Ever wondered what a healthy period looks like? Unsure how to decode what your symptoms mean? Our period could be considered our monthly report card giving us clues into what our overall health is like, so let's clarify what a healthy period looks like, what your period is trying to tell you and how to work on balancing your hormones if your ‘grade’ is below parr.
What is a healthy period?
A period is termed a period because it occurs periodically throughout each month, but it isn’t just the days you are bleeding (a.k.a. your period) it is also what happens throughout the whole of the cycle that can give you clues into your health status.
Let’s firstly consider the length of each menstrual cycle. On average this is around 28 days but a healthy menstrual cycle can be anywhere between 21 and 35 days, and up to 45 days as a teenager.
During the first half of your cycle oestrogen increases which can contribute to a boost in libido and mood, so you might notice you are more motivated and generally happier during these days. Oestrogen also stimulates fertile mucus which looks and feels very similar to a raw egg white. Its production peaks as oestrogen does which is why you might notice it most heavily just before ovulation.
Ovulation typically occurs at day 14, but may fluctuate based on your cycle length. During ovulation you might notice a small twinge or mild pain just below your hip bone on either side. Ovulation occurs when the egg is released, and it is this release that can cause the sensation.
After ovulation you enter the luteal phase where progesterone takes over. Progesterone is like the yin to oestrogen’s yang. Whilst oestrogen's job was to build up the uterine lining, progesterone works to thin the lining, which can help to create a lighter period. Progesterone also has a calming effect and can benefit sleep, make it easier to deal with stress and generally lower inflammation levels.
If everything has gone right so far this means your uterine lining should be well-formed, not inflamed and easy to shed. And if you have produced sufficient progesterone levels then your period should arrive smoothly with only a gentle period pain, no intense cramps or spotting. And no PMS!
During your period, the fluid you release should be mostly liquid without large clots (no bigger than a 5 pence piece). The colour should be a shade of red and can start out a lighter or brighter red, before becoming darker as your period draws to a close. Menstrual flow should last for 3 - 5 days as well as a couple of extra days with light spotting. You should lose about 3 tablespoons worth of blood during your period which can be hard to estimate if you are routinely using tampons or pads. Ideally you shouldn’t be changing these more than every two hours during the day and as your flow slows at night, you shouldn’t need to change anything whilst you sleep.
What is your period report card telling you?
No period or irregular periods
An absence of a period can occur for lots of different reasons:
Pregnancy - not to be overlooked and always good to consider especially if you are sexually active and previously have had regular periods
Perimenopause - again, not to be overlooked if you are over the age of 40. The timing of menopause is generally genetically programmed so ask your mum, aunt or older sisters what age they went through the menopause as an additional clue. If you suspect you are going through the transition, then get your FSH levels tested.
Stress - this can happen because the brain makes the decision that the body isn’t in a fit state to reproduce. If stress hormones and signals are flying around, then your body and brains view it as not being safe to reproduce. This can be any type of stress such as emotional, psychological or physical stress, including trauma, surgery or illness.
Undereating - this is actually another form of stress which triggers the brain to stop reproduction. The body views the situation as not having enough resources to produce a baby so it takes hold of the situation and shuts down the menstrual cycle.
Low carbohydrate diet - consuming not enough carbohydrates can disrupt the production of luteinising hormone and shut down ovulation. Low carbohydrate intake, as well as under-eating, can trigger the starvation response in the brain which is why your period can stop.
Medical conditions - certain medical conditions such as thyroid conditions, coeliac disease or PCOS can stop regular periods or contribute to irregular periods.
A heavy period is classified by a period lasting longer than 7 days, or using 16 or more fully soaked regular tampons during your period. This could be due to:
Uterine polyps or fibroids
Oestrogen excess is a big contributing factor and can drive many of the conditions above. The best way to understand if you have oestrogen excess (and its ratio to progesterone) is to get your levels checked via the DUTCH test. Symptoms of elevated oestrogen include heavy periods, PMS, breast tenderness and fibroids.
Oestrogen excess can occur for three reasons, firstly by excess production and secondly by reduced oestrogen metabolism. It can also occur because of something called endocrine disrupting chemicals which mimic oestrogen in the body and are found in things like pesticides, plastics, beauty and cleaning products.
Shorter or longer cycles
Longer or shorter cycles are considered irregular periods so see above the reasons why that may be occuring
A small amount of period pain is normal. This is normal to occur on the first couple of days and should be light enough that it shouldn’t affect your day to day activities, it might just feel a little uncomfortable. It is also possible not to feel any sort of pain or discomfort.
More intense pain or cramping is something that should be explored. Period pain is caused by prostaglandins which are inflammatory molecules and can also be a reason why you experience diarrhoea on the first day of your period. Higher levels of oestrogen and lower levels of progesterone can increase prostaglandins causing more intense period pain.
Severe period pain that feels like stabbing pain, burning or throbbing that lasts for many days should be investigated by your GP as this could be caused by an underlying condition such as endometriosis or an infection.
Whilst incredibly common, it is not normal to experience symptoms such as headaches, bloating, irritability, acne, breast tenderness, fluid retention, food cravings or any of the other symptoms you experience as PMS.
PMS can be caused by the following, or a combination of the following:
High oestrogen levels
Low progesterone levels
High histamine levels or histamine intolerance
What to do to start balancing your periods?
The best first step to balancing your periods is to understand what happens during each period. Tracking your cycle and any symptoms you may experience is a really good place to start. Also getting your hormone levels tested via the DUTCH test, which is a dried urine test to understand what your levels are and how they convert between each other can allow for really targeted support.
However, there are general diet and lifestyle changes that can be put in place which support hormonal harmony.
Reduce inflammatory foods
Inflammation can throw off how the body talks and communicates with each other which is a big problem for your hormones are they work much like an orchestra does, cueing off from one another. There are many things that can contribute to inflammation such as an unhealthy gut microbiome, environmental toxins, stress, a lack of movement, but addressing inflammatory foods can be a good place to start.
The top three inflammatory foods everyone should look at reducing or avoiding are sugar, alcohol and refined vegetable oil because quite simply, these are all inflammatory no matter who you are. The other two are also inflammatory, gluten and dairy, but not everyone quite has the same severity of reaction to them. Both the quality and quantity of how much is ingested can affect the reaction in the body. If your hormones are out of whack, I generally suggest a trial elimination of both for a minimum of 4 weeks to see if you notice any difference in your symptoms. It might actually be once you reintroduce the foods that you really notice how much of a difference elimination made.
Up anti-inflammatory and hormone supportive foods
The flip side of reducing inflammatory foods is to focus on increasing anti-inflammatory foods. There are also other foods that can generally support hormonal balance.
Phytoestrogens - these are also known as ‘plant oestrogens’ and are found in foods such as soy, flaxseeds, beans and legumes. They exert a weak oestrogen-like effect on the body which can be helpful if your overall oestrogen load is too high as they block oestrogen receptors acting as a kind of ‘anti-oestrogens’. Make sure to consume only organic, unprocessed soy.
Magnesium is like the miracle mineral for periods and hormonal health. Magnesium is wonderful and calming and can help with period pain, cramps, PMS, PCOS and many other things. It soothes and calms the nervous system, supports sleep, promotes the healthy metabolism of oestrogen and is anti-inflammatory. Unfortunately when we are stressed, this triggers the body to get rid of magnesium which might seem counterintuitive, but the body has a very good reason. Our diets are often quite depleted in magnesium, even if we regularly consume magnesium rich foods such as dark leafy greens, pumpkin seeds, tofu and mackerel. Try upping your dietary intake if it is poor right now, opt for Epsom salt baths rich in magnesium or add in a magnesium supplement.
Zinc is another wonder mineral great for period health. Zinc deficiency has been implicated in irregular periods, increased facial hair, PMS and period pain. Zinc is anti-inflammatory and much like magnesium can work to regulate our nervous system, regulating the stress response. It also works to promote healthy ovulation and progesterone levels and is required for the production, transport and action of all hormones in the body. Oysters, sunflower seeds, pumpkin seeds, shellfish and nuts are the best dietary sources.
With stress comes the increase in the hormone cortisol. Stress in the short term is fine, but most of us experience some form of chronic stress in 21st century living which can curtail ovulation and reduce the production of oestrogen and progesterone (as the body prioritises ‘raw materials’ to build more cortisol).
Reducing your stress is one of the best ways to improve your hormone function. I appreciate this is sometimes easier said than done, however prioritising rest, relaxation and self care on a daily basis is a good place to start. It could be something small like 5 minutes of breathing, journaling or being more present to an everyday task such as brushing your teeth, or it could be a bigger gesture such as a relaxing morning and/or evening routine. Whatever you can manage, prioritise reducing your stress every day.
It probably comes as no surprise that sleep is good for our hormone health, because let's face it, sleep is good for everything! Sleep works to regulate the stress response as well as regulating the release of luteinising hormone, oestrogen and progesterone.
Try to aim for between 7-9 hours of sleep each night, more if you are going through a period of ill health or increased stress. The best way to work out how much sleep you need is to turn your alarm off on a day when you don’t need to be anywhere and see what time you naturally wake up. Repeat this over a few days to get a better idea of your own personal sleep requirement.
Regular exercise or movement can help to improve your hormone health by reducing cortisol, improving blood circulation to your pelvic organs and reducing chronic inflammation. Consistency and repetition is important here, so pick something you enjoy and keep on doing it.