Are your periods normal? For so many women, this is a subject of that causes a good deal of confusion. This post will help to clarify things.
As a Gynecologist, I like to broadly consider three different stages that women go through over the course of their reproductive lives. Fatigue and adrenal dysfunction frequently present with a loss of fertility and with abnormal periods. This is a good place to start. No labs are required, just reflections.
Early menstrual years: age 13-17
At the time of menarche—the onset of periods—the young girl is becoming a reproductive-age young woman. For the first months to years, “abnormal” and “irregular” menstrual cycles are in fact the norm. In these years, irregular cycles are common as the hypothalamic-pituitary-thyroid-adrenal-ovarian relationships mature.
Often the best thing to do is to watch and wait. Of course, for some young women irregular, heavy, or painful periods can cause significant distress. Many physicians immediately reach for hormonal contraceptives to regulate a girl’s cycles.
For some, this may be life-saving, particularly if heavy cycles have caused anemia—a low blood count. But more often education, patience and time are the best medicine.
One note here. With this age group one still needs to consider pregnancy or sexually transmitted diseases. Don’t let “I swear, I haven’t had sex” be the words that delay appropriate care. I have seen undiagnosed chlamydia rob a young girl of future fertility; I have seen an undiagnosed ectopic pregnancy nearly take a young girl’s life.
The menstrual cycle in the reproductive years: age 18-34
These are the years in which a woman is most likely to conceive and carry a pregnancy to term successfully. The following questions can help you to know if your cycles are normal. If you answer in the affirmative to one or more of the following, you likely have normal HPA-Ovarian functioning.
First, what is the interval between your periods? The average menstrual cycle interval across all women is 28 days. But with the following moliminal signs, even a cycle that comes between 24-32 days would be considered normal.
Moliminal signs are clinical signs of ovulation. Ovulation is when the hormonal symphony the promotes the ovaries to release an egg. If you experience one or more of these signs monthly, and your period falls between 24-32 days, you are more than likely ovulatory.
I would ask my patients, “If you were on a desert island with no calendars or cell phones, would you expect any of these symptoms a few days before your cycle?
- Headaches (or migraines)
- Mood changes
- Weight gain
- Food cravings (these are sometimes strange foods, like anchovies or chips)
These are the classic “moliminal signs” that are driven by the higher progesterone levels that follow ovulation. Remember that progesterone defines ovulation. We will return to it in just a bit.
Do you have monthly, predictable periods with one or more of these moliminal signs? You are more than likely ovulatory. There’s no reason to spend any money on hormonal lab testing unless you are having trouble getting pregnant or trying to rule out a condition like polycystic ovarian syndrome.
Hopefully I just saved somebody $200 on serum hormone testing. Even better would be to have saved $600 on a non-diagnostic, unvalidated DUTCH test.
The menstrual cycle in the late reproductive years: age 34-50
In this age group, reproductive potential generally wanes. All the eggs in a woman’s ovary were present before her birth; over time they just get older. That said, I have had a 53-year-old patient gleefully receive news of her positive pregnancy test.
While many have predictable cycles nearly up to menopause, there are some patterns that apply. Again, as with the early reproductive years, there is a slow trend towards more “abnormal” cycles.
Broadly speaking, this age range is characterized by a state of estrogen dominance. This means that the body is still making higher levels of estrogen, but it is not balanced by the high progesterone levels that come with a “robust” ovulation.
In these years, many women begin to lose some regularity to the cycles. They also begin to experience fewer of the monthly moliminal signs. But the unopposed estradiol can cause numerous symptoms that fall under the category of “estrogen dominance.”
Perhaps the most common symptoms of estrogen dominance are weight gain and mood changes. Estrogen is a trophic hormone, which means that it makes things grow. Breast tissue in puberty, fat under the skin and the lining of the uterus all grow in response to estrogen’s signals.
The mood changes that accompany estrogen dominance seem to primarily relate to anxiety. I have had so many patients relate a state of unease, nervousness, and of feeling unsettled.
This group of women has the greatest response to progesterone supplementation in the second half of the cycle. This balances the estrogen dominance. Many women with this therapy report feeling better, sleeping better, and losing weight.
In conclusion, the best way to assess one’s menstrual cycles is to start with a simple self-evaluation. The three general age ranges mentioned here provide a start and a general guideline.