The menstrual cycle is a beautiful rhythm set by the body to promote ovulation and either the progression of a healthy pregnancy, or the shedding of your endometrial lining so you can start again fresh next month.
It is a sign of overall health because the menstrual cycle can easily become irregular when poor health develops.
First of all, let’s review what the menstrual cycle looks like. It has 2 main phases:
The follicular phase encompasses menstruation, follicle development and ovulation. During the early part of the follicular phase your endometrial lining with shed (this is menstruation). At the same time your pituitary gland (a tiny little gland close to your brain) will send a message to your ovaries via a hormone called follicle stimulating hormone (FSH) asking a follicle to begin maturing.
I like to think of a follicle like an eggshell. Within the egg shell we have an egg (also known as an oocyte). During the follicular phase the egg will mature within the egg shell. As the egg matures, estrogen will be released. This helps to build up the endometrial lining so that it is ready to receive an embryo. Once estrogen levels have risen high enough, it means the egg/follicle have reached full maturity. There will then be a sudden drop in estrogen and this triggers your pituitary gland to release another cool hormone called luteinizing hormone (LH). This hormone subsequently triggers ovulation. Ovulation is the main event whereby the egg shell breaks and releases the mature egg.
The whole point of the luteal phase is to support a possible pregnancy. At this point, the egg has been released into the fallopian tube and it will wait for sperm to arrive. In order to support a possible pregnancy the leftover egg shell now becomes the corpus luteum. It will produce progesterone to engorge the uterine lining and allow an embryo to cozy up and start progressing as a pregnancy proceeds. If there is no embryo present, estrogen and progesterone levels will drop and your body begins to shed the lining.
We’ve now come full circle!
Now that you have the basics of the menstrual cycle, let’s talk about what’s normal in terms of menstrual cycle length…
The average menstrual cycle is 21-42 days. Yes, you read that correctly – a menstrual cycle does not have to be 28 day to be considered normal. In fact, some variation between each cycle can even be normal as long as it’s not more than 5 days. For example, one month you may have a 29 day cycle and then next month you may have a 32 day cycle. That still means you have a regular cycle.
When we become concerned is if the menstrual cycle is longer than 42 days, shorter than 21 days, if there is great variation between each monthly cycle, or if the menstrual cycle is completely absent. We also become concerned if either the follicular phase or luteal phases are too short. For example, a healthy luteal phase is at least 10 days in length, while a healthy follicular phase should be at least 10 days in length. We also become very conscious of cervical mucus, or white flow, which is an excellent fertility sign that you are close to ovulating. If cervical mucus is completely absent, it’s a sign that you may not be ovulating.
How do you know if your cycle is irregular? The first thing to do is to begin tracking your menstrual cycle. Ideally it is recommended to have at least 3 cycles tracked before interpreting the results.
How do you track your menstrual cycle? I recommend using a fertility-friendly app like Kindara. It will allow you to track each phase of your cycle as well as 2 important fertility signs – cervical mucus (CM) presentation and basal body temperature (BBT).
BBT is your temperature at complete rest. You can track this using an oral thermometer that measures to 2 decimal points. You’ll want to take your BBT first thing each morning. CM will begin to change as you lead up to ovulation. You’ll see a discharge that looks almost like egg white – it is stretchy and shiny.
Once you begin tracking, you’ll begin to understand if there are any concerning issues with your cycle – too long, too short, or otherwise.
How do you regulate your cycle if there is an issue? Of course, this is a complicated answer. What we really need to understand is what could be at the root of your irregular cycle.
Some of the most common causes of irregularity include, but are not limited to:
- Thyroid disorders
- Polycystic ovarian syndrome (PCOS)
- Excessive stress including undereating and overexercising
- Premature ovarian insufficiency (POI)
- Medications, such as hormonal contraceptives
- Pregnancy and lactation
It is often best to get a full workup done by your healthcare provider to determine which condition is impacting your cycle.
Once we understand the root of the issue, we can determine how to best to treat the situation.
If we are managing a thyroid condition then we will consider medications to improve thyroid regularity, as well as discuss dietary changes and supplements that can help with managing thyroid conditions, such as selenium.
If PCOS is the root of the issue, we will work to reduce insulin resistance and hyperandrogenism through dietary and lifestyle modifications, as well as recommended supplements like myo-inositol.
Conditions like pregnancy, lactation, POI and perimenopause are more difficult to treat because these aren’t medical conditions necessarily. These are natural changes the body is undergoing and it is normal for a period to not occur at these times.
Endometriosis and fibroids sometimes need surgical considerations, but the pain and inflammation can often be managed with supplements like omega-3 fatty acids and melatonin.
Managing stress is extremely important. This includes ensuring you are getting adequate caloric intake as well as being mindful of how much exercise you are doing. Too little caloric intake paired with too much exercise can cause the complete absence of a menstrual cycle.
For the average person who isn’t managing the conditions above, here are some helpful tips for managing a healthy menstrual cycle:
- Eat enough, but not too much
- Eat well – with a focus on healthy fat, lean protein and low glycemic-index carbohydrates
- Exercise in moderation without overdoing it
- Stay hydrated
- Sleep enough
- Manage stress levels
Ultimately, the menstrual cycle is an excellent sign of overall health and any irregularity of the cycle will not only impact fertility outcomes, but is also a sign that you may need a check up. It’s best to get to the root of the issue and manage from that point forward.