EP.285/ REPLAY: What is The Menstrual Cycle and How to Know If Yours is Healthy
Today’s episode is a replay as I have been in and out of hospital all week undergoing testing for coeliac disease and chronic appendicitis. As you can imagine, these appointments have eaten into both my time and energy, so I am resharing an old episode today! One that I think provides you with a great foundations for the rest of the year. Today I am resharing my episode about what you should look for in a healthy menstrual cycle, even with endometriosis (because just because you have endo, doesn’t mean you have to suffer with a terrible cycle). If you notice your cycle does not match up with what I share today, you may have some hormonal imbalances, which can be improved, even with endo, and I’ll link to some episodes so you can further identify what you may be experiencing. Okay, let’s get to it…
Now of course, having endometriosis, you period probably doesn’t look healthy to you. Maybe you have really heavy bleeding, prolonged periods or a lot of pain. And whilst we have to take into account that yes, our cycles and periods in particular will probably look different from others, we shouldn’t dismiss these differences as just because of endo and that there’s nothing we can do about it. In truth, there’s probably a lot you can do!
When my clients first come to me, many show signs of lack of ovulation, low progesterone, excess or oestrogen dominance.
As we work on their hormones with blood sugar balancing, stress regulation, nutrition for healthy hormones and so on, these symptoms fall away and their hormones stabilise and they end up with really healthy looking cycles - and it’s then that we can see a clear picture of what endo is doing and what are the actual symptoms of their endo that are left remaining, which we can continue to work on. And the great thing is, that working on your endo improves your hormones, and working on your hormones improves your endo, so they usually both get better by default.
So today, I want to give you a basic overview of what is happening in your cycle so you can actually understand the changes, and I’ve taken snippets from my course Live and Thrive with Endo and have combined them to give you a short and succinct breakdown of what your hormones, body and emotions are doing throughout your cycle and what a healthy cycle looks like.
Now remember, we’re not aiming for perfection here. Some months my cycle is great, some months I overdo it in one area and notice a few signs of oestrogen dominance, or perhaps I notice I’ve ovulated late. We don’t live in a bubble, and there will be times when our menstrual cycle is affected, but that’s fine - it’s about doing what we can to have a healthy cycle whilst also still living our lives. If it’s going to cause you more stress to be aware of your menstrual cycle or try to balance your hormones right now, then that’s going to actually be detrimental, so maybe revisit this when you’re ready - and if it’s just something you’re not interested in, that’s okay too! These are only ever options for you and you have to pick the ones that are right for you.
Finally, I just wanted to offer a trigger warning that this episode does discuss conception, fertility, etc. in relation to the menstrual cycle.
Hormones Overview
Right so let’s start with a quick overview of the key hormones involved in the menstrual cycle.
Before I go ahead with this lesson, I do want to let you know that I talk about fertilisation and preparing the body for pregnancy, so if that feels triggering for you right now, please feel free to skip this lesson.
In a moment I’m going to take you through each stage of the menstrual cycle and to do that I thought it would be helpful just to give you a brief look at the core role of the main hormones involved in the menstrual cycle. This is a basic overview as I said, so if you want to dive deeper into this subject, I really suggest looking into my tutor Nicole Jardim’s work, and I’ve linked to some resources in the handout.
The key hormones and their main roles are:
Luteinising hormone’s main role is to trigger ovulation.
Follicle stimulating hormone’s main role is preparing follicles to develop mature eggs for ovulation.
One of oestrogen main roles is to build the uterine lining, but it’s also the hormone that triggers the onset of puberty and feminine features like breasts and hips, and boosts serotonin production and activity in the brain, supports bone density, sleep and heart health.
One of progesterone’s key roles is further preparing the uterine lining for pregnancy, but it also boosts GABA receptor function in the brain, allowing us to feel more of the calming benefits of this neurotransmitter. Additionally, progesterone supports sleep and heart, bone and breast health.
Lastly, I want to mention a few others involved (though there are more):
Gonadotropin-releasing hormone stimulates FSH production from pituitary gland
Testosterone plays a role in ovulation and libido but is much lower in females than males. It also affects mood to enhance confidence and assertiveness.
Androstenedione plays a role in ovulation alongside testosterone and again, is in much higher levels in males.
Again, there’s more to these hormones than these roles and there are actually more hormones involved in this cycle in general, but FSH, LH, oestrogen and progesterone are the star players here. If you’d like to learn more, refer back to the resources in then handout.
The Four Phases
Okay so now you have a good knowledge of the key functions of these hormones, let’s look at how they behave across the cycle.
Menstrual Phase
So the start of your menstrual phase is Day 1 of your cycle and on average, this phase lasts about 3-7 days (again, on average, but varies from person to person).
Progesterone at this stage has dropped dramatically, which stimulates the breakdown of the uterine lining. Histamines and prostaglandins are released to help with contractions, which aid in the shedding. During this time, progesterone and oestrogen continue to stay low, while GnRH lets the pituitary gland know it’s time to start dishing out FSH during days 1-4. FSH begins stimulating the maturation of a couple of follicles during this time (remember, follicles are like sacks which contain an egg) and then on days 5-7, one follicle is chosen to be the one to go onto ovulate.
During this time hormone levels are at their lowest so energy and focus may be lagging, and you may be feeling less social due to lower levels of feel-good neurotransmitters, hormones and energy. You may also feel more reflective due to lack of oestrogen, which tends to put rose tinted glasses over our eyes, so we feel desire and closeness with our mate. Without oestrogen and testosterone to make us feel social and outgoing, we may feel more inclined to turn inwards and want to spend time alone.
Follicular Phase
Now the menstrual phase is actually the first half of the follicular phase because FSH actually begins rising in this part, so what we generally call the follicular phase is actually the second half of the follicular phase, and this occurs on average from day 8 to day 14.
The follicles which were selected by FSH begin making testosterone, which is in large part then converted into oestrogen (so when we say oestrogen is made in the ovaries, this is what we mean). Oestrogen goes about thickening the uterine lining and this rising oestrogen lets the brain know that it’s time to lower FSH because the follicle chosen for ovulation is happily growing away. This then triggers the rise in LH, which in turn stimulates more testosterone and androstenedione production. The body starts preparing itself for pregnancy by releasing fertile cervical fluid and moving the cervix higher up, which means that only the strongest sperm will make it to the egg, meanwhile, the chosen follicle takes the lead while the others disintegrate.
During this time, energy begins and continues to rise with the rise in oestrogen. Oestrogen begins to boost serotonin and dopamine, so you feel more positive and social and the rise in testosterone boosts confidence, potentially making you feel more outgoing.
If you noticed you’re actually feeling fatigued, run down, depleted, or you’re having mood swings in your follicular phase, you’re not alone. I see this with many endo clients and I experience it myself time to time if I don’t take some space to rest or slow down during menstruation. For my clients, I tend to see the culprits being low iron and magnesium levels due to excessive blood loss, not resting enough during menstruation, low levels of rising oestrogen in the follicular phase or low cortisol levels (and in these clients, they usually feel depleted all month long). This collection of symptoms post-menstruation has actually been labelled as post-menstrual syndrome and if you’d like to learn more, I’ve put a link in the show notes to an article by the wonderful Nicole Jardim.
Ovulatory Phase
Next up is ovulation, which on average occurs between days 12-14, but really that timespan varies greatly, and I’ll take you through that shortly.
So, as the chosen follicle matures, more oestrogen is made and this rise in oestrogen triggers off a surge in LH with oestrogen dropping just as this LH surge kicks in. The LH surge transforms the follicle into the corpus luteum gland, stimulating it to make progesterone and together, LH, progesterone, testosterone and androstenedione set off ovulation 12 hours after the LH surge.
At this point, the egg has 12-24 hours to be fertilized before it disintegrates. At this part of your cycle your cervix is at its highest point and you have sticky clear fertile cervical fluid.
It’s important to note here that if oestrogen doesn’t reach its peak, LH won’t be stimulated, and ovulation won’t occur.
This phase is fairly similar to follicular, but revved up:
Oestrogen is driving us to find a mate in this time frame so it’s normally our most social time. We tend to feel more confident and outgoing at this stage due to oestrogen and testosterone working together.
There may be pain going on for you so appreciate that this phase may be different for you and work on lowering inflammation so you can hopefully feel more of the benefits of this time in the future.
Higher oestrogen levels tend to improve focus and concentration, though for some of us this may impair concentration because the high levels of neurotransmitters could have us feeling like it’s Friday afternoon every day! I also want to mention here that some people can have an excess of dopamine, which can actually cause irritability and anger. If that’s you during this time, I recommend working on stabilising your hormones first and seeing if that helps improve things, if not, work with a functional practitioner to assess your dopamine levels and what might cause this. In the meantime, you could try adding in calming practices like meditation and breathing to help ease your mood.
Normally, you may have rose-tinted glasses thanks to oestrogen’s desire to get pregnant so this is a good time for enjoying time with loved ones, especially family members who might rub you up the wrong way at other times of the month or who you clash with around your health!
Luteal Phase
Finally, we have the luteal phase, which is named after luteinising hormone.
This kicks in after ovulation, between days 14 - 29 on average and is anywhere from 11 to 17 days long, but the average is 12-14 days.
During this phase, progesterone reigns supreme because it is being released in hopefully plentiful amounts from the corpus luteum. Progesterone continues to fluff up the uterine lining for the potentially now fertilised egg to eventually plant itself in. LH and FSH continue to stay low at this point and oestrogen should be at levels lower than progesterone. Of course, if progesterone is low or oestrogen is too high, we’ll get that oestrogen dominance scenario.
As we edge closer to menstruation, oestrogen rises briefly to support possible implantation, so you’ll likely notice some clear and sticky cervical fluid at some point a few days before your period (but this isn’t fertile cervical fluid). Then, just before your period, FSH starts to rise again to begin choosing new follicles for maturation.
In this part of our cycle, oestrogen is dropping so energy can drop across the phase, though we tend to start out with continued high levels at first. If progesterone is sufficient, you’ll feel calmer and sleep better but if your levels are low, you may feel a sudden decline in mood, energy and focus and have disturbed sleep. As oestrogen falls, you’ll likely become more introverted because you no longer have the same drive to be social.
A Healthy Cycle
Now you know how the menstrual cycle works, let’s look at what a healthy cycle looks like.
In research, a healthy cycle has been shown to be between 21 to 35 days, however, in our training, Nicole Jardim recommends 25–35-day cycles as she sees this time frame to be most consistent with healthy hormones. The average cycle length is 29 days.
Ovulation should occur ideally between days 12-21 and will normally vary slightly every month (it’s not true that we all ovulate on Day 14!), then if we’ve had successful ovulation, this should be followed by an 11-17 day luteal phase. If it’s less than 11 days, this could indicate you're not making enough progesterone or that you didn’t ovulate at all and the period you’re having is essentially just a breakthrough bleed as a result of dropping oestrogen levels (so in short, a period doesn’t mean you’ve ovulated).
There is usually some variation in cycle lengths from month to month and this is normal, and in fact, statistically you’ll likely have a cycle that varies greatly at some point each year (which may be due to stress, nutrient deficiencies, illness, etc), but if your cycles are varying dramatically all the time or frequently, then there’s a hormonal issue here or a condition like PCOS.
Having said all of this, everyone is different, so if you have shorter or longer cycles and you feel well, and healthy, and you’re sure you’re ovulating (I’ll show you how to check this in the next lesson) and you’ve ruled out PCOS, etc. then this is just your cycle and that’s fine!
Now let’s look at a healthy period.
The start of your period is the first day of bright red blood which is freely flowing - any spotting beforehand doesn’t count as Day 1.
It should last between 3-7 days, periods less than 3 days could indicate low oestrogen or low iron and periods longer than 8 days are regarded as ‘heavy' and are associated with low iron, oestrogen dominance and a number of other conditions I’ll flag in the next lesson. Research shows that a normal period ranges between 2-7 days but in my training, we’re taught that at least 3 days is optimum for healthy hormones and fertility. However, if you’ve always had two-day periods, your hormone levels are good and you’re ovulating, this is just how your period is and don’t worry about it not being three days! As long as you’re healthy, that’s all good.
The first one to two days should be the heaviest, with a vibrant red colour and thick yet flowing consistency (like maple syrup). Blood colour will change as time goes on and normally will get darker as the blood becomes older and exposed to oxygen. Your flow should start tapering off after day 2, gradually getting lighter until it stops entirely. If you have any spotting beforehand, it shouldn’t go on for longer than 1-2 days before your period actually starts. If your period has always started lighter, gotten heavier and then lighter again or they are the same flow every day and then stop or fade away, these are also normal scenarios.
Okay so there was a lot of hormones flying about in this lesson, so really, just remember the key takeaways, which are:
Oestrogen dominates in first half of cycle
Oestrogen needs to reach its peak for ovulation to occur
Ovulation must occur for sufficient progesterone to be made
Show Notes
The main hormones and their roles
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5743731/
https://jnnp.bmj.com/content/jnnp/74/7/837.full.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879914/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3226892/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1327664/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4327930/
https://pubmed.ncbi.nlm.nih.gov/29962257/
https://pubmed.ncbi.nlm.nih.gov/8865143/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5709037/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4546331/
Post-menstrual syndrome
https://www.healthline.com/health/post-menstrual-syndrome
https://nicolejardim.com/post-menstrual-syndrome-pms-after-period/
A healthy cycle
https://epublications.marquette.edu/cgi/viewcontent.cgi?article=1010&context=nursing_fac
https://pubmed.ncbi.nlm.nih.gov/1622917/
https://pubmed.ncbi.nlm.nih.gov/15451332/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3166706/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299419/
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Can you help me save Jelly the kitten? We are currently travelling, working remotely, and within 24 hours of arriving in Montenegro, we met Jelly. He was extremely thin, with a distended stomach and a little lollypop head and bulging eyes. We took him to the vets where he was put on an IV drip for dehydration, and treated with antibiotics and anti-inflammatories for a bacterial infection that has spread into his bloodstream from his intestines. His intestines are damaged due to excessive worms, which has caused him to become malnourished.
The vets have given us a very stark picture of the reality. If Jelly goes back on the streets, his condition will deteriorate and he will suffer until he eventually passes away. We have been told to find him a home where he can continue getting care or put him to sleep.
We have found him a foster home and a forever home in the UK, but the total cost is over £1200. We have already spent hundreds on vet visits getting him to this point, and need your help, if you can.
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This episode is sponsored by Semaine. Semaine is a plant-based supplement for reducing period pain and inflammation, that you take for 7 days of your cycle, during your period. Semaine is made up of 9 super-powered plant extracts and minerals that are all vegan and sourced for maximum quality and bioavailability and selected based on the latest clinical research. If you want to try Semaine, they are currently offering 20% off your first order with code: THEENDOBELLYCOACH and they deliver worldwide! Head to: www.semainehealth.com
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Produced by Chris Robson