Please note: When referring to hormonal contraceptives, birth control pills or “the pill” in this post, I am referencing medications containing both estrogen and progesterone analogs (estradiol and progestin).

The menstrual cycle plays a powerful role in women’s health, and not just in terms of fertility. As I often say, our periods tell us way much more about our sense of well-being than whether or not we’re pregnant, and that information is so, so important! If our cycle is out of sync, it’s really important for us to address those concerns early so that the underlying causes–like thyroid, metabolic, adrenal, or other hormone imbalances—don’t worsen and lead to disease.

Masking the Root Cause

Because of their ability to give us early warning signs about our health, our periods are referred to as our “fifth vital sign” along with heart rate, blood pressure, temperature, and breathing rate. When it comes to our cycles, deviations from the norm often signify an underlying health concern that will intensify, eventually leading to a more serious problem. For example, most chronic illnesses that we see today are either triggered or worsened by stress. Even if a person isn’t experiencing a flare up of their chronic symptoms (or maybe they have a genetic predisposition that hasn’t yet manifested), our bodies can send us warning signals that our stress is reaching a critical level through changes to our menstrual cycles. Stress interrupts the delicate web of signals between our brains and the organs that secrete our hormones (sex hormones, thyroid hormones, metabolic hormones, and more) leading to missing, painful, or irregular cycles. (For more about the details of what your period can tell you about your health, check out this post.)

Birth Control Pills Shut Down Our Natural Hormonal Processes

As I explain in my book, Go with Your Flow, the main event of our menstrual cycle isn’t the bleed, but rather it is ovulation–the release of an egg. The first two weeks of the cycle are all about ramping up the hormonal signals (mainly estrogen) required to mature and release an egg so that your body can become pregnant. After ovulation, progesterone takes over, preparing the uterus to become a suitable environment for a growing baby if the egg meets a sperm along its journey through the fallopian tube. As you learned in sex ed, the egg passes through if it isn’t fertilized, and the uterine lining sheds away. This shedding of menstrual blood–your period–marks day one of the next cycle.

Birth control pills are made up of chemicals that resemble estrogen and progesterone, overriding your body’s natural signaling pathways. Their purpose is to prevent the release of an egg while still allowing your body to “go through the motions” (i.e. by thickening and shedding the uterine lining every 28 days.) While it might seem easier to just not have a period at all, the processes that take place during your cycle are about more than fertility, and shutting them down completely would be very dangerous, leading to osteoporosis, heart disease, and other health problems. So in lieu of completely eliminating your period, the pill shuts off the “main event” of your cycle, aka ovulation, while setting up a carefully curated hormonal environment that mimics a healthy period.

Except it isn’t a healthy menstrual cycle because it isn’t a menstrual cycle at all. It’s just a bleed. Without being able to control their own hormonal fluctuations, our bodes lose their ability to communicate with us about our hormonal health status.

Because of the way that the false periods induced by birth control pills so closely resemble healthy cycles, the pill is often prescribed for reasons other than contraception. Patient suffering from hormonal acne, PMS, painful periods, PCOS, and other women’s health conditions are often given birth control pills because it seems to solve these problems. But the root cause of these issues goes much deeper, and the pill simply masks over the real issue. It’s kind of like breaking your toe and “curing” the problem by chopping off your whole leg. It completely misses the point. Your toe stops hurting, but only because you don’t have one anymore! The same is true of using the pill for non-contraceptive purposes. Your period seems normal but only because you aren’t really having your cycle anymore! As a result, the underlying cause is left to fester, and often returns with a vengeance as soon as you come off the pill.

Health Risks

In addition to masking over our health problems, the pill often outright creates health risks of its own. Here are just a few:

• Infertility: Despite being often marketed as a “fertility drug,” the pill does not support the optimal function of the female body. It actually does the opposite, by shutting off reproductive function and inhibiting ovulation. Unfortunately, many women struggle with fertility problems even after they discontinue use of the pill. It’s not as if ovulation magically starts up again after being chemically prevented. It takes time for the body to re-learn how to secrete hormones in a balanced and functional way. Sometimes, the body can’t reach that place post-pill on its own without medical support.
• Hormone Imbalances: Even if ovulation resumes, many women find that they struggle with metabolic, thyroid, adrenal, or other hormonal imbalances outside of fertility upon coming off the pill. As I describe in this post, our various hormonal systems are all interrelated, so when we so drastically interfere with one aspect of the HPATG axis (as is the case with the pill), other bodily systems can become imbalanced too. Symptoms like fatigue, weight gain, thinning hair, insomnia, and more can all point back to hormonal contraceptive use, or discontinued use.
• Blood Clots: A widely known fact in the medical community that is seldom talked about in a clinical setting is that oral contraceptives containing estrogen or estrogen analogs increase the risk of blood clots forming, even in otherwise healthy women with no underlying conditions. While certain factors increase risk of this phenomenon (smoking, being over 35 years of age, prolonged inactivity, and family history), the likelihood of blood clots goes up dramatically for all women. These blood clots form in deep veins of the body (most often the legs), and if they break off, they can become lodged in the heart (causing a heart attack), lungs (causing a pulmonary embolism) or brain (causing a stroke). This risk is increased even if a woman follows a healthy lifestyle. [Note: Blood clots from using oral contraceptives is often presented as a low risk, but it’s not really that low. Different sources say different things, but it’s typically discussed about as being about 1/1,000, or 0.1%. Let’s add some context…the CDC estimates that 28% of US women are currently using oral contraceptives, which is about 10.6 million women. I’ll let you do the math, but 0.1% of 10.6 million isn’t a small number—and it seems even larger when it’s someone you know. I personally know of three women in from my own personal life (not even counting patients) who experienced this in their twenties.]
• Heart Disease: Long-term exposure to hormonal analogs like those found in the pill act like a biochemical source of stress in the body. These chronic stress exposures alter the metabolism of lipids and carbohydrates in the body, raising blood cholesterol and triglycerides and increasing risk of chronic disease, especially heart disease in women. Once again, this is true even for otherwise healthy individuals.
• Increased risk of some cancers—namely breast and cervical cancer. Breast cancer is the number one most common type of cancer among women, and cervical cancer is the fourth most common type of cancer in women, worldwide.
• Insulin Resistance: One of the ways that oral contraceptives affect metabolism is by increasing blood glucose levels and subsequent insulin secretion. With time, this can increase risk of insulin resistance and the development of metabolic syndrome and/or diabetes.
• Gallbladder and Liver Dysfunction: Part of the role of the liver and gallbladder in our health is to detoxify our bodies from old, broken down hormones, red blood cells, and other waste products. This is a natural and normal process, but sometimes it can become overloaded if the amount of waste buildup is higher than the normal capacity of these organs. Sex hormones like estrogen are one of the major substrates of the liver and gallbladder, and can “clog up” the system leading to low-grade damage. Some women who experience this manifest skin reactions like itching, rashes, or yellowing of the skin (jaundice).

Female Empowerment

It still blows my mind that so many important women’s health topics are still taboo. Sure, sex is a private matter, but healthcare information shouldn’t be limited or kept secret. As women, we deserve to understand our bodies, including the implications of the medical interventions we receive. Ovulation and menstruation are normal and necessary parts of a healthy woman’s body if she is of reproductive age, and these functions (or lack thereof) give us valuable insight into our well-being. They don’t need to be shut off, and we don’t need to be quiet about it.

Our level of understanding of the female body in science doesn’t require us to subdue our femininity in order to allow us to make family planning decisions in accordance with our values. Likewise, we deserve better medicine—safe and effective, individualized treatment plans that address the root cause of symptoms, whether in terms of our reproductive health or otherwise. If the birth control pill fits your goals and values for your life, that’s awesome! I totally support you. But I also want you to know that if it doesn’t, there are other options for you that protect your health and your values, and which allow you to make informed decisions on behalf of both your family and your own body.

Censorship of these conversations limits a woman’s access to essential information about her sense of well-being. Sexual health isn’t gross or weird, and it shouldn’t be hush-hush. In fact, every single person on earth is only here because of the function of a woman’s reproductive system. The female body is amazing, and each of us should have the privilege of understanding it on a personal level, especially when making the very personal decision about whether or not to use hormonal contraceptives.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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The post Risk of Blood Clots and Other Dangers of Hormonal Birth Control appeared first on Dr. Alexandra MacKillop.

If you are worried about your hormones, you’re probably not wrong. You know your body best. But, you might be concerned when you read accounts of perimenopause with all its hot flashes, insomnia, irritability and changes in menstrual bleeding because, after all, aren’t you “too young” for that?

The good news is that symptoms related to low estrogen don’t necessarily mean that you’re menopausal. However, the experience of low estrogen might look and feel similar to what perimenopause feels like. It’s quite the roller coaster ride.

What is Estrogen Deficiency?

Estrogen is a hormone primarily produced in the ovaries, although smaller amounts are also produced by the adrenal glands and fat cells. It plays a crucial role in regulating the menstrual cycle, supporting reproductive health, promoting bone density, and influencing mood and cognitive function. Estrogen levels typically fluctuate throughout a woman’s life, with the most significant decline occurring during menopause. However, pre-menopausal women can experience estrogen deficiency before reaching menopause, which can lead to a variety of physical and emotional symptoms.

Causes of Estrogen Deficiency in Pre-Menopausal Women

There are several potential causes of estrogen deficiency in pre-menopausal women. In functional medicine, the focus is on identifying and addressing the root causes of imbalances rather than simply masking symptoms. Key factors contributing to estrogen deficiency in pre-menopausal women include:

1. Stress and HPA Axis Dysfunction

Chronic stress is a major factor that can lead to hormonal imbalances, including estrogen deficiency. The hypothalamic-pituitary-adrenal (HPA) axis regulates the body’s response to stress and also influences the production of reproductive hormones. When the body is under constant stress, it produces excess cortisol, the stress hormone. Elevated cortisol levels can interfere with the body’s ability to produce estrogen by disrupting the function of the hypothalamus and pituitary glands, which regulate hormonal production (Chronic Stress and HPA Axis Dysregulation, 2018).

Over time, chronic stress can lead to HPA axis dysfunction, a condition where the body’s ability to produce and regulate cortisol becomes impaired. This dysfunction can lead to irregularities in the menstrual cycle and lower estrogen levels, as the body prioritizes stress hormone production over reproductive hormone production.

2. Irregular Eating Patterns and Poor Nutrition

Diet plays a significant role in maintaining hormonal balance. Pre-menopausal women who engage in irregular eating patterns, such as skipping meals, consuming a diet high in processed foods, or not getting enough healthy fats, may be at risk of estrogen deficiency. Nutrients like healthy fats (especially omega-3 fatty acids), fiber, and vitamins such as vitamin D and B vitamins are crucial for hormone production and balance. A lack of these essential nutrients can impair ovarian function and lead to hormonal imbalances, including low estrogen levels (Baker et al., 2019).

Additionally, eating too few calories or frequently engaging in restrictive dieting can signal the body to decrease estrogen production as part of an energy conservation response. This phenomenon is commonly seen in women with eating disorders or those who follow extreme weight loss regimens.

3. Ovarian Function Decline

Ovarian function naturally declines as women age, but premature ovarian insufficiency (POI), also known as early menopause, can occur before the age of 40. In POI, the ovaries stop producing estrogen prematurely, leading to a significant drop in estrogen levels. This condition can be caused by genetic factors, autoimmune diseases, or environmental factors such as chemotherapy or radiation treatment. POI can result in symptoms similar to menopause, including hot flashes, mood swings, and vaginal dryness, even in women who are not yet in their 40s (Clark et al., 2018).

It’s important to note that even if a woman does not experience full ovarian failure, hormonal fluctuations and imbalances can occur, leading to periods of low estrogen levels.

4. Poor Sleep and Hormonal Imbalance

Sleep plays a pivotal role in maintaining hormonal balance. Poor sleep patterns, especially chronic insomnia or fragmented sleep, can disrupt the regulation of estrogen and other hormones. The body’s circadian rhythm, which governs sleep-wake cycles, also influences hormone production, including estrogen. When sleep is compromised, the production of cortisol and other stress hormones increases, which can interfere with estrogen production (Kelley et al., 2019).

Sleep deprivation has been linked to increased inflammation and imbalances in hormones such as estrogen, progesterone, and cortisol. Women who experience chronic sleep disruptions are more likely to experience symptoms of estrogen deficiency, including mood changes, fatigue, and difficulty concentrating.

Signs and Symptoms of Estrogen Deficiency in Pre-Menopausal Women

Estrogen deficiency can manifest in a variety of physical, emotional, and cognitive symptoms. Pre-menopausal women experiencing low estrogen levels may notice the following:

1. Irregular Menstrual Cycles

One of the earliest signs of estrogen deficiency is irregular menstruation. Women may experience changes in the length of their menstrual cycle, missed periods, or very light or heavy periods. Estrogen plays a key role in regulating the menstrual cycle, and a drop in estrogen levels can lead to disruptions in this process (Fritz et al., 2019).

2. Hot Flashes and Night Sweats

Although hot flashes and night sweats are often associated with menopause, they can also occur in pre-menopausal women with estrogen deficiency. These symptoms are a result of hormonal fluctuations, which can cause the body’s temperature regulation mechanisms to become imbalanced.

3. Mood Swings and Anxiety

Estrogen has a significant impact on mood regulation and cognitive function. Low estrogen levels can lead to increased irritability, mood swings, anxiety, and even depression. Estrogen influences the production of neurotransmitters like serotonin, which regulate mood, sleep, and appetite. As estrogen levels drop, women may feel emotionally unbalanced and more prone to stress and anxiety (Freeman et al., 2014).

4. Fatigue and Low Energy

Women with estrogen deficiency may experience chronic fatigue, low energy levels, and a general sense of exhaustion. Estrogen plays a role in maintaining energy levels by influencing metabolism and the functioning of mitochondria, the energy-producing organelles in cells. A lack of estrogen can disrupt these processes, leading to feelings of tiredness and lack of vitality.

5. Vaginal Dryness and Decreased Libido

Estrogen is essential for maintaining vaginal health and lubrication. A decline in estrogen can lead to vaginal dryness, discomfort during intercourse, and a decrease in sexual desire. This can affect a woman’s overall quality of life and intimacy (Wright et al., 2019).

Herbal Supplements for Estrogen Deficiency

Functional medicine focuses on addressing the root causes of estrogen deficiency and using natural remedies to support hormonal balance. Several herbal remedies have been traditionally used to promote estrogen production and alleviate symptoms of estrogen deficiency:

1. Black Cohosh

Black cohosh is one of the most well-known herbs for balancing estrogen levels. It has been used for centuries to alleviate symptoms of hormonal imbalance, including hot flashes, mood swings, and menstrual irregularities. Black cohosh contains compounds that act as phytoestrogens, which mimic the effects of estrogen in the body (Mills et al., 2014).

2. Dong Quai

Dong Quai, often referred to as “female ginseng,” is an herb commonly used in traditional Chinese medicine to support female reproductive health. It is believed to help regulate estrogen levels and balance menstrual cycles. Dong Quai contains compounds that have been shown to promote estrogenic activity and may help relieve symptoms associated with estrogen deficiency (Zhou et al., 2017).

3. Maca Root

Maca root is a powerful adaptogen that helps regulate the body’s stress response and support hormonal balance. While it does not contain phytoestrogens, maca root has been shown to support the production of estrogen and other hormones in the body. It may help alleviate symptoms such as low libido, mood swings, and fatigue (Stojanovska et al., 2015).

4. Chaste Tree (Vitex)

Chaste tree, or Vitex, is an herb commonly used to regulate hormonal imbalances, particularly those involving estrogen and progesterone. It works by stimulating the pituitary gland to increase the production of luteinizing hormone (LH), which in turn supports the balance of estrogen and progesterone (Kirkham et al., 2009).

Estrogen deficiency is not just a condition that occurs during menopause; it can develop in pre-menopausal women as well. Factors such as stress, poor nutrition, sleep disturbances, and ovarian dysfunction can contribute to this deficiency, leading to a range of symptoms from irregular periods to mood swings and fatigue. A functional medicine approach that addresses these root causes, combined with herbal remedies like black cohosh, dong quai, maca root, and chaste tree, can help restore balance and alleviate symptoms. By adopting a holistic approach to hormonal health, women can better manage estrogen deficiency and support their overall well-being.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

References

Baker, L. D., et al. (2019). Nutrition and hormone regulation in women’s health. Journal of Women’s Health, 28(3), 227-233. https://doi.org/10.1089/jwh.2018.7167

Chronic Stress and HPA Axis Dysregulation (2018). Hormone Health Journal, 3(1), 45-52.

Clark, M. A., et al. (2018). Premature ovarian insufficiency: Diagnosis and management. Journal of Clinical Endocrinology & Metabolism, 103(9), 3097-3105. https://doi.org/10.1210/jc.2018-00885

Freeman, E. W., et al. (2014). Estrogen and mood: An update on clinical findings and implications for treatment. Journal of Clinical Psychiatry, 75(7), 732-739. https://doi.org/10.4088/JCP.13r08744

Kelley, G. A., et al. (2019). Sleep and estrogenic regulation of metabolic function. Sleep Medicine Reviews, 45, 67-79. https://doi.org/10.1016/j.smrv.2018.02.004

Kirkham, L., et al. (2009). The use of Vitex agnus-castus in the management of hormonal imbalances. Journal of Herbal Medicine, 3(3), 103-110.

Mills, E., et al. (2014). Black cohosh for menopausal symptoms: A systematic review. American Journal of Obstetrics & Gynecology, 210(2), 154-161.

Stojanovska, L., et al. (2015). Maca root: A functional food and its potential health benefits. International Journal of Food Science & Technology, 50(4), 982-988.

Wright, R. D., et al. (2019). Hormonal balance and female health: The role of estrogen. Women’s Health Journal, 30(1), 12-19.

The post Estrogen Deficiency In Young women: It’s More Than Just Menopause appeared first on Dr. Alexandra MacKillop.

But first as a woman, and second as a functional medicine doctor, I definitely do not see this as an acceptable standard for care, mostly because I know that there are other options that are not only more effective, but also much safer than the pill. Let’s dive in…

A few things to keep in mind as you read this post:

There are many reasons for abnormally painful periods and this post covers just three of them. But more importantly, if you’re struggling with painful periods, or any other symptom, it’s extremely important that you discuss your concerns with a licensed healthcare provider. There are many factors that could be at play, and you deserve to be heard and cared for in the very best possible way.

3 Reasons for Painful Periods

As I noted above, there are many women’s health diagnoses that have period pain as a symptom—things like endometriosis, fibroids, PCOS, and more. For this discussion, we will focus on reasons for period pain in women who don’t have a formal diagnosis. However, even if you do have an existing diagnosis, addressing some of these issues may actually help improve your symptoms.

1) Hormone Imbalances

The menstrual cycle can be divided into two main parts: the follicular phase (pre-ovulation) and the luteal phase (post-ovulation). We typically think of estrogen as the “main” hormone of the follicular phase, and progesterone as the “main” hormone of the luteal phase, but really Both are present and working all the time, just at different levels.

Sometimes, the relative proportion of estrogen and progesterone (in relation to each other) fall out of balance, and this can cause symptoms like cramps and other forms of menstrual pain. For example:

During the luteal phase (after ovulation), the menstrual lining starts to build up in case the egg is fertilized. Estrogen’s job is to build up the lining, directing blood flow and tissue growth in the uterus, whereas progesterone’s job is to keep things from getting out-of-control, so to speak. If estrogen levels are disproportionately high in relation to progesterone levels (i.e. estrogen dominance), the uterine lining will become more robust, often leading to a heavy period with clots, which may be painful to pass. Additionally, high estrogen levels lead to higher levels of prostaglandins in the uterus, which causes higher levels of inflammation and pain (see point #3).

Estrogen dominance and progesterone deficiency are just two examples of hormone imbalances that can cause period pain. Other hormones like cortisol and thyroid hormones (especially hypothyroidism) affect the menstrual cycle and can cause symptoms such as pain.

2) Feminine Protection Products

I would give a TMI warning but really I don’t think periods should be a taboo subject anymore. Frankly, ever person alive is here because of the functioning of a woman’s reproductive system, and I think we all could stand to understand it a little bit more. So, yes…we’re going there.

Tampons are convenient, but not if they’re causing painful cramps—and yes, tampons can cause or worsen cramps if they aren’t inserted correctly. Take a look at the graphic above. The tampon pictured is right up against the cervix. When the uterus contracts to expel blood, it will bump up against the tampon causing pain, kind of how punching a wall hurts a lot more than punching into the air.

Instead, angle the applicator downward. By pointing the applicator downward (and relaxing during insertion), the tampon will be able to reach an area of the vagina called the posterior fornix, which is behind the opening of the cervix. Then, instead of bumping into the tampon, which is held firmly in place by the muscles of the vagina, it will slide past the tampon, which is much more comfortable.

However, some women have cramps no matter where the tampon is located. Alternatively, you can use pads or a menstrual cup. The Diva Cup takes a little getting used to (you’ve gotta be up close and personal with your lady parts) but rather than stopping at the cervix, it encircles it, eliminating any possibility of bumping and pain. The plus side of a menstrual cup is that it only needs to be changed every 12 hours, rather than 4-6.

Another reason women tend to tolerate pads or menstrual cups better is because most brands of feminine hygiene products contain preservatives and bleaching chemicals that can irritate the vagina, increasing the local levels of inflammation and causing pain. (More on inflammation in point #3). For this reason, I typically recommend keeping foreign objects out of the vagina and instead using external protection (pads), a menstrual cup (made from silicone), or organic tampons such as seventh generation, Rael, Tampax pure, or OB Organic.

3) Inflammation

When you have cramps What do you do?

If you handle it the way I did for many years, you pop an Advil, take a nap, and pray that you feel better in an hour. And, if you’re like me, it works.

That’s because napping and NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen both reduce inflammation in the body, and it’s inflammation that’s responsible for period pain.

The inflammation caused by a period comes from chemicals called prostaglandins, which are naturally produced in the lining of the uterus to trigger contractions during menstruation and labor. In addition the triggering muscle contractions, these prostaglandins also create low-grade inflammation , which is perceived as pain in the pelvic area (i.e. cramps).

Whenever we have a localized area of inflammation, we have pain. This pain can vary in intensity, but in general, the higher the level of inflammation, the worse the pain is. That’s why bumping your shin on the corner of the bed hurts, but not as badly as breaking your leg would. The injury is much worse in the latter case. However, bumping your shin on the bed hurts more when you already have a bruise from doing the exact same thing the day before, or if you have a sore leg from running a marathon, or if your whole body is sore because you have the flu. That’s because in each of those cases, there is pre-existing inflammation in the body and the higher the level of inflammation, the worse the pain is.

The same is true with the localized inflammation in the uterus during menstruation. The naturally produced (and very necessary) prostaglandins in the uterine lining cause some inflammation, enough to produce mild cramping during the first couple days of a period. However, if there’s already a heightened degree of inflammation in the whole body, be it from chronic stress, poor nutrition, crash dieting, over-exercising, illness, or otherwise, the total amount of inflammation in and around the pelvis is higher. The higher the level of inflammation, the worse the pain is.

No matter the reason for the period cramps, whether due to a hormone imbalance, endometriosis, fibroids, or anything else, reducing the total amount of inflammation in the body will decrease the level of pain.

How to Naturally Reduce Inflammation

1. Acupuncture: this is probably my #1 recommendation for co-management of care with women’s health concerns in practice. Traditional Chinese Medicine is incredibly powerful in terms of its ability to help balance hormones, reduce stress, and decrease the inflammatory response.
2. Nutrition: Not eating enough, or enough of the right nutrients, can create imbalances that lead to heightened inflammation. Some of the most common nutritional deficiencies that predispose women to painful periods include omega-3 fatty acids, magnesium, and vitamin D. Talk to your doctor about having your levels checked.
3. Musculoskeletal Problems: Tight muscles are painful muscles, and if you’re dealing with chronically tight and painful muscles, that probably means you’re also dealing with high levels of inflammation in your whole body. I’m always amazed by how much better I feel when I rub epsom salt lotion into sore shoulders, massage out the knots in my neck with my acucurve self-massager, or stretching out on my foam roller.
4. Sleep: Poor sleep causes all kinds of problems, not just in terms of periods. Not getting enough sleep is interpreted by the body as a chronic form of stress, and pretty much all other health efforts will be blunted if you’re not sleeping enough. Adults need 8-10 hours per night.

In general, it’s not normal to feel awful during your period. While I’m a firm believer that menstruation is a natural process (and therefore it’s normal to feel different at different times of the month), but if your period is getting in the way of your ability function, that’s not okay. You deserve to find out what’s going on so you can feel your best and live a fulfilling life.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post 3 Reasons for Painful Periods (and Natural Treatment) appeared first on Dr. Alexandra MacKillop.

Maybe you can relate: for most of my life I preferred not to think about my period very much. I found it to be inconvenient and, at times, embarrassing. (We’ve all been there…) Once I got married, though, I started paying more attention to everything going on in relation to my cycle. At first it was for family planning purposes, but I slowly started to notice cyclic, predictable changes in my body that had nothing to do with “that” time of the month—energy levels, hunger patterns, motivation, introversion versus extroversion, and more. I found it super fascinating, especially when I started comparing those changes to the hormonal patterns I’d learned about in school.

In the same way that gentle nutrition practices have helped me build trust with my body, learning about my cycle in a more personal way (rather than just reading a textbook) has helped me manage my health more confidently. It feels so good to know that everything is working as it should, and what to do if something seems amiss. If you’re interested in learning about that too, this post is for you! (Want to go deeper Check out my book, Go with Your Flow: a revolutionary guide to better periods, balanced hormones and a cycle that works for you)

Hormones and the HPATG Axis

If you’ve read my post about the hypothalamic-pituitary-adrenal-thyroid-gonadal axis, or HPATG axis for short, you’ll remember that our monthly cycles begin and end in our brains. Part of the brain called the hypothalamus sends hormonal signals to the pituitary gland, triggering another hormone cascade that tells our reproductive organs what to do, and when. Although different circumstances can interfere with that communication axis, for the most part, the hormonal pathways work like this:

The main signals sent out by the pituitary gland are luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These hormones travel through the blood stream to the ovaries, stimulating the production of estrogen and progesterone. These four hormones rise and fall in predictable patterns throughout the menstrual cycle to trigger ovulation, thicken the endometrial lining, and shed unused tissue if pregnancy doesn’t occur.

The menstrual cycle is divided into two main stages: the follicular phase and the luteal phase. Within those two phases we have two pretty noteworthy events (ovulation and menstruation), so I like to think of the cycle as having 4 phases, beginning with the first day of your period (cycle day 1 [CD 1]). Although the length of normal cycles can range anywhere from 21 to 35 days, most textbooks use a time frame of around 28 days, so that’s the reference range I’ll be using in this post.

• Phase 1 (Menses [Cycle Days 1-7]): This is probably the part of your cycle you’re most familiar with: your period. When counting the days of the menstrual cycle, we count the first day of the cycle as the first day of a period. Some women experience light spotting in the days leading up to their period, but those days are counted as part of the luteal phase (phase 4). Cycle day 1 (or CD 1) is counted as the first full day of bleeding. Technically, the days of your period fall within the follicular phase, because they start the beginning of the hormonal processes that lead to menses in the following month’s cycle. In terms of your hormonal cycles, the formal end date of your period doesn’t matter so much as the first day of bleeding.
• Phase 2 (Follicular Phase [Cycle Days 1-13]): During this phase (yes, even starting on the first day of your period), your body is starting to prepare for next month’s period—or a possible pregnancy. The first day of the follicular phase, CD1, is the day when hormone levels are at their lowest. Estrogen and progesterone are at their minimum, and follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are laying low, too. Over the course of the first week, FSH levels slowly start to rise, stimulating ovaries to slowly ramp up production of estrogen. The estrogen circulates throughout the body playing a number of different roles, but the most noteworthy action in terms of fertility takes place locally, at the ovary. When estrogen levels begin to rise, about 12-18 ovarian follicles start to ripen. Eventually, most of these follicles die off, and just one finishes the maturation process, an event that corresponds to the day when estrogen is at its highest. Estrogen production peaks at around days 11-13, then sharply falls. The pituitary gland senses this drop in estrogen through a feedback loop. Its response is to send out a surge of FSH paired with an even stronger surge of LH to trigger ovulation.
• Phase 3 (Ovulation [Cycle Day 14]): On the day of ovulation, the sharp rise of FSH and LH stimulate the mature ovarian follicle to burst open, releasing the egg. The egg travels down through the fallopian tube, and if unfertilized, dissolves within 24-36 hours. What’s left of the follicle collapses, becoming the corpus luteum, and begins producing progesterone which is the dominant hormone of the luteal phase.
• Phase 4 (Luteal Phase [Cycle Days 14-28]): After ovulation, FSH and LH levels drop back down again, and hormones in generally reach another realative low. Beginning with the day of ovulation, however, the corpus luteum takes over hormone production, secreting progesterone and some estrogen, which thickens the uterine lining to prepare for a possible pregnancy. Progesterone levels peak at about CD 21, followed by a gradual decline of both estrogen and progesterone. (Eventually the corpus luteum breaks down into the corpus albicans, ultimately dissolving completely.) When the hormones levels bottom out, the menstrual lining begins to slough off and the cycle starts all over again.

Getting to know YOUR cycle

In my experience, women typically express an interest in their cycle when they start the process of trying for a baby. While unprotected intercourse technically could lead to a pregnancy at any point in the follicular phase depending on each individual woman, there are really only 5-7 days each cycle that conception is really possible. These days correspond to the 5 days leading up to ovulation, the day of ovulation itself, and then the day after ovulation.

Fertile Days

These fertile days really depend on the lifespan of sperm. The actual union of sperm and egg can only take place on the day of ovulation and the 24-36 hours thereafter, until the egg dissolves. Sperm, however, can live up to five days in the uterus and fallopian tubes, waiting around for the egg to be released. In a 28 day cycle, these fertile days would correspond to CD 10 through CD 15. Having unprotected sex on any other day corresponds to a very, very, very low chance of conception, and this awareness serves as the basis for Fertility Awareness Methods of family planning.

But of course, not every woman’s cycle lasts the textbook length of 28 days. In order to get to know you and your cycle, there are a number of personalized methods you can use. I explain these in detail in my book, Go with Your Flow, but here is an overview:

Cycle Tracking Method #1: Hormone Testing

At-home urine hormone tests can be used to predict and confirm ovulation, and they’re pretty inexpensive. The testing procedure involves placing a urine dipstick into a sample of urine. If the hormone target is present in the urine, it will react with a reagent and bind to a dye strip—similarly to a home pregnancy test.

Ovulation predictor test strips qualitatively measure levels of luteinizing hormone in the urine, and generally show a pale pink line on most days of the follicular phase. On the day of LH surge, the test strip will turn dark pink, indicating a sharp increase in the level of LH. This LH surge means that ovulation will likely take place within the next 24-48 hours. (Note: LH typically peaks between midnight and 8:00 am, so the first morning urine tends to catch the LH surge better than other times of day.)

Affiliate Link: Ovulation Test Strips (LH)

In a small percentage of women (particularly those with PCOS), the pituitary gland sends out a surge of LH, but the follicle fails to release an egg. Because of this, many women prefer to confirm that ovulation has taken place by testing for progesterone metabolites in the urine. During the luteal phase, as progesterone production ramps up, so do the levels of the breakdown products detectable via urine test strips.

Progesterone test strips function similarly to ovulation predictor kids, except in reverse: a second pink line showing up (in addition to the control line) indicates a negative test, and the absence of a line indicates a positive. (Note: progesterone test kits typically recommend testing the first morning urine.)

Affordability: Good. LH test strips each cost less than 50 cents each, but the downside (especially with ovulation predictor kits) is that you need to test every day—sometimes multiple times per day. (Progesterone test strips are a little pricier.) If you have no idea when you might be ovulating, using these strips regularly, or for multiple months in a row, can add up.

Ease: Excellent. Open, dip, read, move on.

Validity: High. The test is either positive, or it isn’t. When both the LH and progesterone tests are positive in a given month, there is a near-perfect likelihood that ovulation has taken place.

Accuracy: Pinpointing ovulation with urine test strips is not really possible. The LH surge simply means that ovulation will take place sometime in the next day or two. Progesterone test strips mean that it has taken place sometime in the week, give or take. Using urine strips alone would not be considered a reliable way to prevent pregnancy if you are tracking your cycle for contraceptive purposes.

Cycle Tracking Method #2: Basal Body Temperature

If you look back at the chart at the top of the post, you’ll see that the very top line corresponds to body temperature. Sometime throughout history, women realized that the menstrual cycle creates predictable changes in basal body temperature (BBT)—our core body temperature while at rest.

Throughout the follicular phase, our BBT is at its low point. The day after ovulation, it takes a sharp rise, usually of more than 0.2 degrees. This temperature rise is sustained until a few days before your period, when it slowly drops back down again. After tracking your BBT for a few cycles, you’ll have a pretty good idea of when you ovulate and when to expect your period, which can be helpful whether you’re trying to conceive, or altogether avoid pregnancy.

Affordability: Excellent. However, measuring BBT requires a more precise measurement than most at-home thermometers are capable of. In order to offer the level of precision needed for accurate monitoring, the thermometer needs to read more than two places past the decimal point. Thankfully, this method is popular enough that BBT thermometers are extremely affordable—less than $10. [Affiliate link: Basal Body Temperature Thermometer]

Ease: Medium. Basal body temperature readings are only valid if they are taken first thing after waking up, even before getting up to use the bathroom, get a drink of water, or anything else. The reading also must be taken after at least 3 hours of uninterrupted sleep. If you’re a restless sleeper, struggle to remember to take your temperature, or snooze abuse, this method might not be right for you.

Validity: Medium. BBT can easily get thrown off from things like illness, alcohol, sleeping next to a warm person, or even temperature changes in your bedroom. But when the conditions are right, BBT charting can be highly effective.

Accuracy: When done correctly, BBT charts are a highly accurate method for tracking fertility. The post-ovulatory temperature rise is a pretty clear indication that ovulation has successfully taken place.

An additional benefit of this method is that sometimes it can serve as an early method for detecting pregnancy. Many women experience an “implantation dip” about 6-12 days after ovulation, when the temperature drops around 0.3 degrees, and then rises back up again. If the temperature remains high and doesn’t start to drop off, as is the case before menstruation, this usually is an indicator of pregnancy, sometimes even earlier than a home pregnancy test.

Cycle Tracking Method #3: Tracking Cervical Mucus

This method is the most…intimate of all. It requires that you get really comfortable with yourself and your anatomy.

Vaginal discharge (AKA cervical mucus) is a normal part of female health. Significant changes in color or odor can indicate infections, but outside of these instances, clear, white, or pale yellow discharge is a predictable part of being a woman. Throughout the cycle, the texture and color of cervical mucus changes in predictable patterns:

To accurately assess your cervical mucus, you can wipe your vaginal area before urinating, and observe the tissue. Alternatively, with clean hands, you can insert a finger or two slightly inside your vagina and observe the color and texture of the mucus between your fingers.

On days when cervical mucus is scant, fertility is low, meaning pregnancy is highly unlikely. But on days when cervical mucus is more abundant, and especially when watery and stretchy in the days leading up to ovulation, fertility and chances of conception are very high. Typically in the few days leading up to ovulation, cervical mucus will become clearer and more abundant, resembling raw egg white. Not only do these days signify pending ovulation and a time frame in which sperm can survive, but the egg white cervical mucus (EWCM) actually serves to promote sperm survival. It contains high levels of water and nutrients, promoting sperm fertility as well as a nutritious environment to help them traverse the journey up through the fallopian tube to wait for an egg. If you’re trying to conceive, the days you notice EWCM are the days you and your partner should focus on physical intimacy.

Affordability: Excellent. All you need are your own two (clean) hands and/or some toilet paper.

Ease: Medium/Low. This method of cycle tracking requires a degree of personal intimacy and comfort that the other methods don’t. Learning how to differentiate among the different textures and quality of cervical mucus can also be really challenging during the first few months. It’s not as cut-and-dry of a method as taking your temperature or using a test strip.

Validity: Medium. The results are mixed with this method, as not all women follow quite the same patterns. For example, some women may produce low amounts of EWCM, making it difficult to identify fertile days.

Accuracy: Medium. When EWCM is present, chances of conception are high. However, for women trying to avoid pregnancy, tracking cervical mucus alone may not be sufficient to identify fertile days.

Cycle Tracking Method #4: Symptom Spotting

I’m listing this method last because it really shouldn’t be used as a method for pregnancy prevention, or even timing intercourse for conception. However, paying attention to your internal, bodily signals at different times of the month can give you valuable insight into your own body’s needs, informing your self-care routine throughout the month.

Menses: Letting Go

Most women tend to feel lethargic and less social during the first few days of their periods. Looking back at the rise and fall of hormones throughout the cycle, this totally makes sense. Estrogen and progesterone are at their all-time low during the first few days of your period, and low levels of these hormones are known to correspond to feelings of anxiety, depression, and fatigue.

I used to find these low-energy feeling extremely inconvenient, but as I gained knowledge of and trust in my body, I slowly came to recognize that things go so much better when I accept my natural design instead of trying to battle against what my body is doing. Menstruation is a natural part of life as a woman, and when I set aside my pride, I can see that this natural time of release and letting go can be really healthy depending on how I respond.

Many women (myself included) find that symptoms like cramps and breast tenderness are less severe when I accept my body’s invitation to slow down and rest. I tend to naturally feel more introverted and tired during the first few days of my period, and I’ve realized that I feel so much better if I don’t push myself to perform or be social, and take it easy with exercise. Instead of focusing on my productivity, I try to use this time to relax, reflect, and let my body go through its own process of restoration.

Follicular Phase: Estrogen for Energy

On a biochemical level, estrogen is an energizing hormone. As levels start to rise during the follicular phase, we tend to feel motivated, energetic, and productive. I personally find that intense exercise feels really good in my body throughout days 5-15 of my cycle, and I’m madly efficient when I work on things (like writing this monster of a blog post, for example…)

I also find that I’m much more willing to get things done around the house, participate in trips and social events, and tie up loose ends at work. While I don’t necessarily go so far as to make special plans during this time, the knowledge that I’m not always so energized allows me to have a little more grace on myself when I realize that my hormones have such a profound affect on that areas of my life.

Ovulation: Transition

I personally don’t notice any remarkable changes in my body or mind during ovulation, but many women report slight cramping (mittelschmerz), breast tenderness, or light spotting on the day leading up to or day of ovulation. This can serve as another means for tracking your fertility if you find yourself with these sorts of symptoms.

Luteal Phase: Rest and Restore

Progresterone is the hormone responsible for PMS symptoms. As the corpus luteum starts to ramp up its secretion of progesterone, levels of fatigue, breast tenderness, cramping, irritability, and bloating tend to follow suit if stress levels also remain high. Digestion slows way down, electrolyte levels fluctuate (leading to water retention), and mammary tissue starts to develop in the event of a possible pregnancy—leading to swelling and tenderness.

As with the first days of my period, I tend to feel sluggish, tired, and sore during the last few days of my luteal phase. By tracking the symptoms of my own cycle, I’ve come to recognize that feeling slow and tired during exercise, mild tension headaches, and a predisposition to feel a little more introverted is normal for me. While I find these things to be a little inconvenient, they aren’t debilitating, and I generally feel pretty good when I respond appropriately to my body’s signals for rest. As it says in Ecclesiastes chapter 3, “For everything there is a season, a time for every activity under heaven. A time to be born and a time to die, […] A time to tear down and a time to build up. A time to cry and a time to laugh.”

To sum things up…

The female body is an incredible, awe-inspiring creation. I am truly amazed every time that I sit down and study the details of hormonal balance, the delicate web of connections between our hormones and our bodily systems, and the amazing miracles of pregnancy and birth. The beautiful, graceful way that everything works together inspires a deeper sense of respect for everything that my body is—and isn’t—and drives me to take self-care seriously so that I can continue to live a healthy, vibrant life. How about you?

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

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