Is Your Cycle “Normal”?
Written in collaboration with student dietitian Eleni Zeniou @bumpandbeyond.nutrition
Until I studied biological sciences as part of my science degree at university, I thought the menstrual cycle was just your period. Fast forward 10 years and I had almost forgotten that the other three phases of the menstrual cycle still aren’t common knowledge.
For many couples, the first time learning about the menstrual cycle comes after months of unsuccessful attempts at trying to conceive.
I believe it’s extremely empowering to learn about the menstrual cycle so you can understand how your body works, what is “normal” and what might need flagging with your health care team. I’d also highly recommend educating your partner about it too so they can understand how to best support you during the ebbs and flows of constant hormonal fluctuations.
So let’s dive in! We all know the average length of a menstrual cycle is 28-29 days, however in reality it can range from 26-35 days and still be considered normal. The month is divided into four phases and I like to start at phase 2 and end at phase 1 (just because I think it flows better – pun most definitely intended).
Phase 2 – The Follicular Phase (Days 6-14)
Week 2 is when both estrogen and progesterone levels are rising. You may feel more energetic, focused, assertive and have a higher libido. This phase is called follicular because it is when the follicles inside your ovaries are beginning to form and mature into potential eggs. Your body is preparing the lining of your uterus (endometrium lining) in preparation for a possible pregnancy.
Phase 3 – Ovulation (Days 15-17)
This is it, the big moment your body has been working towards…ovulation! Over 2-3 days, a mature egg bursts from the follicle and starts to make its way down the fallopian tube. This is the time you are most likely to fall pregnant.
Phase 4 – Luteal Phase (Days 18-28)
The beginning of week 3 sees progesterone levels surge with smaller amounts of estrogen to continue building and thickening the lining of your uterus in anticipation of a fertilised egg.
Phase 1 – The Menstrual Phase (Days 1-5)
If an egg is not fertilised, estrogen and progesterone levels plummet to their lowest, allowing the nutrients and blood (endometrium) that lined your uterus to leave your body - this is your period. Your energy levels might be lower during this time and for some women, period cramps, back and upper thigh pain can feel as if your uterus is throwing a toddler-style temper tantrum. For others, symptoms may be more mild like bloating, food cravings and tender breasts. For the lucky ones, there are no symptoms at all. And thus, the cycle repeats!
For anyone who likes to get really nerdy, check out this YouTube video which shows you exactly what’s going on inside your body during the menstrual cycle.
What about PMS (Premenstrual Syndrome)?
Whilst this isn’t considered a phase of the menstrual cycle, you might notice mood swings in the weeks or days leading up to your period. Estrogen, testosterone and progesterone take a sharp nosedive causing an imbalance in our mood neurotransmitters serotonin and dopamine. During this time, respect your body with an increased level of self-awareness. Rest if you feel tired, eat when your body tells you it’s hungry and switch to more gentle forms of exercise if you’re just not up for a booty burn session at the gym. You might notice more emotional, non-hungry food cravings around this time (particularly for chocolate), so I’d recommend dipping into your self-care toolkit here. I help all of my clients build their own unique toolkit which may include things like taking a shower/bubble bath, colouring in, calling a friend or lighting a candle and reading a good book.
If you notice extreme mood shifts that disrupt your relationships and work, you may need to talk to your doctor. Some women experience Premenstrual Dysphoric Disorder, a condition that usually presents with more severe emotions like panic attacks, extreme anger and hopelessness. There are many treatments options available so don’t be afraid to reach out to your health care team.
Signs of a Hormone Imbalance
The hormones involved in orchestrating the complexities of the menstrual cycle include follicle stimulating hormone (FSH), luteinising hormone (LH), gonadotropin releasing hormone (GnRH), estrogen and progesterone. These hormones follow a pattern of rising and falling at specific time points throughout the menstrual cycle which you can see in this picture below.
Image credit: https://www.instagram.com/brightgirlhealth/
Hormone imbalances occur when these hormones do not follow their expected pattern throughout the menstrual cycle . This imbalance can impact the release of an egg during ovulation making it difficult to fall pregnant naturally. This is known as ovulatory infertility and can be caused by both medical and lifestyle conditions such as premature menopause, polycystic ovary syndrome (PCOS), insulin resistance, endometriosis, thyroid conditions, low body fat levels, high body fat levels, stress, exercise and diet. Some of the common symptoms experienced by women with hormone imbalances include:
Irregular menstrual cycles
Unexplained weight loss or gain
Acne
Heavy periods
Painful periods or cramps
Mid-cycle spotting
Fatigue and low energy levels
Depression or mood swings
Hair loss or excessive hair growth
Intolerance to cold temperatures
Muscle aches or headaches
Concentration problems
Gut issues - constipation, diarrhoea, bloating
Back pain and/or pelvic pain
Leg pain
Nausea
Painful intercourse
Painful urination
Decreased libido
If you have any of the symptoms above, it can be really helpful to start collecting and tracking data about your cycle, gut, mood and any other bothersome symptoms. That way, you can communicate easily with your healthcare team to get on the same page as you.
I’ve personally used a cycle tracking app called Natural Cycles and absolutely loved it. Using a basal thermometer each morning when you wake up and a LH urine test a handful of times per year, you can track where you are in your own unique cycle. You can also track symptoms alongside and view graphs that show you trends and patterns. Although this app costs a fair bit more than others, it has rigorous science behind it, uses objective data to map your unique cycle and is 93% effective as a contraceptive which is equal to the effectiveness of the contraceptive pill (approved as a contraceptive in the USA and EU). You can switch it to different modes depending on whether you are trying to fall pregnant or prevent a pregnancy. However, as always, this advice does not replace that of your health care team and I encourage you to do your own due diligence to make sure this app is right for you.
If you are struggling with cycle irregularities, a specialied women’s health dietitian is a key health professional to have as part of your team. Diet and lifestyle changes have a tremendous ability to both regulate hormone imbalances and also help manage medical conditions which cause hormone imbalances. If you are struggling to find support, I can help you navigate the healthcare system to get the investigations, diagnosis and solutions you need.