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Menstrual cycle is a vital sign

The past decade has seen a marked shift in how we engage with the topic of menstruation, in both social and print media, as well as in the rise of women’s circles, red tents and spaces where folks feel safe to share about this historically taboo topic. Some even say there is a menstruation revolution happening! If you already know that the menstrual cycle is a vital sign then you are a part of that movement.


If you’ve never heard of this concept… read on. We’ll break down this complex, interconnected communication system, known as the endocrine system, into a language that you understand and is relevant to you.

 

A vital sign… and our definition of fertility


In 2015 the American College of Obstetrics and Gynecology proposed that the menstrual cycle be used by medical professionals as a “vital sign”, particularly in adolescents (1). Vital signs, such as heart rate, blood pressure and respiratory rate, are used to identify potentially more serious health conditions.


They say, “identification of abnormal menstrual patterns in adolescence may improve early identification of potential health concerns for adulthood” and use 3 primary signs for evaluation

  • Onset of menarche (first menstruation)

  • Cycle length and ovulation

  • Abnormal uterine bleeding (amenorrhea, irregular or heavy bleeding)

According to their article, causes of these symptoms may include:

  • Immaturity of the hypothalamic–pituitary–ovarian axis

  • Hyperandrogenic anovulation eg, polycystic ovary syndrome

  • Hypothalamic dysfunction (eg, eating disorders [obesity, underweight, or significant fast weight loss] or stress-related hypothalamic dysfunction)

  • Thyroid disease

  • Primary pituitary disease


We view this perspective as relatively simplistic, but important nevertheless. The focus on adolescence is a good start, but we argue that the menstrual cycle can be used through a woman’s reproductive years as a feedback system of underlying health issues. In our practice we take things further by uncovering the root causes of these dysfunctions and diseases.


At Natural Fertility, we view reproductive health as interconnected with all other systems in the body. We understand reproductive health to be an expression of whole-body health, including emotional and spiritual well-being (2, 3). Our understanding of fertility is about more than babymaking! It includes: vitality, health, functionality, creativity and the ability to show up and contribute in your community. Although there are many structural barriers to good health, we stand for the right to thriving health for all humans (and other beings) and work with what is within our sphere of accessibility.


The menstrual cycle… or the ovulatory cycle?


The menstrual cycle and the sex hormones involved, namely estrogen and progesterone, are driven by the process of ovulation. Imbalanced hormones mean that less-than-optimal ovulation is happening, and if we are not ovulating optimally then hormones will be out of balance.


How do you know if you’re ovulating? In our practice we teach a symptothermal method of fertility awareness (4) to confirm ovulation. Ovulation can also be confirmed via a well-timed ultrasound or by the presence of progesterone in blood or urine. We love the fertility awareness method (FAM) of confirming ovulation because

  • After learning how, you can confirm whether ovulation has taken place, at home and by yourself using a basal body thermometer and cervical mucus observations

  • It is a cheap, relatively simple way to collect continuous data for monitoring of egg health and hormonal balance that you can share with your (FAM-aware) health practitioner


Why is ovulation so essential? Even if we’re not thinking about pregnancy, ovulation is the only way that the hormone progesterone is produced (5). Only after ovulation, the follicle from which the egg ruptured undergoes a rapid transformation into a temporary gland known as the corpus luteum, which produces progesterone.


Progesterone is the key to healthy cycles (2) and has benefits beyond reproductive health (5). It is the calming, grounding anti-inflammatory and anti-stress hormone that provides the perfect balance to the inflammatory and excitatory nature of estrogen. We need both… and we need balance, but all too often that is not the case. A common group of hormonal imbalances is estrogen dominance (meaning too much estrogen not balanced by enough progesterone).


A more accurate description of the hormonal cycle is the ovulatory cycle because ovulation is the main event, not menstruation.


Hormonal symptoms… or clue to underlying health issues?


So we need a balance between estrogen and progesterone to have healthy, symptom-free cycles and we know these are produced in the ovaries and driven by the process of ovulation. But it doesn’t all happen in isolation… This complex process is reliant on various other systems that can impact if, when and how ovulation occurs.


The hypothalamic pituitary adrenal (HPA) axis (including the hypothalamus, the pituitary gland and the adrenals) rules the reproductive system (and many other systems, including immune, metabolic and digestive). It works by interpreting physical and psychosocial factors, allowing us to use resources effectively and optimise survival (6, 7). One essential component of this is stress and managing the body’s stress response. If the body is under stress, from a real or perceived threat, the HPA axis may use it’s complex communication system to shut down ovarian function (7). That’s why we may look at cortisol levels and other stress markers when investigating your hormonal health.



To have abundant nutrients available in the body we need to firstly, be consuming a diverse and nutrient dense diet and secondly, be digesting and integrating these nutrients optimally (8, 9). So, we need a well-functioning digestive system to support ovulation, stress resilience and all other functions in the body. The gut microbiome forms part of the detoxification and immune systems too.


Lara Briden says “ you cannot have healthy periods until you have a healthy digestion” (2)


Every day, our hormones are used, detoxified and excreted. The detoxification and excretion process includes transforming our fat-soluble hormones into water-soluble compounds that can be excreted through the colon (10). This, again, is a nutrient-intensive process that requires a well-functioning and not-overburdened liver and gut.

While this section is not a comprehensive review of all the systems involved in ovulation and balanced hormones, it’s aim was to demonstrate a few aspects when considering hormonal health. In order for optimal ovulation to take place, we need an environment abundant in nutrients and free from stress, at least for the maturation timeline of the follicle in which that egg has been growing: a minimum of 100 days. Healing your hormones naturally is not a quick fix! It may take a minimum of 3 months to see the impact of dietary and lifestyle changes on your hormones.


We can see by the interconnected nature of the body, that hormonal symptoms cannot be treated in isolation. It requires a whole-body and holistic approach, looking at digestion, detoxification, stress and more to find underlying causes of hormonal imbalance or obstructions to fertility.


A window into overall health


To conclude: although only recently acknowledged as a vital sign by an institution of western medicine there are other healing modalities that have understood and worked with concept for much longer.


The human body is made up of interconnected systems that are reliant on one another for optimal functioning. Reproductive health and ovulation in particular, require an abundance of nutrients and an environment free from physical and psychological stress. Because of this relationship, we can use ovulatory or hormonal health as a window into underlying health.


In our practice, we use a symptothermal method of confirming ovulation as one tool for monitoring client health. We also spend time looking at a detailed medical and personal history, addressing all symptoms of whole-body health and pathology testing (blood, urine, stool) to identify root causes of hormonal issues.


We use nutritional medicine, dietary, herbal and supplement recommendations, lifestyle changes and reducing chemical exposure to address these. We are also happy to work with your team of health practitioners and make recommendations where appropriate.


 
  1. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Committee Opinion No. 651. American College of Obstetricians and Gynecologists. Obstet Gynecol 2015;126:e143–6.

  2. Briden, Lara. 2015. Period repair manual: natural treatment for better hormones and better periods.

  3. Pope, Alexandra & Hugo Wurlitzer, Sjanie. 2017 Wild Power.

  4. Frank-Herrmann P, et al. 2007. The effectiveness of a fertility awareness based method to avoid pregnancy in relation to a couple's sexual behaviour during the fertile time: a prospective longitudinal study. Hum Reprod. 2007 May;22(5):1310-9. doi: 10.1093/humrep/dem003. Epub 2007 Feb 20. PMID: 17314078.

  5. Taraborrelli S. Physiology, production and action of progesterone. Acta Obstet Gynecol Scand. 2015 Nov;94 Suppl 161:8-16. doi: 10.1111/aogs.12771. PMID: 26358238.

  6. Smith, S. M., & Vale, W. W. (2006). The role of the hypothalamic-pituitary-adrenal axis in neuroendocrine responses to stress. Dialogues in clinical neuroscience, 8(4), 383–395. https://doi.org/10.31887/DCNS.2006.8.4/ssmith

  7. Joseph, Dana N., and Shannon Whirledge. 2017. "Stress and the HPA Axis: Balancing Homeostasis and Fertility" International Journal of Molecular Sciences 18, no. 10: 2224. https://doi.org/10.3390/ijms18102224

  8. Fontana, R., & Della Torre, S. (2016). The Deep Correlation between Energy Metabolism and Reproduction: A View on the Effects of Nutrition for Women Fertility. Nutrients, 8(2), 87. https://doi.org/10.3390/nu8020087

  9. Procter, S. B., & Campbell, C. G. (2014). Position of the Academy of Nutrition and Dietetics: nutrition and lifestyle for a healthy pregnancy outcome. Journal of the Academy of Nutrition and Dietetics, 114(7), 1099–1103. https://doi.org/10.1016/j.jand.2014.05.005

  10. Thomas MP, Potter BVL. The structural biology of oestrogen metabolism. J Steroid Biochem Mol Biol [Internet]. 2013;137:27–49. Available from: http://dx.doi.org/10.1016/j.jsbmb.2012.12.014