How to Understand your monthly Cycle

Ovulation, menstruation, and our monthly cycle can tell us a lot about our fertility, or infertility, as well as our overall health.

When we understand the normal physiology (the way our body works and why it does what it does) we can begin to tap into the incredible benefits that come from working with our hormones, rather than against them.

Many think that a normal, healthy, cycle is measured by the presence of a bleed every 28 days, but this simply isn’t the truth.

I have even heard it argued that “women no longer need their menstrual cycles” and that “it’s just an unnecessary inconvenience in this day and age”.

However, once we truly begin to understand hormones, the female cycle, and our body, then it’s quickly obvious that saying that is just as absurd as saying something like, “men no longer need testosterone”; which is also simply not true.

As a holistic chiropractor whose passion lies in fertility and preconception work, I believe it’s incredibly helpful and important for families to understand the normal physiology of a healthy cycle, as well as, the benefits that go along with such.

Regardless of whether or not you are trying to conceive, these are all things that pertain to our overall wellbeing and health- now and for decades to come.

The 3 Events of Your Cycle

There are three events in a healthy, normal, female cycle.

1. The (pre-ovulatory) Follicular Phase
2. Ovulation- The Main Event
3. The (post-ovulatory) Luteal Phase

The most important event in our cycle is ovulation, not menstruation.

Therefore, a cycle without ovulation can’t be a healthy, normal, cycle because it’s missing the main event.

Unlike the bleed which can be triggered by multiple things, and occur for numerous reasons, to varying degrees, ovulation either happens or it doesn’t; there is no such thing as kind of ovulating, or ovulating a little bit.

Even conception aside, regular ovulation is extremely beneficial to us as women and is a sign of health; that we are eating enough food (specifically carbs) and that we are not under too much stress.

When we ovulate we receive a monthly dose of the hormone progesterone which builds bone and a metabolic reserve to carry us through the decades following menopause.

Research has shown that regular ovulation during our premenopausal years can help prevent osteoporosis, breast cancer, and heart disease.

This is why it is so important that we ovulate during our reproductive decades and not shut down ovulation and our normal cycles with hormonal birth control methods, such as the pill.

What about birth control pills?

Birth control pills override our body’s own hormones and are really good at masking symptoms that may tell us when things aren’t working as they should be.

We often think (myself included- I was on the pill for years before I learned what I now know) that because we’re still bleeding while on hormonal birth control, then we’re still having our menstrual cycle.

However a bleed while on hormonal birth control is not a true period, rather it’s just a withdrawal bleed, as it essentially bypasses 2/3 of our cycle: ovulation and the luteal phase.

It is important to understand that it’s our cycle that is beneficial, not the bleed. The bleed, or a pregnancy, is just merely an outcome of our cycle.

There are around 120 different risks and side effects associated with synthetic hormonal birth control estrogen and progestin (not the same as progesterone) combos.

Some of these risks include cancers of the reproductive organs, breast cancer, diabetes, asthma, thyroid imbalance, immune dysfunction, blood clots, depression, low libido, hair loss, and weight gain.

Often we hear that the “newer, low dose, high progestin pill actually lowers the risk of breast cancer”, however this is only part of the truth. Yes, it has a lower risk in comparison to its high estrogen pill counterpart, but both still increase the risk of breast cancer by 60% and 70% respectively verses not being on them, and unfortunately the low dose actually carries an increased risk of blood clots in addition.

When we’re on the pill or hormonal birth control we don’t ovulate, have a luteal phase, form a corpus luteum, or produce progesterone.

This means we’re not having a cycle while on the pill and are therefore not only increasing our risks and side effects, but we’re also missing out on all the protective benefits from having a cycle.

Your Normal Menstrual Cycle

Like I mentioned above, a proper menstrual cycle is based around the ovulatory event.

The 3 events of your cycle are:

1. The (pre-ovulatory) Follicular Phase:
   • This phase of the cycle usually takes about 2 weeks, but can be as short as 7 days and as long as 21 days.
   • This is the phase in your cycle that is estrogen dominant. Many women feel the most energized and productive during this time.
   • This phase begins when 6-8 follicles enter the race to ovulation. The total lifespan of a follicle, from dormancy to ovulation, is 120 days. This is why our protocol works in phases of 120 days. If you’ve had an “off” cycle count back 120 days and then you’ll be looking at what may have been going on or what you were doing during that time.
   • Developing follicles make the hormone estradiol which is our best form of estrogen.
     • It’s our happy hormone. It stimulates mood and libido, boosts our feel good neurotransmitters serotonin and dopamine, positively effects insulin, sleep, skin, and bone health, increases vaginal lubrication and stimulates growth of the uterine lining to thicken and prepare for a potential baby.
       • Fertile cervical mucus is very beneficial for helping sperm reach the egg quickly. With it sperm can reach the egg in under 4 minutes, without it the trip can take hours.
         • Fertility drugs prevent the formation of cervical mucus and actually create a hostile environment for sperm.
2. Ovulation:
   • This happens in 1 day.
     • When 1-2 follicles reach about 120 days, they swell, trigger luteinizing hormone, rupture and release an egg. This swelling can take a few hours, but the burst of the follicle and release of the egg takes only about a minute. Sometimes when this happens you may feel a quick, little, twinge in your lower pelvis.
     • You either ovulate or you don’t- ovulation is not something that partially happens.
3. The (post-ovulatory) Luteal Phase:
   • This phase lasts exactly 14 days following ovulation.
   • This is the phase in your cycle that is progesterone dominant. Many women feel more need and/or desire to rest and relax during this time- honor that.
     • This is the phase immediately following and triggered by ovulation. Once the egg is released the empty follicle restructures itself into the corpus luteum, which is the progesterone secreting gland. The corpus luteum is only created if ovulation occurs, so if we don’t ovulate, we won’t create a corpus luteum, and therefore progesterone won’t be secreted. If pregnacy occurred this cycle the corpus luteum will remain and help nourish the fetus for the first 3 months. If no pregnancy occurred it will survive for for the 14 days of the luteal phase.
       • We want progesterone to be secreted because it’s a calming hormone. It counter balances estrogen, stimulates our thyroid (why our basil body temp increases during this phase), calms our nervous system and relaxes us.
       • Fertility treatments don’t allow for the formation of the corpus luteum, which means there is no progesterone to nourish a growing baby. This is why fertility drugs must be taken for the first 3 months of pregnancy.
       • A few things that can interfere with the corpus luteum are thyroid problems, insulin sensitivity, and nutrient issues which is why the protocol we follow is set up the way it is.

How to Determine the Length of your Normal Cycle

As mentioned above, a healthy, normal, cycle begins with the follicular phase (which lasts 7-21 days), is then followed by ovulation, the main event, (which occurs in 1 day), and then immediately following ovulation is the 14 day luteal phase.

Therefore a healthy, completely normal cycle can last anywhere from 21-35 days depending on how long your personal follicular phase is.

In order to determine the length of your cycle begin counting from your 1st day of heavy bleeding. This is day 1 of your cycle. Light spotting is not part of your current cycle, but rather left over from your previous cycle. 

Continue counting until your next first day of heavy bleeding the following month. That is the length of your cycle for that month. I recommend tracking this over several months so that you can get a baseline for what your current average cycle length is. This is my favorite app for tracking this.

A normal bleed should last 2-7 days and you should lose no more than 80ml of menstrual fluid total over all the days of your period.

You can track this using a menstrual cup which I love and highly recommend. There are many- my personal favorite is the Diva Cup.

How to Know if you’re Ovulating During your Cycles

Occasional anovulatory cycles (cycles where you don’t ovulate) are normal from time to time, but not all the time. There are ways we can test whether or not you are ovulating, however I’ve listed 3 signs, below, that you may not be.

3 Signs of an Anovulatory Cycle are:

1. Bleeding that lasts too long
   1. Bleeding that lasts more than 7 days is a very good sign of an anovulatory cycle.
2. A cycle that is too short
   1. A cycle less than 21 days is almost always an anovulatory cycle.
3. A cycle that is too long
   1. A cycle over 35 days is a possible anovulatory cycle.

Remember bleeds while on hormonal birth control or “the pill” are not real cycles. These forms of birth control are anovulatory drugs and they suppress our body’s estradiol and progesterone production, essentially flatlining our hormones like what happens in menopause.

2 Common Issues with Cycles

There are various issues that can affect our cycles. Two of the most common that both present with absent, irregular cycles and polycystic ovaries are:

1. Polycystic Ovarian Syndrome (PCOS)
   1. Those with PCOS are often insulin resistant which is why the protocol we follow is set up the way it is.
   2. Please note: If PCOS is solely diagnosed from an ultrasound it may be a misdiagnosis. As referenced above there are actually times during the follicular phase that it’s normal for multiple follicles to be present.
2. Hypothalamic Amenorrhea
   1. This is often referred to as under-eating and is an adaptive response to insufficient food supply. Eating more real food, specifically carbs can make a world of difference in this case.

I hope this helped bring a bit more light to your understanding of your incredible female cycle and maybe answered a few of your questions. Although this article may seem robust it still only scratches the surface of all there is to know about fertility and preconception. 

Please remember that the content above and on this site is intended for informational and educational purposes only and is not intended to provide or replace any individual medical advice and/or treatment from your personal physician. Please consult your doctor or qualified healthcare practitioner for individual and specific questions and concerns.