Now that I know what I know, it is easy for me to say that I'm astounded by the sheer amount of women (even in the small cross section that I have come to work with) that don't know what constitutes a healthy period. However, the truth is that I was once that young woman who didn't have adequate education about my cycle, and I was disconnected from it. In fact, I wasn't just disconnected from it; I was disgusted by it; and I hated that it was something else that I could add to my "shame" bucket, something to hide, to embarrass me, to cause me pain.
It wasn't until I was on my fertility journey and stopped taking "The Pill", that I started tracking my cycle. When I started giving it my attention I came to realise just how important it is and how little respect I had given to this beautiful ability my body has. It has been described by health professionals (even in the Western world) as another vital sign. Your menstrual flow, your cycle length, and the symptoms you experience give us valuable information about your gynaecological and general health.
Before we get into what a healthy menstrual cycle is, it needs to be said that you can't assess your cycle health adequately while you are on contraception. Contraceptives are designed to block ovulation and the thickening of the uterine lining. The bleed that happens while taking contraception is a faux period; the result of minimal lining sloughing and shedding from the uterine wall in response to a drop in the levels of synthetic hormones. Please don't take that to mean that I suggest you all stop taking necessary precautions in your life - whatever contraceptive decisions you make, look after yourself and practice safe sex.
With that said, let's get into it!
WHAT IS A HEALTHY MENSTRUAL CYCLE?
Ultimately a healthy cycle should be a walk in the park; free of pain or other symptoms that significantly impact your day to day. Here's the breakdown:
Anywhere between the range of 26 to 32 days is considered to be a normal cycle length, taking into account that every body is different. Anything outside of these figures gives us clues about potential imbalances.
From an Eastern point of view, if your cycle is less than 26 days it may indicate that you have qi deficiency or heat in the blood.
A cycle longer than 32 days suggests there is either a blood deficiency or stagnation, or a cold pattern.
In Western medicine, a short cycle may indicate implantation bleeding, and represent the early stages of pregnancy, or they may be a sign of hormonal imbalances brought about by a number of different conditions (such as, but not limited to, Polycystic ovaries, thyroid disorders, anaemia, breastfeeding).
A delayed cycle is more commonly associated with pregnancy, however there are many other reasons menses may come late. Significant stress can cause low levels of hormones being secreted from the pituitary gland, resulting in the ovaries failing to produce an egg (this can be physical or emotional stress). Hormones again come into play in the cases of puberty, menopause, during breastfeeding and in conditions like polycystic ovary syndrome (PCOS) or thyroid issues.
NORMAL BLEED VOLUME
I was once lucky enough to sit in on a talk by Dr Danielle Arabena, who said "if whenever you bleed it looks like a crime scene, then it probably is". The take home message; heavy bleeding isn't normal. So what is normal? On average we lose about 30ml of blood per cycle, however anywhere between 10 - 80ml is considered to be normal. If we lose a greater amount than 80ml then it is considered to be menorrhagia. The number of days that bleeding occurs should be between 4-6 days, with the first couple of days the heaviest.
You might be thinking "well numbers are great but what the heck does that actually look like?!" A pad or tampon holds 5ml (a teaspoon) when soaked. If you are soaking through 16 or more sanitary products, then your period is too heavy. Menstrual cups should also get a mention because a lot of people are using them. Menstrual cups make measurement a little more obvious with markers on the side; with most holding at least 15ml.
What causes heavy bleeding? In a lot of women, the cause of menorrhagia is unknown but likely hormonal. Heavier bleeds are typically seen during puberty and perimenopause when there are higher levels of estrogen. In some women it may be a sign of uterine abnormalities (such as, but not limited to, PCOS, endometriosis, polyps or fibroids).
In Traditional Chinese Medicine (TCM) if menses are scarce or the bleed is short then, similar to if you experience late cycles, the likely causes are blood deficiency or stagnation, or a cold pattern. If you have heavy periods, much like early periods, then you could look at treating either heat in the blood or qi deficiency.
COLOUR AND QUALITY
Generally people are a bit grossed out by the idea of checking out their bodily eliminations too closely, but us medical folk (I can say that as a Clinical Nurse Specialist) love it! I am no stranger to asking all about the intimate details of your "ones and twos" and no less attention should be paid to "that time of the month" either. As the endometrium sheds small blood vessels are exposed, from which the main component of menstrual blood exudes. Naturally the broken down endometrium makes up part of the menstrual blood, and it is not unusual to see bits of tissue. The western world is a bit more lenient on the colour of your blood than TCM is, with a large spectrum of colours being considered normal. It is suggested that it is more to do with how old the blood is and its rate of flow, with some inclination that if you have endometriosis or PCOS you may be more likely to experience brown or black period blood. In western medicine, the colour of period blood is more significant if it looks more like a grey or green discharge, as would be present in vaginal infection. Clots are generally not seen to be an issue unless they are associated with heavy bleeding, are larger than the size of 20 cent piece, are passed mid cycle or are passed painfully. These symptoms could point towards many of the aforementioned conditions.
TCM scrutinises your menstrual blood a bit more thoroughly. Bright red blood may represent heat in the blood; pale blood suggests blood deficiency; purple or blackish blood is indicative of blood stasis or a cold pattern. If you are experiencing blood clots, regardless of clot size or if your period is scanty or heavy, these are associated with blood stagnation. The viscosity of your menstrual blood gives information about the health and flow of your blood and qi.
Ah, period pain. That uninvited visitor that follows Aunty Flow to your house every month (or so) and kicks you right in the vagina. Over the years I have been literally doubled over with painful periods. The thing was, I thought that was normal. Everyone has painful periods, right?! Pharmaceutical companies have made that "fact" a significant part of their marketing strategy. If you google "period pain" you will come across a bunch of reputable health sites that tell you that, "yeah, most women experience some level of pain during menstruation at some points in their life; exercise, put on a heat pack or take analgesics". They do acknowledge that there is the potential for underlying conditions bringing about the pain, but ultimately the list of recommended treatments remain the same; except for in extreme circumstances when invasive procedures are mentioned.
Period pain is not normal. TCM recognises that pain is a reflection of the state of flow of blood and qi. If either become impeded in flow, the severity of the disturbance determines how severe the pain will be.
It is these barriers to the smooth flow of qi and blood that also precede other unfavourable period symptoms such as headaches, bloating and irritability (to name a few).
So there you have it! I hope that I have given you some insight into your menstrual cycle, or at the very least been the catalyst for you to do your own exploration of the topic and your own body. Despite the fact that our menstruation has been a tool in women's repression over the years, it is in fact our power. Our cycle, our bleeding, is the embodiment of life and death. Without it none of us would be here.
Written by Rebecca Filby; Clinical Nurse Specialist; Shiatsu Practitioner
The Nurture Place - Wellness for women.
Check out the website to see how we could work with your menstrual cycle - www.thenurtureplace.net
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- Tolu Oyelowo DC, Mosby's Guide to Women's Health, 2007, <https://www.sciencedirect.com/topics/medicine-and-dentistry/menstrual-cycle>;
- Wei Liu, TCMD, MPH, LAC and Changzhen Gong, PhD, MS, The American Academy of Acupuncture and Oriental Medicine, <http://www.tcmpage.com/hpirregular_period.html>;
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