In this article, I discuss common questions about the menstrual cycle. This includes issues like constipation or diarrhea before periods, menstrual cramps, and irregular periods.
This article is for informational purposes only and should not replace medical advice.
I’m a body worker specializing in reproductive and digestive health, so I’m writing from an anatomy and physiology background. Plus, I’ve had my period every month for the last 32 years. That’s about 384 periods! I’ve learned a lot during this time. Yes, I’ve bled on and off for around 2,000 days, and I’m still alive and happy to have my periods!
#1 Let’s start with the question, “Where the heck is my uterus?” I know you might have a general idea of where your uterus is. However, please don’t skip this explanation. It’s essential to understand your body and how it functions to care for it properly. Knowing where your uterus and ovaries are and what they look like deepens your connection to your body and its messages. Watch the video explanation of ‘Where the Heck Is My Uterus and Ovaries’
#2 “How often should I bleed?” This is an excellent question! Your first periods may be irregular. You might have long gaps without menstruation because your body is still developing. Your cycles may vary for a while, but they should usually be in the 21-45 day range in those first years after menarche (the onset of menstruation). If your cycle is significantly different from normal and you experience other symptoms, consult with your parents. They can help you set up an appointment with a Nurse Practitioner or a Gynecologist. A Gynecologist is a doctor who specializes in female reproductive health. Once your body starts to ovulate (release an egg from your ovary) regularly, a typical cycle (from the first day of your period to the day before your next period starts) is usually anywhere between 21 and 35 days for most women. If your cycles are shorter (every 26 days or less), you should check your iron levels. Shorter cycles mean more periods, which can raise your risk of anemia. It’s essential to establish what is normal for you, so you may want to start keeping track using a period app.
Some girls who have late-onset ovulation may take 8-12 years to establish regular cycles! Your body needs time to mature. The hormones that your ovaries produce are not only crucial for reproductive health but also for brain, bone, skin, and breast health.
#3 “How long should my period last?” Typically 3-7 days.
#4 “Why do I get constipated before my period?”
Progesterone is a hormone that, amongst many things, has muscle-relaxant properties (3). Progesterone is at its highest level during the second half of the cycle, which may affect the motility of your colon at that time, slowing down peristalsis (the wave-like movement of the colon). This doesn’t mean that progesterone is to blame for your constipation. Progesterone is beneficial and has numerous advantages. The natural ebb and flow of progesterone alone (when in balance with other hormones) wouldn’t be enough to cause constipation; otherwise, every woman would get constipated leading up to their periods, and that’s not the case!
Another possibility of constipation right before your period may be a retroverted uterus (tipped back). The uterus can increase in volume right before menses, so if it’s pressing against the rectum (the poop chute), it can narrow the poo’s pathway, causing constipation or thinner stools (see image). There are many degrees of retroversion, and sometimes a retroversion doesn’t cause any issues. The problem is when it’s severely retroverted or flexed and has lost its mobility (it’s stuck in place by adhesions), affecting surrounding organs and blood flow. Fibroids and adenomyosis can make matters even worse with retroversions since both of these conditions make the uterus heavier.
#5 “Why do I get diarrhea when I start my period? Not everyone gets diarrhea (A.K.A. poop smoothie) with their period. Again, it’s a sign that there’s an imbalance. Your body is trying to tell you something! Symptoms are messages from your body, and the diarrhea message is NOT that you are deficient in Pepto Bismol! Poop smoothies at the start of your period may have to do with the natural drop in the hormone progesterone. Again, the drop is natural, but it shouldn’t cause Hershey’s Squirts alone. Most likely, your back door trots are related to inflammatory prostaglandins (compounds with hormone-like actions). Excess inflammatory prostaglandins can cause menstrual cramps and diarrhea. So, eliminating foods that cause inflammation is the first step. The main inflammatory culprits are dairy (especially A1 dairy), sugar, coffee, wheat, and vegetable oil. If eliminating these items seems overwhelming, start by picking one thing at a time to eliminate. I suggest ditching the sugary coffee drinks (if that’s your thing), which usually contain three of the ingredients you want to avoid! I promise you that once you break the coffee and sugar habit, you’ll have more energy and feel a ton better. If you love the coffee flavor, try replacing your usual sugary coffee beverage with half decaf, then full decaf, and replacing the sugar and cream with grass-fed butter, collagen powder, and two drops of flavored liquid stevia. I know it sounds weird, but try blending it up and let me know what you think. The second thing you can do is replace the vegetable oil with coconut oil, ghee, or butter from grass-fed cows. If you think “replace” instead of “remove”, you most likely won’t miss the food that’s been replaced. Now, if replacing one or two of the inflammatory foods doesn’t eliminate your cramps, it doesn’t mean that it’s not making a difference; it just means that it’s only part of the problem, or you haven’t given it enough time. Everything you do and don’t do now can affect your subsequent three periods!
#6 Do I even need a period? The “period” (shedding of your uterine lining) is a part of your hormonal cycle. Ovulation is also a part of the cycle that coincides with periods. If you ovulate, you need to bleed (unless you become pregnant). So, the question should be “Do we need to ovulate?”. The answer is yes. Without ovulation, you wouldn’t make enough estrogen or progesterone. “During bone growth, estrogen is needed for proper closure of epiphyseal growth plates both in females and in males.” (2) By the way, your bone density is developing for the first 25 years of your life, so please don’t interrupt the process by taking synthetic hormones! Estrogen and Progesterone also affect the brain, heart, skin, and other tissues of the body. Again, that’s why I’m not a fan of “regulating your cycle” with birth control pills, especially when your body is still maturing. Birth control pills don’t fix or regulate your cycles; they halt the natural process altogether! If you’re thinking about going on hormonal birth control, please first read Holly Grigg-Spall’s Book Sweetening The Pill. The book inspired the making of a documentary Sweetening The Pill, check out the trailer below.
#7 What does the moon cycle have to do with my cycle? I wrote about the moon, menstrual cycles, and natural light exposure in the article Moon Cycle and The Menstrual Cycle.
#8 Does uterine position matter? The short answer is, “it depends”. The uterus is supposed to move in many directions; the problem is when the uterus is stuck in any one position. The uterus must be mobile to function correctly. When the uterus is fixed in one position, fibrosis of the ligaments can occur, resulting in impaired local circulation. When circulation is impaired, cells do not receive proper nutrients or oxygen, and pain and dysfunction will follow. Some symptoms of an immobile uterus may be:
- painful and/or irregular periods
- back, hip, leg, pelvic, and/or abdominal pain
- hemorrhoids/varicose veins
- hormonal imbalance and fertility challenges
- irritable bladder
- constipation, especially with a retroverted uterus
The good news is that there are ways to prevent and correct a “tipped” uterus. For more information, refer to the following articles: Uterine Mobility and Retroverted Uterus. And watch the video below for details on why your bladder doesn’t like an anteflexed uterus:
#9. Why does my back hurt during my period, and what can I do about it?
#10 Why are my periods so heavy, and what can I do about it? There can be many reasons for heavy periods, so identifying the cause is the first step in managing them. Talk to your ND, doctor, Nurse Practitioner, or other women’s health specialist. That said, many women think they have heavy periods when they technically don’t. So, first identify if you do in fact have a heavy period. A regular tampon holds about one teaspoon of blood (5 ml). Soaking 16 or more tampons during a menstrual cycle would be considered excessive bleeding. The average 30-40 ml blood loss would soak between six and eight regular tampons. A “super” tampon can hold 10 ml of blood; therefore, eight or more soaked “super” tampons would be considered excessive.
Remember, as a teen, some of the causes in the article might not apply to you. Your endocrine system may not be fully developed yet. The treatment plan will depend on the cause and the person involved. If your doctor doesn’t find a reason for your heavy bleeding, here are some general guidelines that may help:
- Maintain healthy blood sugar levels,
- Improve uterine tone by learning abdominal massage,
- Incorporate foods high in Vitamins A, B, and C.
- Get your iron tested
- There are also excellent herbal teas to help tone the uterus and reduce flow. I recommend consulting with a herbalist and inquiring about nettle infusion, yarrow tea, and cinnamon to help slow bleeding.
Source 1 Menstruation in young girls: A clinical perspective.
Source 2 Estrogen and Bone Metabolism
Source 3 Effects of progesterone on motility and prostaglandin levels in the distal guinea pig colon
Author: Barbara Horsley has more than 26 years of experience as a licensed massage therapist. She specializes in abdominal massage and Visceral Manipulation™ and is an NCBTMB-approved educator. In addition to being certified in abdominal massage, she also studied biomechanics and restorative exercise. She is also a Certified Women’s Herbal Educator and a graduate of the IWHI Perimenopause & Menopause Certificate Program.