Irregular periods - what's going on?!

Many women don't realize what's normal and healthy during menstruation. How much cramping is considered “normal”? How long can I go without a period before I officially hit menopause? How long should my period last? Every woman's body is different, and this specific information regarding women's health and wellness is rarely taught. If you don't know the answers, don't sweat it! You don't have to accept "bad periods" as a common occurrence in your life. Here are some guidelines to help you identify what's normal in your menstrual cycle and what warrants a conversation with a gynecologist or healthcare provider.

The menstrual cycle begins with the first day of a period. The average length of a cycle is 28 days, however cycles lasting anywhere from 24-38 days are normal. There are four stages of the menstrual cycle and each one is influenced by fluctuations in hormone levels. Both the ovaries and the pituitary gland in the brain release these hormones throughout the menstrual cycle, which causes the reproductive tract to react in certain ways. The four stages are:

1. The menses phase: The menses phase is probably what you think of when you think of a period. This is when the uterine lining is shed through the vagina, causing bleeding if pregnancy has not occurred. It typically lasts one to five days, but anywhere from two to seven days is still considered normal and healthy.
2. The follicular phase: After the menses phase ends, the hormone estrogen is on the rise. This helps the uterine wall to heal and grow. Simultaneously, a hormone called the "follicle-stimulating hormone" (FSH) causes new follicles to form in the ovaries, eventually forming an egg. This usually lasts from the end of your period to about day 14.
3. Ovulation: During ovulation, the luteinizing hormone causes the ovary to release its egg. This typically only lasts a day.
4. The luteal phase: Days 16 to 28 are known as the luteal phase in which the egg travels through the fallopian tubes to the uterus. During this time, the body produces the hormone progesterone to prepare the uterus for pregnancy. If this does not occur, the progesterone levels drop and the cycle starts all over again.

Food cravings, bloating, tender breasts, acne, cramps in the abdomen and back, trouble sleeping, and volatile mood are all common PMS symptoms (premenstrual syndrome). Now that we've made it through the whole "normal" cycle as detailed above, here are some complications that are out of the ordinary.

• Not menstruating before 16 years of age
• Bleeding for more days than usual
• Having heavy periods compared to previous periods
• Experiencing severe pain that affects your day to day functioning and well-being
• Bleeding between periods
• Severe emotional symptoms such as depression and anxiety
• Skipping your period for more than three months after stopping birth control pills

In any case, if you have a question or concern about your body and period, big or small, it never hurts to consult an OB-GYN.

Irregular periods can be caused by a number of things from diet to hormonal imbalances. The latter of which can lead to conditions such as polycystic ovary syndrome (PCOS) or endometriosis. Endometriosis is linked to excess estrogen and PCOS is linked to excess androgens. Both of these conditions can lead to heavy bleeding and infertility if efforts to balance hormones and manage inflammation are not taken. You can find more information about identifying the symptoms of both endometriosis and PCOS here.

Home remedies and supplements to help regulate your period

While making small lifestyle changes may help to regulate your period, if the underlying cause is a hormonal imbalance (like in the cause of PCOS and endometriosis) you will likely benefit from:

• Daily yoga: Interestingly, research shows just 35 to 40 minutes of yoga, done 5 days a week for 6 months, lowered levels of thyroid-stimulating hormone, follicle-stimulating hormone, luteinizing hormone, and prolactin, all markers of irregular periods. It may also reduce menstrual pain and cortisol levels to make your period smoother. This free youtube playlist has a great compilation of beginners yoga sessions to help you get started.

• Maintain a healthy weight: Weight gain and weight loss can both impact your menstrual cycle and reproductive health. Extra fat cells can lead to the production of estrogen and thus excess bleeding and menstrual disorders. Being underweight can also influence the hypothalamic-pituitary-ovarian system (HPO axis), which regulates the production of reproductive hormones. Thus, maintaining a healthy weight through diet and exercise may support the healthy production of hormones.
• Regular exercise: There are many health benefits to exercising regularly, including regulated periods. Clinical trials have shown that 30 minutes of aerobic exercise 3 times a week can effectively treat primary dysmenorrhea. This may also help to regulate periods by supporting a healthy weight.  
• Add some spice with ginger and cinnamon: Preliminary studies have found that taking ginger, cinnamon, and turmeric in supplement form may help to reduce some of the symptoms of irregular periods. Taking ginger powder and/or cinnamon in the week leading up to your period may help to reduce pain and improve mood during and before your period. A small study also found that taking a cinnamon supplement may improve the symptoms of PCOS.

• Try a natural anti-inflammatory supplement like boswellia: Boswellia Serrata, also called Indian frankincense, is a natural anti-inflammatory used to manage pain and treat inflammatory conditions such as rheumatoid arthritis and ulcerative colitis. Compared to other anti-inflammatory medications like NSAIDS or even turmeric, boswellia is safe to use long-term and rarely causes stomach irritation. It's also fast-acting, so if you forget to take your supplement the day your cramps come on, it can provide quick pain relief for period cramps.
• Chasteberry or Chaste Tree: Chasteberry, also called Vitex Agnus-Castus or chaste tree, may improve PMS symptoms and help to regulate periods by raising progesterone levels in the body. However, menstrual bleeding is one of the side effects of taking this supplement, so it should only be incorporated into your diet under the advice of a medical professional.
• Vitamin D: Studies have found vitamin D deficiencies are often common in women with menstrual irregularities. Though dietary sources of vitamin D are available, they are often dairy-based and thus prohibitive for vegans. Additionally, sun exposure (another way to boost vitamin D) can be risky. Thus, supplementation of vitamin D may be the safest and most effective way to manage your menstrual cycle and reap the widespread health benefits of this vitamin.
• B Vitamins: Another vitamin commonly recommended to women with menstrual irregularities is vitamin B. Studies have found that by consuming more vitamin B, specifically vitamin B6, B1, and B2, women were less likely to experience PMS and their symptoms were less severe than those who received the placebo. Additionally, one study found that when paired with a daily calcium supplement, women were less likely to experience the physical and mental symptoms associated with irregular periods.
• Inositol: Inositol, a sugar that is found in the brain and other tissues, "appears to regulate menstrual cycles, improve ovulation and induce metabolic changes in polycystic ovary syndrome" according to a 2017 study. Inositol can be found in many different plant-based foods and can be produced by the body, but it is widely available in supplement form.

• Magnesium: Magnesium is regularly prescribed to treat PMS, PCOS, and perimenopause. It impacts the menstrual cycle in a number of ways, such as excreting excess estrogen and preventing common PMS symptoms like period cramps, mood swings, and migraines. According to one study, it is even more effective when taken with vitamin B6.
• Omega-3 fatty acids: In addition to supporting heart and brain health, omega-3s may help to regulate periods and reduce the many symptoms associated with hormonal imbalances. Studies have shown that a daily omega-3 supplement may decrease testosterone levels and regulate the menstrual cycle by improving insulin levels and mood, lowering inflammation, and even preventing hormonal acne. If you're over the fish oil burps or follow a vegan diet, vegan omega-3 supplements derived from algae are available and proven to be just as effective as fish sources.

Irregular periods are not regular, and they're not something you have to grin and bear! With a couple of simple lifestyle changes and natural supplements, you may be able to help your periods be smoother and pain-free. Before you begin adding them to your diet, be sure to consult your OBGYN to share your concerns and get the green light.

Article References:

1. https://www.healthline.com/health/womens-health/irregular-periods-home-remedies#8.-Eat-pineapple
2. https://www.healthline.com/health/how-to-regulate-periods#dietary-supplements
3. https://www.theglobeandmail.com/life/health-and-fitness/suffering-from-pms-chow-down-on-b-vitamins/article622658/
4. https://helloclue.com/articles/cycle-a-z/magnesium-and-the-menstrual-cycle#:~:text=Magnesium%20may%20help%20to%20prevent,pain%20(1%2C8)
5. https://helloclue.com/articles/cycle-a-z/magnesium-and-the-menstrual-cycle
6. ​https://www.composednutrition.com/blog/omega-3-for-pcos
7. https://www.everydayhealth.com/pms/weight-and-your-cycle.aspx