3 Period Problems Women Should Never Ignore (Heavy Bleeding, PMS, and Period Pain)

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0:42Gemini and Chrome is here for it. Ready to make anything online make sense? There's no place like Chrome. Check responses set up required, compatibility and availability varies 18+. there's one food that i recommend for hormone health across the board no matter your age diagnosis life stage i'm talking like if you're a teenager trying to conceive perimenopause menopause just cycling day-to-day postpartum doesn't matter and i'm going to tell you what it is and why it works in just a minute because today we're breaking down the three most common period problems I see over and over again. Heavy bleeding, PMS that's getting worse, and the dreaded period pain.

1:25And I'm not just explaining why they happen. I'm going to walk you through what actually works so you can start to get some relief today. And if you've been piecing together information from Instagram to Google and five different doctors who all gave you different answers, stay with me because at the end of this episode, I'm going to explain the one pattern that connects all three of these. Welcome to the Dr. Brighton Show. I'm your host, Dr. Jolene Brighton. I'm board certified in naturopathic endocrinology, a nutrition scientist, and a certified menopause specialist. And if you can take a minute to hit the subscribe button and leave me a review to help get this info out to all the women who need it, I'd appreciate it so much.

2:08But I don't want to hold up this episode anymore, so let's get into it. Now, before I tell you the food that I recommend across the board, we need to clear one thing up, and that is estrogen is not the villain. How your body processes estrogen and how much inflammation your entire system is carrying, that's where things get interesting, and that's where things get complicated, and that's where symptoms arise from. And that's why the one food I recommend across the board is broccoli sprouts. Not broccoli. Broccoli sprouts. Now, the reason is, is they are rich in sulferaphane. That's a compound that activates something called Nrf2, which is essentially the master regulator of your body's antioxidant and detox pathways.

2:56Okay, but what does that mean in plain English? It means that broccoli sprouts support how your body is metabolizing your estrogen. So when you use estrogen, you need to metabolize it, break it down, and get it out. So broccoli sprouts are going to support phase two detox. That's happening in the liver. They reduce oxidative stress, and they help modulate inflammatory signaling. And inflammation is deeply connected to heavy bleeding, PMS, period pain, all the things that we're covering today. So if you do nothing else, start with broccoli sprouts. One to two tablespoons of fresh broccoli sprouts daily, or you can do like a half a cup a few times per week.

3:37You can also take sulforaphane in a supplement form. Usually the label is going to say broccoli seed extract, but it needs to be coupled with mustard seed extract or myrosinase. And that is the way you're able to activate that sulforaphane. Now, let's talk about the first major period problem. If you are soaking through a pad or tampon every hour, that's not just a heavy period. That qualifies as abnormal uterine bleeding. It is not normal. And in a minute, I'll tell you the one lab most women aren't having checked by their providers, or if they are, that number is not actually normal versus what they're being told is normal.

4:21Now, when we go to our doctor for heavy bleeding, they often just say, take the pill, get an IUD. And they don't often explain that heavy bleeding is about endometrial overgrowth. And endometrial overgrowth is often about unopposed estrogen, which is very common in PCOS, perimenopause, and when we're dealing with chronic stress. Now, the endometrium, that's the lining of your uterus. Estrogen stimulates that uterine lining to grow, progesterone opposes estrogen helps stabilize it. If you ovulate consistently, then progesterone rises in the second half of your cycle and tells the lining, stop growing, mature, prepare to have a baby implant or get ready for your period.

5:07But if you're not ovulating consistently, which is common again in perimenopause, when we have chronic stress, we can see this in insulin resistance and thyroid dysfunction. It is one of the hallmarks and one of the criteria you have to meet to get diagnosed with polycystic ovarian syndrome or PCOS. And if you have any of those conditions or you're not ovulating, you can have estrogen stimulation without adequate progesterone balance and that's called relative estrogen excess, what has also been termed estrogen dominance. So the lining keeps thickening. More lining means a heavier period. And then there's a second layer to this, is that even though your estrogen level isn't high, like on the lab, it doesn't look high, if your body isn't metabolizing estrogen efficiently or you don't have enough progesterone, you can still have excess tissue stimulation.

6:07So this is where liver detoxification and gut clearance matter because estrogen is metabolized in the liver, excreted through the bowel and the urine. So if detox pathways are not supported, bowel movements are infrequent, there's gut dysbiosis, estrogen can recirculate and that increases total estrogen load. So now that you understand that, let's talk about what actually helps. So number one is we need to support ovulation. So progesterone is protective. If you're late stage perimenopause, it may be time to start progesterone hormone therapy. I have episodes. I'll link them in the show notes all about that.

6:44But if you're in your reproductive years, you have to ovulate to make enough progesterone. And blood sugar instability, so insulin resistance, this can interfere with ovulation signaling. This is especially true for those with PCOS. So there's going to be more tips today that can help support ovulation in this episode. But one thing you can do, make sure you have a strong breakfast. 30 grams of protein, getting yourself 5 to 10 grams of fiber, that's going to help stabilize insulin. It's going to support your body with consistent ovulation. Consistent ovulation protects the lining of your uterus.

7:22Now, the second thing we can do is support estrogen metabolism. So we want to get progesterone up to oppose the estrogen. We want to break down estrogen and make healthy metabolites. This is where broccoli sprouts come back in. Sultheraphan activates phase two liver detoxification enzymes. This is going to shift estrogen metabolism towards more favorable pathways. So we have our two, our four, our 16 hydroxy estrogen. We want to be more towards the two. That's less proliferative signaling, less tissue overstimulation, and I prefer to use a trifecta of DIM, sulforaphane, and calcium deglucarate to help estrogen not just through the liver but clear it through the bowels as well.

8:08That's why I put those three in my Balanced Women's Hormone Support Formula. Now we're helping make estrogen metabolites but we also want to support clearing it. Daily bowel movements matter. Fiber matters. Hydration matters. So if estrogen is metabolized by the liver but not eliminated, it recirculates. So it can be reactivated, put back into circulation. So you can do some simple things like add fresh ground flax seeds to your diet. Maybe you start seed cycling. I'll link a resource in the show notes for that. Eat more cruciferous vegetables during the week. Eat soaked chia seeds, raspberries are an excellent source of fiber.

8:49Eating fiber-rich foods that can help you hit that minimum threshold of 25 grams of fiber a day will support elimination of estrogen you no longer need. And by the way, I do have a free meal plan and recipe guide at drbrighton.com slash plan. It helps you hit your fiber and your protein goals in case you need support in that arena. I designed the plan around perimenopause weight loss goals, but the reason it works for that is because it helps optimize key hormones. So that's drbrighton.com slash plan, D-R-B-R-I-G-H-T-E-N.com slash plan. Now, another avenue we want to go in helping with heavy periods is modulating inflammation.

9:34So inflammation and prostaglandins go hand in hand. Prostaglandins increase uterine contractions and can increase bleeding intensity. So this is where omega-3 fatty acids matter. They compete with potent prostaglandin builders. So you make prostaglandins, these hormone-like chemicals, from omega-3 or omega-6. The more omega-6 you have, the more potent the prostaglandins, the worse the bleeding, the worse the period cramps. So bringing in omega-3 rich foods into your diet. Cold water fish are definitely some of the best sources for that, can help shift prostaglandins in a positive way. So for women who are having heavy bleeding, painful periods, I typically recommend a high quality omega-3 fatty acid.

10:25A combination of like omega-3, 9, 11 is really excellent. And we want to aim for like 2 ,000 milligrams a day with a combination of EPA and DHA, so we're supporting our brain as well. Now, the lab your medical provider shouldn't miss with heavy periods is ferritin. Heavy bleeding depletes iron. Low ferritin worsens fatigue, hair loss, and cycle dysregulation. Optimal ferritin for many women is above 50. Below 30 is commonly labeled as normal, and some labs won't even call it a problem until you're below 15. But 15 is nowhere near optimal, and you can already be feeling the brain fog, fatigue, hair loss, even restless leg syndrome before your doctor identifies an iron issue.

11:19So if you've had heavy bleeding, you want to talk to your doctor about it for sure, figure out the cause, and you want to make sure that you're getting a CBC and a ferritin run. Now, when should you see a doctor? I think this is so critical because lifestyle support is powerful, but there are times where heavy bleeding requires medical evaluation and you shouldn't have to go it alone. So if you're having any of these symptoms, track it, write it down, bring it to your doctor. So if you soak through a patter tampon every hour for several hours out of the day, that's a problem. If you are passing large clots consistently, like they're larger than a quarter, time to see the doctor.

11:58Period is going longer than seven days. You're also having symptoms maybe like dizziness, shortness of breath. You can't go up the stairs. You've had another doctor say you have severe anemia. If your cycles are changing suddenly, you're having bleeding between periods. And if you're postmenopausal and you start bleeding, this all needs to be evaluated. And often, imaging is going to be necessary with a transvaginal ultrasound. And a transvaginal ultrasound can evaluate for things like fibroids, adenomyosis, also sometimes called adenomyosis, endometrial thickening, so endometrial hyperplasia.

12:40Polyps could be a cause for this. And in some cases, an ultrasound can also catch endometriosis. On top of all of that, thyroid labs should be checked. And I have a full episode on thyroid labs that I'll link to in the show notes because knowing the numbers to look for is important. Just like ferritin gets a pass to be just obscenely low, thyroid is no different. Now, if you have had heavy bleeding, like lifelong, since you started your period, coagulation disorders need to be ruled out as well. and if you're in perimenopause with unpredictable cycles, evaluation definitely matters and you might need progesterone therapy.

13:21They might want to place a progestin IUD. You may need an intervention to stop that bleeding. All right, let's move on to PMS. Did you know that anxiety before your period isn't always a mental health issue? It can actually be a progesterone signaling issue, a neurological issue. I'm going to explain how that works and what you can do about it in just a minute. But first, I want you to understand this. Worsening PMS often means ovulation is inconsistent. We have a weak corpus luteum, the structure left behind after ovulation, the cyst that produces progesterone. But if ovulation is inconsistent and progesterone production is dropping, and progesterone, by the way, is not just a pregnancy hormone, it interacts with GABA receptors in the brain in the same calming pathway targeted by anti-anxiety medication.

14:11So when ovulation falters, that calming signal drops. So what works to help with PMS? So in situations of significant PMS, especially if you're over 35, we want to confirm if ovulation is even taking place. So we can track basal body temperature. You'll see a spike somewhere 10, maybe 14 days before your period. You can use LH strips to confirm at home that you're getting that spike, but that won't necessarily tell you if you're actually ovulating. It's telling you that luteinizing hormone is telling you to ovulate. So the most accurate way is to test seven days before you expect your period. And in fact, what's most precise is to use an LH test strip, then count five to seven days after a positive and measure your progesterone via blood.

14:59That number needs to be above 10 to confirm ovulation. So don't assume you're ovulating just because you're bleeding too. You can have an ovulatory cycles. And if you're having heavy periods and significant PMS, that might be what's going on. Now, I mentioned that we were going to talk more about ways to support ovulation. And we need to do that if we have PMS as well. So morning light, within 10 to 15 minutes of waking, try to get 5 to 10 minutes of natural light exposure, maybe 15 minutes of walking, no sunglasses, this is going to help your circadian rhythm. We want to affect the circadian rhythm in a positive way because that's affecting the HP access, how your brain and your adrenal glands talk.

15:43And if you're always pushing into stress, that is going to shift you away from ovulation. And even if you ovulate, it could shift you away from producing enough progesterone. One thing I hear from women all the time is that they're struggling with symptoms like hot flashes, sleep disruptions, and brain fog, but aren't sure where to turn to for help. Menopause is inevitable, but suffering through it isn't. That's why I want to tell you about Alloy. Alloy is a digital health platform that connects you with a menopause specialized doctor who can create a personalized treatment plan tailored to your needs, all from the comfort of your home.

16:22Join the 95 % of women who tried Alloy and saw relief in the first two weeks. Head to myalloy.com and use the code Dr. Brighton. That's myalloy.com, M-Y-A-L-L-O-Y.com and the code Dr. Brighton, D-R-B-R-I-G-H-T-E-N. Share your symptoms and you'll get a fully customized treatment plan and unlimited messaging with your doctor. Plus, you'll get$20 off your first order today. That's M-Y-A-L-L-O-Y.com, code Dr. Brighton. So for just about every patient in my practice, I'm going to give them daily stress practices that they're going to do twice a day for at least five minutes to positively affect their stress system and their ovaries in producing progesterone.

17:20So that might look like box breathing or maybe inhale for four, exhale for six. Humming, singing out loud, doing legs up the wall, journaling, whatever helps get you into parasympathetic activity and helps you feel more relaxed in your body. It's going to support your nervous system, going to support danger signaling, well, dampen danger signaling so that your body doesn't feel so stressed and it prioritized the ovulation cycle that you need. When we can lower cortisol, so we're not spiking it constantly, we can get better progesterone signaling. This is a way that we can start to influence our nervous system, but also our endocrine system.

18:07So it's a neuroendocrine regulation. Now, if you are a high achieving woman, or maybe you're a woman with ADHD, we got to talk about how to support cortisol on the next level. So getting one daily activity that, you know, just produces no cortisol for you, right? So like stretch without a goal, walk with a podcast, sit outside, like whatever it takes to give your brain the safety signal, that safety signaling matters for ovulation. So trying to find one activity in the day that like, Like if you were like shifting a car, it just puts you in neutral and you just feel like you're coasting. Now let's talk about adaptogens.

18:50Adaptogens don't lower cortisol. They help modulate the stress response. So some adaptogens like ashwagandha have research supporting their role in supporting how you perceive stress and your stress resilience and also helping regulate the stress hormone patterns. So this is why adaptogens are included in formulations like adrenal support. Not to make it so you can burn the candle at both ends, but to help your nervous system adapt more efficiently while you try to work on the stressors in your life. So adaptogens aren't going to do the work for you, but they're going to support you and assist you as you do the work to lower your stress.

19:33So things like the ashwagandha that's KSM-66, rhodiola, holy basil, these herbs, and sometimes coupled with like vitamin C, vitamin D5, can really help support the stress system. And when stress signaling stabilizes, ovulatory signaling stabilizes, and then ovulatory production of progesterone stabilizes. And then when progesterone stabilizes, PMS feels more improved. There's a whole pattern here where we don't want to be chasing symptoms. We want to be looking at where are those symptoms coming from and start addressing that. Now, not everyone feels better with progesterone. And so that's what I was alluding to at the beginning of this is that some people feel much worse, much more heightened anxiety, much more severe symptoms where they are experiencing maybe 10, 14 days of what feels like the most severe PMS of their life.

20:37This is PMDD, premenstrual dysphoric disorder. And so with premenstrual dysphoric disorder, what is happening there is neurological. Okay. It's hormonal, but it's neurological as well. So it's not about the amount of progesterone that you have. It is that your GABA-alpha receptor isn't responding appropriately, and that can leave you feeling way worse, way worse. You know, I think about women who have PMDD and endometriosis, and they'll be like, yeah, my period pain is nothing compared to that two weeks of feeling just the worst mood of my life. So when it comes to PMDD and TMS, there are a couple things that can help both of them.

21:19The first one is amino acid called N-acetylcysteine or NAC. This supports glutathione production and it modulates inflammatory pathways. There's emerging research that is exploring NAC for PMS and PMDD-related symptoms. The data is promising, but it's still developing. So this is a supportive tool. It's not a replacement for medical care, especially in severe cases. And if your PMDD is severe, you definitely need to have a mental health provider supporting you. Now, another evidence-based ingredient that I really love is saffron. So saffron has been studied in several small randomized control trials for mood support, including depressive symptoms and PMS-related mood symptoms.

22:06It's also been studied with ADHD. and that's important when you consider that roughly half of women with ADHD, at least according to one survey, reported also having PMDD. So PMDD and ADHD can go together. NAC and saffron are two things that might help both PMDD and ADHD. Now some studies suggest that saffron may support serotonin signaling and reduce overall PMS symptoms. The severity of them, when you compare it to placebo. There's also some research exploring saffron and PMDD and showing promising results as well. And so I think it's important to understand that the research is all really promising, but we also always want to have additional support with something like PMDD.

23:01You know, I have my saffron-containing supplement, which is Radiant Mind, and it's mood and focus support. And I love it. However, I would never want anyone to think that it's a substitute for a good mental health provider supporting you. So when it comes to PMDD, that is usually a person who's more hormonally sensitive. They need to have a team that's supporting them, and they shouldn't ever feel like they have to go it alone. So I don't want you to feel like you have to solve all your PMDD problems on your own. Now, the last one I want to talk about is Vitex. There are a lot of women who report Vitex helping them regulate their cycle, being able to support progesterone production, lessening their PMS.

23:51Usually when we're using Vitex, we're using around 200 milligrams, and this is to support progesterone production. So if you are that individual who has PMS, you are struggling with stress, you are struggling with feeling like you can handle your stress, that's when we start to look at piecing together adaptogens along with Vitex, looking at how are we actually moving our estrogen out. So what are we bringing in to support estrogen metabolism? on top of the foundation, which is your nutrition and lifestyle and those factors that we've discussed. All right, we're moving on to our third and final period problem, which is period pain.

24:35So there is a cause of severe period pain that has been identified in fetal tissue, meaning some individuals may be predisposed to painful periods before they were ever born. I'm going to explain what that means in just a minute. But first, it's important to understand that pain can come from excess prostaglandins. We talked about those already. Inflammatory cytokines, so inflammation. Also, histamine can be involved in all of this. Fibroids, adenomyosis, pelvic floor dysfunction. Never sleep on that one. I swear we don't talk about pelvic floor dysfunction enough, but I do have episodes on it.

25:15I'll link it in the show notes. But also thyroid dysfunction. It also can be coming from central sensitization. That's where pain is felt even when there's no longer a trigger for it. This typically develops after years of chronic pain and it's like a memory of pain. It is not made up, okay? It's not made up. It is that your nervous system has adapted and so it's more hypersensitive. Other causes of painful periods is endometriosis. I probably should have said that one first. So as we move into this discussion about painful periods, we need to talk about the difference between normal cramping and something more serious because not all period pain is the same and it's a subjective experience, right?

26:02So there are two broad categories of menstrual pain. There's primary dysmenorrhea and there's secondary dysmenorrhea. Primary dysmenorrhea is typically driven by prostaglandins, inflammatory compounds that are hormone-like that cause the uterus to contract. Secondary dysmenorrhea is caused by underlying structural or inflammatory conditions. So if right now you're like, I don't know if I need magnesium or I need imaging, the distinction between primary and secondary amenorrhea matter. So let me break it down a little bit more and let's talk about primary dysmenorrhea. This is pain that starts right before you're bleeding.

26:42It peaks maybe on the first day, the second day. It improves after your blood flow decreases, so your period is tapering off. It's responsive to non-steroidal anti-inflammatories, NSAIDs. This type of pain, again, is largely driven by prostaglandins and prostaglandins, those inflammatory compounds that trigger uterine contraction, they are very responsive to magnesium and omega fatty acids. So specifically, how are we going to target prostaglandins? Because whether you're primary or secondary or dysmenorrhea, this is going to help. So listen up. First is the omega-3 fatty acids I talked about.

27:21Those are going to reduce the production of arachidonic acid derived prostaglandins. That's a bit of a mouthful, but there are randomized control trials showing omega-3 supplementation may reduce menstrual pain, the severity of it, compared to placebo. So it's not theoretical, it works. And so omega-3s, again, we're looking at 2 ,000 milligrams daily. I may ramp that up so that seven days before the period, we are doing 2 ,000 milligrams twice daily. And omegas, again, they're not a painkiller, but they are a modulator of prostaglandins. And it's important to note that anything you initiate now can take up to three cycles for you to fill that effect, which is super lame, but it's going to take at least one cycle.

28:09So be patient because if you start this like tomorrow and your period comes a week later and you're like, that didn't really help that much. That doesn't mean you did something wrong or that it's ineffective. It's that you have to give it more time. Supplements do not act in the same way that pharmaceuticals do. They're just different. Supplements are trying to support your body, support your lifestyle, your nutrition efforts, and try to slowly turn things around. A pharmaceutical is to come in to suppress, to change the system, to come in and replace what maybe the system is missing. So pharmaceuticals are working in a different way.

28:47And by the way, if this is a lot to take in, sitting here and listening to it, I want you to know you can go to drbrighton.com. In the show notes, I'm going to put a list of all the supplements that I recommend. Everything that we're talking about, you're going to be able to find in the show notes so that you can access that in an easy way. As somebody with stage 4 deep infiltrating endometriosis, adenomyosis, who's struggled with period pain, I know what it's like to be in pain, to listen to something and be like, oh God, this is too much. So I got you. Now I mentioned magnesium. Magnesium relaxes smooth muscles.

29:22Magnesium glycinate can help with sleep. There's evidence suggesting magnesium supplementation may reduce cramping severity when you have painful periods. Typically we're aiming for 300 milligrams daily. That I will kick up to 600 milligrams daily, five to seven days before expected painful period. And between omegas and magnesium. If you have primary dysmenorrhea, those do pretty well, but I'm going to give you a couple more things. So ginger, multiple randomized control trials have shown that ginger may reduce menstrual pain severity when taken at the start of bleeding. I would honestly take it sooner than waiting for you to have cramps.