Do you have a regular menstrual cycle? Do you know when you ovulate? Do you have a healthy period?
These are all questions you need to be able to answer to optimize your chances of having a healthy baby.
Let’s start with your cycle length. A healthy menstrual cycle will last somewhere between 26-32 days. There are 3 phases of the menstrual cycle.
The first phase starts on the first day of your period and is known as the follicular phase. This is when your eggs begin to develop and reach maturity. This phase on average lasts between 12-18 days. If it is shorter then this, it can mean your body doesn’t have long enough for your eggs to properly mature. A hormone called FSH (follicle stimulating hormone) is released from your pituitary gland and signals to your ovary to begin the process of maturing follicles. Often as we age the follicular phase will become shorter. This doesn’t mean it isn’t possible to get pregnant with a shorter follicular phase as I have had patients report having a healthy pregnancy with ovulating as early as day 9 but if we have to opportunity to develop the eggs a little longer they are generally more likely to be viable.
Your period can also tell you a significant amount about your menstrual health. Your period will ideally begin with menstrual flow that is bright red. If it begins with a lot of brownish discharge this indicates blood that is older and more stagnant. Flow should last between 4-7 days. Ideally you shouldn’t need to change your pad or tampon more then every 2-3 hours for 2-3 days of your period then the remaining days should be lighter. If your flow is lighter, then this it can mean you aren’t developing a robust enough lining for an embryo to implant. If your flow is heavier then this, it may indicate that you have an excess of estrogen compared to progesterone or that you have fibroids. These are both reason to follow up with your health professional.
Mid cycle is known as the ovulatory phase and lasts a few days. During this phase you should see changes in your vaginal secretions. Secretions become thinner and stretchy and will have an egg white like consistency. This mucus is designed to assist sperm and provide easier passage to the ovulated egg. Some women will have a regular menstrual cycle but will not ovulate regularly, while others will have an irregular cycle without regular ovulation.
There are several potential contributors to anovulatory cycles including:
- Having an endocrine disorder such as PCOS
- Having low body weight or body fat percentage
- Poor blood sugar regulation
- Premature ovarian failure
There are multiple ways to test if you are ovulating or not. At home you can do a combination of monitoring your basal body temperature as well checking your cervical mucous. To test your basal body temperature – measure your oral temperature first thing in the morning before getting out of bed for one full cycle. During the first half or follicular phase your temperatures should average 36-37 degrees Celsius. When you ovulate, your temperature should raise by around 0.4 degrees Celsius. This increase should correspond with the change in cervical mucous to thinner egg white like secretions.
You can also test for ovulation using urine-based test strips that test for metabolites of a hormone called luteinizing hormone (LH). LH will surge right before you ovulate, so this can be a great indicator that your ovary is going to release an egg.
At a fertility clinic health professionals can assess if you are ovulating using a combination of regular blood work and transvaginal ultrasounds. With this option you are able to monitor the number of follicles developing and if they reach a size that is viable for a pregnancy.
If it is determined that you are not ovulating regularly it is very important to try to discern the underlying cause.
If you have been diagnosed with polycystic ovarian syndrome (PCOS) you may have irregular menstrual cycles and only ovulate during some cycles. PCOS is an endocrine disorder which means it has an impact on your body’s ability to regulate its hormonal cycle. Often women will have a challenging time regulating blood sugars, which can lead to inflammation in the body and disruption in healthy hormonal regulation. If this is your situation one of the most important things to do is to begin a regular exercise program. Exercise helps sensitize your hormonal receptors and helps regulate blood sugars as well as other hormones. If you aren’t currently exercising aim to start with regular daily walking for at least 20 minutes. If you are exercising already try to switch up between higher intensity training, cardio and weight training. It is ideal to do something active daily.
If you have an endocrine disorder, an autoimmune disorder (example Hashimoto’s thyroiditis or rheumatoid arthritis) or are low body weight making sure you are eating enough dietary fats can make a significant difference to help you ovulate regularly. Some of the foods to include more of include olive oil, coconut oil, avocado, nuts and seeds. It is also important to make sure you are getting enough carnitine in your diet. Carnitine is an amino acid that comes from animal protein. Carnitine works as a shunt to move fatty acids from the blood stream into mitochondria. Mitochondria are organelles that make energy in the form of ATP. If you don’t have enough carnitine the mitochondria can’t make enough fuel/energy. This can be a concern for cycle regulation as well as in conditions such as chronic fatigue syndrome, fibromyalgia, poor egg or sperm quality.
The third phase of the menstrual cycle is the luteal phase. This phase usually lasts between 12-15 days. During this phase the predominant hormone is progesterone. Progesterone encourages more blood flow into the uterus and is necessary for the fertilized egg to implant. If progesterone drops too early this results in a shortened menstrual cycle and often time can be the cause of early miscarriage if the newly formed embryo doesn’t have enough time to implant properly.
Low progesterone can result from chronic stress. When under stress your body makes more of a hormone called cortisol. Cortisol is made from progesterone, so if your body is making more cortisol than normal this can result in lower progesterone. This will not only impact progesterone during the luteal phase but can also lead to lower progesterone levels during the first half of the cycle. Low progesterone during the first half of the cycle can lead to a thinner uterine lining. If there is a lot of stress (which is commonplace during periods when fertility is an issue) then implementing stress management is critical. Exercise again will be important in this case but not excessive exercise. Aiming for between 30-60 minutes daily is great but going beyond 60 minutes daily can in some cases increase the depletion of progesterone. Eating a diet full of nourishing fruits and vegetables along with minimizing packaged and processed foods also takes stress off the body.
If progesterone is still low after implementing changes, there is an herb called chaste tree that can help support your body’s ability to make more progesterone. There is also the option of using either transdermal or oral progesterone medication. If this is a route you need to go it is important to continue your stress reduction as this extra progesterone can end up converting to cortisol as well.
We can also see a higher ratio of estrogen to progesterone which will give a similar result. If you have too much of either 16-OH estrone or 4-OH estrone this can impact your menstrual cycle as well as contribute to conditions such as endometriosis or fibrocystic breasts. You want to have most of your estrogen processed to end up as 2-OH estrone. A nutrient called indole-3-carbinol (I3C) which is found in brassica vegetables (kale, cabbage, broccoli and cauliflower) can assist your body encouraging estrogen to follow the pathway to end at 2-0h estrone or the “healthier estrogen”. This can then result in your body having a better ratio of estrogen to progesterone and resume regular ovulation.
An irregular menstrual cycle is a sign that hormones are not being effectively regulated in your body. Your body thrives on routine and wants to follow the natural rhythms of mother nature. An effective natural way to help regulate your menstrual cycle is with the use of traditional Chinese medicine and acupuncture or acupressure. Seeing a trained acupuncturist, you will have the opportunity to have imbalances acknowledged and improve the movement of energy or qi through the body. Another effective way to regulate your cycle is to look at the moon every night. Your monthly cycle will often then time with the planets natural moon cycles. Connecting with nature on a regular basis can also go a long way to helping your body’s natural rhythms. Many of us live in cities with very little exposure to the outdoors and nature. If you try to find a trail or to step in your backyard on the grass in your bare-feet these our great ways to connect yourself with the earth. This will not only help your menstrual cycles but your sleep cycle as well. Patients often will also note the more they connect with natural the less stressed or anxious they feel.