Menstrual Health | Lets Talk About Periods
Aren't periods just the best. If you don't love your period, I will make it my mission to help you love it. Ladies you're menstrual cycle is part of who you are, it's an incredible indicator of health & it really doesn't have to be a nightmare. Promise! The information here is solely to help you gain a better understanding of whats actually happening during your cycle. It's here that we can develop a deeper, more empathetic relationship with ourselves.
First up.....Hormones - The Basics
Before we delve into the wonder that is the menstrual cycle, it important to have a basic understanding & awareness of the hormones responsible for this process.
Oestrogen (or Estrogen)
Oestrogen is an umbrella term used for:
- Oestradiol - most biologically active & potent form of endogenous oestrogen secreted by the ovaries.
- Oestrone - primary form of oestrogen in post-menopausal women, synthesised mainly in peripheral tissues.
Oestriol - weaker endogenous oestrogen, beneficial to the vagina, cervix & vulva.
Oestrogen plays many fantastic roles in our health due to the fact that there are oestrogen receptors in most tissues in the body including cardiovascular, thyroid, skeletal & neurological. When talking specifically about menstruation, oestrogen is responsible for production of the ovum (egg formation), thickening of the lining & ovulation. Oestrogen thins out cervical mucous to improve chance of concept during the fertile window of the cycle. Oestrogen is predominant in the first half of the cycle (pre-ovulation), otherwise referred to as the 'follicular phase'.
The major role of progesterone is to prepare the body for pregnancy in the event that the released egg is fertilised. Progesterone is mainly produced from the corpus luteum, formed from the ruptured follicles post-ovulation. Meaning ovulation is ESSENTIAL for adequate progesterone production. Progesterone begins increasing gradually post-ovulation & peaks right before menstruation. Anovulatory cycles (lack of ovulation) is a common cause of progesterone insufficiency.
Progesterone is an incredible hormone, it helps to improve mood & sleep, supports energy levels & fat metabolism, reduces excessive bleeding during menstruation, modulates immune function, reduces incidence of acne & support healthy hair growth. We need it, we want it!
Androgens are hormones that are produced by both male & females. Most are familiar with testosterone however androstenedione & dehydroepiandrosterone (DHEA) also fit under the androgen umbrella, all are produced by the ovaries & adrenals. Testosterone is the most prevalent form of androgen found in the female body and peaks just prior to ovulation. It is response for increasing energy, libido & strength....hence why you feel much more frisky around this time ;) Isn't the body seriously cleaver!!!
Follicle Stimulating Hormone (FSH)
As the name suggests FSH is responsible for the growth & development of the ovarian follicle in preparation for ovulation. Rises in oestrogen during the follicular phase stimulates the product of FSH, which continue to rise together throughout this phase.
Luteinizing Hormone (LH)
Secreted by the anterior pituitary gland & works in conjunction with FSH to support the growing follicle in the ovary to secrete oestrogen throughout the follicular phase. Just prior to ovulation there is a significant surge in oestrogen & LH, as well as a subsequent surge in FSH in order to initiate ovulation. Post-ovulation LH support the production of corpus luteum, which supports the production of oestrogen & progesterone for the entirety of the luteal phase.
WHAT SHOULD MY PERIOD REALLY BE LIKE?
There is no one exact way a period should be. However the health of your menstrual cycle (or lack of) can tell us a lot about your health in general. It truly is an expression of what else is going on inside. In times of crisis (chronic stress, ill health, etc.) the reproductive system is often the first to become affected because of how susceptible it is to changes in the body. It's really the only organ system in our body that it knows we can survive without, it's needs will always be sacrificed before the needs of organs essential to our survival. Sorry ovaries!
A textbook menstrual cycle will typically last 28 days but rarely are women textbooks, right?!
The average womens period may last 5 days, generally 2 days of heavier bleeding followed by 3 days of lighter bleed or even spotting. There should be minimal discomfort on day 1, somediscomfort & mild premenstrual symptoms are in fact normal. Needing to go up 2 bra sizes, feeling depressed, anxious, irritable, experiencing diarrhoea or constipation & craving mountains of sugar are NOT normal.
WHAT SHOULD MY CYCLE BE LIKE?
Our hormones change through-out our menstrual cycle meaning we will likely feel different throughout the cycle. To explain this the analogy of seasons (winter, spring, summer, autumn) works really well as its represents these shifts really beautifully. In this analogy the days are based on a 28 day cycle. To deeper your understanding of your own seasonal changed, journalling can be really powerful. This is how you begin to pick up patterns in your cycle.
Through this you can gain true appreciation, patience & acceptance of yourself & your cycle. The ebbs & the flows.
Winter (Day 1 - 6) - Menstruation | Follicular Phase
This marks the very first day of the cycle & first day of bleeding. It important to note that pre-menstrual spotting is not counted as Day 1. The first day of bleeding can be really difficult for many woman, as it can bring on significant pain & cramping, heavy bleeding (or even flooding) and just generally feeling pretty crap. As we move through the next couple of days & our hormones begin to shift it can almost feels as though a weight is being lifted. Hello the rise of oestrogen.
Spring (Day 7 - 13) - Pre-Ovulation | Follicular Phase
Follicle-stimulating hormone (FSH) & oestrogen are now on the rise, getting the egg ready for ovulation. As oestrogen continues to increase during this phase the following occurs:
- Lining of the uterus thickens
- Glycogen production is increased to make the vaginal secretions become less alkaline, making the environment more acidic & less susceptible to infections, ensuring the environment is perfect for conception.
- The days leading up to ovulation cervical mucous secretions will take on a more "egg-white" consistency, otherwise known as "fertile mucous"
- Ovum continues to develop into the most mature follicle
Summer (Day 14 - 21) -Ovulation/Post-Ovulation | Luteal Phase
We are officially feeling pretty amazing. Energetic, sexual, social & wonderful thanks to the nice surge of testosterone. This is the phase in the menstrual cycle when everything is at it's peak. Ovulation is occurring & you're hormones are doing everything in their power to assist you in achieving their goal....conception. This is definitely not the time to have unprotected intercourse unless pregnancy is indeed your goal.
Autumn (Day 22 - 28) - Pre-Menstruation | Luteal Phase
The eggs has been released & if fertilisation was not achieved the emptied follicles restructure itself into a progesterone secreting gland known as the corpus luteum. Over this phase of the menstrual cycle we began secreting progesterone. The main role of this amazing hormone it to help nourish & support pregnancy however its plays an incredibly important role in cycle function. Progesterone works to reduce to thickness of the uterine lining, after oestroegn did all the hard work building it up, in preparation for the shedding. Progesterone is also incredibly calming. Ever wonder why just before your period you're a bit more off with the fairies than usual or feeling rather reflective, this is why.
And finally after all that commotion we bleed! Hallelujah!
I think one of the best explanations of this beautiful concept comes from Adore Your Cycle written by Claire Baker. I've come across this concept to explain the menstrual cycle a number of times but I can't recommend this particular resource enough. It truly gets you in touch with not only the physical changes through the menstrual cycle but the emotional, spiritual & energetic ones. We are constantly moving, there is constantly flow, we are never stagnant, we are never the same.
WHAT HAPPENS WHEN THINGS GO PEAR-SHAPED?
Before we go forward, it important to know the following information is not for diagnostic purposes. If anything is a little strange, off or changes with your menstrual cycle please please always go & get it investigated by your GP. This is not a time to throw caution to the wind. When you are in touch with your menstrual cycle, you deepen your awareness of whats going on in your body. And it doubles as a fantastic method of preventative health carer, teaching you how to look for the clues. So here goes...
Heavy periods are defined as blood loss of greater than 80mL ( that's 16 soaked regular tampons) in total or a period which lasts longer than 1 week. Overtime heavy periods can lead to iron deficiency anaemia & fatigue. Heavy periods can be caused by a number of conditions including: thyroid disease, fibroids, endometriosis, liver disease, pelvic infections & blood clotting disorders. It's essential that if you are experiencing heavy periods that your see your doctor so that an accurate diagnosis can be made.
Some women just have light periods & can be perfectly normal for them. Happy days for them! However it's important to distinguish whether it's actually a true period or just spotting as it tells us a lot about whether a women is actually ovulating or not. In some women light periods may also indicate low oestrogen. If you're unsure about which category you may be in or your period has become very light always consult with a health professional.
When it comes to period pain its's important to understanding that slight discomfort or cramping on Day 1 of the cycle is actually very normal & commonly experienced by many women. And I do mean slight discomfort. It's when this pain is so great that it impairs your ability to go about your normal day & isn't entirely relieved by pain medication that something is up.
Premenstrual Syndrome (PMS)
PMS can present with many different variations. Generally symptoms will include dramatic changes in mood (i.e. low mood, depression, irritability, anxiety), breast swelling & tenderness, fluid retention, sugar cravings, sinusitis & insomnia....just to name a few. These symptoms (or collection of symptoms) generally represent hormonal imbalance occurring. Maybe there's not enough progesterone at the end of the cycle, is there elevated prolactin or inflammation occurring. Whatever it may be, there is generally a solution. PMS is not a jail sentence.
Irregular periods or Lack of periods (amenorrhoea)
Where amenorrhoea is concerned, the first thing to rule out is......pregnancy. Always! This is the number one cause of missing a period. A lack of menstruation maybe also be cause by menopause. If both of these don't apply irregular cycles or non-existent cycles can be due to a number of factors including: thyroid disease, malnutrition/under-eating, chronic stress, PCOS,
Also referred to as Abnormal Uterine Bleeding. Mid-cycle bleeding or spotting can occur for many different reasons, good & not-so good. It's really important to have this investigated by your GP. This is a common symptoms experienced by ladies on the contraceptive pill.