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Menstrual Irregularities

Most women today will experience menstrual irregularities at some point in their life. This can include PMS, lack of menstruation (amenorrhea), too heavy menstruation (menorrhagia), spotting (metrorrhagia), painful menstruation (dysmenorrhea) or even stopping and starting of menstruation before menopause (perimenopause). Although menstrual irregularities are common, they are preventable and treatable and do not necessarily have to be part of the monthly cycle.

Understanding The Menstrual Cycle
During the process of menstruation, hormones fluctuate according to the monthly ripening of an egg and subsequent pregnancy or shedding of the lining of the uterus. A cycle is typically 28 days in length with the menses (i.e. period or blood flow) lasting approximately 5 days. A healthy menstrual cycle is also PMS and pain free. In the menstrual phase (days 1 to 5 of the cycle), the uterus sheds most of it's lining. Estrogen and progesterone are at their lowest during this stage. Ovulation normally occurs half way through the cycle (day 14) and is preceded by a rise in follicle stimulating hormone (FSH) and leutinizing hormone (LH). A rise in estrogen levels occurs from days 6 to 14 of the cycle (FSH stimulates estrogen) and peaks at ovulation. It is estrogen that is responsible for building up the lining of the uterus at this time. During the weeks following ovulation estrogen levels decline. In between ovulation and menstruation (days 15 to 28 - known as the luteal phase) progesterone is highest. In fact ovulation occurs as a result of the sudden release of LH, which stimulates progesterone. Progesterone prepares the body for pregnancy and specifically the implantation of a fertilized egg. If the egg has not been fertilized progesterone levels begin to fall, signaling the body to begin menstruation.

Pre-Menstrual Syndrome (PMS)
This is a vague term which is used to describe a group of symptoms which occur after ovulation up until menses. It is not a disease, but rather an imbalance in the body's biochemistry. Technically, to be classifies as PMS these signs need to occur monthly. There are four types of PMS, all with different presentations and causes.

  1. PMS A - most women have this type. It is characterized by anxiety, nervous tension, mood swings and irritability. This is a result of high estrogen and low progesterone levels.
  2. PMS H - is characterized by hydration (water retention), weight gain, swelling of the hands and feet and breast tenderness. This is a result of high levels of aldosterone, which have been stimulated by excess estrogen.
  3. PMS C - characterized by cravings (specifically sweets), headaches, fatigue, increased appetite, dizziness, fainting palpitations and blood sugar imbalances. It is the result of low magnesium levels in red blood cells, and increased inflammation (specifically low PgE1 for all you biochemists).
  4. PMS D - characterized by depression, forgetfulness, crying, confusion and insomnia. This is the least common type of PMS and is experienced by approximately 30% of sufferers. There is low estrogen, high progesterone and possibly high androgens (male sex hormones). Fifty percent of menstruating North American women experience PMS symptoms.
Endometriosis
Occurs when there is a benign (i.e. non-cancerous) mass of endometrial tissue outside the uterus. The masses are usually in the pelvis but can be found in the ovaries, fallopian tubes, bladder and uterus. The area of tissue can range from small (several millimeters) to large (even up to 15 centimeters) and responds to hormonal changes in the body. They have the ability to bleed, and may 'stick' to surrounding tissues. Although the exact cause is unknown endometriosis does tend to run in families. Symptoms include pain with menses, pain with intercourse and pain with bowel movements. The individual may also experience pelvic pain, change in menses, infertility, abdominal bloating, rectal bleeding, painful urination, blood in the urine, excessive bleeding, spotting between cycles, large clots with menses, anemia, vomiting and constipation.

Uterine Fibroids (Fibromyomas, Leiomyomas)
Fibroids are benign (i.e. non cancerous) masses of the uterine smooth muscle and connective tissue. It is the most common tumor, affecting 40 percent of women under the age of 40. They are round, firm, vary in size and there are usually more than one. Fibroids are estrogen sensitive, meaning that estrogen causes them to grow. As a result they develop after the onset of menstruation, enlarge during pregnancy and decrease after menopause. While half of women with fibroids have no symptoms many may experience pain, pressure or fullness in the lower abdomen, frequent urination, painful menstruation, painful intercourse, heavy flows, bleeding between periods, lower back pain and disturbances in their bowel movements. This condition can also result in infertility, miscarriages and complications during labor. Thyroid function should also be assessed, as there is often a connection between hypothyroidism and fibroids.

Fibrocystic Breast Disease
Occurs when there is inflammation, tenderness and cystic tissue in the breasts. This is usually a result of too much estrogen compared to progesterone in the body. Cysts can form in one or both breasts, can be single or multiple and are significantly increased by caffeine. The cysts usually occur in the second half of the menstrual cycle, are movable upon examination and are extremely sensitive to touch and going up or down stairs. Women with fibrocystic breast disease are 3 times more likely to develop breast cancer. However these women often do not perform monthly self-breast exams because they are painful. These exams are crucial in detecting cancer at an early, treatable stage and should be part of every woman's monthly routine.

What Are My Treatment Options?

Conventional / Allopathic Treatment Options
The type of treatment prescribed by medical doctors depends on the condition and the severity of symptoms. It can range from hormones, muscle relaxants and anti-inflammatory medications to surgery (including removal of the uterus and ovaries). One of the most common prescriptions for menstrual irregularities is the birth control pill. Birth control pills contain 17-beta estradiol (the bad estrogen), which has been associated with cancer production (See article on soy for more information). These pills also deplete your body of B vitamins, put a stress on your liver and (obviously) elevate estrogen levels, therefore potentially making the situation worse. They may also mask symptoms without getting to the cause. Anti-inflammatory drugs and muscle relaxants have their own side effects and also simply mask symptoms rather than getting to the cause. Surgery is a drastic option and should only be used as a last resort.

Naturopathic Treatment Options

  1. Nutrition - This can involve cleanses or fasts, and usually focuses on removing estrogenic foods from the diet. Estrogenic foods are foods which either contain xeno-estrogens (bad estrogens from sources outside the body such as plastics) or promote estrogen production in the body. These include animal products such as meat and dairy, especially those that are not organic. Eliminating nightshades (eggplant, potatoes, tomatoes and peppers) and peanuts can also be of value, as they promote inflammation and pain in the body. Coffee, chocolate, tea and colas all contain methylxanthines, which can exacerbate menstrual irregularities and therefore should be avoided as well. Foods that support the liver in getting rid of estrogens and other toxins should also be added to the diet. These include carrots, beets, artichokes and lemons. Increasing phytoestrogens such as tofu, soy, apples and cherries helps balance estrogen levels in the body, and therefore can beneficial as well. Being over weight or 'pleasantly plump' can contribute to menstrual irregularities. Fat cells convert testosterone to estradiol (the bad estrogen) in the body and can further tip the balance towards having too much estrogen. Weight loss is often the best form of treatment and prevention.
  2. Supplements - Often it is too difficult to eat enough of the right foods, or the amount necessary to get all the nutrients we need. Vitamin E and ferrulic acid (found in grains) both affect LH levels (which stimulates progesterone) and are useful supplements to add. B6 and lipotrophic factors (choline and inositol) are also beneficial as they help the liver detoxify estrogens. Calcium and magnesium in a 2 to 1 ratio supplements are also of value as they help regulate hormones and decrease smooth muscle spasms.
  3. Botanicals - Herbs have been used for centuries to prevent and treat menstrual irregularities. Although there are too many to list here, some commonly used botanicals include;
    • Black Cohosh (Cimicifuga racemosa) - this herb is useful in decreasing LH (stimulates progesterone) levels. As a result it can help relieve painful menses, PMS (when there is low estrogen), uterine spasms, ovarian and menstrual cramps.
    • Chaste Tree (Vitex agnus castus) - is a hormone regulator which also promotes lactation. It increases LH (stimulates progesterone) and decreases FSH (stimulates estrogen) and therefore increases progesterone and decreases estrogen levels. As a result it is useful in treating PMS (esp. with mood swings), painful periods, painful breasts during menses (mastodynia), heavy or lack of periods and even infertility.
    • Dandelion (Taraxacum officinalis) - this herb is helpful in stimulating liver detoxification. It helps the body get rid of estrogens and other waste products, and therefore can be useful in supporting other treatments.
    • Licorice (Glycerrhiza glabra) - (The herb not the candy!!!!) contains phytoestrogens and is useful in balancing estrogen and progesterone levels. It also helps decrease inflammation and pain, and can be used to treat inflammatory conditions of the skin. At the same time supports the adrenal glands (the glands that secrete stress hormones) and therefore is helpful in people who are under a lot of stress. ***Note: This herb should not be used by anyone with high blood pressure.
  4. Traditional Chinese Medicine and Acupuncture - there are many different organ systems that can be involved depending on the symptoms before, during and after menstruation. Herbal formulations and acupuncture are used according to which organs are affected, the flow of blood and qi (energy) and if the person has a hot vs cold or excess vs deficient condition. As lifestyle and diet can affect these systems, they are also an important consideration in balancing the body.
  5. Homeopathy - attempts to match the remedy to the specific personality and physical symptoms of the individual. Classic homeopathy uses only one remedy at a time and can be very useful in treating menstrual conditions. There are also general combination remedies, which have been very helpful in relieving the symptoms of menstrual irregularities. Some of the remedies include;
    • Pulsatilla - useful in treating painful menstruation, irregular menses, painful breasts and PMS. It is especially useful when the person is weepy and feels better in open air.
    • Sepia - useful in treating painful menstruation, especially when there is an offensive discharge, pain and stiffness in the uterus region and a fullness and/or bearing down sensation in the pelvis. This person feels worn out and does not want to be around people. She is usually chilly and will feel better after exercise.
    • Lachesis - this person experiences painful periods that feel better with blood flow and worse tight clothing. She will often have short, scanty periods and headaches related to her cycle.
    • Silica - can be of great value in treating women who have PMS, fibroids and endometriosis. It is specifically indicated when the individual has a heavy flow with bleeding between periods. As well her body is ice cold, and there is hard lumps or an abscess in the breasts.
  6. Hydrotherapy - using alternating hot and cold water and castor oil packs can be very helpful in improving blood flow and getting rid of waste products from the pelvic area and liver. They are of great value in conditions such as endometriosis, fibroids and ovarian cysts. PMS symptoms can also be relieved using these treatments. Castor oil packs over the pelvis should not be used during menstruation itself, as it can increase uterine contractions and cause pain. Epsom salt baths can also be used to relax muscles and relieve pain and spasms.
  7. Lifestyle - Exercise, stress relief and healthy emotional expression can have a very positive impact on your hormonal balance and overall health. Exercise improves blood flow and helps you maintain a healthy weight. It also causes the release of endorphins, which make you feel good and relieve pain. Stress management can be in the form of deep breathing exercises, yoga or even taking a hot bath. Anything you enjoy which helps relieve stress will help you and your muscles relax. There are many yoga exercises that specifically improve blood and energy flow through the pelvic area, and help balance organs responsible for hormone production and release (e.g. the pituitary and hypothalamus). Tai chi (pronounced chee) and Qi (same as chi) Gong exercises balance energy channels in the body and therefore can be useful as well. Remember that your hormones affect your moods and energy levels. It is perfectly normal and healthy to feel more energized and creative during ovulation (mid-cycle), and more introverted and contemplative around menstruation. Taking some time out for your self when you need it will help you be more productive and can help prevent mood swings.

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