NB: This one is for the ladies. And the lads, whether they have a lady lover or are perhaps just a little curious about the inner workings of female physiology…
You have probably had at least one of your vital signs measured at some point in your life. Vital signs are clinical measurements of essential bodily functions: your blood pressure, pulse, temperature and rate of breathing. All pretty important, right? And if you’re a woman (or a man) it may interest you to know that a woman’s menstrual cycle is now being classified as the fifth vital sign, as put forward by The American Congress of Obstetricians and Gynecologists. A woman’s menstrual cycle is literally so important that it is now being considered a crucial element of overall medical health assessment. So how do we know what is normal and what is not?
What actually happens during the menstrual cycle?
This table may look a little overwhelming, but it sums up the basics of what goes on in a monthly cycle. The first day of bleeding is regarded as day 1 of the menstrual cycle.
Days 1-5: the menstrual phase – the endometrial lining of the uterus is shed and a period occurs.
Day 6-13: the proliferative phase – oestrogen increases and the endometrial tissue in the uterus starts to build again.
Day 8: the dominant follicle develops – follicle-stimulating hormone (FSH) begins to rise and causes one of the follicles to become dominant; this is the follicle that will house the fertile egg.
Day 14: ovulation occurs – oestrogen peaks and causes luteinising hormone (LH) to surge. LH is the hormone responsible for releasing the egg from the follicle. Once LH has surged, ovulation generally occurs between 16-32 hours later. Then the egg makes its way down the fallopian tubes to the uterus.
Day 15-28: the luteal phase – the follicle which released the egg forms the corpus luteum, which has a primary role of producing a hormone called progesterone. Progesterone levels rise in order to thicken the endometrial lining in preparation for fertilisation and implantation of an egg (for pregnancy to occur).
If fertilisation of the egg does not occur, pregnancy does not ensue, the endometrial lining is shed (a period occurs) and the cycle begins again.
Our periods are like report cards, we get one each month and it reminds us how we’ve been treating our body that past month. If you have been stressed, your digestion has been playing up, you’ve been extra tired or feeling like your emotions are out of control, then this may also be reflected in your period. Likewise, too much sugar and too much partying can also cause changes in our periods. Our periods can tell us a lot more than just baby or no baby. And whilst no two women will have the exact same menstruation experience, there are some signs that we can look out for to let us know when things are a little off within our system… But how do we know what is normal and what’s not?
Some questions to consider when getting to know your period are…
How many days is your cycle?
A normal menstrual cycle is 28 days, give or take 1-2 days. A normal bleed is generally between 4-7 days, give or take 1-2 days. If your cycle is longer or shorter however it has always been that way, then this is normal for you. If your cycle has changed in length or duration then this warrants investigation. Polycystic ovarian syndrome (PCOS) is a hormonal condition which can cause irregular menstruation as well as weight gain, facial hair growth, anxiety, depression and acne. Increased stress can also make our cycles longer or shorter.
What colour is your menstrual blood?
Bright red blood is a sign of a healthy period. Dark coloured blood may indicate blood stagnation and inflammation in the body. Inflammation is a key driver behind all modern day illness including gastrointestinal disorders, cardiovascular disease, cancer, mental health conditions and even obesity. Fried and processed foods contain pro-inflammatory compounds such as trans fats and excessive sugar, worsening period pain and wreaking havoc on your skin; especially if you get break outs around your period. Avoid.
How heavy is your bleed? Do you experience any clotting?
A normal period generally consists of between 30-40ml of blood loss, with approximately 80ml being the upper limit. A regular tampon or pad holds about 5ml of blood. If your menstrual flow requires changes of pads or tampons every 1–2 hours, this is considered excessive, particularly if your period lasts more than 7 days in duration. Although heavy bleeding can cause iron deficiency, iron deficiency can also cause sudden heavy bleeding – a confusing concept, I know! – but if you are experiencing heavy periods it is important to monitor your iron levels. Whilst a small amount of small clots are normal, large clots and heavy bleeding are signs of hormone imbalances such as oestrogen dominance. Oestrogen is not evil, it is an essential hormone required for life (it also protects our bone density and cardiovascular health) but it depends on the type of oestrogen (there are three main types), the amount, and the ratio between oestrogen and other hormones such as progesterone. An excess of oestrogen is linked to signs and symptoms such as weight gain (especially around hips and stomach), food cravings (hello sugar!), depression, anxiety, irritability, anger, bloating, fuzzy thinking, headaches, migraines, recurrent thrush, breast tenderness and lowered sex drive. The more we look at our bodies’ as a whole, the easier it is to understand how our periods can both affect and be a reflection of our wider picture of health.
Do you experience period pain and PMS symptoms i.e. mood swings, anxiety, depression, bloating or cravings?
Although common, PMS is a symptom of hormonal imbalance, which can be caused by a number of things. For example, the health of our digestion and liver. If our gut bacteria is out of whack or our liver is functioning sub-optimally, this can change the metabolism of oestrogen and contribute to PMS. Poor digestion or liver function can also mess with testosterone metabolism, which may contribute to acne. Period pain can be caused by both hormonal imbalances and inflammatory processes which cause reduced blood flow to the uterus, leading to muscle spasm and pain. Period pain can also have other causes, including hormonal conditions such as endometriosis and uterine fibroids. Interestingly, endometriosis, a serious inflammatory reproductive disorder that affects one in ten females, is commonly associated with Irritable Bowel Syndrome (IBS), a digestive disorder. Our digestive system and our hormones are very much linked. Severe period pain and PMS is not normal and is not something that needs to be “put up with”. And no, the oral contraceptive pill is not the answer, it simply masks the symptoms whilst ignoring the underlying causative factors. Speak to your qualified naturopath about identifying the cause of your period pain or PMS and creating an individualised plan to naturally and effectively combat it.
Do you experience discharge throughout your cycle?
Discharge is a normal, healthy part of a menstrual cycle and can be monitored to assess phases of the menstrual cycle and identify ovulation. While the colour and consistency of discharge fluctuates throughout the month, it is the clear mucous with a raw egg white consistency that signals ovulation. This discharge usually begins 3-5 days before ovulation. Once you are familiar enough with your cycle, you will know exactly when you have ovulated thanks to this discharge; some women use this as their method of contraception. There are several useful smartphone apps which can help track your period and ovulation, such as Kindara or FMC.
So while on day one of our period we may either breathe a sigh of relief with the reassurance that we are not pregnant, feel frustrated at the inconvenience of not being able to wear a white dress on the weekend, or are left with cramping pain and sugar cravings wondering why it’s 2017 and paracetamol and chocolate do not yet come in a value pack, one of the most empowering things we can do as females is to connect with and understand how our own bodies work, including our amazing menstrual cycles. Just as abnormal blood pressure, heart rate, pulse or respiratory rate can be key to diagnosing potentially serious health conditions, so too can identification of abnormal menstrual patterns. Understanding what a normal menstrual cycle looks like, and how our periods interact with other aspects of our bodies’ such as our digestion and stress levels is paramount for all women. As the saying goes… Knowledge is power!
If you are experiencing menstrual irregularities it is important to speak to your healthcare practitioner to understand the cause and determine appropriate treatment options. Take heed that it is not compulsory to become an emotional Cadbury-inhaling demon every 28 days. There are plenty of safe and effective herbal, nutritional, dietary and lifestyle interventions which can assist in rectifying the underlying imbalances of menstrual complaints, without the side effects that come with the pill, but with the added benefits of improved mood, digestion, skin, energy and the list goes on. If that’s not motivation enough, unresolved menstrual issues can often complicate fertility and menopause when the time comes, so your future self will thank you for regulating your fifth vital sign now!