| Written By: Dr. Alice Veirs |
In this series, we are going to learn about periods and menstrual cycles and discuss how to start tracking your period, PMS symptoms, irregular periods, painful periods, heavy periods, and lastly PMDD (premenstrual dysphoric disorder). You’ll learn the basics of anatomy, tools to use at home, simple dietary and lifestyle changes, and other naturopathic treatments.
Let’s start with the anatomy. The picture below shows the major female reproductive organs. The ovaries are two glands held to the uterus by ligaments. They are the major producers of female sex hormones including estrogen and progesterone. The ovaries also store eggs, also called oocytes, that are released once a month during ovulation. Connecting the ovaries and the uterus are the fallopian tubes. They have finger-like fimbriae that sweep the egg released from the ovary into the fallopian tube where it then travels down into the uterus. The journey of the egg into the uterus takes up to 30 hours. At any point during that journey the egg may be fertilized by sperm. The uterus is a muscular organ that consists of three layers – endometrium, myometrium, and perimetrium. The endometrium thickens during the month and then is shed during a period. The very end of the uterus is the cervix which opens into the vaginal canal.
The next piece of the puzzle is to discuss the menstrual cycle. The menstrual cycle consists of ovulation and menstruation (a period). The picture below shows the different hormones’ activities during the menstrual cycle as well as significant phases that mark changes and stages of the cycle. The first phase is the Follicular phase lasting from days 1-14. Day 1 starts with a period, during which time the uterine lining is shed. Estrogen initially lowers during the period then starts to rise again soon after. A fluid-filled sac, called a follicle, begins to develop inside one of the ovaries and is stimulated by follicle-stimulating hormone (FSH) released from a gland in the brain. This developing follicle contains an egg that will be nourished by the follicle and then released during ovulation. Ovulation is marked by a sharp increase in luteinizing hormone (LH) that comes from the same gland in the brain releasing FSH. Ovulation usually happens on day 14 of the cycle. Ovulation also has outward signs including a rise in basal body temperature, a change in cervical mucus, and in some cases cramping or slight bleeding. Cervical mucus, which is usually thick and white during the follicular phase, will change to a watery and then sticky egg-white-like consistency during ovulation. Cramping during ovulation is called Mittelschmerz and is experienced on the side of the ovary releasing the egg. It is rare to experience bleeding during ovulation but may be normal due to hormonal changes happening during ovulation. It could also be a sign of the implantation of a fertilized egg. The next phase is the Luteal phase lasting from days 15-28. During this phase, estrogen may rise again then begin to decrease and progesterone rises drastically. Progesterone is released from the corpus luteum, a remnant of the follicle in the ovary. Progesterone is the most important hormone during the luteal phase as it prepares the uterus for an embryo. Progesterone is also protective against the negative side effects of estrogen. If there is no fertilized egg the corpus luteum will decay and stop releasing progesterone. The luteal phase ends with the start of a period on day one.
Now that you understand the anatomy and the phases of the menstrual cycle, we can talk about how to track your menstrual cycle and why this may be important. It is important to note that if you are on any type of hormonal contraception (ie birth control pills, hormonal IUD, Depo-Provera, or hormonal implant) you are unable to ovulate and therefore not able to have a menstrual cycle. The bleeding that may occur during a period while taking hormonal contraception is a withdrawal bleed.
To start tracking your menstrual cycle note the first day of your period flow and then the first day of your next period flow. This will mark day 1 and then the number of days between your periods. You’ll want to do this for a least 3 cycles to know on average how many days your menstrual cycle is, as it can vary slightly each time. A normal menstrual cycle is 21 to 35 days long with the average being 28 days. You will also want to note how many days your period flow lasts. This can vary from 2-7 days with the average being 5 days. It is also helpful to track any physical, mental, or emotional symptoms during and around your period, and how heavy or light the flow is each day.
You may also want to start tracking your ovulation during this time. There are several ways to track your ovulation as noted below.
Ways to track your ovulation:
- Cervical mucus method
- Basal body temperature method
- Calendar method
Tools to use:
- LH test strips
- Ovulation thermometer
The cervical mucus method involves evaluating your cervical secretions a few times during the day to decide if you are on a potentially fertile day. As was described above your cervical mucus will change on and around the day you ovulate from thick white to watery then sticky egg-white consistency. You can evaluate your cervical mucus by either checking your underwear, wiping with toilet paper before you pee, or inserting a clean finger into the vagina. There are subcategories in the cervical mucus method including the two-day method, Billings ovulation, and Creighton Model methods. In each method, it is helpful to note your cervical mucus consistency on a calendar or in an app. Many apps have a category for cervical mucus making it coinvent to easily note.
The basal body temperature method consists of taking your temperature every day and recording the result then noting which day you had a decrease and then a sharp increase in temperature. This increase in temperature is subtle and only easily spotted with a highly accurate thermometer that measures to a tenth of one degree. The increase in temperature is typically 0.5 degrees Fahrenheit and 0.3 degrees Celsius. Specific ovulation thermometers are sold online. They are best used every morning before getting out of bed since any movement before taking your temperature will decrease the accuracy of the reading. One of the most popular tools is Tempdrop which consists of a wearable thermometer and its own app.
The calendar method consists of tracking how long your menstrual cycle is (ie 28 or 32 days long) and then noting your ovulation window which is typically about 12-14 days before your next menstrual cycle. Determine your fertile window by backtracking 5 days before your anticipated ovulation, including your day of ovulation, and adding one day after, for a total of 7 days. For example, if your period is 29 days long and to be conservative you estimate your ovulation day is 14 days before your period, then you would mark your ovulation on day 15. Your fertile window would be days 10-16. Realistically you may ovulate any day within your fertile window. It is important to determine your fertile window for either pregnancy prevention or to become pregnant. As sperm can live in the vagina for up to 5 days.
LH test strips can be purchased online and are used to detect a spike in LH through urine. These can be helpful to pinpoint your ovulation window to within 24-36 hours.
A combination of these tracking methods and tools is the best way to learn exactly when you ovulate and when your fertile window is. Apps will often combine methods by using the calendar method as the base and then asking questions about cervical mucus or basal body temperature. You can also combine any of these methods on your own without the help of an app.
Reasons why tracking your menstrual cycle is important:
- Learn about your body
- Note signs and symptoms of PMS or PMDD
- Note if you have heavy bleeding, prolonged bleeding, or your bleeding is very light
- Note if your menstrual cycle is prolonged
- Understand when you ovulate
- Know if you do not ovulate
- Learn if your follicular or luteal phase is too short or long
- Can be used as a form of birth control
- Can be used to have better chances of pregnancy
- Can become aware of an unwanted pregnancy quicker
If you are tracking your cycle for the purpose of birth control or to become pregnant, it is important to make an appointment with your provider so they can walk you through these methods in more detail. You can also check out our future blog post about contraception to learn more.
If you would like to discuss any of this information, you can schedule a free meet and greet with one of our naturopathic doctors by calling 480-256-2999 or texting 480-256-2829.