Menstrual cycle red flags
I’m sure I don’t need to tell you that there are a lot of symptoms associated with periods and menstrual cycles. But at what point does a niggling, annoying thing become a red flag that we should probably investigate? Below are my top causes for concern and the things that as a women’s health dietitian, I look out for.
Intense period cramps (Dysmenorrhea)
Every month at the end of a cycle and the beginning of a new one, our uterine lining sheds, AKA your period. This is known as the beginning of the follicular phase and typically occurs around days 1-5. After ovulation, our body will begin to break down the corpus luteum and oestrogen and progesterone will decline. This signals the body to release prostaglandins, which are responsible for the contractions of the uterus to help expel the endometrium lining. So in saying that, it makes sense that we may experience some discomfort, given that the process is inflammatory in nature. But when the pain is so severe that you are not able to go about your daily tasks, you experience dizziness, headaches, back pain, nausea, digestive issues or any pain that is beyond a mild discomfort, that’s when it is not normal. Common? Maybe, but not normal. Please also note that extreme pain may be a sign of endometriosis and is well worth investigation. The rate of diagnosis of endometriosis has recently risen, signifying the importance of acknowledging this condition.
Short luteal phase
The luteal phase is the second half of your cycle, from around day 14-28. The purpose of this phase is to stabilise the endometrium lining and prepare for implantation, if pregnancy were to occur. This time of the cycle is really important for those wanting to get pregnant, but can also be a good indictor of hormone and health status. The average length of luteal phase is 14 days but can be between 12-16 depending on cycle length. There is no magic number but if your luteal phase is less 11 days, it could be due to low progesterone. If our progesterone levels are low, the endometrium lining will not be stablised and will begin to shed early. This makes it harder to get pregnant, but low progesterone levels can also contribute to increased period pain.
Long cycles
It’s common for women to experience cycles that are up to 35 days in length. If you regularly have consistent cycles that are up between 28-34 days than it may not be a big concern. However, if your cycles are often above 35 days or irregular, this may mean that ovulation is not occurring the way it should. We usually ovulate around day 14 and then get our period around day 28. However, if there is a hormone imbalance it can be harder for the body to ovulate which may mean it will take longer, or the body will attempt to ovulate again. Long cycles are often a symptom of PCOS where follicles do not mature properly and may not ovulate.
PMS
As our hormones are drastically changing throughout the month, it is normal to expect some changes both physically and mentally. For example, you may feel more energy around ovulation and more fatigue before and during your period. You may be more confident and outgoing during the follicular phase but prefer some quiet time during the luteal phase. This is normal and a result of changing hormones! Some women however, experience symptoms such as big mood swings, tender breasts, cramping, headaches, migraines, back pain… the list goes on. This signifies a hormonal imbalance - most likely excess oestrogen.
Heavy bleeding
How much bleeding is considered normal? The average amount of blood loss during a period is 60ml, with heavy periods being defined as 80ml or more. The best way to know your amount of blood loss is to use a menstrual cup which displays the amount in ml. There are various possibilities for the cause of heavy menstrual bleeding, including hormone imbalance, fibroids, irregular ovulation and adenomyosis (endometrial lining that grows into the muscular wall of the uterus). It can also have a profound impact on quality of life, with higher risk of anaemia, fatigue and weakness.
Absent periods (Amenorrhoea)
The thought of not having to deal with a period might be a relief initially, but it can have vast impacts on your overall health. Oestrogen is one of the key hormones in the reproductive system, however it also has many other important roles in tissues and organs throughout your body. For example, oestrogen plays an important role in bone growth, maturation and maintenance as we get older. Absent periods are often caused by an oestrogen deficiency that might be the result of psychological stress, excessive exercise, disordered eating or a combination. Basically, when we are not giving our body the energy and nutrients it needs or in a high stressed state, the first thing the body does is shut down the reproductive system. If we can nourish ourselves, how could we nourish another being?
What to do?
If any of these symptoms sound familiar to you I strongly urge you to seek advice. Whether it be with a doctor or women’s health specialist (me!) As always, I recomend the first mode of action to be a change in diet and lifestyle. All of these conditions can be improved, if not reversed through diet and lifestyle.
References
Barcikowska Z, Rajkowska-Labon E, Grzybowska ME, Hansdorfer-Korzon R, Zorena K. Inflammatory Markers in Dysmenorrhea and Therapeutic Options. Int J Environ Res Public Health. 2020 Feb 13;17(4):1191. doi: 10.3390/ijerph17041191. PMID: 32069859; PMCID: PMC7068519
Bull, J.R., Rowland, S.P., Scherwitzl, E.B. et al. Real-world menstrual cycle characteristics of more than 600,000 menstrual cycles. npj Digit. Med. 2, 83 (2019). https://doi.org/10.1038/s41746-019-0152-7
Crawford NM, Pritchard DA, Herring AH, Steiner AZ. Prospective evaluation of luteal phase length and natural fertility. Fertil Steril. 2017 Mar;107(3):749-755. doi: 10.1016/j.fertnstert.2016.11.022. Epub 2017 Jan 5. PMID: 28065408; PMCID: PMC5337433.
InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Heavy periods: Overview. [Updated 2017 May 4]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279294/
Kocaoz S, Cirpan R, Degirmencioglu AZ. The prevalence and impacts heavy menstrual bleeding on anemia, fatigue and quality of life in women of reproductive age. Pak J Med Sci. 2019 Mar-Apr;35(2):365-370. doi: 10.12669/pjms.35.2.644. PMID: 31086516; PMCID: PMC6500811.
Shufelt CL, Torbati T, Dutra E. Hypothalamic Amenorrhea and the Long-Term Health Consequences. Semin Reprod Med. 2017 May;35(3):256-262. doi: 10.1055/s-0037-1603581. Epub 2017 Jun 28. PMID: 28658709; PMCID: PMC6374026.
