You may have learned about it in health class at school, or gotten “the talk” from your mother. But for many people who menstruate, their education didn’t include much about the myriad ways your cycle can affect you — or what you can do about it.
“‘What is a normal menstrual cycle?’ is probably one of my biggest questions I get,” said Dr. Natasha Deshwal, a family physician in Bedford, N.S, just outside Halifax.
As director of the Bedford Basin Women’s Health Clinic, Deshwal sees “anything from cramping to irregular bleeding to changes in their mood, weight changes, acne. … Trying to figure out what the normal is for women can sometimes be quite challenging.”
Deshwal said the menstrual cycle brings hormonal changes that can cause physical, mental and emotional changes. But there are things you can do to help handle those shifts, experts say.
Because all people experience menstruation differently, it is not easy to know what is normal, says Dr. Natasha Deshwal, a family physician in Bedford, N.S. (Mark Crosby/CBC)
How to help with PMS
Premenstrual syndrome (PMS) affects about 90 per cent of people in the days leading up to their period, causing symptoms like insomnia, bloating and feelings of anger or irritability.
“PMS is defined as a collection of symptoms, both physical and emotional, that alert one to the upcoming menstruation,” Dr. Alison Shea, an obstetrician-gynecologist, told Dr. Brian Goldman, host of CBC’s The Dose.
When there are concerns about PMS symptoms, it’s important to first check for underlying issues such as anemia or a thyroid problem, said Shea, an assistant professor at McMaster University and a reproductive mental health specialist. When those are ruled out, lifestyle changes can make a difference, she said.
The menstrual cycle is made up of four phases and lasts approximately 28 days. (Ben Shannon/CBC)
During the second half of the cycle — the luteal phase, which begins after ovulation and includes ebbs and flows in estrogen and progesterone levels — Shea recommends increasing exercise, limiting caffeine and alcohol, or even eating a low-salt diet to help with bloating.
There is evidence that certain supplements, including vitamin B6, calcium, vitamin D and magnesium, can help decrease PMS symptoms, Shea added.
There is also a supplement known as vitex, or chasteberry, that has shown effectiveness in reducing premenstrual irritability and anxiety for those whose symptoms are less severe, she said.
The increased severity of PMDD
A more severe version of PMS, called premenstrual dysphoric disorder (PMDD), affects three to nine per cent of people who menstruate. Its most common symptoms include mood swings, feeling sad or tearful, increased sensitivity to rejection, marked irritability or anger, and feelings of depression, hopelessness, and anxiety.
“Many will describe a switch that goes off — either halfway through their cycle or about a week before their period — where they just feel like a completely different person,” said Shea.
It can be helpful to track symptoms over a few cycles, says Dr. Alison Shea, an obstetrician-gynecologist and assistant professor at McMaster University. (Submitted by Alison Shea)
Treating PMDD can include the same lifestyle changes recommended for PMS, but those with more severe symptoms may need to modulate either the hormones or the serotonin, she said.
That could mean seeking a doctor’s advice on birth control medication, transdermal estrogen or selective serotonin reuptake inhibitors (SSRI).
The cycle’s four seasons
Other methods for interacting with the menstrual cycle move beyond a medical approach to also draw on ancestral wisdom. This is part of the education work that Taq Kaur Bhandal does through her Halifax-based company, I’m With Periods.
“We approach it both from a scientific, evidence-based perspective and then also through ancestral modalities,” said Bhandal, who has a background in biology and social justice.
One of those methods is to regard the phases of the menstrual cycle as four seasons: winter is our period; spring is the lead-up to ovulation; summer is ovulation; and autumn is the premenstrual time.
“We tend to use these four seasons as a way for people to start to tune into our own health, whether that’s physical, mental, emotional and even spiritual — beyond just our period,” Bhandal said.
Taq Khaur Bhandal is the founder of I’m With Periods, a company that provides education to change how people experience their menstrual cycle. (K. Ho )
Bhandal suggests using this method to schedule certain activities during the different phases of the cycle, when mood and energy will likely follow a predictable pattern.
During your period, for example, it can be helpful to take some time to yourself — anywhere from a full day to just five minutes — for inner reflection .
In the lead-up to ovulation, or spring, we’re often feeling more social, she said, and that can be a good time to schedule social outings with friends.
Bhandal and Shea both said it can be helpful to track cycles to spot recurring patterns, particularly physical or mental changes.
“Then you can have objective data to bring that to your health-care provider, if you are concerned,” said Shea.
There are many good cycle-tracking apps, she said, including the MAC-PMSS for iPhone, which was created by McMaster University.
Stigma around menstruation
Despite the menstrual cycle affecting more than half the world’s population, stigma around menstruation persists. Experts say we need to do more work to normalize the cycle and its effects on people who menstruate.
That includes making period products more accessible and affordable, as well as broadening understanding about how the cycle affects different people in different ways, experts say.
Regular movement can help reduce period and premenstrual symptoms, say experts. (Totsaa.arch Studio/Shutterstock)
“For those who don’t identify as being female or those who are not comfortable with the female characteristics, then having a menstrual cycle can be quite distressing and quite bothersome,” said Shea.
There can also be issues in the workplace if people need to have more flexible schedules or take time off for menstrual conditions such as painful periods or PMDD.
“I think we have a lot of work to do to understand that those who menstruate are not the same as those who don’t menstruate,” Shea said.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
