What is a normal period? If you consult a gynecologic textbook, you'll learn that menstruation is bleeding and shedding of the endometrium of the uterus that occurs at approximately monthly intervals from menarche to menopause. You will read that the menarche, or onset of menopause, usually occurs between 11 and 14 years of age, and menopause generally

between age 45 and 55. The book may say that ovulation occurs on day 14 or 15 of the menstrual cycle (I ovulate on day 11). You will then read that any uterine bleeding which differs markedly from a normal flow, either in frequency, duration, amount, or discomfort is abnormal. But where, precisely, do you draw the line between what is a healthy period and what is not?

The point that I wish to make here is that there is a wide range of normal in the menstrual flow. When I studied ayurvedic medicine a few years ago with Dr. Vasant Ladd, he always asked us, "What is normal for whom ? Ayurvedic medicine body types each individual and their range of normal depends on their specific constitution. Each woman has her own range of normalcy. In some cases, even when a woman is in her optimal state of well-being, she menstruates every 26 or 30 days. Some women ovulate twice a month. I use homeopathy most often with my patients to treat the problems on menstruation. After being given the correct homeopathic remedy, a woman's cycle will normalize to the greatest degree possible for her. After such therapy, I often see a woman's period changing, for example, from every five or six weeks to every four or four and a half weeks. A woman's period may last seven to ten days when she comes to see me and, with treatment, will usually reduce to five to seven. If a woman comes in complaining of spotting before or between the menstrual periods, this will generally disappear, or at least diminish considerably, when she is in a state of balance.

How much should my period hurt? The medical term for the pain or discomfort of the menstrual period is "dysmenorrhea". I consider a slight amount of cramping or discomfort within the range of normal for a woman. However, many of the woman I see experience extreme pain with the periods, some to the point of being incapacitated for a day or two. This pain may be mild or severe, constant or intermittent, dull or sharp, and may be accompanied by a wide variety of symptoms including nausea, vomiting, dizziness, back pain, weakness, confusion, and despair. Many women suffer from severe dysmenorrhea from the time of menarche and may have tried a variety of over the counter and prescription medications in order to find relief.

In my experience, the correct homeopathic remedy is likely to put an end to dysmenorrhea, or at least hold it at bay in a very mild state. In many cases, diagnostic procedures will reveal no significant cause for the pain. In other women, however, the diagnosis will be endometriosis.

Endometriosis is defined as the growth of normal uterine tissue in locations outside the uterine cavity. This tissue often invades, or pervades, the abdominal cavity and may, in rare cases, even extend into the lungs. The problem with endometriosis is not the quality of this tissue, but its location. It generally results in scar tissue and may produce painful periods, sex, and pelvic pain in general. The only way to conclusively test for endometriosis is through a laparoscopy, where a small incision is made near the umbilicus, and an instrument is inserted so that the entire pelvic cavity can be viewed from the inside. The orthodox treatment for endometriosis is surgery, however the condition often recurs. Women are also told that their endometriosis is likely to resolve if they get pregnant, which they cannot and do not always choose to do. I have seen considerable success using homeopathy to treat the symptoms of endometriosis. Most women who have been successfully treated, however, do not subject themselves to repeat laparoscopies in order to make sure the abnormal tissue is gone.

How heavy should a normal period be? This is another situation where we need to ask how heavy is a normal flow for whom? According to Ayurvedic medicine, a woman who has a pre-dominance of Pitta (the fire element) is more likely to tend towards a heavier menstrual flow. These women often have blonde or red, but also brown, hair, a ruddy complexion, and often have freckles, moles, or petichiae (red, broken blood vessels). They tend to be warm-blooded and sometimes hot-tempered. They may also have diarrhea or loose stool just before or at the onset of their periods.

Excessive menstrual bleeding, called "menorrhagia", may range from a day in which a woman needs to change her pad or tampon every couple of hours and has a gushing, profuse flow of blood, to an extreme state where she needs to use double protection, and change pads or tampons every half hour or hour. I once saw a woman in her late forties who, for years, slept with a plastic sheet on her bed during her period because she would soak part of the mattress! Her excessive bleeding was remedied quite effectively with homeopathic treatment. In my experience, herbs such as Geranium and Trillium can halt an excessive menses quickly tem-porarily, but does not change the overall tendency as does homeopathy. Since there is no standard homeopathic remedy for menorrhagia, I cannot give you personal suggestions. I can say, though, that I have often found such homeopathic remedies as Belladonna and Sabina, when they match the woman's specific symptoms, to stop bleeding in a matter of hours or a day. Orthodox medicine is likely to prescribe birth control pills. I am very suspicious of estrogen supplementation and strongly advise more natural al-ternatives. Not only can the pill cause mood swings, headaches, yeast infections, and a variety of other annoying symptoms, but can cause or aggravate such estrogen-dependent conditions as fibrocystic breasts, uterine fibroids, ovarian cysts, and uterine or breast cancer. I have one patient whose 18 year-old godchild died of a sudden aneurysm due to the pill.

If the excessive bleeding is longstanding, it is probably something which needs to be treated on a constitutional level. If it develops quickly, it is important to rule out such causes as uterine fibroids, uterine cancer, or ovarian cysts. Your doctor will likely do a pelvic ultrasound and, if cancer is suspected, a uterine biopsy. The same is true for spotting or bleeding between the periods (metrorrhagia).

What is normal PMS? This is another tricky question. I think it largely depends on how affected you are by your premenstrual symptoms. It is one thing to feel kind of grouchy for a day or two once a month and another to feel a strong impulse to kill or be violent. Being overly senti-mental occasionally doesn't put much of a dent in a woman's life. However, if she can't hold her-self back from crying one or two weeks out of the month, it's a different story. Relationships have often been broken because of PMS and jobs have evaporated. There are many natural therapies available ranging from diet, vitamins and minerals to herbs, homeopathy, Chinese medicine, and many more. I have rarely seen a woman who cannot find substantial relief from one or another of these treatments.

Your menstrual cycle is a beautiful outpouring of your feminine nature and spirit. Love and appreciate this aspect of your life as a symbol of the overall flow and outpouring of your life.

Drs. Judyth Reichenberg-Ullman is a naturopathic and homeopathic physician and cofounder of the Northwest Center for Homeopathic Medicine in Edmonds, WA. She is coauthor of The Patient's Guide to Homeopathic Medicine and Beyond Ritalin: Homeopathic Treatment of ADD and Other Behavioral and Learning Problems. She can be reached at (206) 774-5599.