Menstrual Essentials


As teenagers, few of us had mothers or grandmothers who taught us to celebrate our monthly cycles, to embrace the power we receive from our menstrual blood, or to use our cycles as a means of gauging our physical and emotional health.

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As I got older, I tried to look at my monthly cycles in a more positive light. I eventually came to see my body as a microcosm of the universe. Just as the moon waxes and wanes, the tides ebb and flow, the sun rises and sets, so too does my body move through the stages of a cycle—from ovulation to menstruation, from lightness of being to a dark, moody time, from creativity to reflection. I noticed that I am much more outgoing and energized midcycle, around ovulation time, and often need to go inward—even push people away—just before my period starts. This seems especially true at those times when my cycle corresponds to the phases of the moon; that is, I bleed during the darkness of the new moon and ovulate as the moon comes into its fullness. For me, the cycle of menstruation has become a symbol of my connection to the natural rhythms of the universe rather than something to dread each month.

A Delicate Balance

If you consider how our menstrual cycles work, it's not such an outlandish notion that our emotions and our bodily functions could be so entwined with nature's cadence. It all starts in the pineal gland, hidden deep within the dark recesses of the brain, behind the eyes. This tiny, teardrop-shaped gland responds to changes in light and darkness, and produces the hormone melatonin that helps us sleep at night. According to British herbalist Amanda McQuade Crawford, this gland not only registers and responds to the amount of natural and artificial light we're exposed to on a daily basis, but also signals seasonal changes. The pineal gland's responsibility is to alert the hypothalamus to begin the menstrual cycle. The hypothalamus itself is a very sensitive part of the endocrine system. According to McQuade Crawford, this "blobby cluster" sits close to our emotional center—the limbic region of the brain—and can react adversely to emotional upheaval or physical illness. When the hypothalamus is healthy, it performs its duties quite well: It provides the pituitary gland with what it needs to produce important hormones for reproduction. When compromised, however, the hypothalamus may give out erroneous or incomplete information, causing the pituitary to manufacture either too much or not enough female hormones, throwing the body off balance.

The hormones that the pituitary produces, FSH (follicle-stimulating hormone) and LH (luteinizing hormone), in turn are responsible for the production of estrogen and progesterone, respectively, in the ovaries. Secreted in various amounts during the entire cycle, estrogen is at its highest level during the first half of our cycle, the follicular phase, which begins on the first day of our menstrual bleeding. As the egg matures within the ovaries, estrogen allows the endometrium tissue in the uterus to develop and thicken (creating a safe and nourishing home for a fertilized egg to grow), improves blood circulation to the genital tract, and lubricates the cervix as a way of inviting sperm.

Estrogen is also responsible for much more as a young girl's body changes into a woman's. Estrogen, as herbalist Rosemary Gladstar explains, helps shape our secondary sex characteristics, giving us womanly breasts, pubic hair, feminine voices, and broader hips. Estrogen also helps our bones retain calcium, preventing osteoporosis, lifts our spirits and, as Gladstar is so fond of saying, "keeps us moist and juicy!"

This first half of our cycle prepares us for ovulation and reproduction. If our estrogen output is balanced, our bodies and our emotions are ripe with possibilities—we are at our most sensual, our most creative, and our most fertile. If we experience estrogen imbalance, however, says Gladstar, we can face debilitating menstrual cramps, infertility, fibroidic breasts, and radical mood swings.

When we ovulate, according to Christiane Northrup, M.D., author of Women's Bodies, Women's Wisdom, our bodies give off hormonal signals that we are fertile, sexual, and alive. Most young women—and probably older women too—find it difficult to tell when they are ovulating. First of all, if you don't ovulate, you can't tell when your period is due—it just shows up, and not necessarily on a schedule. Usually, one tell-tale sign around the 15th or 16th day of your cycle is a watery, whitish vaginal discharge. This "fertile flow" signals additional hormonal fluctuations, called premenstrual molimina, that include bloating, swollen or tender breasts, and moodiness, as progesterone production increases. Some women even get a crampy feeling in one ovary midmonth.

During the second half of our cycle, the luteinizing phase, our bodies prepare for the possibility of pregnancy. The hormone progesterone helps that happen. Manufactured in the corpus luteum (a kind of temporary womb), progesterone brings nourishment to the uterus through increased blood flow and forms a thick mucus plug at the opening of the cervix to keep bacteria out. If pregnancy does not occur, estrogen and progesterone production plummets and the corpus luteum dissolves and is shed as menstrual blood.

If progesterone production is balanced, many women feel reflective, intuitive, and in touch with their dreams during this time. If too much is present, progesterone can cause women to feel depressed and lethargic and not the least bit sexually attractive.

To complete the monthly housecleaning we call menstruation, our bodies call upon the liver and kidneys to rid the system of excess hormones and accumulated toxins. If either organ is overburdened by an unhealthy lifestyle, it can't do its job effectively and the unprocessed hormones get reabsorbed into the bloodstream to wreak havoc.

<a href="/health/ayurveda">Ayurvedic physicians teach us that women have a distinct advantage over men by bleeding every month. According to Nancy Lonsdorf, M.D., director of Maharishi Mahesh Yogi's Wellness Center in Washington, D.C., menstruation purifies the body every 25 to 35 days, gathering all the toxins that have built up over the month and moving them out of the body along with the menstrual blood. Ayurvedic physician and scholar Robert Svoboda, thinks that this monthly cleansing process may be why women generally live longer than men.

Menstrual Problems

Amenorrhea is the technical term for no bleeding. It's quite common among teenagers who are just beginning their periods. They may have a light period one month and then no bleeding for several months. This can often happen because the pituitary gland, which produces the FSH and LH hormones necessary for ovulation, is underdeveloped. When everything is normal, estrogen builds up a thick, unstable lining in the uterus, and following ovulation, progesterone comes along to stabilize the uterus and prepare the nest for an egg to grow. If you don't ovulate, you can't produce progesterone. And if you're not making progesterone, estrogen gets no signal to stop thickening the uterine lining. After a while, some of this lining begins to slough off and scant bleeding will occur. Generally, according to Tierona Lowdog, M.D., a physician and medical herbalist in Santa Fe, New Mexico, the body will correct itself, and there's nothing a young woman needs to do but wait.

Because the hypothalamus and pituitary gland are so closely connected to the emotional center of the brain, the limbic region, it stands to reason that even after our periods are well-established, we may stop bleeding when we're under a lot of stress. Arabella Melville, author of Health Without Drugs, says stress commonly disrupts our cycles. Some women, she says, stop bleeding when their relationships fall apart; others find a demanding work schedule the culprit; still others are so frightened of getting pregnant that they miss their periods. Again, missing a period on occasion because of stress does not usually require medical intervention, but it should cause you to re-evaluate your lifestyle. Prolonged amenorrhea should be evaluated by a physician since suppressed menstruation could be a sign that severe medical conditions exist, such as diabetes, thyroid malfunction, extreme weight gain or loss, or acute emotional distress.

Geeta Iyengar, daughter of B.K.S. Iyengar and a specialist herself on women's health, recommends yoga to jump start a cycle or to get our periods back on track. She particularly likes inversions to increase blood circulation and balance the endocrine system, backbends to tone the liver, and twists to massage the internal organs. John Friend, a yoga teacher in Houston, Texas, agrees. He explains that blood circulation affects the glands of the endocrine system. Each gland pulsates just like every cell in our bodies pulsates; so as blood flow diminishes, the pulsation of the actual gland diminishes, too. In fact, if circulation to the particular gland is either excessive or restricted, he says, you won't get an optimal level of health for that gland.

Just as a woman can go a month or more without a period, she can also have bouts of heavy bleeding. For some women, according to Gladstar, such bleeding is normal, as long as their blood is bright red, they don't experience clotting or heavy cramps, and they aren't wiped out every time they get a period. When the bleeding becomes excessive, that is, when you continue to soak through pads or tampons every hour or two even on the second or third day of your period, something's wrong. According to Sharon Olson, an osteopath and women's health specialist in Northern California, if menorrhagia continues month after month, it can lead to anemia or an iron deficiency, so she recommends seeing your doctor for an evaluation. Dr. Northrup points out that chronic stress over what she terms "second chakra issues, including creativity, relationships, money, and control of others" may be the culprit. She encourages her patients to set aside time to be creative, to mourn the loss of old relationships, and learn to voice their joys and frustrations in new ones. When women heed the signals their bodies give them, their periods will often return to normal.

Sometimes heavy bleeding can be a sign of something more serious. Endometriosis, uterine fibroids, or ovarian cysts cause many women severe pain and have resulted in many an untimely hysterectomy. We've learned that during the first phase of our menstrual cycles, the presence of estrogen allows the tissue within the uterine walls to thicken prior to our monthly bleeding. When a woman has endometriosis, bits and pieces of this uterine lining break off and instead of moving down and out of the body, move upward and lodge in other areas of the body. According to Dr. Northrup, the most common places for this tissue to attach itself is on the pelvic organs, the pelvic side walls, and sometimes on the bowel. When we begin to bleed, these bits of tissue, stimulated by our hormones, appear to bleed as well, and that's what most physicians believe produces such severe cramping.

No one really knows what causes endometriosis, but Ayurvedic physicians believe it stems from a disruption of our doshas (the three vital energies or biological forces that control all physiological and psychological processes in the body and mind) and the presence of ama, the sticky, icky "stuff" that accumulates in our bodies when something is amiss. You can see it as the white film on your tongue after a night of eating rich, heavy foods, or when you are sick.

When everything is working optimally, a woman's menstrual cycle flows trouble free. As the blood moves out of the body, it gathers all the ama and other toxins that have accumulated during the month and removes them. This process is governed by the vata (wind) dosha, and more specifically its subdosha, apana vata. Apana vata pushes the waste downward through the intestines, the urinary tract, and the uterus. If it gets stuck, apana vata can't do its job efficiently, and everything begins to move upward. Menstrual blood and uterine tissue are then likely to find their way into the fallopian tubes where the tissue takes root. Ayurvedic physicians recommend changes in diet and lifestyle, including lots of rest during the first day or so of your period, and gentle yoga asanas to relieve cramps, reduce stress, and deliver fresh blood to the pelvic region.

A number of physicians and healers agree with Dr. Northrup, who feels that endometriosis can be a wake-up call for women who compete in high-stress jobs. She says it is often the way a woman's body demonstrates that her "innermost emotional needs are in direct conflict with what the world is demanding of her." In other words, women who consistently and relentlessly focus their energies outward and neglect their emotional and spiritual sides are prime candidates for pelvic inflammatory disease (PID)—and the accompanying heavy bleeding.


Menstrual cramps—the bane of many a woman's monthly cycle—come in many different types. Sarah, a 19-year-old art student, gets sharp, colicky cramps. Complete with constipation and periodic bouts of diarrhea, they bring her to a fetal position for the first 24 hours of her period. Jen, a 32-year-old new mom who has thankfully outgrown her cramps, suffered from sharp, painful cramps as well, but hers came with vomiting and an elevated fever. Linda, a 37-year-old dance teacher, feels a dull ache in her back and inner thighs. To add insult to injury, her muscles and joints feel stiff, and her breasts are painful and swollen.

Sarah, Jen, and Linda are among a majority of women who suffer from what is called primary dysmenorrhea, the most common form of menstrual cramping. This type of dysmenorrhea is not associated with any pelvic disease or inflammation; it's menstrual cramps, pure and simple. Secondary dysmenorrhea is menstrual pain caused by something else going on in the body: PID, endometriosis, or adenomyosis (growth of endometrium into the muscular layer of the uterus). Secondary dysmenorrhea can be quite serious and it's important to consult your health practitioner if your cramps are unusually severe, don't respond to dietary changes or stress management, or are accompanied by bleeding.

Western physicians believe that primary dysmenorrhea is caused by an overabundance of the hormone prostaglandin F2 alpha in the menstrual blood. When the prostaglandin hormone gets released into the bloodstream, according to Dr. Northrup, the smooth muscle of the uterus goes into spasm, and we get cramps. We can blame a diet high in animal protein and dairy products for too much prostaglandin F2 alpha in our systems, as well as a lifestyle filled with unrelenting stress.

Susan Lark, M.D., author of several self-help books for women, explains that primary dysmenorrhea manifests itself by either spasmodic or congestive cramps. Spasmodic cramps are most commonly found in teenagers like Sarah and women in their early 20s. Dr. Lark blames poor blood circulation and compromised oxygen delivery to the uterus, which aggravate the problem and result in an accumulation of lactic acid and carbon dioxide. Women sometimes find this type of cramping subsides after their first pregnancy. Congestive cramps, on the other hand, make life miserable for women in their 30s and 40s and seem to worsen after childbirth. These dull, achy cramps bring with them bloating, breast tenderness, weight gain, and headaches.

Gentle yoga can benefit women with primary dysmenorrhea. Some women like to bend forward and have something pressing against their bellies when they have cramps; other women feel better when they take pressure off the abdomen and create space in the pelvis. They find relief through mild backbends, like supported Supta Baddha Konasana (Reclining Bound Angle Pose), using belts, bolsters, blankets, and eye bags.

Premenstrual Syndrome

A catch-all phrase if there ever was one, premenstrual syndrome, or PMS, could be any one of more than 150 symptoms. Do you feel irritable, edgy, or "hot under the collar?" You have PMS. Anxious, moody, or ungrounded, and you can barely remember your own name? You have PMS, too. How about bloated, achy, and depressed—in fact you could cry if someone looked at you sideways? You guessed it, PMS. You could also have periodic bouts of acne, heart fibulations, insomnia, herpes, hives, migraines, salt or sugar cravings, or even asthma, and these would all be PMS symptoms. According to Dr. Northrup, the type of symptom doesn't much matter—it's the way it occurs. Generally speaking, she explains, women should see a pattern of flare-ups each month. Some feel anxious and flighty about a week before their periods and as soon as they begin to bleed, they feel better. Others may get angry and rage out of control two weeks before their periods only to fall into a depression the next week and feel appreciably better the first or second day of their periods. I get intense sugar cravings—particularly of the chocolate variety—about 10 days before I bleed. If I give in to my weakness, I end up not only with a horrific headache a few days later, but my joints ache and swell until I'm through the first or second day of my cycle.

In order to alleviate premenstrual syndrome, it's important to understand its physical and emotional causes. On a physical level, most physicians agree that an imbalance of hormones and a sluggish liver contribute to our symptoms. If we feel anxious and moody, chances are we have an overabundance of estrogen in our bodies or we're not producing enough progesterone to balance it. If we are depressed, confused, can't sleep, and can't remember a thing, too much progesterone may be the culprit. Regardless of which hormone predominates, it could be a sign that our endocrine systems are not doing their jobs efficiently and have failed to produce the correct amount of the hormones we need. If we experience bloating, breast tenderness, and weight gain, the pituitary gland and adrenals may be to blame.

The liver also plays a role in alleviating our PMS symptoms. If we keep the liver healthy through proper diet, exercise, and stress relief, it has no problem breaking down excess hormones and passing them along to the kidneys, which excrete them from the system.

Svoboda calls PMS our "monthly dysfunction syndrome," and believes it is a result of the disharmony created during the early part of our cycles. In other words, if you eat junk food, drink lots of caffeinated beverages, function with very little sleep, shelve your exercise routine, and fail to deal with feelings (especially anger and hurt) that crop up, you can count on problems later in the month.

My favorite definition of PMS comes from Joan Borysenko, who deems it "emotional housecleaning," the time during our cycles in which we are more apt to confront what is bothering us and release it. As we enter the luteinizing, progesterone-dominant phase of our cycle, we often turn inward, becoming more in touch with our deepest, even darkest emotions. Suddenly something we've repressed all month long seems overwhelming and we need to express it, get it out, deal with it. Unfortunately, society in general—and often our families in particular—aren't really thrilled to see that side of us and quickly label our behavior as bitchy and out of character. Women who listen to their feelings and needs during this time, however, often discover many of their physical PMS complaints subside.

Yoga helps alleviate PMS in a number of ways. On a physical level, yoga relaxes the nervous system, balances the endocrine system, increases the flow of blood and oxygen to the reproductive organs, and strengthens the muscles surrounding those organs. Psychologically, yoga works to ease stress and promote relaxation so that the hypothalamus can regulate the hormones more efficiently. It offers a woman the time—and often the permission—she needs to go inside, to listen to her body, and to respond to what she hears.

Keep Healthy All Month

The most important thing you can do to minimize menstrual problems is to take care of your body, to honor yourself, all month long. If you know, for example, that drinking coffee or Coke brings on premenstrual headaches, find a noncaffeinated substitute. I love raspberry leaf herb tea on ice and know if that's in the refrigerator, I'm less inclined to grab a Coke when I'm craving a sweet drink. Those tasty Italian sodas (sweet syrup and fizzy water) offer a little more sinful treat without doing much harm. In general, if you avoid greasy foods and sugary desserts, cut down on alcohol and caffeinated beverages, and substitute home-cooked meals for processed foods, you may find much of your physical and emotional discomfort alleviated. Here are some other suggestions many women have found helpful.

Get Sufficient Rest. If you do nothing else for yourself, rest during the first day or two of your period, and you'll be amazed at how much better you feel the rest of the month.

Be Selfish.The first day or two of your period is your time for quiet reflection. Don't use this time to cook elaborate meals or invite friends over. Do things that make you feel good about being you.

Exercise in Moderation.Unless you are plagued with debilitating cramps the first day of your period, exercise is fine; just don't overdo it. Walking or gentle yogastretches work best. During the rest of the month, a consistent yoga practice and moderate aerobic exercise can help alleviate PMS and menstrual problems.

Beware of Food Cravings. If you crave sweet or junk food just before your period, Dr. Lonsdorf suggests pacifying the salt craving first as that sometimes mitigates the desire for sweets. But don't turn to chips and salsa; instead, cook something seasoned with salt—that should satisfy you longer. If you still crave sugar, she recommends a cup of warm water sweetened with honey.

Eat Pacifying Foods.Prepare warm foods that are easy to digest such as rice, cooked green vegetables, and beans. Avoid cold, raw foods, as well as ama-creating foods such as red meat, cheese, and chocolate. Sip warm water throughout the day to break up excess ama.

Modify Your Routine.Baths disrupt the natural rhythms of your menstrual flow, so shower the first four days of your period. After that, treat yourself to a warm oil massage or a facial to balance the nervous system and soothe the mind. Once or twice a month, rub warm sesame oil into your hair, leave it in for a few hours (or overnight), and shampoo it out. Whenever you can, wear menstrual pads, not tampons, especially during the first few days of your period, to encourage the downward flow of blood.

Linda Sparrowe is former managing editor and current contributing editor of Yoga Journal. This article is adapted from her upcoming book (with Patricia Walden) on yoga and women's health, to be published by Shambhala in the fall of 2002.