I’ve recorded a few videos (here here and here) and written several posts about amenorrhea (aka the absence of a period) but what if you are in fact getting your period…what does that tell you about your health?
I talk about periods and hormones and menstrual cycles all day long in my full time NP job. A good percentage of my patient load is women with either active or past eating disorders, women with PCOS or thyroid issues, or women who have anxiety/depression. At some point I start asking about their menstrual cycle. One, because I think as women we aren’t educated enough about this really huge thing that happens in our body called reproduction. Two, because I think we tend to turn to birth control as the answer to our hormonal problems (when really that’s a band aid that is covering up the root cause) and three, because I think the more we know about our health, the more empowered and in tune with our bodies we become. And I think that’s really helpful when it comes to taking care of ourselves as women.
If you aren’t getting your period, circle back to the links above for previous posts on not getting your period. If you’re on birth control for any reason, your period won’t tell you much about your health since having a period on birth control isn’t a true period. Back in my teens and early twenties I thought I was getting a real period on birth control. I didn’t know a “pill-bleed” was really a fake period.
I think birth control can play a beneficial role (like preventing pregnancy) in someone’s health at the right time, for the right reasons and with informed consent so a women can make a health decision that is best for her. But birth control unfortunately masks a true, natural menstrual cycle. Birth control pills, patches or rings contain hormones, usually both estrogen and progestin. There is also a shot called Depo Provera, “the mini pill” (aka progestin only pill) and an implant that contain only progestin, which is a synthetic form of progesterone. All these methods work in essentially the same way by releasing synthetic hormones into your body in order to…
- stop ovulation (meaning an egg does not get released from the ovary)
- thicken the cervical mucous so it’s harder for sperm to pass through into the uterus
- thin the uterine lining so it’s difficult for a fertilized egg to implant
Hormonal IUDs (Mirena, Skyla, Liletta, etc) work similarly as above – primarily in the first two ways. The exception is the copper IUD called Paraguard which is non hormonal. Sperm do not like copper so the IUD prevents sperm from ever reaching the egg.
Except for Paraguard, any other form of birth control is overriding your natural period and preventing the natural ebb and flow of hormones. Paraguard, even though it’s non hormonal, may alter your period to be heavier and longer (especially in the first few months after insertion) so keep that in mind. Also, some forms of birth control affect your “period” so you don’t get in monthly, but most birth control pills work cyclically so you get a “period” every month. But that period is simply because during the last week of the pill pack, you take the non hormonal white placebo pills vs the hormone pills. This drop in synthetic hormones mimics the same drop in hormones during a natural cycle and so you bleed. Think of it as a withdrawal bleed. It’s not a real period though because it’s artificially versus biologically induced.
So if you are not taking birth control and you are getting a period, no matter how regular, here’s are some things your period might be able to tell you:
WHAT IS A NORMAL PERIOD ANYWAYS?
Ideally, your cycle lasts two to seven days. When you first notice bleeding, it’s a bright cranberry red color and stays that color throughout your entire period. The blood has the consistency of real maple syrup (like that analogy? :)) so not too thin and not too thick. There are a few small clots, if any at all. You can wear a regular to super absorbency tampon or pad for about four hours without leaking. And you do not experience PMS – you might get some mild symptoms but nothing that interferes with your ability to participate in your daily life.
WHAT ABOUT A HEAVY FLOW OR CLOTTING?
I’ve been there, a lot of women have been there, and maybe this is you. If you find you are changing your tampon every hour or couple of hours and/or find dark, purple colored clots this could mean your estrogen levels are elevated. In a normal menstrual cycle, a balance between estrogen and progesterone regulates the buildup of your endometrium (the lining of your uterus), which is sloughed off during your period. If progesterone and estrogen get off balance, the endometrium builds up in excess and eventually sheds by way of heavy bleeding. There are other conditions that can cause hormonal imbalance like PCOS, insulin resistance and thyroid problems. An under functioning thyroid could cause heavy flow and/or painful periods. Having abnormal tissue in the uterus, such as polyps or fibroids can also cause heavy bleeding. Also keep in mind Paraguard can cause heavier periods as can medications so check with your doctor to rule out other causes. It’s also important to make sure you aren’t developing anemia if you do have heavy cycles, so check with your health care provider about that too.
WHAT ABOUT BROWN SPOTTING?
What if you have brown spotting that comes before you see red blood? Spotting can be normal, but it can also be a sign of something else going on. Low levels of progesterone can be the cause here. Progesterone is what thickens your uterine lining so a fertilized egg can implant into your uterine lining. Decreased levels of progesterone can also make is difficult to ovulate regularly, have a regular cycle and contribute to infertility. Other problems related to your period can also be caused by low progesterone so it’s worth making an appointment with your doctor.
WHAT ABOUT SKIPPED PERIODS, SHORT PERIODS OR A LIGHTER FLOW?
A period shorter than 2 days with a light flow can indicate low estrogen levels. What’s considered a light flow? Typically, if four or so hours pass and your regular pad or tampon is barely red or if you only need a panty liner…that’s considered light. An over or under functioning thyroid can also cause irregular periods. Low estrogen levels (and potentially abnormal thyroid function) can be caused by lifestyle factors including inadequate calorie and nutrient intake, over exercising for your body, lack of sleep, and high levels of life stress – mental and emotional stress. Certain medications and hormonal birth control can also cause your period to be light and/or irregular too so remember that.
WHAT ABOUT SHORT CYCLES OR HAVING TWO PERIODS IN ONE MONTH?
A short cycle is different than a short period. A short cycle means less than about 21 days or two periods within a 4-5 week cycle. When this happens there can again be problems with your thyroid – you should ask your health care provider about getting some blood work done to check your thyroid. Your eating and exercise habits can directly affect your thyroid so that’s something to explore too.
Often with these abnormal variations in your period, birth control is prescribed for a quick fix to “balance out hormones” when really, that’s brushing the problem under the rug. When you get off the birth control those same problems are still there. Which is so frustrating! Taking a look at your eating, exercise habits, stressors and sleep habits can often reveal where the real problem lies, and then you can work towards healing to get things back in sync. We work with women all the time in doing that and more often than not, your body is no different.
If you’re comfortable, share in the comments if you’ve experienced any of the above. Or ask questions! I feel like we don’t talk about this lady stuff enough…so beyond your friends, consider this the space to do just that 🙂