Joys of Womanhood I - Menstrual Literacy [EN]

This is a part of a series of blog posts about women, women's health and other related subjects. The information is coming from a one year course called "Saúde integral da Mulher", or "Women's Holistic Health". 

This is an initial post which can get quite technical and heavy. So, if you don't know anything about this topic, don't panic! You can skim through the first part about hormones and cycles and go right to the part where you can see how your own cycle is, and then come back to which hormones have an active part on our menstrual cycle; Or you can even go to another post and see if it makes more sense, or is less confusing for you. 

There's also a video which may help you visualising some of the technicalities.

The next post, about endocrine disruptors, talks about specific steps and small changes you can do in order to actively minimize your day-to-day hormonal disruption. 

This post is  a gathering of questions you maybe have had at some point in life about your cycle, a part of the “Menstrual Literacy” Module.

How much should I know about my cycle?

Well, you should know everything about your cycle! You should understand how cycles work, which types there are, and you should definitely know your own cycles. Are they short? Long? Normal, abnormal? How long is your luteal phase? Do you ovulate? What's the color of your blood? Do you experience severe pain? How are your general PMS symptoms? What's the average length of your cycle? How much do you bleed, and what is normal for me?

Don't worry if you don't have the answers to these questions yet - It may take you some time to be fully aware of your body and your cycles. This is as good a time to start as any.

What are the main factors which influence my cycle?

• Pregnancy, breastfeeding, menopause, adolescence;
• Hormonal contraception;
• Stress, diet, weight;
• Tabaco;
• Some diseases;
• Endocrine disruptors;
• Physical exercise (either too much, or too little).

Which main systems and hormones are linked to my period?

First of all, you should be aware that the endocrine system works like a spider's web. Everything is connected together. As a consequence, almost everything that disturbs any of its elements can have a direct effect on our menstrual cycle.

• The brain — More specifically, the hypothalamus.
• Hypothalamus and the endocrine system — Your hypothalamus is responsible for producing the hormone that triggers the start of your menstrual cycle (The hypothalamus is also directly involved in your metabolism, growth and sex drive);
• The pituitary gland — The hypothalamus produces hormones that activate the pituitary gland to stimulate other hormone-producing parts of your body like the thyroid and your ovaries. These are the FSH and the LH. The pituitary gland has also direct influence in our: skin, adrenal cortex, liver, bones, thyroid, testicle (and breast), and ovaries.
• GnRH or gonadotropin-releasing hormone — Produced by the hypothalamus in an intermittent, pulsatile fashion. 
• FSH (Follicle Stimulating Hormone) — Stimulates the follicles and stimulates the ovary to produce estrogen;
• LH (Luteinising hormone) — Stimulates the ovary to produce progesterone. The LH peak provokes ovulation;
• Estrogen and Progesterone — The cyclic changes of these hormones are responsible for your menstrual cycle, including your ovulation and your menstruation.
• Estrogen (along with FSH) stimulates follicular growth and also the production of fertile cervical mucus.  Estrogen also has other functions, being a main player in fetus development, preparation for breastfeeding, puberty and development, lubrification and bone density.
• Progesterone (Along with LH) is responsible for the preparation for implementation of the ovule, thickness of the cervical mucus and for the beginning and end of the menstruation. With less progesterone, the body enters in "stress mode". 

How many cycles exist in my menstrual cycle?

Ah, indeed — When we talk about our menstrual cycle, you should know that it is actual composed by two cycles. They are the ovarian cycle and the uterine cycle.

• The ovarian cycle: Follicular phase, Ovulation, and Luteal phase.
• The uterine cycle: Menstruation, Proliferative phase, and Secretory phase.

The Ovarian cycle:

1. Follicular phase: From day 1 until ovulation (Includes menstruation); Lasts between 7-21 days; All the follicles grow, but eventually the follicle with the most FSH receptors becomes the dominant follicle and the others de off. The peak of estrogen is right before ovulation.
2. Ovulation: "Day 14", is a "sudden" process. The ovule survives around 24 hours;
3. Luteal phase: From ovulation until menstruation, lasts between 10-16 days.

The Uterine Cycle:

1. Menstrual phase: "day 1-5", is when the uterus sheds its inner lining and women bleed;
2. Proliferative phase: Day 1 until ovulation; Estrogen levels go up, there's a thickening of the endometrium and growth of the endometrium glands. This is the period where there is an optimal chance of fertilization and the cervical mucus is the most hospitable for sperm.
3. Secretory phase: From Ovulation until Menstruation. LH Hormones are decreasing, but still there is more progesteron than estrogen, which is also decreasing. Progesteron is the dominating hormone of this second part of the cycle. After ovulation, the uterus slowly becomes lest hospitable to the sperm as cervical mucus thickens.

Here you can see how it all plays together:

So, I hope that now you got a clearer idea about the women's cycle generally work. 

The questions you are probably asking yourself are: How do I know if everything is OK? - What is considered normal and what is not? These following questions are related to whether or not I should be worried at all about my cycle.

What is a "normal" cycle?

A normal cycle lasts between 21-35 days and has a menstrual flux from 2-7days. Don't forget to "ignore" spotting and count your day 1 as your first day of actual bleeding.

How much blood is "normal" to lose?

The usual quantity of blood is, in average, 50ml per month (10 normal tampons, or 5 maxi;). Less than 25 ml is too little, and more than 80 ml is too much; Note: You shouldn't have to change your pad in less than 2 hours, or need to get up during the night to change it.

You can follow the 7-7-21 rule: < 7 pads a day, < 7 days, > 21 days between menstruation

What does my menstrual blood color indicate?

• Very light or strawberry - Low estrogen;
• Live red - Normal;
• Brownish, dark - Excess estrogen.

Should I experience pain? How much is normal?

Some pain and discomfort is normal. However, if  it regularly lasts more than 2-3 days, do not get better with medication, and affects your normal life, you may be experiencing dysmenorrhea.

Dysmenorrhea is another name for "painful menstruation". It is caused by the excess production of PGF2 on the endometrium. In this case, you should try to: Try to reduce inflammation; Improve your pelvic circulation; And diminish your spasms. 

As a way to generally improve pain you can experiment with: Ginger; Calendula; Curcuma longa. Also "Wild yam root" can be a good choice in case of spasmatic pain. For better pelvic circulation, ginger and cinnamon are your friends.

PMS - Pre-Menstrual Syndrome

There are many different types of PMS:

• PMS-A - Anxiety - Due to many estrogens relative to progesterone and is characterized by anxiety, insomnia irritability;
• PMS-C - Carbohydrates - Due to glucose tolerance, characterized by heightened hunger, hypoglycemia, palpitations, sweats, hunger for carbohydrates;
• PMS-D - Depression - Too much progesterone relative to estrogens and is characterized by depression, despair, crying, fatigue, apathy, low libido;
• PMS-H - Hiper-hydration - Due to augmentation of aldosterone in the luteal phase, due to excess estrogen, and characterized by breast swallowing, weight gain, breast tension.

Most women suffers a mixture of all these conditions throughout their cycles and life. Some supplements which may help to alleviate some of the SPM symptoms are:

- B group Vitamins; (Except B6, which should be taken with care in small quantities)

- Crocus sativus (Saffron) as an anti-depressive;

- Quelated magnesium 400mg.

What are other conditions women may suffer from related to their cycles?

1. Anovulation (menstrual cycle without ovulation, low progesterone levels);
2. Amenorrhea (The absence of menstruation, low estrogen levels);
3. Perimenopause or Luteal phase defect (Very short luteal phase, usually less than 11 days);
4. Polycystic ovary syndrome (PCOS) (Infrequent, irregular or prolonged menstrual periods, and often excess androgen levels);
5. Hypothyroidism (an underactive thyroid, which is not producing enough hormones);
6. Menorrhagia (Heavy menstrual bleeding, usually due to unbalance of estrogen and progesterone).

(Note: These are very specific conditions which will not be covered on this post - But you should  consult a doctor in case you suspect you have any of them, since they can have a negative impact on your ability to get pregnant and on your health in general)

What's the best way to identify conditions or irregularities in my cycle? 

Women who keep track of ovulation are more likely to notice irregularities and changes to their bodies. 

This was a really eye-opening topic for me. Even though this will be better explained on another module, know that just by tracking your basal temperature and your cervical mucus you can know if you have ovulated.  

Nowadays it's easy to do this, all you need is to check your cervical mucus consistency and you basal temperature, with a specific thermometer. After learning how to analyse these and keeping a map, you can easily take full control of your body without any additional help from medication.

I know, I know. "Easy", right? That's what they keep telling me!

It definitely takes some discipline and learning.

But if you go down that road you will probably never go back again.

We will talk about the specifics in another post.

I hope you've enjoyed your reading this far and maybe make are becoming more aware of yourself. 

This is a great journey and I'm really happy we're doing it together!

Let me know in the comments if you have additional questions on any of the subjects mentioned above or if there are more specific questions you would like to see answered.

This article is meant to gather the extensive knowledge into a digestible way so that I can maybe provide some insight and knowledge to friends and curious women. Even though I have made some research and additional readings to write these articles, I credit all to our amazing teachers in the course. They are the true women warriors. I’m just passing the word along. 

The course is coordinated by Antonella Vignati, an amazing teacher and professional. I recommend her if you are looking for a trained professional in any health issues related to fertility, cycles, or even generic health - If you are ready to make some significant life changes.

I really recommend this course to any woman, at any age — As women I believe we deserve to have all the information available to us, so that we can make the right choices for us, and for our body.