3.1 The Mechanics of Menstruation

{Read time: 5 minutes}

The menstrual cycle is like a heartbeat. The cycle itself is referred to as an ebb & flow of 4 hormones:

  • Estradiol
  • Progesterone (made by the corpus luteum after ovulation)
  • FSH & LH – made in the pituitary gland

Testosterone does not feature in the uterine cycle but is made in the ovaries and the change in level across the cycle influences female physiology and ovulation [1]

Menstrual Health is defined as:

“a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity, in relation to the menstrual cycle.”

Menstrual Health is every single day of a menstruators life from menstruation to menopause, not just the days they bleed.

Next to body temperature, blood pressure, heart rate, and respiratory rate, Menstrual Health is the 5th Vital Sign.

“For women, menstrual health is an integral part of overall health because, between menarche and menopause, most women menstruate and menstruation can have a significant impact on the physical, mental, and social well-being.”[2]

Menstruation: science and society

The Menstrual Cycle

On average a menstrual cycle can take between 21 – 35. This range is classed as ‘normal’ or ‘regular’. Regular may also be one cycle of 26 days, one cycle of 29, and then back to 26. Whilst termed monthly, in line with the lunar calendar of 28 days, only 16% of menstruators experience a 28-day cycle.

Cycle length is relative to the individual. Each menstruator should collect the data on their own regular or normal. 

“You don’t know what you don’t know”, and if a change in the menstrual cycle is a marker for perimenopause symptoms, how do you know if it’s changed, if you don’t know what it was in the first place?

Menstrual cycle tracking can also include the flow – heavy or light, how many days a few or a lot, but most important how you feel.

With the knowledge of what sex hormones do and an awareness of the cycle, combined, this information is valuable for each menstruator. Rather than just counting the number of days in a complete cycle and what happens during menstruation, think beyond the bleed. It is advisable for menstruators to think like hormone detectives and tune in to physical and emotional changes each day. This can be done easily with a notebook or journal.

The time of bleeding is often prioritised, or navigated and never thought about until the next one. But if we engage with menstrual health in its entirety, every single day, this is a much healthier way to view the cycle over age.

The cycle can be disrupted by cofactors such as –

  • Stress
  • Sleep
  • Breathing
  • Nutrition
  • Movement
  • BMI extremes
  • Lifestyle (smoking & alcohol)
  • Environment

Therefore if the cycle is disrupted we should look at the things we can control to restore a positive cycle. During perimenopause when the cycle is disrupted by accelerated ovarian aging, the cofactors become even more important to monitor & modify.

Anovulatory cycles

Not every cycle results in ovulation. In a typical menstrual health timeline, there are approximately 2-3 cycles a year that are anovulatory. When there is no ovulation, there is no corpus luteum and therefore, no ovarian progesterone is made. 

As a result, there is a continued production of estradiol that is not opposed by progesterone. This creates a different kind of menstrual bleed, often heavy and uncomfortable. In general, the whole cycle will feel different. An anovulatory cycle is often the explanation of a ‘caught short’ moment or sudden heavy bleed. However, sometimes it may be a very light, short bleed, followed quite quickly by another ‘period’.

During perimenopause, the number of anovulatory cycles a year can double [3, 4]. This can result in very heavy bleeding across several cycles. As the cycle is also unpredictable managing this on a daily basis can be a very stressful experience.

The physical and emotional challenges

Just because a menstrual cycle is a ‘natural’ occurrence it does not mean that every menstruator finds them easy to manage. There is a huge assumption that if a person has been menstruating for several years they know what works best for them, or have the resources to support themselves.

Fluctuating levels of multifunctional sex hormones (with a focus on estradiol) can create a wide variety of menstrual health symptoms, which in general, menstruators are encouraged to deal or cope with.

Oestrogen and Progesterone have vital roles in brain chemistry, as neurotransmitters and neuroprotectants. The fluctuating levels during the cycle have a direct impact on mental health.

It’s estimated that over 90% of people who have a period also have symptoms throughout their menstrual cycle. Many women experience premenstrual syndrome (PMS) a week or two before their bleed. This can leave them feeling irritable, upset, nervous and anxious.

Modifying the nutritional components of the diet the entire cycle can significantly improve PMS and other symptoms.

It’s estimated that three to eight percent of people suffer more severely with premenstrual dysphoric disorder (PMDD.) This can lead to severe depression, fatigue, trouble focusing and panic attacks.

In conclusion

How the individual learns about the menstrual cycle and how to optimise the strengths and vulnerabilities will provide them with valuable knowledge with which to help navigate perimenopause.

The menstrual cycle should be viewed as a health marker for the whole person, beyond the bleed. Collecting the data on oneself is of paramount importance and a really good tool for optimising overall health across the entire menstrual health timeline. Journalling and period tracking form a solid framework for a Menopause Toolkit.

[NB. There are more detailed ways in which to support the menstrual cycle with nutrition and movement that are outside the scope of this particular training]