Your Menstrual Cycle

Menstruation: The female vital sign of health.

According to the American College of Obstetricians and Gynecologists the menstrual cycle is a vital sign of health. Proper functioning of the reproductive system is not only critical to reproductive health but women’s overall health. Health is the foundation of performance in every endeavor.

The reality is that most of us do not talk about something that effects every single one of us.

Menstrual cycle phases and what’s considered normal?
The menstrual cycle is typically between 24 and 35 days and has two primary phases—follicular and luteal phase. With a surge of LH ovulation of the egg occurs.

Menstruation: Day 0 to 3-7
When one menstruates (a period), menstrual fluid consisting of blood, uterine lining, cervical mucus and vaginal secretions leave the vagina. The menstrual fluid is often initially deep red and free of large clots. Some small clots are normal. As your period progresses the blood is brighter red or fresher.

The first day of menstruation is Day 0 and it typically lasts 3-7 days.

Normal flow is approximately 50mL. This equates to ten fully soaked regular tampons. A heavy flow is about 80ml over the entire course of your period. This is about 16 soaked tampons.

Physiologically, this is the lowest point of your hormones before the new cycle starts again. While this period seems like there isn’t much going on, it is actually a crucial time to build the foundation for a happy and healthy cycle for the upcoming 4 weeks.

Follicular Phase: Days 3-5 to 13
Estrogen comes from a single group of cells called a follicle. These cells belong with the egg. Each week we start the process of growing a number and then several become inactive. The process of follicle growth and inactivation seems to speed up in women’s late thirties.

During the follicular phase FSH is released causing 10-20 follicles to develop and usually one to fully mature. The follicles produce estrogen which support the growth of the developing egg (oocyte) and the uterine lining. The total period of each follicle development is 100 days to ovulation. Usually only one per cycle will make it all the way.

There are three estrogens but estradiol is what is released from the developing follicle and benefits bone health, stimulates muscle growth and supports sleep. Long follicular phase can occur at any age, if you are <45 then is can result from stress, illness, undereating or PCOS.

Perimenopause short follicular phase is most common – increase in FSH and higher estrogen. More FSH increases estrogen.

Ovulation: Day 14 (on average)
At the midcycle peak estrogen levels have increased by 220 % from their low level during flow. That peak triggers the LH. The LH peak triggers ovulation (the burst of the egg). Associated with ovulation is the stretchy mucus (egg white) that makes it easy for sperm to swim upward.

Luteal Phase: Day 15-35
Once the egg is released by the ovary (ovulation) the now empty follicle, called the corpus luteum, shifts from producing estrogen to higher levels of progesterone and some estrogen. This is done by LH stimulating LH receptors on cells of the ovary to convert cholesterol (low-density lipoproteins) to progesterone and estrogen.

During this high hormone phase progesterone thickens the uterine lining. Progesterone also stops the production of the slippery mucus to prevent more sperm from having easy access when it is no longer right.

Progesterone rises to its highest point which is about 1400 times higher than baseline. That happens one week after ovulation. While the luteal phase can be shorter due to a lack of progesterone, it never is longer than 14 days because the corpus luteum can only survive for about that long.

Some research shows that women on average eat 240 more calories per day during the luteal phase of their cycle compared to their follicular phase. In part this is due to the fact that your body temperature increases and you require more calories. You also may find that your sleep increases as it is known to support rest.

Symptoms and Experiences Pre-menopause (Perimenopause)

About half to almost 95 per cent of people who have a period report some type of physical or psychological discomfort before or during their periods. Just because it is so pervasive does not mean that it is normal. The following information reviews some of the symptoms and experiences of women and some potential solutions.   While there are a number of reasons that women can have painful or irregular periods, this summary of hormone health will focus on two: 1) estrogen excess and 2) low progesterone. According to Naturopathic Doctor Lara Briden who has specialized in Period Health, there are three questions to start:

1. Do you ovulate regularly? If you do not ovulate, then why not?
2. Do you metabolize or detoxify estrogen well? If not, why not? And what can you do to improve that?
3. Do you suffer chronic inflammation that is interfering with your hormonal communication? What can you do to reduce inflammation?

 One of the things that will keep coming up is that it is about the balance of estrogen to progesterone.  When it is out of balance, we suffer.

Pre-Menstrual Symptoms: 

It is estimated that 80 per cent of women experience PMS.  The root cause is not clear nor is the ability to diagnose or test it.  What is fascinating is that some research has shown that PMS can occur without any relationship with period onset. Other research however states that it must occur during ten days before one period and disappear during or shortly after your period.

PMS can include emotional symptoms of irritability, anxiety, depression, and weepiness. Physical symptoms include: sleep disturbance, fluid retention, abdominal bloating, palpitations, joint pain, headaches, brain fog, food cravings, breast pain and pimples.

One suggestion is that PMS could be associated with the fall of estrogen and with it lower serotonin (Feelings of well-being) and dopamine levels.  Serotonin is produced by the gut endocrine, nerve and immune cells. Certain gut bacteria species stimulate endocrine cells in the gut to produce serotonin.

Having enough progesterone in relation to estrogen smooth’s out the up and downs of estrogen.

The challenge in training is that if you do not recover, chronic inflammation can increase the symptoms of PMS. This is because chronic inflammation can distort the way hormones communicate. Specifically, inflammation down regulates GABA receptors which impairs your response to progesterone.  Inflammation also can cause less progesterone and GABA and more estrogen.  

Immediate Actions You Can Take:

• Increase Magnesium through nuts and seeds, dark green leafy vegetables.
• Increase Vitamin B6: It is essential for the synthesis of progesterone and GABA.  Target 20-150mg per day spaced out through the day in lead up to your period.
• Consult whether Hormone Therapy (HT) is for you. HT has been shown to increase serotonin levels.

Cramping

Cramping is caused by prostaglandins which cause the uterus to contract.  High levels of estrogen and a tight lining of the uterus contribute to higher levels of prostaglandins. Prostoglandins are also part of the body’s inflammatory response.

Breast Pain (Mastalgia)

Breast pain or tenderness can sometimes be experienced when progesterone is released following ovulation.  This is because prostoglandins stimulate the milk ducts in the breast to swell and prepare for potential milk production should there be a pregnancy.  Higher levels of estrogen unopposed by progesterone can contribute to the soreness. Breast soreness can also signal that your period is coming.

Headaches and Migraines

More than 50 per cent of people with periods report menstrual related headaches and migraines.  They can be due to the fluctuations of hormones and can occur at any point of the cycle. Migraines are one-sided and can involve sensitivity to light, sounds and smells. They can occur due to sudden drops of hormones through the cycle, stress and diet. For a full resource on headaches and methods to prevent and manage them click here.

Heavy Flow and Cramps

Ibuprofen (200 mg) improves the balance of two kinds of prostaglandins that are made in the uterus, acting on the endometrium and causing heavy flow. If taken in higher doses and as frequently as needed to prevent the intense crampy pain of dysmenorrhea.

Dr. Stacy Sims Period Cocktail

If you experience significant PMS symptoms, you can try countering the inflammatory responses that create these: taking 250mg magnesium, 45mg zinc, 1 gram of omega-3 fatty acids, and 80mg aspirin or white willow bark.

PELVIC FLOOR HEALTH

Pelvic Floor dysfunction is rarely discussed and often ignored. Yet, in one study 50% of women experienced stress urinary incontinence. While it is out of scope of practice of THAA to make any recommendations around pelvic floor dysfunction, it is important to know what optimal pelvic floor function is. THAA endeavors to educate all female athletes on pelvic floor function and include specific pelvic floor exercises to strength programs.