Healthy Periods

Period problems don’t need to be normal

You read that right! Menstrual disorders (problems that involve your menstrual cycles or periods) are extremely common but are neither normal nor healthy.

It is possible to have pleasant, predictable, and pain-free periods!

Menstrual disorders include conditions such as:

Abnormal uterine bleeding - including:

Menorrhagia: abnormally heavy or prolonged bleeding at menstruation (occurring at regular intervals), periods lasting longer than 7 days, “heavy periods”
Metrorrhagia: abnormal bleeding (occurring at irregular intervals), spotting between normal periods (intermenstrual bleeding), after sex, bleed after menopause
Menometrorrhagia: prolonged or excessive uterine bleeding occurring irregularly and more frequently than normal

Amenorrhea: absence of periods for 90 days or more)

Dysmenorrhea: painful periods and severe menstrual cramps)
Menstrual irregularities
Oligomenorrhea: infrequent menstrual periods - less than 9 periods per year or intervals between menstrual cycles >35 days
Ovulatory disorders including anovulation (failure to ovulate)
Polymenorrhea: very frequent menstrual periods - intervals between menstrual cycles <21 days
Premenstrual syndrome (PMS) - including mood swings, depression, anxiety, insomnia, bloating, fatigue, and other symptoms that occur before your period
Premenstrual dysphoric disorder (PMDD) - a more severe subtype of PMS

What are healthy periods supposed to be like?

Your menstrual bleeds are called periods because they occur periodically or in a regular monthly pattern.

For a lot of people, periods are associated with cramping, pain, irritability, depression, bloating, heavy bleeding, unpredictability and a lot of other discomforts. These experiences are common, but are not normal.

The timing and the qualities of a healthy, ovulatory menstrual cycle are primarily determined by three (3) phases.

Firstly, the follicular phase, which can last anywhere from 7 to 21 days, is when your brain and your ovaries communicate to facilitate ovulation.
Secondly, ovulation, which lasts one day, is when an egg is released in preparation for a potential pregnancy (yes, even when you aren't trying to get pregnant).
Finally, the luteal phase, which lasts 10 to 16 days, is the phase between ovulation and your menstrual bleed.

In total, a healthy, ovulatory menstrual cycle can last anywhere between 21 and 35 days. Check out my article on What A Healthy, Ovulatory Cycle Looks Like to learn more.

The hormonal fluctuations involved (and expected) in your cycle will also influence your experience of your menstrual cycles. That is, your premenstrual symptoms, the length and the heaviness of your menstrual blood flow, the presence of menstrual blood clotting, the length and the predictability of your cycles, the presence of menstrual blood clots, etc. Below is a summary table of what a healthy, ovulatory cycle looks like.

What a healthy, ovulatory cycle looks like

Premenstrual symptoms	None to mild (manageable) cramping, tiredness, mood changes, appetite changes, skin changes, etc.
Menstrual symptoms	None to mild (manageable) cramping, some tiredness (not exhaustion), etc. similar to premenstrual symptoms
Cycle length	25-35 Days During perimenopause, your cycles may be longer or shorter.
Menstrual blood flow length	3-7 Days
Menstrual blood loss (heaviness)	First few days are the heaviest. Changing used/soaked menstrual products (menstrual cup, menstrual pads, tampons, etc.) every 4-6 hours. No more than 6 pads or tampons per day. Around 80 mL of blood loss is considered normal. More than 120 mL of menstrual blood loss may substantially increase the risk of developing anemia from heavy menstrual bleeding.
Menstrual blood clotting	Few strands of tissue
Spotting in between periods	None
Ovulation discomfort	None

When should I worry about my periods?

If you are concerned that you may have a menstrual disorder or irregularity (see above conditions or below for a guide to Period Self-checks), it is very important to discuss your concerns with your Health Care Practitioner (HCP).

Your HCP will begin with questions about your menstrual concerns. Ideally, details about your other body systems will be asked to get a better understanding of your state of health. In addition to these questions, a physical exam and/or laboratory work-up may be performed and suggested (depending on what their scope of practice is in your jurisdiction). Your doctor may also recommend the following tests:

Ultrasound – This produces an image of your uterus which can also help determine if there are any abnormalities.
Sonohysterogram – Fluid is inserted into the uterus through the cervix to examine the uterine lining.
Endometrial biopsy – This requires a sample of your uterine lining which is taken for testing.
Hysteroscopy – This involves the insertion of a camera to detect any abnormalities.

How can Dr. Kim help me?

Your experience of your menstrual cycles is unique. You deserve a Healthy Period Management Plan that is unique to you.

You and Dr. Kim will work together to develop a Healthy Period Management Plan that addresses the issues surrounding your menstrual disorder and fits your unique circumstance. Dr. Kim may suggest treatment modalities that can have a profoundly positive impact on your period issues.

These treatment goals and modalities include, but are not limited, to the following:

Provide insight and potentially identify factors affecting your health that may have been previously missed with a thorough health history intake
Uncover and explain what may be the reason for the progression of your Period Problems
Provide evidence-based information surrounding your menstrual cycle challenges and how we can help you achieve Healthy Menstrual Cycles in spite of such conditions
Provide education and counseling on diet and nutrition, lifestyle, and environmental factors that impact your menstrual health
Run comprehensive laboratory investigation to get a sense of your biomarkers.
Prescribe nutraceutical supplements and bioidentical hormones as needed
Provide support for managing stress in a realistic and sustainable way
Provide acupuncture and some body work treatments to help address menstrual cycle issues

Dr. Kim will propose solutions for you that are specific for your current (and future) health goals, have measurable means for progress, and manageable for your schedule. She will support you every step of the way to optimizing your health and wellness, so that you can continue to enjoy your life without being held back by your periods.

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