Welcome to Am I Dying, a column that hopes to save you from your late-night WebMD spiraling. You can email us your hypochondriac questions at firstname.lastname@example.org.
Lately my period has been preceded by a week or so of brown/red spotting. What are some likely culprits? Is it hormonal? When I Google, results suggest that I might be served, hormone-wise, by reducing my caffeine intake. I also lost some weight over the past two years (I started exercising and trying to eat well) — could that have anything to do with this? If so: brutal, because I feel great. But also, what am I doing wrong?
Coffee is one of those things (like sitting, or standing, for instance) that is terrible for you one minute and great for you the next, according to the latest study, and maybe also according to how bad your caffeine headache is on any given day. On the subject of coffee’s effect on the menstrual cycle, there are numerous academic studies available, most of which provide little to no evidence that an increased consumption of caffeine causes any significant disruption. And yet, it’s perhaps even easier to find declarative advice on women-oriented wellness blogs, suggesting that anyone with a period either dramatically reduce or cease their caffeine intake altogether.
Dr. Lila Nachtigall, a gynecologist at NYU Langone Health, affirms that available evidence of caffeine’s effect on menstruation is scant, comparing these concerns to earlier concerns that drinking coffee led to the development of breast cysts. “I just pulled up about 25 articles, and they used to say coffee was bad because it made breast cysts. Now coffee is good, and protects breasts,” she says. “But none of the studies are really evidence based with real controls.” The studies that do suggest coffee might mess with menstruation are similarly poorly conceived, says Nachtigall. “They’re just observational studies where they look at women who happen to drink coffee and women who didn’t,” without controlling for other mitigating factors, she says.
And even in meta studies on the subject, which combine results from five or six experiments, Nachtigall says it takes four cups of coffee a day before you see any difference between caffeine drinkers and non-drinkers. Now, I don’t know how much coffee you drink, and no judgments if you drink that much, but I’m willing to bet that it’s probably less than that. (Most people in the U.S. report drinking between one and three cups a day.) Drinking copious amounts of coffee might have some effect on your period’s regularity, says Nachtigall, but it’s unclear what, and she can’t definitively say that reducing your intake is worth that marginal possibility. “Cutting down on your coffee is not going to do anything for your hormones,” she says.
Now, you also mention losing weight. Without knowing your specifics, of course, Nachtigall says it’s much likelier that this is what’s affecting your cycle. A significant change in weight, she says, can lead your body to stop producing progesterone, which means you stop ovulating. “It would have to be at least ten pounds, but losing ten pounds often will make a woman skip an ovulation,” she explains. And beyond that, at the point at which you cross the line into underweight territory, and your body fat drops too low, you might stop getting your period altogether, she adds — and this is an especially likely side effect of the weight loss caused by under-eating, or too much exercise.
Spotting before one’s period can be caused by a number of things, says Nachtigall, many of them innocuous, but it’s important that any changes to one’s menstrual cycle (especially ones lasting more than a couple of cycles) are examined by a doctor. So that’s the bad news: it’s probably time for a pelvic exam. The good news? No need to cut back on coffee — not for this reason, anyway.