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In today’s episode, Dr. Lisa and Dr. Toni are discussing some of the basics around our menstrual cycles and periods.
In this episode, we cover:
- What a normal period is
- The hormones involved in your menstrual cycle
- The four phases of your menstrual cycle
- Common (but not normal) things you could be experiencing with your period and menstrual cycle that are signs of abnormal function
Menstruation could be considered your 5th vital sign, after heart rate, blood pressure, breathing rate and body temperature.
What are your first memories of your period?
Most of us in North America don’t experience some of the celebrations around the appearance of a girl’s first period, unlike some cultures around the world. You might think about your period as an annoyance, something to hide or embarrassment.
As a woman, you are a cyclical being. You experience ebbs and flows of different hormones throughout the month – estrogen, progesterone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, as well as prostaglandins (chemical messengers that stimulate uterus to contract).
Your menstrual cycle is impacted by moon cycles, since the different phases of the moon shifts the movement of fluids, especially salt water. It can also be impacted by stress, blood sugar, liver and gut health. These can cause different imbalances and problems that are common, not normal!
If you are taking a birth control pill or have an IUD with hormones, you need to be aware that it is masking your natural menstrual cycle.
The age range for menarche, or your first period, is 9-18 years of age. Back in 1840, the average woman’s menarche was 16.5 years of age, while now it’s between 12-13 years of age.
Why has this changed? It’s possibly impacted by different environmental toxins you are now exposed to that your grandmother wasn’t exposed to, and a lot of these new chemicals are hormone disruptors.
Normal menstruation includes:
- 4-7 days of flow
- 26-32 days long
- Average flow is 30-50ml (1 regular pad or tampon can hold up to 5ml)
- Starts bright, cranberry red in colour and ends bright, cranberry red colour
- No PMS or cramping
- No clots
- No spotting
- Viscosity of jello that hasn’t set
- Cervical fluid (aka vaginal discharge) changes
- Consistency and predictability is key
4 Phases of the Menstrual Cycle:
- Menstruation: previously released egg doesn’t become fertilized, estrogen and progesterone drop, your endometrial lining is shed. Day 1 = 1st day of your period flow
- Follicular (proliferative) phase: overlaps with menstruation
- Starts on Day 1 – your brain releases FSH to tell your ovaries to create follicles, or sacs with immature eggs in them
- The healthiest egg will be released during ovulation
- You are born with all of your eggs (vs. sperm made every 2-3 months)
- You used to be an egg in your mother’s ovaries before your mother was born and in utero in your grandmother! See here to learn more.
- As the follicle matures, your body releases estrogen to build your uterine lining so you’re ready to implant a fertilized egg if there is sperm available
- Ovulation: typically between day 10-17 of your menstrual cycle WHEN FERTILE
- Rising estrogen triggers your brain to release LH, which stimulates one of your ovaries to release the mature egg
- Mature egg travels down the fallopian tube to the uterus and can be fertilized anywhere during this journey for up to 24 hours. It’s possible for another egg to be released after (like Dr. Lisa and her fraternal twin!)
- Your cervix starts moving up your vaginal canal and opens up, releasing your cervical fluid with a consistency like raw egg white that can hang out! This quality of cervical fluid supports fertility as it helps sperm swim up to egg
- Your basal body temperature (BBT) changes – on average, you could have an increase of 0.5oC 12-24 hours after ovulation. You may also get a slight temperature dip right before you ovulate
- Ovulation predictor strips test LH, not necessarily ovulation! You can have LH surge without an egg release
- Luteal phase:
- If your egg isn’t fertilized, the follicle turns into the corpus luteum, which releases progesterone to keep uterine wall thick and gets uterus ready for implantation,
- The length of your luteal phase is based on how long progesterone is maintained, rise in temperature from progesterone
- Estrogen remains low
- In perimenopause, you may have low progesterone levels and may not ovulate with every menstrual cycle
- If the egg isn’t fertilized, the corpus luteum is dissolved into your body, levels of estrogen and progesterone drop, and you get your period (restarting the menstruation phase)
- If you get pregnant, the fertilized egg tells your body to release hcG and stimulates the release of progesterone to support the thickness of the uterine lining
Abnormal Menstrual Issues You May Be Experiencing:
Brown flow:
- Old menstrual blood from your last period
- Caused by stagnation, low progesterone, possible scarring from past C-section, D&C, abdominal surgeries or trauma
- Can be helped by:
- Arvigo abdominal massage or other bodywork like osteopathic, craniosacral, yoga therapy
- Castor oil packs or topical use (not during period, as it can speed up flow)
- Progesterone support with vitex, B vitamins, oral micronized progesterone or progesterone cream
- Addressing root causes of low progesterone, like stress!
Heavy bleeding, clots, spotting or your period keeps starting and stopping:
- Often linked with high estrogen and could be a sign of fibroids, endometriosis or polyps (get ultrasound imaging and further assessment from family doctor or gynecologist!)
- Can also be caused by low iron or low thyroid function
- Consider iron supplementation or estrogen detoxification support for the liver with DIM/I3C, herbs like yarrow, capsella, milk thistle, curcumin/turmeric, green tea, NAC/GSH
- Support bowel movements, increase fibre to bind extra estrogens and other toxins
- You might need extra bile support if your gallbladder was removed
- Limit your beer intake due to the estrogenic effect of hops
Short flow, light flow, missed periods, longer cycles:
- Can be caused by low estrogen, most likely in late perimenopause as you are nearing menopause!
- Can happen if you are underweight and/or overexercising; typically in younger women
- Consider:
- increasing your intake of protein and fat, including cholesterol for hormonal building blocks from eggs, or plant sterols
- Ground flaxseeds, traditional forms of soy (like miso, tofu, tempeh)
- Bioidentical hormone cream, or herbs like caulophyllum, cohosh, red clover
Your period comes every few weeks/ you have shorter cycles:
- Low thyroid function and low progesterone are both likely in perimenopause
Cramping:
- Can be from high levels of estrogen or inflammation
- Helped by castor oil packs, liver detoxification pathway support, magnesium, cramp bark, ginger
Why should you avoid NSAIDs like naproxen (Aleve) and ibuprofen (Advil, Motrin)?
They negatively impact liver function, can cause leaky gut and deplete your body from critical nutrients like folic acid, melatonin and iron.
Tylenol is not better! It reduces your levels of glutathione, which is a crucial antioxidant for your brain and liver.
PMS: things come out that may be unaddressed or suppressed – no filter!
- Symptoms: headaches, breast tenderness, bloating, stool changes, sleep disturbance, breast tenderness, food cravings, fatigue, mood swings, change in libido, hot flashes/heat symptoms during sleep (perimenopause)
- What’s your hormone imbalance? Low progesterone, high estrogen, low thyroid
- Don’t forget about possible low iron!
Supplements and herbal support for PMS:
- Reduce caffeine in coffee, tea, chocolate
- Consider low-dose iodine for breast tenderness
Today’s Mama Must Have:
Dr. Toni has used the Period Tracker app for many years to track her menstrual cycle. It was super helpful when she was working on getting pregnant, as well as when she was working on not getting pregnant!
Dr. Lisa is a big fan of the Geratherm thermometer for its accuracy for tracking basal body temperature. She also loves the Real Coconut Coconut Flour Tortilla Chips….yummy!
Thank you for joining us today!
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Please tell your perimenopausal mama friends about us, too!
Stay safe everyone!
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