By: Dr. Jodie Peacock ND
In my clinical practice, I often see women who are experiencing challenges with hormonal balance and their menstrual cycles. I often find that women are not aware of what a healthy or normal menstrual cycle should be like. This is not something discussed in schools or even with our medical professionals unless brought up by the patient. I feel young women should be educated to understand, from the time they enter puberty and throughout their lifetime, what a normal or healthy menstrual cycle should look like and when they should be seeking the assistance of a medical doctor or a naturopathic doctor.
Let’s break it down!
A menstrual cycle is determined by the number of days from the first day of one period to the first day of the next. Day one of the menstrual cycle is the first full bleeding day of the period. A typical cycle is approximately 24 to 35 days (average 28 days for most women). It is not abnormal for a woman¹s cycle to occasionally be shorter or longer.
On Day 1 of the menstrual cycle, estrogen and progesterone levels are low. Low levels of estrogen and progesterone signal the pituitary gland to produce Follicle Stimulating Hormone (FSH). FSH begins the process of maturing a follicle (fluid-filled sac in the ovary containing an egg).
The follicle produces more estrogen to prepare the uterus for pregnancy. This is what helps the lining develop in the uterus. At ovulation, usually around Day 12 – 16, increased estrogen levels trigger a sharp rise in Luteinizing Hormone (LH) from the pituitary gland, causing release of the egg from the follicle.
The ruptured follicle (corpus luteum) now secretes progesterone and estrogen to continue to prepare the uterus for pregnancy. If the egg is not fertilized, estrogen and progesterone levels drop and on Day 28, the menses begin.
The menstrual cycle occurs in three phases: follicular, ovulatory and luteal. The first half of the cycle is the follicular phase and the second half the luteal phase. Midway through the cycle, between days 12 and 16, ovulation occurs - known as the ovulatory phase.
You are most fertile starting about three days before ovulation to one day after ovulation.
Why is it important to understand and be able to interpret what is happening with your menstrual cycle.
- It is essential to knowing your fertile window to be able to time intercourse to your fertile days.
- If your menstrual cycle isn’t regulating properly, this could be a reason why you aren’t achieving your goal of becoming pregnant.
- It makes it easier to understand what interventions are going to work best for you depending on where you have imbalances.
- It can help identify treatment options for conditions such as PCOS, endometriosis and PMS, which can be linked to an overabundance of estrogen compared to progesterone.
How do you monitor your menstrual cycle?
Basal body temperature (BBT)
Your body temperature dips a bit just before your ovary releases an egg. Then, 24 hours after the egg's release, your temperature rises and stays up for several days. Before ovulation, a woman's BBT averages between 36.1°C (97°F) and 36.4°C (97.5°F). After ovulation, it rises to 36.4°C (97.6°F) to 37°C (98.6°F).
You can track your cycle by taking your BBT every morning. Take your temperature at the same time every day before getting out of bed. Next, record the results on a chart or in an app. If you have a somewhat regular cycle, the chart will help you predict when you will ovulate next. As your body senses the hormone shifts that indicate an egg is about to be released from the ovary, it begins to ready itself for the incoming sperm and give the egg its best chance of fertilization.
One cervical sign you can watch for is the appearance, increase in quantity, and change in consistency of cervical mucous. After your menses there is typically a small amount of vaginal discharge. As your cycle progresses you will notice an increase in discharge that is whitish in colour and if you tried to put it between your fingers, it would break apart. As you get closer to ovulation, the discharges will become more clear, copious and similar to the consistency of egg white. If you put it between your fingers it will stretch. After ovulation the discharges can either dry up or become thicker and white. Monitoring your cervical mucous can give you some great insights into what is happening with your cycle.
With a normal or healthy BBT, your follicular phase should last between 11-14 days then ovulation occurs followed by the luteal phase, which should also last between 11-14 days.
If your follicular phase is shorter than 11 days this may indicate that there isn’t enough time for your egg to properly develop. There was a study published that explored the pregnancy rates of women with a follicular phase of less than 11 days, to women who’s follicular phase was between 12-20 days. Pregnancies were achieved by 9/32 women (28.1%) who were early ovulators compared to 19/32 (59.4%) of controls. The 12-month pregnancy rate in early ovulators was 31.4%, compared to 66.3% for controls.
If your follicular phase lands in the 12-20 day window then likely there is enough time for proper oocyte development. If you are ovulating before day 12, then a botanical called tribulus could be helpful at lengthening the follicular phase.
Your luteal phase begins once your temperature has increased. It should stay up for between 11-15 days. If the temperature doesn’t elevate for at least 11 days, this can be an indicator that your progesterone is dropping too early.
Stress can certainly play a role in altering your luteal phase, so implementing some stress reduction techniques can be helpful. If you are still seeing a short luteal phase, you can try a botanical called chastetree to help support progesterone production. Chastetree will usually take about 3 cycles to have a full effect. Low progerestone can also present as symptoms such as mood swings, breast tenderness and night sweating. These concerns can often improve using the herb Chastree as well as by increasing your B6. If you are under the care of a fertility specialist you will likely be prescribed progesterone as either a cream, suppository or via injection that will also help with this concern (this is generally done with IVF cycles or if labs show low progesterone).
Your period is another important part of this equation. Your period should last somewhere between 4-7 days. During your period, it is normal to have mild cramping but if you find you need pain medication or are taking time off work, these are indicators that you should be having discussions with your naturopathic doctor or health provider. Short or light menses can also be a concern. If your body isn’t creating a healthy uterine lining it can be very difficult for an embryo to implant and receive enough nourishment. If you have a thin lining, essential fatty acids, vitamin E and ginkgo can all potentially be helpful.
If you have any concerns with the length of your cycle or symptoms associated with either your menstrual flow or pain, please speak to your health professional to start the process of determining how you can optimize your cycle for your health and fertility.