Is My Period Normal?
Normal doesn’t always mean optimal: Understand your menstrual cycle to learn about your health and to optimize it.
By Dr. Cynthia Hall ND CA
7 MINUTE READ
Is My Cycle Normal?
Menstrual cycles (period cycles) are managed by the cyclical nature of, and relationship between, a variety of hormones. Normally, unless we are having troubles conceiving, or transitioning into menopause, we haven’t heard about these hormones since high-school biology class. They are: Estrogen, Progesterone, Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH) and Gonadotropin-Releasing Hormone (GnRH).
The relationship between these hormones creates an opportunity for ovulation, uterine lining (endometrial) growth and lining maintenance throughout the menstrual cycle. Each hormone plays an important role in creating an optimal environment for conception (meeting of the sperm & egg) and implantation of an embryo.
What is a Normal Menstrual Cycle?
But what is considered normal? When we saw the menstrual cycle in school, we learned the average length is 28 days. A 2020 global study found 77% of its app users in the US and Canada had cycles ranging from 25-31 days. Where Day 1 is the first day of menses (ie. period).
We know each person has a unique cycle, there is variability between cycles, and cycles are affected by various triggers (ex. extreme stress and illness). Despite all of the external factors that affect cycles, they can still be considered normal. Today’s research finds normal cycles are anywhere between 21-35 days.
But, as we shorten or lengthen our cycles, are they still optimal? Optimal for fertility? Optimal for hormone balance? Optimal for general health and wellness?
To look further into this topic of ‘optimal’, let us start by digging into the phases of the menstrual cycle first.
The Phases of the Menstrual Cycle
Cycles can be split into two main phases: Phase 1 - Follicular and Phase 2 – Luteal.
Let’s start with discussing Phase 2: the Luteal Phase, and how this phase can be connected to shorter cycles.
Phase 2: The Luteal Phase and Shorter Cycles
The luteal phase begins after ovulation and ends with the beginning of your next period. For simplicity’s sake, let’s work with a 28-day cycle. The luteal phase begins around day 14 immediately after you ovulate, and ends the day before your next menses. The luteal phase is approximately 14 days long.
The key hormone in this phase is progesterone. The dip in progesterone levels at the end of phase 2 send a cue to your body that it is time to have a period, and release the endometrial tissue that has built up.
In cases where cycles are less than 28 days, progesterone levels may be the culprit. Adequate progesterone levels are important to maintain the endometrial lining for the entirety of Phase 2 (the full 14 days). Other clues that progesterone levels may not be optimal are in cases of spotting the week prior to a full period. Early spotting is usually a sign that progesterone has dropped too low and too early in the cycle.
This is part of the reason why lab tests of progesterone are done 7 days after your predicted ovulation date (ie. Day 21 of a 28-day cycle). Health care professionals can use this information to help assess why you may be struggling to conceive, and whether you ovulated. This information also helps indicate whether your progesterone levels are high enough to maintain the uterine lining for the entire cycle (which is important for implantation of an embryo).
For those who are trying to conceive, progesterone metabolites (by-products of progesterone metabolism in body) can be measured in the urine around 7-10 days after ovulation was predicted. These at-home options help to interpret whether you have ovulated and whether progesterone levels are adequate for implantation.
Other symptoms that may indicate progesterone levels are not optimal may include: jaw-line acne appearing one week before menses, insomnia and significant mood swings/PMS before menses.
In cases where cycles are longer than 28 days – after confirming you are not pregnant – let’s look at Phase 1: Follicular Phase for some explanation.
Phase 1: The Follicular Phase and Longer Cycles:
The Follicular Phase is made up of two parts: menses (period) and pre-ovulatory. Your menses marks Day 1 of a new cycle, and lasts to approximately day 5-7. Pre-ovulation is from approximately Day 5 – Day 14 (of a 28-day cycle).
Your menses coincides with Day 1 of your new cycle. Estrogen and progesterone levels have naturally dropped, and without progesterone, your uterine lining begins to shed. Within the first few days of the new cycle, certain hormone signals from the brain begin to increase. The first hormone, FSH, helps to stimulate maturation of an ovarian follicle. Over Phase 1, one ovarian follicle will mature until ovulation where it is released from the ovary. The follicle now becomes what we normally call “the egg” (ovum).
Interestingly, if FSH levels are too high at the beginning of Phase 1, this can contribute to infertility. This is because, it is the act of FSH rising that helps to mature a follicle. If FSH is already high, it may not increase enough to stimulate ovarian follicle maturation. This is commonly seen in cases of PCOS. The common ovulation drug used in PCOS cases, clomiphene, acts by promoting more FSH release from the brain to drive a greater increase in value. This is also why one of the risks of taking clomiphene is multiple ovulations. The body may react to rising FSH by maturing more than one follicle.
During Phase 1, the ovarian follicle matures and begins to release estrogen. Estrogen is paramount in the building a thick uterine lining, and contributes to cervical mucous changes that better promote sperm survival and conception chances. For fertility cases, a thick uterine lining is important for implantation of an embryo later in the cycle.
Through a series of feedback loops, a second hormone from the brain, LH, begins to increase during Phase 1 until it peaks just before ovulation (day 14 of a 28-day cycle). The LH peak contributes to follicle release from the ovary, and transition to Phase 2 of your menstrual cycle. Hormonal contraceptives disrupt this cycle of hormones in order to prevent pregnancy. At-home ovulation kits do their best to measure this peak in LH to predict whether ovulation will occur in the next 24-48 hours.
Something to note, LH peaks are not the only thing to measure while you are working to conceive. As a Naturopathic Doctor, I look at cervical mucous status, vaginal pH, sperm health, inflammation, and other hormones that all contribute to successful conception. I will discuss this more in an upcoming blog post.
How Does Phase 1: Luteal Phase Contribute to Longer Cycles?
To create an optimal environment for a developing embryo, there needs to be enough time for the uterus to build an appropriate lining. But, in cases where menstrual cycles are significantly longer than 28 days, it is important to look at the hormones that have a prominent role in Phase 1. If these hormones are not cycling normally, or are unable to reach their required levels, ovulation may not occur and delayed transition into Phase 2 will prolong your overall cycle.
5 Easy Ways You Can Start Tracking Your Cycles:
There are a few valuable things that you can track during your menstrual cycles to create a better picture of the length of Phase 1 and Phase 2, and your transition between.
The date each menses begins and ends
Note any cramping, heaviness, clots, color
Presence of spotting (minimal light brown menstrual blood)
Libido (sex drive)
Consistency and amount of cervical mucous (dry, sticky, cottage cheese, egg white, watery)
Other symptoms: headaches, neck aches, insomnia, cravings, acne, bloating, cramping, mood changes
There are also further tests that can provide valuable information as to the root cause of very short or very long periods. Insurance may cover many common hormones that can impact cycles (ex. LH, FSH, Estrogen, Progesterone, TSH). It is important to do these tests on the appropriate day of each Phase in order to get the most useful information. Speak to your health care provider about what day that is for you.
Other lab tests track a variety of hormones throughout the cycle with multiple readings. These tests are paid for out-of-pocket, but provide a more holistic view of hormone trends through your entire cycle. This can provide very valuable information if you are trying to conceive.
If this information resonates with you, and you would like to learn more about your own cycle and how to optimize it, phone now to book an appointment: 603-249-5771
References:
PMID: 232442161, 31482137