What is an Average and Healthy Menstrual Cycle?
As long as you start a period every 21 to 35 days, you have a healthy cycle. It is also normal for it to vary from month to month.
How Much Bleeding is Normal?
You should bleed between 2 to 7 days, and not lose more than 80 ml of menstrual fluid over all of the days. Regular size tampons or pads hold 5 ml. If you are losing more than 80 ml of menstrual fluid, you have a heavy period. Women who have had children or are in peri-menopause tend to have the heaviest flow.
Benefits of Tracking Your Menstrual Cycle
1.) Avoid a Period Surprise
After a few months of tracking your cycle, you will begin to understand approximately how long your cycle is, when you ovulate, when PMS may start and when your period will arrive. You can then plan accordingly - e.g., if you know you tend to have painful cramps on the first day of your period, you may be able to re-organize your schedule.
2.) Know When You Are Fertile
This is important if you are thinking of starting to conceive OR if you just want to know more about what is happening with your fertility. Approximately mid-cycle, your temperature will spike slightly, you will see a change in your discharge to being similar to ‘egg-white’, and you probably will have a spike in your libido. These are all signs that you are ovulating. Ovulation is a sign that all is well in the health of your body, specifically not too much stress or lack of food.
3.) Get Control of your PMS
Learn when your PMS symptoms typically start, and if it varies every month. Some women notice symptoms for 1-3 days before they start to bleed, others notice it for 2 weeks. The duration of your PMS gives you an indication of the severity of your symptoms. When recommending treatments for PMS, I recommend tracking the PMS symptoms as this lets us know if your experience is improving or changing.
There are many apps available, I like ‘Clue' because it does not sell the data or use it for advertising.
PMS = Pre-Menstrual Syndrome
There is a laundry list of symptoms that can occur before a period. Some include:
-Mood changes (anxiety, depression, irritability)
-Breast Tenderness
-Headaches/Migraines
-Food Cravings
-Bloating
-Acne
-Insomnia
Should I Do Hormone Testing?
It depends.
I often start with blood testing to get a general overview of hormone levels. I always want to evaluate for all of the complex causes of hormonal symptoms, e.g., Polycystic Ovarian Syndrome, and this is best done through bloodwork. For hormone evaluation I also like to test nutrient levels, blood sugar, and cholesterol, as these all have a role in hormone production.
After a basic evaluation if we need more information, I will do functional hormone testing, e.g., DUTCH Test.
PMS Solutions
PMS symptoms can be due to an imbalance of progesterone/estrogen, and/or high levels of inflammation. The principles of my treatment plan include Stabilizing Progesterone, Reducing Estrogen Excess and Reducing Inflammation. My treatment recommendations focus on a combination of optimizing nutrition, nutrient supplementation and utilizing herbal medicine.
Nutrition
• Adequate hydration, general rule of thumb is approximately 2 liters of water per day - although this will vary based on levels of activity and your individual health status.
• Avoid inflammatory foods such as dairy, sugar, processed foods and for some gluten.
• Avoid alcohol - As it is high in sugar, negatively impacts sleep and puts strain on your liver which you need happy for effective hormone metabolism.
• Ramp up the green veggies - specifically the ‘Brassica’ family and cruciferous veggies - cabbage, broccoli, brussel sprouts, and kale. I recommend 3 cups of these per day.
Nutrient Supplementation
Vitamin B6
Vitamin B6 is an essential component for the production of progesterone, and it is also involved in the manufactoring of serotonin, GABA and dopamine.
B6 supports the clearance of histamine and estrogen, both of which can worsen PMS symptoms.
Food sources of Vitamin B6 include fish, poultry and nuts.
The form of Vitamin B6 that is most effective is pyridoxal-5-phosphate (P5P). Starting doses are typically around 50 mg, and can go up to 200 mg.
Magnesium
Magnesium deficiency is thought to be one of the causes of PMS. [I] Magnesium has demonstrated effectiveness in helping mood symptoms related to PMS. In addition to that,
it is also a muscle relaxant, and may help menstrual cramping. If you have menstrual migraines, it has also shown benefit in preventing menstrual migraines. [II]
I typically recommend magnesium glycinate, as it tends to have superior absorption and be gentler on the bowels. Note: too much magnesium will cause tummy upset!
A double-blind, placebo-controlled study of 150 women demonstrated efficacy in treating PMS with a combination of Vitamin B6 and Magnesium, better than placebo. [III]
Herbal Medicine
Chaste tree (Vitex agnus-castus)
This is a berry, and it has shown to be effective in treating PMS symptoms including mood symptoms, breast pain and irregular periods.[IV] It works by promoting ovulation through supporting dopamine production and lowering prolactin levels.
Generally it is well tolerated, although be wary of brands that are not testing their product to ensure what is on the label is in the product.
I always recommend speaking with your primary care provider prior to initiating any of the above supplements/herbals because of potential interactions with your current treatment plan.
References
[I]Ventskivs' ka, I. B., & Senchuk, A. (2005). Role of magnesium in the pathogenesis of premenstrual disorders. Likars' ka sprava, (8), 62-65.
[II]Facchinetti, F., Sances, G., Borella, P., Genazzani, A. R., & Nappi, G. (1991). Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium. Headache: The Journal of Head and Face Pain, 31(5), 298-301.
[III] Fathizadeh, N., Ebrahimi, E., Valiani, M., Tavakoli, N., & Yar, M. H. (2010). Evaluating the effect of magnesium and magnesium plus vitamin B6 supplement on the severity of premenstrual syndrome. Iranian journal of nursing and midwifery research, 15(Suppl1), 401.
[IV] van Die, M. D., Burger, H. G., Teede, H. J., & Bone, K. M. (2013). Vitex agnus-castus extracts for female reproductive disorders: a systematic review of clinical trials. Planta medica, 79(07), 562-575.