way back to your best possible you!

If you suspect a hormonal imbalance may be the root of your erratic periods, our products can help bring you back to a balanced state. If you suspect the issue is related to perimenopause, try our Menopause Program, which includes a high quality multivitamin to ensure you are getting essential nutrients, adrenal support, and our herbal menopause support designed for hormonal balance that can relieve symptoms of menopause, such as hot flashes and mild mood swings. 

by Marcelle Pick, OB/GYN NP

Dysmenorrhea, the medical term for menstrual cramps, affects almost half of women everywhere, causing painful cramping before and during their periods. Some women are even bedridden by their discomfort, often having to miss work or school and cancel other plans. Reports vary on methods of data collection, but there’s no question the distress women suffer with menstrual cramps is a widespread problem.

This causes us to question why so many health practitioners in the past have regarded menstrual discomfort as an unjustified complaint. As the medical community has learned more about the cause of premenstrual syndrome, we now know that dysmenorrhea exists as a real condition. There are true medical reasons for your monthly painful symptoms. And seriously, why should women have this discomfort on a monthly basis when there are things that can be done to help?

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We have hope for you. If you are in otherwise good health, the cramps you experience with your monthly period can be eliminated by giving your body the support it needs. Even severe cases of dysmenorrhea that are unable to be completely eliminated can be greatly helped with a few simple changes in lifestyle and improved nutritional approaches that promote your hormonal balance.

Primary dysmenorrhea is cramping in the lower abdominal area that can last for several days during your period. Because of excess prostaglandin levels dysmenorrhea can be accompanied by a number of uncomfortable symptoms that include bloating, nausea, vomiting, headache, backaches, pain that radiates down the thighs, or diarrhea. Prostaglandins are hormone–like fatty acids that send pain signals to the brain. The additional prostaglandins cause tiny contractions of the uterine wall and the gastrointestinal. They are very affected by our dietary intake.

In younger women, it is common to experience irregular menstrual cramps and they often resolve with age. After their first pregnancy, many women report their menstrual cramping lessens greatly as well.

You should be aware that occasionally a benign ovarian cyst or ectopic pregnancy can cause severe pelvic pain nearing the end of the cycle. We suggest that you visit with your healthcare provider if you’re experiencing tenderness and sharp pain that will not subside during the onset of one’s menstrual flow.

Secondary dysmenorrhea is described as a type of congested, dull pain that begins as much as two weeks before the start of your monthly flow. Women in their 30’s and 40’s are more likely to experience this kind of cramping and these symptoms usually do not subside with age. It could be coupled with bloating, an increase in weight, breast tenderness, headaches, lower back discomfort, and irritability. Warning signs could end up being amplified by changing estrogen levels, which in turn trigger fluid retention. Chinese medical doctors look at this sort of painful period as a kind of blood stasis, in which important energy (chi) is unable to flow freely through the lower abdominal area. Root causes of this kind of discomfort apart from hormonal imbalance may consist of:

• Endometriosis (ectopic endometrial tissue)
• Adenomyosis (endometrial tissue within uterine wall)
• Pelvic infection or uterine infection
• Intrauterine device (IUD)
• Cervical stenosis (stricture of the internal cervical os, the opening to the uterus)
• Congenital uterine or vaginal abnormalities
• Fibroids
• Ectopic pregnancy
• Ovarian cysts
• Ovarian torsion

An unhealthy weight, cigarette smoking, chronic pelvic infections and/or STD’s are typical risk factors for secondary dysmenorrhea. Please schedule a check-up with your healthcare practitioner if you have persistent menstrual cramping that remains the same or worsens or if your symptoms last for several months.

If you are free from the conditions listed above, we may be able to help you find natural relief from your monthly menstrual cramps. At Women to Women we have experienced excellent results in treating women suffering with dysmenorrhea with nutritional supplements, exercise programs and occasionally, progesterone support. Once hormonal support is restored, periodic cramps generally subside and often completely resolve.

Take our Hormone Health Assessment to check your symptoms and get started. Women to Women also offers high-quality, pharmaceutical grade supplements to enhance your health.

 

by Marcelle Pick, OB/GYN NP

The causes of menorrhagia can vary greatly between women, but some problems are commonly root causes of the unusually heavy bleeding. Such things as fibroids, low progesterone relative to estrogen (both common in perimenopause), polycystic ovary syndrome (PCOS), or other hormonal imbalances are usually to blame.

Occasionally an intrauterine device (IUD) could cause excessive menstrual bleeding, but his is not the norm unless there is an infection. Other less common problems, but ones that certainly need to be considered, include a thickened build up of tissue also called a thickened endometrium, uterine hyperplasia, polyps, uterine or cervical cancer, ectopic pregnancy, cervical lesions, pelvic inflammatory disease (PID), hypothalamic dysfunction, hyperprolactinemia, parathyroidism or other thyroid problems, even premature ovarian failure (POF).

Some practitioners when doing the initial workup will test a woman for vitamin K deficiency, a vitamin necessary for maintaining blood-clotting platelets. A woman with bleeding issues may also have a coagulation problem (coagulopathy), or other blood-related (hematologic) causes. For example, genetic variants such as Von Willebrand’s disease, factor VIII, or factor XI deficiency are relatively uncommon, autosomal traits that may be suspected in a woman who has had heavy periods since menarche, bruising issues, or prolonged bleeding after surgery, childbirth, or trauma. In fact it is the first thing I will do if someone comes to me with heavy bleeding as this is often overlooked and helps greatly with the patients understanding of what is going on. Heavy menses may be the only sign of this genetic condition. See your practitioner if you suspect you have a clotting disorder as it is only a simple blood test and often goes undiagnosed.

The truth is that we see heavy bleeding often but rare disorders and not usually the cause. Rare disorders aside, our first and major concern for women with menorrhagia is anemia. A (CBC) better known as a complete blood count tells us if you are indeed anemic and need to add an iron supplement and more hormonal support. If hormone levels are imbalanced, especially in perimenopause, we may want to try a combination of nutritional intervention and endocrine support for you. Though rarely our first-line choice, when the bleeding needs to be kept under control, we will prescribe a synthetic form of progesterone like Aygestin or Provera. It does work extremely well and has its place when necessary.

We are happy to say that in our experience, most cases of heavy periods can be brought under good control with diet and exercise modifications, along with a medical-grade nutritional supplement and progesterone support. Of note is that the time we see the most problems with heavy bleeding (outside the usual pattern for our patients) is around the holidays, when stress levels are often over the top for women.

Gentle phytonutrient support and the use of a pharmaceutical grade multivitamin (Click here to learn about our specially formulated one that Women to Women offers) can also help keep your estrogen-to-progesterone levels on a much more even keel. But we always place equal weight on looking at addressing the impact your emotions and stress have on your hormonal symphony once a woman’s body gets the support it needs, it usually resumes its normal menstrual cycles—without having to resort to surgery. We see this on a daily basis in the clinic and online.

For more information, read our informative article, “Menorrhagia and Hypermenorrhagia.”

by Marcelle Pick, OB/GYN NP

Let’s talk about one of the women that I have worked with. You might be able to identify with her and her situation. After graduating from college, Celeste landed an internship with a public relations company. She was thrilled by this exciting opportunity—but worried about how her difficult periods would affect her work life. “My bleeding has always been heavy, but lately it’s gotten just ridiculous—and my cramps are so painful that I can’t concentrate on anything else. I’ve been to a couple of gynecologists, but all my tests came back normal. One of them offered to put me on the pill, but I don’t like the side effects. If I have to tough it out, I guess I can— but I really want to figure out what the problem is. I worry that something serious may be going on!”

For Celeste it turned out that imbalanced hormones were her real problem. As you also may have experienced, her menstrual cramps were playing havoc with her energy, her mood, her psyche, her appearance, her weight, her profession, and her sex life. Celeste had gone to her healthcare practitioner for help, but she hadn’t really gotten any help. Instead, she was given the message that nothing was really wrong, that the problem she faced was just a normal part of a woman’s life.

Thank goodness this isn’t true. Painful periods are often the result of a hormonal imbalance. When your hormones are balanced again, these problems can disappear. And balancing your hormones is surprisingly simple. You’ll be amazed to discover you can do this through a combination of diet, herbs and supplements, lifestyle, and psychological support, in some cases complemented with some gentle bioidentical hormones.

Now at this point, you may be wondering why, if these problems are so real and the solutions are so simple, your own health-care practitioner hasn’t already given you this information. The answers to that question are not so simple. So let’s take a closer look.

Heavy menstrual bleeding and blood clotting are common problems for a lot of women, especially in the perimenopausal years or when the cycle just begins. When a woman soaks a pad or a tampon in an hour for several hours or more, or if she bleeds for more than a week and a half each month, this is called menorrhagia. This is a usual occurrence for many women. If she soaks through two or more pads or tampons in an hour, this is generally considered hypermenorrhagia.  These are fancy medical words – but they do have their place.

Excess bleeding such as this can be worrying when it occurs and, as any woman knows who has experienced it, terribly inconvenient. Remembering to bring a change of clothes or to not wear white during those times seems unfair. So much so that it is a leading reason for elective hysterectomy. As with many other menstrual irregularities, however, the primary cause of heavy periods is most frequently hormonal and/or nutritional imbalances resulting from diet, lifestyle, and stress. This is good news then because then you can do something about it. And in many cases, substantial menstrual bleeding can be relieved without a surgery or a hysterectomy.

Almost all women will tell you that they have experienced heavy bleeding and or clotting at some point or another in their lives, and some women have regular intense menstrual flow. If your periods are heavy on a regular, cyclic basis, then that is your normal.

Or, if you have some irregularities in your flow that go away the following month, there is probably nothing too serious going on. I tell all of my patients that two irregular cycles a year is probably normal for many women. If you encounter extreme menstrual bleeding for two successive months, and this is different for you or if your periods are heavy and ongoing in an erratic fashion, it would be good idea for you to check in with your healthcare provider.

Other things associated with menorrhagia and hypermenorrhagia include:

•  A menstrual period that lasts longer than 10 days and is different
•  Menstrual flow that includes large blood clots and that is not your norm
•  Heavy periods that interfere with your regular lifestyle
•  Constant pain in your lower abdomen combined with heavy menstrual periods
•  Tiredness, fatigue, or shortness of breath (symptoms of anemia)

For more information, read our article, “Causes and Treatment of Menorrhagia.”

by Marcelle Pick, OB/GYN NP

• Your period is a monthly health report card
• Menstrual cycles highlight your “best times of the month”
• Regular cycles help inform your health decisions

While there are many things I don’t enjoy about my period, this conversation is about embracing the positive rather than the negative. Not everything about your period has to be viewed as bad.

When I talk with other women about the benefits of our monthly periods, many women will roll their eyes, some of them laugh, and others will say “It was called ‘the curse’ when I was a young girl.”

Your menstrual cycle is essential to helping you learn, plan for, and make choices about your personal well being, mood, exercise — and naturally, your sex life.

In addition, your regular menstrual period will let you know that your hormones are in balance. This is so important when you realize that about 80 percent of the women that we see in our clinic experience symptoms relating to an imbalance of their hormones. If this issue is not looked into, it can lead to worsening premenstrual syndrome symptoms (PMS), feelings of fatigue, and weight gain. It can also lead to an increased risk for other more serious health issues. When you miss early signs of hormonal imbalance, you may also miss the opportunity to find relief.

Your menstrual cycle is distinctive to you. I encourage you to take a better look at the benefits that I have outlined below. This will help you to determine how your cycle affects your health and well-being in each area. Remember, if you are taking birth control pills, your cycle is regulated by the pill, rather than natural hormones, so you will not experience all of the benefits outlined below. Here are some of the most essential health benefits of your period:

• You can know when your hormones are in or out of balance.
• You can learn about your bones, thyroid, and metabolic wellness.
• You can identify your best days for sexual arousal and enjoyment.
• You can leverage improved energy for your exercise and fitness routine.
• You can inform your health decisions about your life.
• You can create emotional wellness.

What is a normal period? Regular vs. irregular

We often hear that the “regular” cycle is 28 days long, and many women’s bodies are like clockwork this way. But a cycle lasting anywhere from 21 to 36 days, if you’re regular, is also perfectly normal for many women.

What can you do about irregular periods?

If you suffer from irregular periods or PMS, your body is telling you that it may not be balanced to its fullest extent. This is an opportunity to bring yourself back into balance, so you can enjoy the health benefits of a regular menstrual cycle.

Your menstrual period provides a “monthly update” about your hormonal, reproductive, thyroid, and metabolic functioning

I want you to understand and embrace that regular periods indicate that your body is ready to become pregnant! But in addition to reproduction, your menstrual cycle rhythms reflect a balance in other bodily systems and functions as well.

This is because every month your period is the result of a coordinated discussion between your brain and your ovaries. The hypothalamus and pituitary glands are two of the areas that direct this conversation. They are also closely connected to the adrenal glands, the thyroid, and the digestive system along these same pathways. When one system is disrupted, then the other systems may suffer. Changes to your period, or if you have irregular periods, are usually the first indication of a disrupted signal along the pathway, with implications that can be felt throughout your entire body.

For example:

• Hormonal imbalance. Normal menstruation tells you that the body is in homeostasis, producing acceptable levels of sex hormones optimal for reproduction. When these hormones are in balance, you feel excellent, are energetic, sleep effectively, and take interest in sex. When you’re beneath constant stress, your hormones turn out to be out of balance. An irregular period is 1 of its 1st strategies of asking for assistance.

Read More about Reverse The Curse – Benefits Of Your Period

by Marcelle Pick, OB/GYN NP

Answers to your questions

To begin with, let me reassure you that most irregular periods are benign. Missed periods, too frequent periods, spotting, or bouts of heavy clotting and bleeding are usually caused by an underlying hormonal imbalance that is easily treated.

Most of us have missed a period at one point or another — some with anticipation of a pregnancy, others because of anxiety or tension. At the clinic, we see women who menstruate like clockwork, while others report never having had a regular cycle. One thing is a given, however – shifts in hormonal balance will alter whatever pattern a woman has experienced in the past. Such shifts are especially common in perimenopause.

What is an irregular period?

At the clinic we answer questions all the time about irregular periods. A textbook period happens every 24-29 days, but in truth what is “regular” covers a wide range. Cycles between 23-35 days are very common. A woman may get her period only one to four times a year. Or she might have periods that occur 2-3 times in a month and involve spotting or extremely heavy flow. Alternatively, she may have heavy episodes of bleeding every 2-3 months. Irregular periods are simply what is irregular for you.

For the most part, we don’t worry at the clinic about a missed period or two over the course of a year. More variation than that may indicate to us the beginning of perimenopause or a disruption of the natural chain of hormonal events that controls menstruation. A wide variety of factors can be responsible for irregular periods, among them:

• Significant weight gain or loss
• Overexercise
• Poor nutrition (or a diet too high in carbohydrates)
• Smoking
• Drug use
• Caffeine
• Excessive alcohol use (interfering with how the liver metabolizes estrogen and progesterone)
• Eating disorders
• Increased stress
• Polycystic ovarian syndrome/Estrogen dominance
• Uterine abnormalities (fibroids/cysts/polyps/endometriosis)
• Hormonal imbalances related to perimenopause
• Medications
• Chemotherapy
• Recent childbirth, miscarriage, or D&C
• Breastfeeding

As you can see, there are many different ways a woman can be irregular for as many different reasons, and it can be very confusing when it happens.

Why does being stressed cause irregular periods?

When we are stressed, regardless of the source (danger, personal relationships, work, environment) our adrenal glands are designed to secrete the hormone cortisol  (read more in our articles in our Adrenal Health section). Cortisol has a direct impact on the sex hormones estrogen, progesterone, and DHEA. Eating disorders, dieting, drug use, and reliance on stimulants like caffeine and alcohol are also interpreted by the body as kinds of stress. Poor nutrition seems to physically change the proteins in the brain so they can no longer send the proper signals for normal ovulation.

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Am I in menopause if I have irregular periods?
 

No – irregular periods are generally an indication of hormonal imbalance, not necessarily related to menopause. Strictly speaking, women aren’t considered menopausal until they have gone for one year without a menstrual period.

by Marcelle Pick, OB/GYN NP

A woman’s menstrual cycle is highly individual, and can range anywhere from 24–37 days. What’s “normal” is what’s normal for you. The length of your cycle may be affected by many things, including illness, stress, travel, fertility medication, and close association with other women.

At different times in your life, your menstrual cycle may become irregular due to a variety of factors, including pregnancy, stress, diet, hormonal imbalance, exercise, and illness.  For more information, refer to our articles on irregular periods.

Let’s consider a typical 28–day cycle, and call the first day of bleeding day 1.

Each month our ovaries begin to ripen a number of follicles, which is why days 1–14 are called the follicular phase. Each of the many follicles in the two ovaries is a pocket of tissue filled mostly with estrogens. The number of active follicles changes with each cycle, but typically only one follicle per month in a single ovary becomes dominant over the others and produces a viable egg. As the follicles ripen, estrogen levels rise.

Just before mid-cycle, the hypothalamus and pituitary gland release LH (luteinizing hormone) and FSH (follicle stimulating hormone) spikes to trigger the dominant follicle to ovulate. Estrogen levels continue to rise.

Days 14–28 are termed the luteal phase, when estrogen levels begin to fall and progesterone levels rise. Around day 14 (but it can vary) ovulation occurs.  The dominant egg is released from the follicle and is drawn into the fallopian tube on its way to the uterus. This triggers a host of hormonal secretions — including estrogen — that thicken the uterine lining to support a pregnancy. Many women know they are ovulating by vaginal mucus discharge, nipple tenderness, or the tell-tale twinge in their abdomen called mittelschmerz.

Women are fertile for about 24–48 hours around the time of ovulation. Progesterone levels remain high unless the egg goes unfertilized, in which case the egg is re-absorbed and progesterone levels fall. In this event, progesterone levels continue to fall until day 28, when progesterone reaches its lowest level, menstruation occurs, and the cycle repeats. This turning point almost always occurs 14 days after ovulation.

by Marcelle Pick, OB/GYN NP 

From puberty until menopause, a women’s biochemistry waxes and wanes to her own unique monthly rhythm, known as the menstrual cycle. The word menstruation is derived from the Latin word menses, which means month. Regular menstruation is a sign that the body is producing appropriate levels of hormones in a balanced fashion according to a rhythm established over millennia as optimal for human reproduction.

Each monthly period results from a sequential conversation between your brain, your adrenal, pituitary and thyroid glands, and your ovaries. This conversation tells your body to release an egg, which is then either fertilized and implanted in the uterus (conception) or shed in your menstrual flow along with the lining of the uterus. The sequence is orchestrated by a cascade of reproductive hormones, but the main actors are estrogen and progesterone.

Women generally begin menstruating between the ages of 11 and 13 – this first period is called menarche. Most of us will have more than 500 periods during our so-called childbearing years — the time frame between menarche and menopause, which is defined by the point in time when a woman has gone for 12 consecutive months without having a period. When menopause will occur varies for the individual, but the average age is 51. And just as there are gradual changes leading up to menarche, menopause is preceded by a gradual transition phase called perimenopause. Perimenopause is a premenopausal condition often characterized by irregular cycles, sometimes with heavy bleeding or skipped periods (amenorrhea), that can begin as early as the mid- to late-30’s.

One thing we’ve learned over the years is that no woman’s menstrual cycle is exactly like any other’s. While some sail through periods without much thought, others suffer with abdominal cramps (dysmenorrhea), excessive bleeding (menorrhagia), moodiness, and more. The range of symptoms that correspond with monthly cycles are sometimes called premenstrual syndrome or PMS, and this time of the month can be extremely difficult to get through for many women.

Oftentimes symptoms of PMS and PMDD (premenstrual dysphoric disorder, an extreme form of PMS) are the result of an underlying hormonal imbalance. And the good news is there are many natural solutions. No matter what their age, women have questions about their periods and PMS. And we’ve spent years talking to women about solutions for nurturing healthy menstrual cycles. We hope you’ll find the answers you’re looking for.

 

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