WHAT IS A HEALTHY PERIOD?
Written By: Brittani Kolasinski (BHSc Nut, Adv Dip Nut Med)
Starting this 5-part series, where we will be talking all things hormones & health, with the topic of periods. This is our menstrual cycle. A topic near & dear to me, and often times one that comes up in conversations with girlfriends as well as in clinic with my female clients. It’s something that should be celebrated, talked about, and something that we as women (and our male companions) need more education and clarity around as many of us don’t truly understand the intricacies of the women’s cycle and the hormones at play - or how to appropriately support them.
The menstrual cycle
This is the cycle that occurs, involving a number of hormonal and physical changes that makes pregnancy possible. The ovaries, fallopian tubes, uterus, thyroid, and brain are all involved with a number of different hormones at play. The process, in a nutshell, involves the development of an egg (ova) by the ovaries that are released (this is ovulation) to travel down the fallopian tubes and become embedded within the uterus ready to be fertilised. The lining of the uterus thickens each month in preparation for a possible pregnancy. Without fertilisation the uterus contracts to shed the thickened lining of tissue (which is our endometrial tissue) and this is the bleeding that occurs with menstruation which is known as the woman’s period.
The first day of the cycle is the first day of bleed, and the cycle finishes once the following months bleed occurs. The average length of a woman’s cycle is between 28-32 days. Anything outside of this time window is worth investigating. The entire cycle can be broken up into three stages:
1. The follicular phase – this stage lasts typically from days 1 to 14, it is the first stage of the cycle in which the follicles in the ovary begin to mature. The follicles are tiny sacs in which an egg is contained.
2. Ovulation/The fertile window – once an egg has reached maturity, it is released to enter the fallopian tube and make its way to the uterus. This usually takes place between days 13, 14 or 15. This ‘window’ is the fertile window, the ideal time to have sex if you’re wanting to conceive. Worth noting that not all women will ovulate at this time, so it’s important to understand and look for the signs that you have ovulated to know the ideal time for you and your partner to conceive. Ovulation does not need to occur to still experience a menstrual bleed, this is known as an anovulatory bleed.
3. The luteal phase – the finale, in this time the lining of the uterus has thickened in preparation for a fertilised egg. Without fertilisation the lining will break down and contractions allow this to be shed as the bleed and signaling the beginning of the next cycle.
Hormones are chemical messengers produced by the body that stimulate a number of reactions and responses from tissues. There are a number of different hormones needed throughout a woman's cycle for it to be completed.
Follicle Stimulating Hormone (FSH) – this is needed for puberty and healthy ovarian function. As the name indicates, its required for the stimulation of growth and the maturation of follicles to become the egg that is ultimately released during ovulation. FSH is also needed to stimulate the secretion of oestrogen. It's highest in the follicular phase of the cycle and peaks just prior to ovulation.
Oestrogen – this is secreted by the ovaries and has a number of functions throughout the body. It's stimulating and is responsible for the drive we as women have, it promotes the growth and development of tissues, from breast to uterine lining. It halts the production of FSH so as to ensure that only one egg is matured and released with each ovulation, it stimulates the release of luteinising hormone (LH), it allows the secretion of fertile mucous (a clear indication of ovulation), which is a creamy egg white discharge that provides the sperm with an easier trip to the fallopian tubes to reach the egg.
Oestrogen levels peak during the follicular phase with a particular spike around ovulation – this triggers LH which allows ovulation to occur. Oestrogen is also needed for healthy bones, muscles, brain, heart, sleep, skin and metabolism. It tapers off during menopause, a time where there is an increased risk of bone, heart and metabolic conditions.
Luteinising hormone – a spike in LH mid-cycle triggers ovulation to occur, it’s also required for the development of our corpus luteum which is needed for the synthesis of our hormone progesterone.
Progesterone – almost opposing the effects of our stimulating oestrogen, progesterone is our calming hormone. It's secreted by the corpus luteum and also by the placenta during pregnancy. Progesterone is anti-inflammatory, involved in muscle growth, promotes sound sleep, protects against cardiovascular diseases and supports the nervous system during times of increased stress. Progesterone is needed to maintain pregnancy, its levels are highest during the luteal phase of the cycle. Without fertilisation of the egg, progesterone levels will then taper off which stimulates the contraction of the uterus to shed the lining and induce the monthly bleed.
Signs you’re ovulating
It’s common for women to experience anovulatory bleeds on the odd occasion, but regular occurrences may indicate hormonal imbalance is warrants further investigation. Without ovulation, there is a lack of progesterone made which can contribute to premenstrual symptoms including breast tenderness, insomnia, changes in mood (anxiety, depression) and increased appetite and food cravings. A lack of progesterone can also shorten the length of your cycle as the lining of the uterus cannot be maintained as long.
One way to track ovulation is by checking your basal metabolic temperature. This is a simple, effective and non-invasive tool to use. Using a thermometer which you can purchase from your local chemist, you take your temperature the moment you wake and can chart it using a hand-written method or through an app on your phone (I use Kindara). You can see what you have ovulated as you will find a rise in temperature.
Additionally, you can watch for physical signs such as fertile mucous, this will appear as an eggwhite consistency that you will note around mid-cycle or during the luteal phase and is an indication that you are ovulating.
Premenstrual Syndrome – PMS
PMS is common, with a variety of symptoms occurring for each woman that can significantly impair their quality of life. Although incredibly common, PMS is certainly not normal. A healthy period should not cause distress, it should not induce significant pain or cramping, or be responsible for changes in weight and mood or disrupt your normal sleeping pattern. If you’re experiencing such complaints month to month it's worthwhile to work with a healthcare practitioner to make the appropriate changes to diet and lifestyle or include nutritional supplementation to restore balance and harmony.
Changes or irregularities to your period are a clear indication that something needs to be addressed, a great resource for further understanding this is the book by Sydney naturopath Lara Briden, where she refers to your period as your monthly report card. A great analogy in my opinion.
Our periods are a gift and a healthy period is a sign of balance, health and wholeness. Further articles to come will address natural treatments for PMS, look into lifestyle factors that are affecting your period, discussing what pathologies might be underlying your menstrual irregularities of pain – things like PCOS, endometriosis, fibroids etc, to finish up the week with healthy hormone foods and recipes. Here’s to happy, healthy hormones ladies!