We all are familiar with the 4 standard vital signs that your doctor probably checks in a regular visit: blood pressure, temperature, pulse, and respiratory rate. These are used as basic measurements on how the body is doing. But did you know that women and menstruators are very unique in that we have a 5th vital sign?
I know that when I started menstruating in my early teen years it was far from a celebration. I was a dancer and found the monthly visit to be a hassle and something that kept me from being able to do the things I wanted to do for several days each cycle. And honestly I didn’t think much about my cycle other than the few days when I was actually bleeding. Sound familiar? I do recall learning in school about ovulation and the menstrual cycle and felt at the time like I had a good understanding of how it all worked. It wasn’t until years later into my adult life that I realized how much I didn’t know about my own body. I learned that if I really tuned into my body it could tell me so much about what is going on and if I listened to it instead of fighting it my body and I could work together.
Your Menstrual Cycle:
It is important to start with a good foundational understanding of how the menstrual cycle works. Here is a brief overview of the four phases:
- Follicular Phase: The follicular phase encompasses the first part of the menstrual cycle, up to ovulation. This is when the ovarian follicles develop and estrogen stimulates the growth of the endometrial lining to prepare for possible pregnancy.
- Ovulatory Phase: Ovulation occurs when the mature egg bursts from the developed follicle. Day 14 is the average day of ovulation in the cycle, but it is important to know that this can vary greatly from woman to woman and even from cycle to cycle.
- Luteal Phase: The luteal phase begins after ovulation. This is the phase when progesterone rises, making it possible for a fertilized egg to implant into the endometrium if there is one.
- Menstrual Phase: Menstruation marks both the beginning and the end of the menstrual cycle. This is when, if pregnancy hasn’t occurred, the endometrial lining sheds and the body prepares for a new cycle.
How to read your vital sign:
Just like we would need to have an idea of a normal range to determine what our blood pressure or body temperature is telling us, we also need an idea of the normal range for our menstrual cycles. Here are some good guidelines to start with:
- Your period arrives around the same time every month and the total cycle length between 25-35 days
- Bleeding lasts between 3-7 days
- Total blood loss is between 30-60ml (this equates to 6-12 fully soaked tampons throughout the length of your period)
- Bleeding is a bright red cranberry color with a thin, smooth consistency and zero to minimal clots
- Minimal discomfort and pain
- Minimal shifts in mood and energy
Does this sound like you? If so, great! If not, that’s okay! Read on for some common imbalances and why they might happen.
Long Menstrual Cycles: Menstrual cycles are considered long if they are over 35 days. This is a common sign that you are not ovulating regularly, or possibly not ovulating at all. This can be a sign of PCOS. Long cycles are also often associated with heavier and more painful periods since they long cycles typically point to a long follicular phase, meaning the endometrial lining has more time to thicken.
Short Menstrual Cycles: A short menstrual cycle is anything less 26 days. This can be a sign of high estrogen or a short luteal phase, which is due to low progesterone levels.
Skipped Periods (Amenorrhea): Of course the first thing that comes to mind with missed periods is pregnancy and this certainly is a common reason, but not the only one. Other imbalances a missed period can point to are menopause/perimenopause for those over the age of 40, stress or illness, undereating, and other medical conditions.
Heavy Flow (Menorrhagia): This refers to anything over 80ml (16 soaked pads or tampons) of accumulated blood loss during your period or periods lasting longer than 7 days. This can be a sign of excess estrogen, low thyroid hormone, endometriosis, adenomyosis, or can be caused by abnormal growths like polyps and cysts.
Short, Scanty Periods (Hypomenorrhea): This category includes anything less than 30ml of total blood loss or periods lasting less than 3 days. This can be a sign of low estrogen and may be a sign of anovulation or the beginning of amenorrhea.
Spotting: Spotting refers to bleeding in between periods, which commonly occurs in the days leading up to your period or the few days after your period finishes. This can be a sign of low progesterone, a misaligned uterus, or starting or stopping hormonal birth control.
PMS: The dreaded Pre Menstrual Syndrome. Going back to my teen years, my friends and I would often joke about this and assumed that because it was so common amongst friends and family members that it was a normal symptom that menstruators are doomed to experience throughout their menstruating years. PMS encompasses a range of symptoms, including mood swings, tender breasts, food cravings, fatigue, irritability, and depression. While PMS is a very common issue, it is not something that should be experienced in a normal menstrual cycle. Experiencing PMS often points back to low progesterone and/or excess estrogen.
Period Pain (Dysmenorrhea): Painful periods are another symptom that so many menstruators think of as “normal” because it is so very common, but in fact a normal period should have little to no pain and certainly nothing that should disrupt your day to day life. Cramping is a sign of increased inflammation. This occurs when the body produces a high amount of inflammatory prostaglandins and not enough anti-inflammatory prostaglandins. In cases of extreme pelvic pain, this can also point to conditions such as endometriosis, adenomyosis, fibroids, uterine cysts, or pelvic infections.
Menstrual Migraines/Headaches: This is a common symptom associated with excess estrogen. It is initiated by the sharp drop of estrogen right before menstruation. It can be caused by deficiencies in magnesium or potassium as well as dehydration or can point towards a histamine intolerance.
Period Flu: Some women experience flu-like symptoms around their period including nausea, vomiting, and achy-ness. This can be due to excess estrogen and/or low progesterone as well as the increase of inflammatory prostaglandins around menstruation.
What to do next:
If any of these symptoms sound familiar to you, that’s okay. Now you are building some awareness of what your body might be telling you. The good news is that there is so much we can do in a natural and holistic way to address these symptoms and get you feeling your very best. A good place to begin is to start eating a whole food diet filled with nourishing protein, healthy fats, and plenty of fruits and veggies. Avoid processed foods and added sugar. And most importantly, work on managing your stress levels. Stress has such a major impact on our bodies and our hormones and is a key element in bringing our bodies into their most optimal state.
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The American College of Obstetricians and Gynecologists. (2015). Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign. Retrieved from https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2015/12/menstruation-in-girls-and-adolescents-using-the-menstrual-cycle-as-a-vital-sign
Carr, Bruce R. and Reed, Beverly G. (2018). The Normal Menstrual Cycle and the Control of Ovulation. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK279054/
Mayo Clinic. (2022). Premenstrual Syndrome (PMS). Retrieved from: https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/diagnosis-treatment/drc-20376787
Romm, Aviva, MD. (2021). Hormone Intelligence. New York, NY: HarperCollins Publishers.
Briden, Lara, ND. (2018). Period Repair Manual. Greenpeak Publishing.