Part 1: 3 Must-Know Signs Your Menstrual Cycle Is Healthy

Transcript: 

TERESA: Welcome to Dishing Up Nutrition, brought to you by Nutritional Weight & Wellness. We are a Minnesota company that specializes in real food nutrition education and counseling. I'm Teresa Wagner, a Registered and Licensed Dietitian, and my cohost is Leah Kleinschrodt, who is also a Registered and Licensed Dietitian.

I am really excited for this discussion today because with today's show, we are kicking off a series of special Dishing Up Nutrition episodes that will be coming out over the next few months. This series is focused on women's health and actually one very specific aspect of women's health, the menstrual cycle.

LEAH: Yeah, I'm excited for this one also, for this episode and this series. This was an idea that a few of us kicked the can around, you know, about a year ago or so. And so I'm happy that it finally made it into the lineup. So we're going to start off today's show. So this is just, it's the show to lay the groundwork of what a healthy, balanced menstrual cycle looks like, you know, and why this matters for our health, not just whether we're having babies or not having babies, but how some of these aspects actually play into our long term health.

And also then how we want to make some nutrition tie ins too, right? Food, lifestyle choices that play into these monthly hormonal and physical rhythms. Then in future shows, we'll cover what happens when we see some imbalances or dysfunction with these cycles. So things like PMS, PCOS, fibroids, and endometriosis, and, and just for our listeners, to anyone who in our audience who maybe they want to skip right to those topics, we have covered each of those issues in previous Dishing Up Nutrition episodes, so you can go back in time and listen.

We will be doing some fresh new content on that coming up soon, so just stay tuned for those. So today we're going to start off with some of those basics and foundations, and we'll be hitting some of those issues later on. And then kind of topping it all off in a few months, then we'll be circling back into those final years of the menstrual cycle. So talking more about perimenopause and menopause.

TERESA: Yeah, I love it. I think it's going to be so interesting to go through all of those various topics. And of course, I feel like there is such an interest right now that's growing in the perimenopause, menopause space, and those will be really fun, too.

LEAH: For sure.

TERESA: So, Leah, do you remember learning about your period in your tween, teen years? I, it's a while back, but I don't know about you, but it was really just, pretty bare bones and I don't want to throw any sort of educator that I may have had…

LEAH: Parents included.

TERESA: Parents included. I just, really truly just remember getting the top line message, right? Like it was, okay, a period is a sign you're becoming a woman now and that, you know, this is a sign that you'll be able to have babies if you want to.

About once a month, you'll have a period, a bleed, it's going to come about once a month. You might get a little moody, you might be a little crampy, you might get a little bloated. But that's about it.

LEAH: Yeah.

TERESA: I feel like that was about what I learned.

LEAH: Yeah.

TERESA: Like maybe get some ways of managing it.

LEAH: Right. We learned a little bit about pads.

TERESA: Tampons.

LEAH: Tampons. Things like that.

TERESA: Exactly. So it was, that's, that's basically what it was. And you know, at the time it felt good enough.

LEAH: Yeah. Yeah. Absolutely.

TERESA: But it wasn't really until I started working for Nutritional Weight & Wellness that I really dug in much deeper and learned how important the menstrual cycle is as a vital sign; that a healthy cycle is really a sign of a healthy woman. And so just learning more and more of the details of it and it's, it's very interesting and beautiful and how the human body works.

LEAH: Yeah. Absolutely. Yeah. And, you know, again, like you said, we learn when you're younger, especially you learn those basics of, yeah, like, okay, about once a month you get a period. You skip a period, maybe you're pregnant or, you know, that's kind of like the only thing you might have learned of like why you don't get a period.

And I would say the same thing too, especially working here at Nutritional Weight & Wellness, then you actually learn about actually, the deeper connections of these, these hormonal rhythms, how they impact our cardiovascular health as we get older, how they impact our bone health. So many different avenues there.

Timing of the cycle: what is considered healthy & normal?

So it's not just about, yeah, like I said, babies or not having babies. It's like there are so many other implications with this. So you know, let's back out like 30,000 foot view and just talk about some signs of what you might see in terms of a healthy menstrual cycle.

And so let's just start off talking about the timing of our periods. What's considered normal and healthy there? And just to set the stage too, when we talk about the menstrual cycle, so when you talk day one, day one of your menstrual cycle is the first day of your period. And then that cycle ends the day before the start of your next period, all right?

So that's one full menstrual cycle. The normal range for a healthy menstrual cycle is between 24 to 35 days or so, with the average length being about 28 to 29 days.

TERESA: Right. And it's normal to fluctuate within that, within that range. But it's, it's interesting because I know women who can set their watch and know the exact day, and maybe even almost like time that they're going to get their next period. But more commonly, you would have cycles that vary a little bit. You know, like maybe 30 days, one cycle, and 27 the next, maybe 31 the next. Some variability is okay and it's normal.

What are considered irregular cycles & possible reasons

Irregular cycles are when your period varies by more than eight days consistently from cycle to cycle. So maybe you're having a 21 day length cycle and then a 45 and yeah, so there's variability there. Much, much more than just a couple of days.

LEAH: Yep.

TERESA: So that begs the question, what does it mean if your cycles are consistently longer or consistently shorter than that normal range?

LEAH: Mm hmm. Yeah, lots of different possibilities there. And this is where we can make some of those nutrition tie-ins or some of those nutrition connections. So longer cycles, so again, like we think 36 plus days or more in a cycle. And that's consistently, again, one 36 or 38 day cycle here and there, not a big deal. But if we're consistently going long with our cycles, that means that ovulation is being delayed or is inconsistent and we're, I mean, we could like do a huge deep dive into ovulation and all the ins and outs there, right?

But, you know, we're not going to focus on that necessarily today. I mean, suffice it to say, you know, ovulation is supposed to be around the halfway mark. So if the ovulation is getting delayed, like we're getting pushed back a little bit. So that first part of the menstrual cycle is getting lengthened out a bit. So then actually we end up with a longer menstrual cycle in general. And one reason for this is a condition called polycystic ovarian syndrome, or PCOS, which we mentioned at the top of the show.

And this is a huge topic. Again, we will cover that more in a future show. And we've done the we've done PCOS shows in the past before too. So again, please go back and listen to that if that is an area that's of interest to you. We work with a lot of women with PCOS or, sometimes I will see women who’s symptoms line up very closely with PCOS, but maybe they don't necessarily have that diagnosis. So PCOS is one reason why we can see delayed or inconsistent ovulation. So we have those longer menstrual cycles.

Another reason could be that the body doesn't feel like it has sufficient nutrients or sufficient energy to build up the follicle that's in the ovary and then to release that egg. So then again, ovulation gets delayed and then our period gets delayed. So we can see this in women who under eat whether intentionally or unintentionally and/or like over exercise.

So lots of stress on the body coming in different forms there and we can even see this in women who eat enough calories but actually don't even eat enough fat in their diet, which I thought was a really interesting tidbit that I pulled from a book that I know I've quoted on this show before called Real Food for Fertility, written by Lily Nichols and Lisa Hendrickson-Jack.

TERESA: Yeah, that is such a good book. Such a great resource. I think when even what that made me think of when you were talking about women who under eat or over exercise, it really reminds me of the female athlete triad, right? Where they are just burning so much energy. I think of a gymnast a lot, right? Where they're burning so much energy and then maybe not eating enough.

And then they don't have a period. That might not be the case for all the women that we're talking to, but that is definitely an example. I feel like many women are familiar with, with the athletes that work really hard and maybe don't eat enough to compensate for all that energy they're expending.

Maybe bringing it back to more of us that are in the audience that we're talking about, you know, think about the last time you really got motivated to lose weight, right? Or maybe your cholesterol numbers were a little bit higher and you're like, you know what, I'm going to start that low calorie, that low fat diet.

LEAH: Yep.

TERESA: Or maybe I'm going to go low carb and you're really motivated and you're able to stick with it for a while. Did you notice when you've done this, any changes with your period or maybe any of the hormonal symptoms that you have around your cycle? I think many women know to watch for missing periods, but did you notice if your cycle got a little longer? Research says that significant caloric restriction can start to impact the menstrual cycle within four months, mostly because it's putting stress on the body and diminishing the estrogen and progesterone we produce.

LEAH: Yeah, exactly. Like, the athlete population, we see some of those, but not too many. I think we see definitely more of the women that fall into that category of doing something a little bit more extreme with our nutrition because we have a fire lit under us for some reason, whether it's a health reason or wanting to just change how we look, things like that.

So, another way this could look actually is rushing out the door every morning. So you have your five bags, like three on one arm, two on the other, empty belly and you're fueled up on caffeine and rage or something like that. So running out the door without having some of that proper fuel in the morning.

TERESA: No comment.

LEAH: Yeah, right. I've never done that before. Another one that I'll hear too from women, like you just get up, you get caught up sometimes in that hustle culture at work. So you push off lunch so long, like you just push it off like, oh, okay. And another half hour or maybe another 15 minutes. And then pretty soon it's the end of the day.

And as you're like, I just might as well save those calories until I get to dinnertime. Intermittent fasting can be another way that we, again, inadvertently kind of back our way into that kind of rabbit hole. So just kind of getting too far into the fasting world. And this could also look like hitting the gym for 6 a.m. boot camp classes four to five days per week.

So again, it doesn't always have to look like missing periods and someone who seems super thin or super athletic, like we can kind of cause some of that stress on our hormones and our bodies with some of the, just like some of that hustle culture that we're living or just some of the lifestyle choices that we're making on a day to day and week to week basis.

And I don't want to discount, I mean, we as women, we are very resilient. And the occasional off-balance eating, the off-balance day, or even an off-balance like a week or two is not going to, we're not going to completely ruin our cycles with that, right? But truly, it comes down to, does our body feel like the environment around us is safe and secure and plentiful so that our hormones feel the same way?

TERESA: Mm hmm, right. And when it comes to the short menstrual cycle, these would be some of the same culprits that we were talking about here. PCOS, stressors from our lifestyle habits, and also perimenopause. A short menstrual cycle usually happens when ovulation occurs early in the cycle or when ovulation doesn't occur at all. So before, Leah, you were talking about how a long menstrual cycle, ovulation is pushed later. The, the short cycle, it’s earlier.

LEAH: Mm hmm. 

TERESA: So this, you know, in thinking about perimenopause, it can be a natural progression towards menopause. But it also could be a sign that the body is feeling stressed in some way.

LEAH: Yeah. Yeah, that's a good point to circle back on. So we talked about why cycles might be long, but also, okay, what could happen or why might they be shorter than that 24 to 35 day cycle or so. Okay, so that's the timing of our periods or kind of like the length of our menstrual cycle.

Is having pain or discomfort normal?

So what else might we look at if we are looking at a healthy menstrual cycle? Another aspect that I'll ask my clients about or clients will mention is pain or discomfort just before or during their period. So this actually has a fancy name to it, it's called dysmenorrhea. And I've even had some clients talk about different kinds of pains at ovulation. So, the idea is pain or discomfort around your period should be pretty minimal or at the very least very manageable.

So maybe some cramping, maybe some feelings of just some heaviness or soreness in the pelvic area, but nothing too horrible. You should still be able to go about your usual day. But unfortunately, I think many of us know that friend or coworker or sister, or maybe it's your cousin who is debilitated by their period pains. Debilitating pain every month is not normal. It might be common, like some of these pains might be common, but they're not normal.

TERESA: So, they're not. And I just feel so for people who, month after month, have to deal with things like that. You know, something I learned at one point that changed how I viewed periods, is that your period is a natural inflammatory process.

LEAH: I've heard that too.

TERESA: Isn't that interesting?

LEAH: So interesting. Mm hmm.

TERESA: Your body ramps up production of these little molecules called prostaglandins as your period gets closer and you start to bleed. So these little guys, these prostaglandins, create inflammation and start the process of uterine contractions and the shedding of the lining of the uterus. Research shows that women who have more severe period pain produce up to four times more of these prostaglandins than women who have minimal period pain. So in short, more inflammation can mean more period pains, and of course, more misery.

LEAH: Mm hmm. And you know, I'm going to take that a next step further after we come back from break, because I think you hit on a really important part there. We're going to talk a little bit more about inflammation, but we have to take a quick break first. So we'll be back in a moment and we'll continue our conversation about signs of healthy menstrual cycle.

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TERESA: Welcome back. You are listening to Dishing Up Nutrition's weekly podcast. Before we went to break, we were talking about the menstrual cycle and the inflammation that can be causing pain with the menstrual cycle. And Leah, I feel like the break kind of interrupted you mid thought, so I'm going to let you take it from here.

LEAH: Yeah, I do have thoughts. I have many thoughts on this. Because you mentioned, and I've heard this too, and again, it also kind of changed my way of thinking about this, that our period is naturally an inflammatory process. So when we have more prostaglandins or just these little guys that wreak some havoc, we tend to have more pain, more misery.

So like there is a biochemical reason why we might have more pain in that sense, but I will also take that a step further and say, okay, our periods might naturally be inflammatory. However we should be, beyond our periods should be in a lower state of inflammation. And unfortunately, the way either some of us eat, the lifestyles that we live, the things that we get exposed to, like so many different reasons, we actually live in a higher state of inflammation day to day.

So even in between our periods, we live in a more constant state of low-level inflammation all throughout our menstrual cycle. And so then when that natural inflamed state hits us once a month, it's probably going to feel a lot worse than if we kept our inflammation level low throughout other parts of our menstrual cycle. And so that begs the question again, like, what causes some of that low grade inflammation all the time that's already in our bodies?

Quality of food matters in reducing inflammation

So what do we talk about here on Dishing Up Nutrition? So often, I mean, first and foremost, we have to look at the quality of the foods that we are eating. Do we live on processed, convenience driven and highly sugared foods? Maybe it's that cereal bar and a latte for breakfast, a prepackaged frozen meal for lunch, and a big bowl of pasta and some sauce, and maybe a couple pieces of chicken in there for dinner.

You know, these types of foods, foods that come out of the factory and not the farm, foods that have more refined starch to them, that just kind of have been through the mill, like literally through the mill, these will almost certainly keep us inflamed throughout our menstrual cycle.

And this was kind of an interesting stat. The number one predictor of a nutrient poor diet is how many refined carbohydrates we eat. So think about, again, more cereals, more breads, pastas, crackers, pastries, cookies. The more of those types of things that we eat, the more inflamed we are. And then the fewer nutrients we have to fight off that inflammation. So it's kind of like a double or almost a triple whammy in that sense.

TERESA: Right. So not only do we keep lighting this inflammation fire with those foods that we're eating, we're taking away those fire hoses needed to put that fire out. Other honorable mentions, or not so honorable, maybe, that keep feeding those inflammation fires are refined vegetable and seed oils, like canola oil, soybean oil, and corn oil.

Overconsuming alcohol and caffeine. And then those artificial sweeteners, like Splenda and aspartame. The thing is, is that most of these items, they often coexist together in that processed food space. So if we work on transitioning over to a more real food, whole food, the diet that we talk about in this show over and over again, we focus on more of those types of foods, just in general, most of those harmful ingredients, the seed oils, the artificial sweeteners, all the chemicals, all those types of things, go by the wayside without us having to specifically focus on them.

LEAH: Yeah. That's what I love about this approach too. Like when we work on including more real foods, it just naturally crowds out some of the items, ingredients, other foods that we don't want. I'll even mention this also maybe why, and I've done this with clients, maybe why we do some trial food eliminations.

Consider possible food sensitivities that can lead to inflammation

Like if we've got kind of this low grade inflammation, maybe we are kind of already eating more of the real food way, but we still got maybe some dairy in the mix, or maybe it's like a couple slices of bread or some crackers or some other things kind of still in the mix, we might want to do some trial food eliminations to see if this helps women with some of the pains around their menstrual cycle and specifically can we lower that inflammation that they're experiencing.

So if you're consistently eating a food or a food group that you are sensitive to and you don't know it, again, this is inadvertently adding to more inflammation. So we may do that trial of gluten free, or maybe it is dairy free. Sometimes we need to look at things like eggs and nuts and some other things, just to see if that helps bring inflammation down in general. So if we can get some of that inflammation down, it should mean less period pain.

What else can cause painful periods?

And of course, those are some of the things we have control over. There are other reasons why women may have pretty terrible period pains. PCOS can be one of those issues, but also things like endometriosis is a big one and that's where some of that uterine tissue starts to grow outside of the uterus and it attaches itself to the abdominal wall or other organs, kind of in that pelvic and abdominal cavity.

Uterine fibroids, which are kind of like large, cyst like growths in the uterus. These are other physical reasons why we could see more period pain. Some fibroids are super small and women don't know they even have them and sometimes they can get really big. So, we'll be sorting through some of these conditions again in some future episodes, but you know, I read this really wild statistic that it said, for someone to get an endometriosis diagnosis, it can take four to 11 years.

And to me, that just is wild and nuts, especially if, like you said, some women do experience those terrible pains month to month and terrible symptoms with their periods and having to do that for 4 to 11 years before you get an idea of what's going on. Like I can't even imagine what that might look like.

TERESA: It's mind boggling how long some women have to deal with terrible pains without answers for relief. I mean, so often women are dismissed and luckily I feel like things are starting to change in this area.

LEAH: Absolutely.

TERESA: But I think often, it was just dismissed and that's why it took so long.

LEAH: Or that's just your lot in life, like unfortunately you drew the short straw for having really terrible periods.

TERESA: Yeah, but it is amazing to see what kind of changes that we can see in women when we change their food a bit. You know and maybe even adding some supplements, too so I would say these are not probably our endometriosis women who there is a physical cause for all this pain but but for more general when we change food, maybe we add some supplements that can help with pain.

Supplements & lifestyle factors that can help with inflammation

So rather than using aspirin and ibuprofen, things that maybe aren't so great for us, maybe using supplements like Magnesium Glycinate, omega-3s, and GLA, these can help to promote less inflammation and relaxation of the uterus muscles. It's amazing how well magnesium can support cramping. And I shouldn't say support it. I should say like, take it away.

LEAH: I mean, dial it down.

TERESA: Yeah. It's, it's fantastic. And so when we talk with women, it just gives them a different way to think about supporting their bodies and their hormones so that they work for them instead of like what feels like against.

LEAH: Yes, absolutely.

TERESA: And sometimes we might also need to work on sleep habits and exercise patterns. Supporting women through life's stressful ups and downs creates that inflammation that we were talking about. All of these things, whether it's sleep, food, exercise, stress, they play a role in our inflammation level. And so there's lots of pieces of these puzzles that we can put together. Maybe it's not just one thing. Maybe it's a variety of things. And generally speaking, it's a variety of things.

LEAH: Yeah. I'd say more often than not, it's like you said, not just one thing, not just one moving piece. It's the whole picture of things. And as dietitians, of course, we're going to go to food first, but we also can't ignore some of those other lifestyle factors that may be helping or they may be hurting our situation. So we hit on period pain there.

Overviewing length of a normal period 

Let's do one last sign of a healthy menstrual cycle and I think this will end up being more of like a two for one or even a three for one here with this one. But let's talk about how long a normal period should last for. So now we're just like talking specifically about the period, not the entire cycle itself. So the average period length is three to seven days.

So usually it starts off heavier that first maybe one, two, three days or so. And then it tapers off over the last few days. And actually, you lose about 90 percent of your menstrual blood in the first 2 to 3 days of your period, and then only 10 percent over the next 2 to 4 days. So again, it just kind of goes to show, ideally, we should be, like, having a bit heavier flow in the beginning, and then tapers off towards the end.

TERESA: Right. And like we said earlier, with the menstrual cycle length, the whole cycle length, there's some wiggle room here in these averages. And what your period length is can certainly shift. So what we're looking for here is what your overall pattern is like over the course of, say, three to six months, or maybe even the course of a year.

But with maybe younger girls today is that we have these period trackers and that we, I mean, Leah, I'm sure you use one too. I mean, we can track now and it's so easy to track how long is the cycle? How many days is it lasting? And you can see what your averages are. You don't have to really write all that down. You know, it's all that is very handy.

LEAH: Yeah. It doesn't have to be a paper calendar or a journal or something like that. Like, and those calculations when it's done for you. Yeah. It totally makes it so much easier.

TERESA: So we can see things, like if we're having really short or very light periods, and that can indicate that you're not building up a lot of that, that tissue inside the uterus each month, which this could be a problem if you're wanting to get pregnant.

This might be from low estrogen or low progesterone, which could be stemming from maybe not ovulating consistently, maybe we're under eating, not eating enough of those healthy fats or those added stressors that we might be having on our body. And if we see really long or really heavy periods, this could be due to some of the things that we’ve mentioned earlier, like endometriosis and uterine fibroids, perimenopause. But, it can also indicate other things too. It could indicate thyroid issues, adenomyosis, or even cancer.

LEAH: Mm hmm, right. Yeah, so if you fall outside of that average window, you'd want to find a practitioner who's willing to dig into things with you and just figure out for sure if there's something going on under the surface. So that's what we want to rule out is endometriosis, PCOS, fibroids, things like that. But, fun fact, but not fun fact, like, kind of like what you said, Teresa.

Lab tests to consider

Many women know that when you bleed heavily each and every month, you can become iron deficient. I've seen this. clinically. I'm sure you have too. But then when you're iron deficient, this can be a cause for heavier bleeding. So it can be kind of this vicious cycle that we have to, you know, somewhere along the line, we got to dig in and break that cycle.

TERESA: Yeah, it is. That's a vicious cycle.

LEAH: Yeah. And another good reason for women to get labs run, right, when this stuff is happening. Test your iron levels, test ferritin and hemoglobin, ferritin in particular. And I find that most of the time you have to ask for that ferritin level or lab to be done. But the hemoglobin level, that one's a little bit more standard. So you don't really have to ask for that one. If we have our clients have that ferritin level run, we can catch iron deficiency sooner than if they're just running that hemoglobin level, because it's just a better indicator.

And then, bonus, if that practitioner is also willing to run a more extensive thyroid panel. One that includes free T4, free T3, antibodies in addition to TSH. So if there is something going on with the thyroid that's affecting our cycle, that we can catch that too.

LEAH: Yeah, absolutely. I'll add on to that and say triple bonus if they're willing to check vitamin D status. Which vitamin D is well known to impact inflammation levels, and actually, if you keep your vitamin D at a decent level, this can decrease pelvic pain and decrease the risk of having fibroids and endometriosis.

So, you know, we've talked about this on the show many times, but ideally, we'd love to see a vitamin D level of at least 50 nanograms per deciliter, so 50 to 70 to 80, somewhere in that range.

TERESA: Yeah, yeah. Anywhere in there, I'm happy.

LEAH: Yep, absolutely.

Recap

TERESA: Well, I hope this show has been helpful for laying out the foundation of what to expect for a healthy period and menstrual cycle. To recap, an average menstrual cycle is 24 to 35 days, and your period should be three to seven days long, starting heavier and then tapering off. Your period should also be fairly pain free and you should be able to go mostly about your everyday life without much hassle. It really should be somewhat unnoticeable that you have your period.

LEAH: Yeah. Yeah, so if your cycle or your periods fall outside of these averages, it's important to assess the quality of the foods you eat, the way you exercise, the way you sleep and manage stress. But this is also what we help women with every single day in clinic.

Especially if your symptoms are more severe, it's important to advocate for further investigation into your periods and your lab work, if you're consistently outside these averages, and especially if it's impacting how well you're functioning on a month to month basis. So, remember, some of these experiences or symptoms, they may be common, but it doesn't mean they're normal and that you have to carry on like nothing's wrong.

TERESA: Agreed. Our goal at Nutritional Weight & Wellness is to provide each and every person with practical, real life solutions for everyday health through eating real food. It's a simple yet powerful message. Eating real food is life changing. Thank you for listening and have an amazing day.