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Women's Health - Menstrual Irregularities

Common Causes of Menstrual Irregularities: Understanding the Factors Behind Menstrual Changes

In addition to pregnancy or menopause, which typically result in the cessation of menstruation, here are the other primary factors contributing to Menstrual Irregularities (irregular periods or amenorrhea):

1. High Stress Levels

Chronic stress can lead to a disruption in the body's reproductive system, resulting in the suppression of ovulation as a means of conserving energy. Traumatic events can trigger excessive adrenal activity, affecting the production of estrogen and other reproductive hormones, leading to hypothalamic amenorrhea. With reduced estrogen levels, the uterine lining fails to develop adequately, causing menstrual irregularities or absence of periods.

The reason behind this mechanism lies in the body's prioritization of emergency responses. While comfort and fertility are essential, survival takes precedence. The body's ingrained survival mechanism continuously produces stress hormones like cortisol and adrenaline to handle threats, real or perceived. These hormones are crucial for fight-or-flight responses, but excessive production can lead to complications.

​During chronic stress, the body allocates resources to produce stress hormones over sex hormones. Insufficient raw materials, such as amino acids for neurotransmitter functioning, might force the body to choose stress hormones over reproductive hormones. Various stress-inducing conditions, including strict dieting, intense exercise, or emotional upheavals, can trigger amenorrhea, irrespective of body weight loss.

2. Poor Diet

A nutrient-poor diet, lacking in antioxidants and probiotic foods while being high in stimulants, can strain the adrenal glands and thyroid. Thyroid issues and adrenal fatigue, accompanied by elevated cortisol levels, are associated with excessive consumption of sugar, hydrogenated fats, artificial additives, and pesticides.

Elevated cortisol levels can disrupt the functioning of crucial hormones, including sex hormones, and lead to the degradation of bones, skin, muscles, and brain tissue over extended periods. This cycle of excessive cortisol may cause protein breakdown, resulting in muscle-wasting and potential osteoporosis.

To address menstrual struggles, ensure an adequate and appropriate diet. Opt for nutrient-dense foods with high antioxidant content, including sufficient amounts of beneficial fats (including saturated fats) and proteins. If underweight, low in body fat, or an athlete, consider a high-calorie supplement to meet your nutritional needs.

3. Extreme Weight Loss and Low Body Weight

When your BMI drops below 18 or 19, insufficient body fat can lead to menstrual irregularities due to reduced estrogen production. Women with extremely low body weight, as seen in cases of anorexia or bulimia, may experience absent or missed periods. Intensive physical activity and the nutritional demands of vigorous exercise can also result in low body weight, putting individuals at risk for hormonal issues.

Following a low-calorie, low-fat diet can contribute to nutrient deficiencies and decreased body-fat percentages, further impacting menstrual regularity and potentially causing bone loss. Some reports suggest that very lean vegans and vegetarians, including those on fully "raw" diets, might face a higher risk due to a greater likelihood of becoming underweight and experiencing deficiencies.

4. Over-Exercising

While moderate exercise is crucial for heart health, mood regulation, sleep, and maintaining a healthy body weight, excessive exercise can strain the adrenal, thyroid, and pituitary glands. Engaging in rapid and intense exercise, such as training for marathons or major events, can lead to sudden cessation of menstrual periods in women.

Cortisol, like other stress hormones, is released in response to physical or emotional stressors, including overworking, overtraining, lack of sleep, fasting, infection, and emotional distress. The pressure to stay thin and fit can drive some women to excessively exercise and sweat too often throughout the week, which can increase stress and deplete energy required for regulating sex hormones.

Studies show that activities like running and ballet dancing are closely linked to amenorrhea, affecting a significant percentage of women in these fields. Shockingly, amenorrhea rates are high among female bodybuilders as well, with many having nutritionally deficient diets. "Exercise-induced amenorrhea" is particularly common among young women, given the substantial increase in female participation in high school athletics over the past 30 years, coinciding with a rise in hormonal imbalances.

This condition can indicate an overall energy drain and may be associated with bone density loss and eating disorders. Addressing skeletal issues, heart complications, and nutritional deficiencies in this population is of utmost importance for physicians.

5. Thyroid Disorders

Your thyroid might be an unexpected culprit behind your hormonal imbalances. Reports indicate that thyroid disorders are a significant factor in missed periods, affecting around 15 percent of amenorrhea patients. As a vital controller of the endocrine system and metabolism, the thyroid gland has a substantial impact on various sex hormones.

Thyroid disorders, such as hypothyroidism or hyperthyroidism, can lead to symptoms like altered estrogen and cortisol levels, resulting in missed periods. Excessive cortisol in the body can cause hormone resistance, including thyroid resistance, necessitating higher hormone levels to perform their functions effectively.

6. Stopping the Birth Control Pill

While some women intentionally stop getting their period while on birth control, their periods may not return even after discontinuing the pill. While doctors suggest that periods should readjust and return within a few months, many women experience missed or irregular periods for an extended period.

The natural menstrual cycle involves fluctuating levels of estrogen and progesterone, but birth control pills maintain a sufficiently high estrogen level, tricking the body into a "pregnant" state and causing irregular periods. It can take the body several months or even years to correct this and restore hormonal balance.

According to a report in the American Journal of Obstetrics and Gynecology, approximately 29 percent of women experience missed periods for more than three months after stopping the pill. As a result, some may choose to avoid birth control pills altogether.

7. Ongoing Hormonal Imbalances and Disorders

Polycystic ovarian syndrome (PCOS) disrupts ovulation due to hormonal imbalances in women. Altered levels of sex hormones, including estrogen, progesterone, and testosterone, can lead to various symptoms such as abnormal body or facial hair growth, weight gain, blood sugar issues, acne, and irregular menstrual cycles. Gynecologists can diagnose PCOS by assessing hormone levels, reviewing symptoms and family history, and possibly conducting ovarian examinations for cyst growths.

In some cases, women may experience "premature menopause" before the age of approximately 40, resulting in missed periods, hot flashes, night sweats, and vaginal dryness. However, this is a less common cause of irregular menstruation.

8. Food Allergies and Sensitivities

Undiagnosed gluten sensitivity or celiac disease can significantly influence hormone levels. These conditions can lead to nutrient deficiencies, disrupt gut health, and induce chronic stress on the adrenal glands, ultimately affecting the production of sex hormones.

Restoring Hormonal Balance: Reclaiming Your Menstrual Cycle

A woman's hormonal health is influenced by various factors, including her diet, stress levels, relationships, exercise habits, and environment. It is essential for women to honestly assess how each aspect of their lifestyle impacts their health to address any irregular periods effectively.

If you have been experiencing missed periods, it is crucial to consult with your doctor and undergo essential tests. Recommended laboratory examinations include measurements of follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), and prolactin. Additionally, your doctor will rule out pregnancy and assess for signs of PCOS and early menopause, considering weight changes, acne, hair growth, and other indicators related to changes in androgen hormone levels.

Experts often propose a three-tier treatment approach for restoring periods and improving hormonal health, starting with appropriate diet, lifestyle adjustments, and stress reduction.

When seeking additional support, explore the use of natural herbs and remedies first. If necessary, consult a healthcare provider and cautiously consider hormonal pills or procedures. Implement lifestyle changes, such as:

1. Reduce Stress

Combat stress and anxiety with natural lifestyle techniques, including light exercise, healing prayer or meditation, essential oils, journaling, and acupuncture or massage therapy. Although limited studies focus on acupuncture for amenorrhea treatment, some preliminary trials suggest it may benefit women with irregular menstrual cycles.

Consider incorporating adaptogen herbs like maca root, ashwagandha, and holy basil to promote hormone balance and protect against stress-related diseases. These adaptogens aid immune function and combat the negative effects of stress, with ashwagandha particularly beneficial for healing thyroid and adrenal fatigue.

Reevaluate intense competitive exercise, coffee consumption, and other stimulant use, as well as excessive work demands, lack of sleep, and exposure to harmful pollutants. Prioritize rest and sufficient sleep for optimal hormonal balance and overall well-being.

2. Improve Diet

Maintaining balanced hormones relies on consuming a diverse range of nutrient-dense foods. Ensure an ample supply of short, medium, and long-chain fatty acids, essential for hormone synthesis. Incorporate healthy fats from sources like coconut oil, nuts, seeds, avocados, grass-fed butter, and wild-caught fish such as salmon.

Probiotics play a role in vitamin production, affecting hormone levels like insulin. Consider incorporating probiotic-rich foods and supplements like goat's milk yogurt, bone broth, kefir, kombucha, and fermented vegetables to support hormone regulation.

3. Reassess Your Exercise Routine

Maintaining cortisol and stress hormone levels requires finding a balance in exercise, avoiding both excessive and insufficient physical activity. If you face menstrual issues, consider incorporating moderate, gentle forms of exercise to potentially alleviate the problem.

View exercise as a stress-reducing activity rather than solely for weight loss. Emphasize soft forms of exercise, such as walking, yoga, dancing, light resistance training, tai chi, or qi gong, to support gentle body movement. Engaging in 30-45 minutes of exercise most days can be beneficial, but exercising for over an hour daily or not allowing enough rest can trigger menstrual problems.

4. Stay Away From Environmental Toxins

To reduce toxins in your body, steer clear of conventional body care products containing hormone-disrupting ingredients like DEA, parabens, propylene glycol, and sodium lauryl sulfate. These compounds can affect estrogen production and potentially lead to thyroid and adrenal problems, so be vigilant in checking ingredient labels for skincare and household products. Opt for glass and stainless steel kitchen equipment and containers over plastic or Teflon whenever feasible to avoid BPAs, hormone disruptors, and other harmful chemicals.

Traditional Chinese Herbal Remedy for Dysfunctional Uterine Bleeding (DUB)

Menstruation is a unique process exclusive to women. During puberty, a woman's uterus matures, and her kidney essence becomes enriched. The kidneys produce a substance called Tian Kui (Heavenly water), promoting sexual functions. This substance activates the conception vessel and thoroughfare vessel meridians, causing them to be vigorous with abundant qi and blood. Consequently, excessive qi and blood flow into the uterus, leading to regular menstrual cycles.

However, as a woman ages, her kidney essence diminishes, and Tian Kui declines. This results in the gradual closure and obstruction of the conception vessel and thoroughfare vessel, leading to menstrual irregularities until menopause occurs.

Traditional Chinese medicine (TCM) holds that kidney qi plays a significant role in governing menstrual cycles. Dysfunctional uterine bleeding (DUB), characterized by irregular periods and excessive or prolonged menstrual flow, falls under the TCM category of "beng-lou," which refers to periods with sudden flooding or trickling for a long time.

TCM attributes dysfunctional uterine bleeding to various factors, including an unhealthy lifestyle, poor diet, lack of exercise, environmental influences, emotional or psychological issues, toxins, and hereditary influences. These factors weaken internal organs, disrupt blood and qi, and impair the conception vessel and thoroughfare vessel meridians, leading to uncontrollable menstrual flow.

Treating dysfunctional uterine bleeding in TCM can be challenging due to its involvement with multiple organ systems, as well as qi and blood dysfunctions, resulting in complex conditions. Early diagnosis and treatment are essential to prevent its progression into more severe and lingering consequences.

During a consultation for dysfunctional uterine bleeding, physicians inquire about specific bleeding characteristics, such as duration, interval, amount, color, and texture of the blood, along with accompanying symptoms. They also consider factors like age, medical history, and lifestyle. The remedies are tailored based on TCM disharmony patterns, guided by therapeutic principles, which are:

  1. Control bleeding and balance the meridians of the conception vessel and thoroughfare vessel.

  2. Address the root cause of disharmony by revitalizing the kidneys and restoring their regulation of menstruation.

  3. Reestablish a healthy uterine environment, normalize the menstrual cycle, and prevent future occurrences.

Herbal prescriptions for dysfunctional uterine bleeding

In cases of dysfunctional uterine bleeding, age, pregnancy, and delivery history play significant roles, influencing the body's changes and serving as essential considerations in identifying disharmony patterns. Adolescent girls commonly exhibit kidney deficiency or over-heated blood, women in childbearing age may experience liver stagnation or over-heated blood, while menopausal women tend to have liver and kidney deficiencies or spleen weakness and qi (vital energy) deficiency, often combined with blood stasis. The following are the common disharmony patterns associated with dysfunctional uterine bleeding.

Heat in uterus

Sudden heavy vaginal bleeding or continuous dribbling of dark red or thick-textured blood may be accompanied by additional symptoms like dry mouth, flushed face, dizziness, irritability, scanty urine, and dry stool. The tongue may appear red with a yellow coating, and the pulse could be taut and rapid. To address these symptoms, the remedy aims to clear heat, cool blood, consolidate the thoroughfare vessel, and stop bleeding.

The sample prescription includes a modification of Clear Heat and Consolidate Menstruation Decoction along with cattail pollen, carbonized hair, and motherwort herb.

Stasis in uterus

Irregular periods, persistent vaginal blood dribbling, or missed periods followed by sudden profuse vaginal bleeding characterized by dark-purplish blood with clots are common symptoms. Pain in the lower abdomen, often relieved after passing blood clots, may accompany these signs. The tongue may appear dark-purplish or have purple spots, and the pulse could be taut or hesitant. To address these symptoms, the remedy aims to activate blood, resolve stasis, consolidate the thoroughfare vessel, and stop bleeding.

The sample prescription includes Resolve Stasis and Stop Menorrhagia Decoction, along with cattail pollen and India madder rhizome (charred).

Damp-heat in uterus

Irregular periods, persistent vaginal blood dribbling, or sudden profuse vaginal bleeding may be accompanied by dark red or purplish-red, thick, and sticky blood. Excessive and foul vaginal discharges, along with pain and distention in the lower abdomen, thirst, general heaviness, and possibly fever, could also be present. The tongue may appear red with yellow and greasy coating, and the pulse could be rolling and rapid. To address these symptoms, the remedy aims to clear heat, resolve dampness, and stop bleeding.

The sample prescription involves a modified Three Wonders Sargentglory Vine-stem Decoction.

Qi deficiency failing to retain blood

Irregular periods that start with profuse vaginal bleeding and then transition to persistent vaginal blood dribbling may involve light and thin blood. Additional signs include paleness, puffiness, fatigue, shortness of breath, poor appetite, loose bowels, and sensations of emptiness and heaviness in the lower abdomen, as well as palpitations and general weakness. The tongue may appear pale, and the pulse could be thready and weak. The remedy aims to replenish qi, reinforce its ability to astringe blood, invigorate the spleen, and nourish blood.

The sample prescription includes Consolidation and Stop Menorrhagia Decoction along with Chinese yam, bugbane rhizome, and India madder rhizome (charred).

Kidney yin deficiency

Irregular periods, excessive vaginal bleeding, or persistent vaginal blood dribbling may involve bright red and thick blood. Additional signs include dizziness, ear ringing, warm palms and soles, irritability, lumbar and knee weakness, insomnia, night sweats, red cheeks, fatigue, weakness, and frequent urination. The tongue may have little coating, and the pulse could be thready and rapid. The remedy aims to nourish kidney yin, consolidate the thoroughfare vessel, and stop bleeding.

The sample prescription is a modified version of the Restore the Left (kidney) Pill, which excludes achyranthes root and includes glossy privet fruit and charred garden burnet root.

Kidney yang deficiency

Irregular periods, excessive vaginal bleeding, or persistent vaginal blood dribbling may involve light-textured blood. Additional signs include limb coldness, cold pain in the lumbar and knee regions, bright white complexion, profuse urination, and loose bowels. The tongue may appear pale and bulky, or exhibit teeth marks on the margin, and the pulse could be deep and thready, particularly in the chi region. The remedy aims to warm and invigorate kidney yang.

The sample prescription is a modified version of the Restore the Right (kidney) Pill, excluding aconite root and cassia bark while including astragalus root, morinda root, and epimedium.

After controlling the bleeding, intensive treatment should continue for three or more cycles. The consolidation therapy aims to restore normal kidney, spleen, and liver functions and establish a regular menstrual cycle. Physicians will tailor treatment based on age groups, invigorating kidneys and smoothing the menstrual cycle for adolescent girls, soothing the liver and nourishing blood while regulating the menstrual cycle and promoting ovulation for childbearing women, and invigorating kidneys and spleen while preventing recurrent bleeding for menopausal women. Menopausal women should also visit their western doctors regularly to rule out other health issues.

It is essential to note that menstrual disturbances can stem from various pathologies and may vary from person to person. The above patterns may appear alone or in mixed form and are subject to change over time, potentially transforming into each other. There is no one-size-fits-all therapy for dysfunctional uterine bleeding; each regimen is tailored to individual conditions and may require adjustments during the treatment course to suit changing conditions.

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