The Dao Does… What actually happens in your menstrual cycle?
“Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less.” ~ Marie Curie
Many individuals go through their reproductive years without knowing what is actually going on throughout their menstrual cycle. Perhaps, you have spent a great chunk of your 20s & 30s on a hormonal contraceptive where you may not have been bleeding at all, or are having a monthly ‘ghost period’, maybe you have been pregnant and breastfeeding, maybe you have lost your period or are experiencing an irregular menstrual cycle. Nevertheless, it is never too late to begin to understand your body and know what the hormones are doing throughout the month to optimise your health.
The menstrual cycle is a complex monthly report of the internal hormone system. It is regulated by continuous interactions of Estrogen and Progesterone which are released from the ovaries, and the combination of Follicular Stimulating Hormone (FSH), and Lutenising Hormone (LH) released by the pituitary gland. These hormones are messengers that circulate through the Hypothalamic-Pituary-Ovarian-Axis encouraging regular ovulation and a menstrual bleed. When we see an imbalance at any point of the cycle we turn to the hormones, reviewed by bloodwork and/or physical signs and symptoms to see who may be out of line.
Traditional Chinese Medicine describes the menstrual cycle by the effect of Qi, Blood, Yin & Yang on the Uterus. The menstrual cycle is one of many physical manifestations of the ebb and flow of Yin & Yang energy, and the balance between these two. We also explain the menstrual cycle in relation to nature, with each stage alluding to one of the four seasons, Winter, Spring, Summer & Autumn.
So, what is actually happening?
Menstruation ~ Winter
When Menstruation (more commonly known as a period) begins, this is recognised as the first day of the menstrual cycle (Day 1). This is now the beginning of the 28ish-day hormonal interaction a female experiences. The uterus lining begins to shred and is accompanied by blood, cervical mucus, and cells to form your period. During this time the FSH starts to rise again to stimulate the ovarian follicles to grow and the race to ovulation begins. These follicles have actually started their development 100 days earlier, thus it shows the importance of looking at menstrual support and preconception care for at least three months – what you are doing today will be a reflection of your period in 3 months’ time.
Menstruation alludes to the season of Winter from a TCM perspective, a time to slow down, rest, keep warm, and nourish the body with warming foods. We don’t need to overdo anything whilst menstruating as there is already a loss of Qi and Blood, we want to restore and rebuild through the Spleen & Kidney Organs, as well as support the smooth flow of a pain-free bleed through the Liver.
The menstruation phase lasts for approximately 5-7 days. We like to see a consistent, controlled flow for at least 3 days, before beginning to taper off. The bleed itself should be cherry red, have no clotting, and only slight cramping as the uterus is contracting and there is increased prostaglandin production, but nothing that should impact your day.
Follicular Phase ~ Spring
The follicular phase has already begun as the ovarian follicles begin to be stimulated by the FSH released from the pituitary gland. This phase can last anywhere from 7 to 21 days, but is widely variable and accounts for variations in cycle length and ovulation.
FSH is pushing the follicles into line and closer to ovulation. The follicles begin to release estrogen called estradiol, aka the Queen of the hormones. Estrogen stimulates mood and libido in turn boosting serotonin (feel-good-hormone). It thickens the uterine lining to prepare for potential implantation to occur if you are trying to conceive. It also drives the fertile cervical mucus which is why you have more of this around ovulation when estrogen is at its highest. Cervical mucus is the ‘sperm highway’ assisting the sperm all the way up to meet the egg in the fallopian tube.
The follicular phase is all about growth, so from a TCM point of view is associated with Spring – like a seedling about to sprout (follicle > egg). Kidney Yin is also most dominant at this time as it nourishes and builds the Qi and Blood and has estrogenic-like properties supporting the follicular phase.
Ovulation ~ Summer
Summer has arrived, but, only for a brief moment as ovulation occurs within 24hrs. Eventually one of the ovarian follicles won the race to become the dominant follicle. It begins to swell and is then triggered by a massive surge of LH from the pituitary gland – the egg is released, and ovulation has occurred! This is when you may experience mittelschmerz, mild pain, or twinge as the egg is released. You will see the egg-white cervical mucus, or will generally feel more lubricated after wiping or during intercourse.
Most of us don’t have a ‘textbook’ 28-day cycle when ovulation would be around Day 14, therefore, depending on your cycle length ovulation could occur anywhere from Day 10-21, or even beyond that. Generally, if you have ovulated, you will be pregnant or your period will arrive approximately two weeks later – so, to estimate you could count back 14 days from Day 1 of your bleed. The egg has now been swept up by the fallopian tube where the sperm can fertilise the egg and conception can occur. But ovulation is so important for overall health too because this is how progesterone is made.
Ovulation is recognised as the season of Summer – it’s big, bright, and makes you feel good! This is the time when you feel more motivated, energetic, focused, and social. You can go a little harder with exercise as your hormones are supporting you through. It is important to note that, some people do experience a big overwhelm around this time, and we should also listen to this and pull back your activities if you find it all gets too much.
Luteal Phase ~ Autumn
After ovulation occurs, Progesterone is released by the corpus luteum (a temporary endocrine gland constructed by the emptied follicle) and we have now entered the luteal phase. This phase of the menstrual cycle is always consistently 10-16 days determined by the lifespan of the corpus luteum. After this time the period will arrive or a positive pregnancy.
Estrogen is the Queen, and Progesterone comes in to calm and balance everything out. Its biggest role is to also hold and nourish a pregnancy, it also thins the uterine lining, supports thyroid function, reduces inflammation, builds muscles and supports bone density, promotes sleep, and calms the central nervous system. But unfortunately, it is only here for a short time before it begins to drop off stimulating the uterus to contract and we move back into the Winter.
Autumn is also the time when the leaves begin to dry up and fall. Kidney Yang is supporting the luteal phase alongside Spleen Qi to support the production of progesterone and maintain body temperature. However, this time can be particularly challenging for some with the rise of premenstrual tension – stemming from a slight hormonal fluctuation between estrogen and progesterone as well as Liver Qi Stagnation from a TCM perspective. It is important to begin to slow down now, opt for lower intensity exercises with a heavyweight, and eat more – lots of root vegetables, carbohydrates, and protein (a ‘period’ steak is a great hit of iron prior to the next bleed), proritise rest.
As you can see the menstrual cycle is complex. Please chat with your TCM practitioner further to understand more specifically how your individual cycle flows.
Other great menstrual cycle resources:
@integratingchinesemedicine or visit our Integrating Chinese Medicine Podcast web page
@larabriden and her book, The Period Repair Manual
28ish Days Later Podcast
@brightgirlhealth
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By Molly Burton