close this window | print article



Irregular Periods



by Susan Fekety, RN, MSN, CNM



I'll do my best to be short and sweet, though frankly, a conscientious approach to a women's health issue rarely lends itself to the quick sound-bite (one of the reasons why women are leaving conventional women's health practices and the 8 minute office visit model so frequently nowadays!) There's a tendency when talking about irregular periods to jump straight to what supplement or herb to take, missing the critical first step of asking "what's out of balance, exactly?" So let's start there, and beat those women's magazines to the punch.

Menstrual cycling starts in the brain, and there is an elegant hormonal symphony that is designed to keep it happening. Chronically irregular periods are a signal – sort of like seeing lilacs blooming in January – that something's playing out of tune. Irregular bleeding can be a signal of a problem that needs checking out – thyroid problems, unsuspected pregnancy, uterine or cervical growths that are bleeding, endometriosis or reproductive tract infection, or even cancer. So – it's not a great idea to try to "fix" this problem on one's own (or at least, for more than a couple months) without working with a clinician who can provide information or do some investigation that can help get those things ruled out.

When you're talking about irregular periods, there are a couple definitions to keep in mind. "Normal" menstrual cycles can run (different people will tell you different numbers) anywhere from 24 to 35 days in between; some women have clockwork 28-day cycles, and others have more variation, and both situations are normal. So there's "irregular" - and then there's "what's irregular for you". Some women cycle erratically their entire lives, never knowing when a period will come. For these women there is often an underlying hormonal or metabolic issue that needs to get addressed, so it's not appropriate to just throw up the hands and say, "Oh, well, it's just how I am" until that's been checked out.

Other women (probably most of us) experience period fluctuations occasionally during times of intense emotional or physical stress – moving cross country, applying to medical school, ending or starting an intimate relationship, training for an athletic event, grieving, "the holidays". If there's an identifiable stressor, and periods return to whatever is normal for the woman afterwards, that's a normal process – and just goes to show how what goes on for us emotionally shows up in our bodies!

The new onset of irregular periods can signal the beginning of perimenopause – as many as 10 years before menopause actually begins. If you're over 35, this might be what's going on with you, so you might want to learn more about that transition so you know what to expect. And finally there are women who bounce back and forth between regular and irregular cycling – and it can take some detective work to figure out what's going on with them. Keeping a written record of your cycles (including days of bleeding, spotting, cramps, PMS symptoms, etc.) can really help your clinician help you do that background work.

The conventional medical approach to irregular cycles is to start a woman on birth control pills or other hormonal contraception, to turn off her own hormone system and substitute a synthetic one. For many women, that works fine; others would rather see what they can do without using the hormone solution. Presuming that serious problems have been ruled out, here are some things that can help a woman get back to a regular cycling pattern, or develop one if her periods have always been erratic.

Food: I see many women who under eat and over exercise in an effort to stay thin. A woman needs to maintain a certain threshold of body fat to have regular cycles (and slightly more to get and stay pregnant.) Even without an "eating disorder", disordered eating can throw a wrench into metabolism by causing a woman to flirt with the lower threshold of her personal body fat percentage, so check out – are you getting enough food, or using exercise to compensate for crummy food choices? Also, high-carbohydrate, high-sugar, highly-processed foods throw the hormone system out of balance by triggering overproduction of insulin and the stress hormones, either of which distort the menstrual symphony and can result in menstrual problems including irregular periods, PMS, heavy periods, and cramps. Emphasize foods that are nutrient dense and organic (lean proteins, legumes, whole grains, fresh fruits and vegetables), with adequate protein and healthy fat for your size and activity level, and be frank with yourself about whether your exercise habits could be pushing your body too hard. At the other end of the spectrum, if you're overweight, the extra body fat you're carrying can be producing hormones that can have impact on your cycles. It would be great to connect with someone who can help you make a balanced assessment about your relationship with food.

Nature: We live in an electronic, artificially lighted "constant-on" world. Yet our bodies are designed to cycle in harmony with the rhythms of nature – which many of us hardly ever get out into anymore except for walking to the car! If you're a person who's gotten totally detached from your wild-animal self and your periods show it, think about whether you could spend more time outside, grow a garden even in a pot on your windowsill, or just become more aware of the cycles of the moon: the same powers that make weather, moon cycles, and tides act in your body, and sometimes it can be helpful to purposefully pay more attention to that stuff. Also, when two or more women live together or work together closely, after a while they will often begin to get their periods at around the same time – which usually means some irregular cycling until they're synchronized. Again, charting your cycles and learning about how to identify and track the cyclic changes in your body (there are great books available about this) can really help you connect to your own amazing biology.

Emotional stress: You hear it all the time, and it's true: emotional issues have impact on the body. Often times we want to skip looking at stress because we feel like we can't do anything (right now) about our lives, our relationships, our families, our job-kids-traffic-politics-pollution etc etc. I like to say, "you can't control the waves, but you can learn to surf". Stress management doesn't mean you have to up and ditch the toxic job/boyfriend/whatever, it's about looking honestly at (and re-negotiating) your commitments and learning how to respond differently to things that come up. Anything that helps you to push your mental "reset button", preferably on a daily basis, and even for as little as 15 minutes at a time (listening to relaxation tapes, singing, meditating, doing breathing exercises, yoga postures or praying, for instance) takes some of the pressure off your hormone system and will help your periods get back on track. Acupuncture, which works with the energy body to restore internal balance, can be very helpful for women with hormone issues like irregular periods.

Supplements and stuff: Hormonal imbalances are complex but the body has elegant internal systems to achieve balance again when given the right building blocks and time to work. Certainly any woman with irregular periods or other menstrual disturbance should be taking a good-quality multivitamin with minerals; skip the formulas that have a laundry list of "women's herbs" added to them since those are rarely present in therapeutic amounts and can actually CAUSE imbalances if they're the wrong blend for you. The B-complex vitamins are especially important for hormone metabolism and can help normalize cycles. A heavy coffee or alcohol habit, or smoking, will alter hormone metabolism, so if these are part of your personal routine it would be helpful to back off from them – or quit altogether! Healthy fats are important (and a lot of us restrict our fat intake because we have bought the misconception that "fat is bad.") Omega 3 oils in particular, such as purified fish oil, provide a healthy fat substrate for the body to use to make healthy cells with, and healthy cells make healthy hormones and use them correctly.

If the above changes haven't made a difference, it might be time to consider using medicines, but you don't want to start with that step. There are a variety of botanical medicines that balance the hormone system; probably the one with the most research to back it up for irregular periods is Vitex, or chaste tree berry, usually taken in the form of a tincture or extract in tea three times a day – many women will notice their periods normalizing after three to six months of Vitex.

Finally, a woman can also manipulate her periods with topically applied bioidentical ("natural") progesterone cream that you get at the health food store, but bear in mind that hormone therapy doesn't address the underlying problem you might be having and its absorption can be unpredictable. It's really a bandaid approach one step removed from using birth control pills – not the place you want to start if you're looking for a "real health" perspective. I encourage women to work with a clinician familiar with botanical medicine and bioidentical hormones rather than using these on her own. When it comes to irregular periods, two heads are better than one!




Article © Copyright 2006 by Susan Fekety. All rights reserved worldwide. Duplication or reprints only with express permission of the author or, for a nonprofit purpose, without consent so long as the author's name and contact information are included as follows: "Reproduced with permission from Susan Fekety," These articles are provided for informational purposes only. Their content is not meant to substitute for the advice provided by your own health care professional. You should not use the information contained herein for diagnosing or treating a health problem or disease, or prescribing any medication. If you have or suspect you have a medical problem promptly contact your health care provider.




close this window | print article