Dealing with an abnormal menstrual cycle? Has your period stopped completely for no clear reason? This article will help you recover a healthy period using diet and lifestyle changes - without resorting to birth control use.
Having a healthy, normal period is incredibly important for long-term health in women.
Some women believe that having a monthly period is an inconvenience or annoyance. But an irregular or absent period, or one with severe symptoms, is a sure sign that there’s something else going wrong in the body.
That’s why addressing the root cause of the menstrual dysfunction is often preferable to immediately starting hormonal birth control as a quick fix.
While hormonal replacement has its place in supporting women’s health, many doctors are too quick to prescribe birth control to women whose cycle issues could potentially be solved by a change in diet and lifestyle.
In the United States, 30 to 40 percent of the reproductive female population experience pre-menstrual syndrome (PMS), and as many as 15 to 20 percent of women have polycystic ovarian syndrome (PCOS). At least 4 percent of US women have secondary amenorrhea: a lack of menses for at least six months in a woman who was previously menstruating.
These stats would suggest that nearly a third of women have some level of menstrual dysfunction. I’d bet that most of you ladies reading this article have experienced some disruption in your cycle at some time in your life. (I know I have!)
Fortunately, hormonal disorders like amenorrhea and PCOS are not only manageable using diet and lifestyle changes, but even reversible in most cases.
These hormonal imbalances are almost always caused by one or more of the following:
blood sugar abnormalities
HPA axis dysfunction (“adrenal fatigue syndrome”)
impaired liver function/detoxification
In this article, you’ll learn the 10 most important diet and lifestyle factors affecting your hormonal function. Keep reading for my easy-to-implement tips for making changes that put you on the path to a healthy menstrual cycle.
1. Eat a healthy diet that controls blood sugar
As with any chronic health issue, the first step is to ensure you’re eating a well-balanced diet that provides you the nutrients you need for optimal physical function. While there are dozens of theories about the “perfect” diet, there truly is no “one-size-fits-all” approach, so I prefer to give general guidelines in this case.
For improved hormonal function, the goal should be to keep blood sugar as steady as possible. A “real food” diet made primarily from whole foods is ideal, with limited amounts of highly refined grains and sugars.
High-quality protein should be consumed at every meal and snack, and plant foods like vegetables and fruit should make up the bulk of the volume of the diet. Healthy fats should be consumed at each meal as well. A higher fiber intake from plant foods can help with the excretion of extra hormones in the stool.
Micronutrient-dense foods like liver, eggs, fatty fish, leafy greens, and full-fat dairy products provide vitamins and minerals that support metabolic function, detoxification in the liver, and ovarian health.
A balanced Paleo template can be a great fit for women provided they pay attention to the next recommendation listed below.
2. Eat enough to meet your needs
In my work with patients, inadequate calorie and carbohydrate intake might be the most common contributor to a dysfunctional menstrual cycle. I wrote an article a few months ago describing the common trend of under-eating in the Paleo community. It amazes me how many of my clients fall into this category.
Calorie intake and energy balance are the most important factors affecting the development of hypothalamic amenorrhea. (1, 2, 3) In fact, calorie intake is an even greater predictor of menstrual cycle function than a woman’s body fat percentage.
“Dietary restraint,” or the conscious restriction of calorie intake in an effort to achieve or maintain a certain body weight, is a risk factor for menstrual cycle disturbances. (4) While this is likely due to the unhealthy reduction of caloric intake compared to calorie burn during exercise, I wonder whether or not the excessive dietary restriction that often comes from following an overly strict Paleo diet might contribute to hypothalamic amenorrhea and other stress-related causes of menstrual dysfunction.
Use a calculator to estimate your daily calorie needs based on your current activity levels. You may be surprised to find that you’re eating much less than your body needs, which could be negatively affecting your menstrual function.
On top of adequate calorie intake, for many women, a moderate carbohydrate intake is important for regular menstrual function. A range of 20 to 50 percent of calories from carbs is ideal for improving fertility, depending on your primary underlying issue.
If you have PCOS, some evidence indicates that a lower carbohydrate intake (20 to 30 percent of calories) might be beneficial. If you are a highly active woman with normal insulin sensitivity, a higher carb intake of around 40 to 50 percent of calories could work better for you.
If you need additional assistance identifying an appropriate calorie and macronutrient target for your needs, I’d be happy to help you!
3. Maintain a healthy weight
Part of following a healthy, calorie-appropriate diet is that it will allow you to maintain a healthy body weight. Extremes of BMI, either significantly underweight or overweight, are associated with amenorrhea and menstrual dysfunction. (5)
BMI is a poor measurement of health, as athletic women with high muscle mass will generally have a higher BMI, but generally, a good BMI target for fertility is between 18.5 and 30. Lower than 18.5 is considered underweight, and higher than 30 is considered obese.
If you are overweight, eating a calorically appropriate, nutrient-dense diet and exercising regularly will help you to shed the excess unhealthy body weight that might be negatively impacting your hormones. Studies consistently show a higher prevalence of PCOS in women who are overweight and obese, which is likely related to the insulin resistance seen in many women who are significantly overweight. (6)
Eating a whole foods diet with limited refined carbohydrates and exercising regularly can help improve insulin sensitivity and shed excess body weight, reducing symptoms of PCOS.
If you’re underweight, you need to work on gaining weight, primarily by eating more food in general. If your BMI is below 18.5 and you are struggling with dysfunctional menstruation or amenorrhea, your goal should be to gain enough weight to get back into the 19 to 25 range of BMI.
A low body fat percentage is often correlated with amenorrhea in women; however, there is no solid evidence that identifies an “ideal” body fat percentage for fertility. Body fat percentage is not predictive for the loss of menstrual function in either women with eating disorders or competitive athletes. (7, 8)
The ideal body fat percentage for recovering menstrual function varies among individuals. One study found that women being treated for anorexia nervosa recovered their menstrual cycle at around 23 percent body fat. (9) Some women will lose regular menstrual function at body fat levels lower than that, while others won’t. (As I mentioned before, a big part of that risk is related to overall calorie intake related to calorie expenditure.)
Most health professionals agree that the level of “essential” body fat in women is about 12 percent, so if you are lower than that, you absolutely need to gain fat to recover normal body functioning. However, a healthy body fat percentage range for women may be more like 16 to 30 percent, with percentages in the low to mid-20s likely being ideal for fertility. Much like BMI, there’s a big range, and individual differences will determine what is healthy for one person versus another.
4. Exercise appropriately
Exercise is important for fertility, and the trick is to develop a workout schedule that allows for enough, but not too much, movement.
General exercise guidelines for women with PCOS are 30 to 60 minutes of any type of activity per day. A combination of strength training and aerobic activity works best for improving the hormonal imbalances often seen in PCOS and other menstrual disturbances. (10, 11)
Avoid exercise styles that make you anxious or overly stressed emotionally, which could exacerbate the physical stress of training. (12) Don’t go to “boot camp”-style classes where the instructor is yelling at you to push harder, and avoid negatively comparing yourself to other women in the class. Your fitness activities should be enjoyable and low stress and make you feel better about yourself when you leave.
And as you know by now, ensuring that you’re not in an excessive energy deficit is crucial to preventing the most common reason for amenorrhea in athletic women. However, some research suggests that there are women who develop abnormal menstrual cycles from the changes in androgenic hormones (i.e., testosterone) that come from high levels of exercise, regardless of their calorie intake. (13, 14) Eating a carbohydrate- and protein-dense meal or snack post-workout can help prevent rises in testosterone after tough workouts. (15)
5. Practice stress management
However, while occasional stress might throw off a single cycle, chronic stress actually changes your hormonal profile and can have a long-term impact on menstrual function. Stress impairs the ovarian cycle through activation of the hypothalamus–pituitary–adrenal (HPA) axis, which affects the output of ovarian hormones like estrogen and progesterone. (16)
Many of the symptoms of “adrenal fatigue syndrome,” such as reduced sex drive, worsened PMS, and even stubborn weight gain, are often related to the impact of chronic stress and HPA axis activation on hormonal balance.
Women under chronic stress are at higher risk for menstrual abnormalities and infertility. (17, 18, 19) And your personality and dispositional resilience to stress may change how much stress affects your menstrual cycle. (20) So if you’re someone who tends to feel crushed by stress rather than thriving in it, you might be at higher risk for menstrual dysfunction when faced with chronic stress.
If this sounds like you, adding in some regular stress management techniques is a crucial part of your period-fixing program. Regular meditation and yoga are two of the easier mind–body practices that can get you feeling better quickly. I recommend Headspace for a convenient guided meditation app and YogaGlo.com for at-home yoga classes if you can’t go to a local studio.
6. Improve your digestion and elimination
Excess hormones are eliminated through our poop, so having regular bowel movements and a healthy digestive system is crucial to good hormonal function.
Not surprisingly, there’s a two-way street between hormonal balance and gut function. Your ability to eliminate excess hormones through your stool will affect your hormonal profile, and fluctuations in hormones can affect your bowel function too. (21)
New research is showing that the gut microbiome has a major impact on hormonal balance. (22) Dysbiotic flora in your gut and/or gut permeability (“leaky gut”) activates your immune system, driving up insulin levels and leading to high levels of androgens. This immune activation also interferes with ovarian follicle development.
To rebalance your gut flora, increase your consumption of fermented foods, as well as vegetables of all kinds. Both starchy and non-starchy veggies contain components that help feed beneficial gut flora, and fermented foods like sauerkraut, yogurt, and kombucha provide live gut bugs that can help boost the diversity of your gut flora. If you have “leaky gut,” following a gluten-free whole foods (Paleo-esque) diet is the first step to repairing the damage caused by gut permeability.
If you’re struggling with major gut symptoms like constipation, bloating, loose stools, or reflux, your digestive function could be exacerbating your hormonal imbalance. Be sure to work with a professional if you need extra help normalizing your digestive system.
7. Sleep on a schedule
Sleep and sleep disturbances are increasingly recognized as determinants of menstrual function. (23) The underlying cause for this is the disruption of the circadian rhythms, which drive the cyclical nature of hormone release and are primarily disrupted by inappropriate light and dark signaling. (24)
In teens, girls with erratic sleep schedules who typically stay up late and sleep in late have significantly worse PMS symptoms than girls who go to sleep early. (25) Women who perform night shift work have a much higher risk of menstrual disturbances than those with a normal daytime work schedule. (26)
The primary hormone that is responsible for these circadian rhythm-related menstrual disturbances is melatonin, also called the “sleep hormone.” (27) Inappropriate patterns of light and dark exposure disrupt melatonin secretion, thus negatively impacting the menstrual cycle.
To get your circadian rhythms on a normal pattern, avoid bright and artificial light at night and get plenty of sunshine during the day. Set a regular sleep schedule and go to sleep well before midnight. If you’re dealing with insomnia, check out these great tips for improving your sleep.
8. Supplement if necessary
There are a handful of supplements that can be helpful for generally balancing hormones, as well as for improving the metabolic disturbances that occur in PCOS.
For women with amenorrhea, I typically recommend supplementing with vitamin B6, zinc, magnesium, probiotics, and methylated B-vitamins. Optimizing vitamin D status and supplementing with vitamin A if necessary can be helpful too. I talk more about supplements for amenorrhea in this article.
One largely unknown B vitamin that has been studied for its effects on PCOS signs and symptoms is inositol. There are two major supplemental types of inositol: myo-inositol and d-chiro-inositol. Myo-inositol improves insulin sensitivity, reduces androgens, and can even restore ovarian activity in women with PCOS. (28) D-chiro-inositol appears to reduce androgens even better than myo-inositol. (29)
It’s important to get both myo-inositol and d-chiro-inositol in a 40:1 ratio, which is the physiological plasma ratio and the amount found to be most effective for promoting ovulation and healthy hormone balance in PCOS. (30) The best way to get these two forms of inositol in a balanced ratio is in a supplement called Ovasitol, which you can order here. (Use my clinician code to get a discount: 127605)
A common herb used for hormonal imbalance, especially low progesterone, is vitex, or chasteberry. There isn’t a great deal of research on vitex; one small study found that 10 of 15 women with amenorrhea recovered their periods after taking chasteberry for six months. (31) Talk to your doctor about adding in vitex as an additional hormone-boosting supplement.
9. Avoid environmental toxins
Our modern environment is full of chemical toxins, in our food, in the air we breathe, in the water we drink, and in the cosmetics and hygiene products we put on our body. Many of these chemicals have the ability to affect our hormones and are called endocrine disruptors. (32) These endocrine disruptors are known to have significant effects on your risk of not only PCOS and menstrual dysfunction, but also thyroid disorders, obesity, and cancer. (33, 34)
Chemicals called xenoestrogens are found everywhere; as BPA in our food, phthalates in our body care products, and atrazine in our landscaping. While we can’t completely avoid these hormone-damaging toxins, we can significantly reduce our exposure to them.
Use the Environmental Working Group’s guide to cosmetics to choose toxin-free body care products, and their food scores guide to avoid eating toxins. Check out Chris’s series on toxic skincare products for a breakdown of the types of products to avoid or replace. And see BeautyCounter for a safe supply of cosmetics, hair care, and beauty products.
10. Get acupuncture
While the evidence for acupuncture’s effects on menstrual function is mixed, there is some support for the use of acupuncture for improving menstrual function and reducing symptoms of PMS. (35, 36, 37) One study found that acupuncture was as effective as NSAID therapy for dysmenorrhea, a cycle with severe PMS symptoms, especially cramping. (38)
Acupuncture should be an adjunct to other lifestyle changes due to limited evidence of its efficacy. If you’ve already made the changes discussed above, you might want to try adding regular acupuncture for an extra dose of hormone balancing treatment.
These top ten tips have given you plenty to chew on, and I hope that the majority of you will experience improved hormonal function and a healthy monthly menstrual cycle after implementing these changes to your diet and lifestyle.
However, this shouldn’t be the end of your health journey. While you’re making these changes (especially if you’re not seeing improvements), you should see your doctor for further testing for thyroid issues, pituitary tumors, pelvic inflammatory disease, endometriosis, uterine fibroids or scarring, or any other number of metabolic or structural issues that can cause disrupted hormones.
Consider getting hormone replacement therapy (HRT) with a licensed medical practitioner who is trained in the use of oral or topical hormones. Sometimes a little boost can help reset your cycle and get your own hormones producing more normally.
Check your medications and ask your doctor if you need to make a change. Certain medications can affect menstruation, including: antipsychotics, cancer chemotherapy, antidepressants, blood pressure drugs, and allergy medications.
Finally, if you need help identifying the diet and lifestyle issues that are holding you back from healing, I’d love to work with you. I truly enjoy helping women who are experiencing hormonal disturbances make the changes they need to recover a healthy period and start feeling better immediately!
by Kris Kresser