How many times have you thought: ‘Is this normal?’

I met my period on a bike ride one afternoon; I thought I had “biked wrong” and broken something. This was more than seventeen years ago, but I didn’t really start asking questions about my period until years later when my roommate, a nurse practitioner who specializes in fertility, shared with me some interesting facts about the female cycle.

Now I know my cycle so well that I can predict it. But I wonder what questions I should have been asking about it back then. Was it OK that some cycles were irregular? Was there a connection with my breakouts? Why were my cramps so debilitating?

I reached out to women’s health program FEMM to speak with Dr. Lindsay Rerko, OD. FEMM is committed to educating women on what is normal and healthy and providing solutions for a wide range of health problems such as PCOS, irregular bleeding, infertility, and even migraines. Here are eight important questions we should be asking about our periods.

01. Is it important for me to have a regular period?

Yes! A woman’s period is a sign of her overall health. It is the shedding of the uterine lining that has built up in the previous cycle under the influence of estrogen and progesterone. It is an important indicator of sufficient hormonal activity.

02. What is considered a ‘normal’ period?

The range of normal for a healthy period is anywhere from three to seven days, with at least one day of heavy or moderate bleeding. Some women find they have cramping, headaches, acne, mood swings, breast tenderness, food cravings or other unpleasant symptoms in the days before her period begins and during menstruation. A few of these symptoms, if minor, are normal, but anything that significantly impacts your life may be a sign of underlying hormonal imbalance.

Proper nutrition, exercise and reducing stress can all help to alleviate the severity of symptoms. However, fluctuations in estrogen and progesterone hormone levels throughout the cycle and particularly around menstruation play a big role in these symptoms. Nutrition, exercise and stress can all influence the severity of your symptoms.

03. Why do I sometimes feel tired during my period?

Many women feel tired because they have trouble sleeping—often due to discomfort or heavy flow. But for a small percentage of women, severe fatigue may be associated with anemia, which could be a result of very heavy bleeding. Hypothyroidism and polyps, among other factors, may cause heavy bleeding. If this is the case, we recommend seeing an OB-GYN who may order some blood tests. It’s important to be attentive to your body, cycle, and lifestyle habits to figure out what may cause your fatigue.

04. How can I tell if my symptoms are severe?

Since only the patient can rate their pain, a one to ten scale is what is commonly used. One is a minor annoyance and a ten would be the worst pain ever experienced (like labor or breaking bones). A seven or higher is severe. If a patient feels that her pain severely affects the quality of her life or her ability to function—she misses work or school—that is severe by my standards.

While conditions of severe pain or discomfort may be routine, they are not normal. A FEMM physician can work with you to address what’s going on in your body, and provide targeted testing and treatment rather than suppressive therapy or symptom management.

05. What can I do to feel better during that time of the month?

For minor discomfort associated with your period, eat a balanced diet low in sugar, salt and saturated fat, and drink lots of water. Avoid smoking, alcohol, and caffeine intake. Take vitamins and mineral supplements, particularly magnesium, calcium, and vitamins D and B—these can help mitigate symptoms. Moderate exercise improves circulation, relieving pain in the process. And it gives you more energy, and improves mood. Even though you may not feel like it when you have your period, get out and move!

For cramps, using a heating pad or a warm bath can help alleviate symptoms. FEMM does not advise the use of painkillers, because pain is a symptom that should be addressed. FEMM physicians evaluate the cause of the pain and support the body’s needs, whether hormonal or supplemental.

06. Am I ‘regular’?

The good and bad news: Almost no one has a “textbook cycle”. A regular, healthy cycle should be between twenty-four to thirty-six days, including ovulation (a sign of sufficient hormonal levels), a good luteal phase (the second half of your cycle after you ovulate), and a period of three to seven days (with one day heavy to moderate in flow).

Often, the first sign of an underlying health problem is an irregular cycle. Hormonal imbalance and associated cycle irregularity may present with symptoms such as acne, hirsutism (unwanted hair growth), or mood disorders. Statistics show that for women with irregular cycles, 80 percent are associated with hormonal imbalance.

07. What does my period have to do with breakouts?

Some acne is a symptom of hormonal imbalance. Hormonal acne typically flares up at cyclical times, related to hormonal activity in the menstrual cycle. Breakouts are more likely to be located around the mouth, jawline, and below the cheekbones. It is often painful and may not respond to conventional treatments. Restoring hormonal balance will help clear up your skin.

08. I’ve always been regular, but now my period is late. Should I be concerned?

Delayed menstruation can be normal. The brain plays a vital role in your cycle. If you’re stressed or sick, the brain can prompt hormones to delay your ovulation, which is the real reason you period is delayed.

On the other hand, having consistent delayed ovulation, or the general feeling of “I have no idea what’s going on with my cycle,” is usually an indicator of something else related to hormonal health. Start to monitor and track your daily hormonal health by using a charting method such as the FEMM app.

By teaching women how to understand and monitor hormonal and other indicators of their health, they are better able to manage it. After all, a healthy woman is a confident woman.

Photo Credit: Shay Ryan