PMS? Sugar cravings? Impending anxiety and looser number 2s? These may be just some of the symptoms that fluctuate over time. Our menstrual cycle may often feel like a mysterious and unpredictable force but unlocking the secrets of your menstrual cycle will empower you to take charge of your reproductive health.
Whether you are trying to conceive or simply want to gain a deeper understanding of your body's natural rhythm, this guide will give you the tools to track your cycle like a pro so you can check in on your health ‘report card. Our menstrual cycle really is a vital sign!
By tracking your cycle, you become more aware of your body’s natural rhythms and patterns. It can help you identify any changes happening in your body such as hormonal fluctuations, changes in mood, energy levels and physical symptoms.
Being aware of these things and keeping track of them can help you recognise what is normal for you, help identify any irregularities and give you an understanding of your body’s optimal time of conception.
Different Phases of the Menstrual Cycle
There are four phases of the menstrual cycle: menstruation, the follicular phase, ovulation and the luteal phase. Cycles can vary in length and intensity and are measured from the first day of a period (first day of bleeding).
Image Credit: Isometrik, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons
Menstrual Cycle Length
A typical menstrual cycle length is 26 to 35 days. If your cycle is on the shorter side (less than 26 days) this may indicate luteal phase disruption (a luteal phase less than or equal to 11 days). If your cycle is closer to 35 days or beyond, this may be indicative of PCOS or hypothalamic amenorrhea.
At a minimum you want to track day 1 of your cycle and the final day before menstruation arrives again.
1. Menstruation Phase and Flow Check
The menstruation phase is the first day of your period to the time when bleeding ends. Typically, this may be anywhere from 3 to 7 days. The thickened lining of the uterus is shed when the body recognises that the egg from the last cycle hasn’t been fertilised. Many females can experience symptoms such as period pain, tender breasts, bloating, lower back pain and mood swings around this time.
With the advent of menstrual cups (if you have not tried one, do see if they are right for you - I absolutely love mine!) it is now easier to quantify and observe your menstrual blood flow.
One study that characterised menstrual fluid loss across 96 cycles, reported blood loss from 15 to 271 millilitres with an average volume of 87 millilitres. In females who had previously given birth menstrual blood volume was 99 millilitres compared to 46 millilitres in females that had never given birth [1]. If you have had a child and you feel as though your period is heavier, it is likely that it is.
Nine to 14% of females may experience heavy periods. Periods that last longer than 7 days or are very heavy are called menorrhagia. Heavy periods can make you feel fatigued, and you may notice many clumps or clots in your menstrual blood. This poses a risk for developing iron deficiency so do have your iron levels checked if you experience heavy periods, or if you are feeling fatigued.
If you experience shorter periods of bleeding and low volumes of blood it is possible that you have not ovulated that cycle [2]. Yes – it is possible to have a period but not ovulate. Research suggests that ovulation does not take place in 16% to 37% of menstrual cycles. Just as your period arriving every 26 to 35 days is a sign of your health, so is the presence of ovulation (more on that below).
A healthy microbiome supports regular ovulation, a reduction in menstrual pain and less gastrointestinal symptoms at the time of menstruation!
2. Follicular Phase
Following menstruation, the body prepares for ovulation by producing follicle-stimulating hormone (FSH), which prompts the ovaries to develop follicles containing eggs.
Follicles are like little water baths for the eggs and the contents of this fluid directly impacts the quality and health of your eggs. If this fluid contains a good balance of antioxidants and anti-inflammatory compounds, and the right hormone and nutrient levels, it will nurture your eggs and protect your follicles from damage.
While 15 to 20 follicles will be maturing at the same time, only one follicle is chosen to reach the final stage and become the dominant follicle. If the right conditions are provided for this follicle, this will then get ready for the big main event- ovulation!
3. Ovulation Phase
During the ovulation phase, usually around day 14 in a 28-day cycle, rising estrogen levels signal the pituitary gland to release luteinizing hormone (LH) to begin the process of ovulation.
The ovary releases a mature egg which travels down the fallopian tube and to the uterus where it can be fertilised by sperm. This is the prime time for conception BUT knowing you are ovulating is a window to a healthy mesntrual cycle, and balanced hormones!
If your goal is conception, knowing when you are most likely to ovulate helps increase the chances of pregnancy.
An egg only lives for around 12-24 hours but sperm can survive for around 5 days. Conception is possible when you have sex five days before ovulation, but the greatest likelihood of conceiving happens with intercourse in the two days before ovulation and on the day of ovulation. 24 hours after ovulating the chance of conception is 0%.
You can see in the figure below that the prime window for sex with the greatest chance of conception starts two days before ovulation, through to the day of ovulation.
*data from https://www.fertilitysociety.com.au/
The gold standard way to tell if you are ovulating is to have repeat transvaginal ultrasounds to track follicle growth and rupture. This is obviously not a very accessible way of tracking ovulation and who wants a transvaginal ultrasound every day? No thanks! So how else might you get some clues to know if ovulation is taking place?
Temperature Tracking
This method of ovulation tracking requires you to monitor your temperature each morning so you can detect changes across your menstrual cycle. A small rise in your morning body temperature of 0.3 degrees Celsius / 0.5 Fahrenheit may let you know that ovulation has occurred.
Once your follicle ruptures to release an egg, the left-over follicle produces progesterone which tells your higher brain centres to set a higher body temperature. While an increase in temperature may indicate ovulation, many other things also affect your temperature such as alcohol, sleep disruption and stress. Also, for 20% of females they may still ovulate but not have a change in body temperature [3].
Pee on a Stick
Measuring urine LH to determine when levels ‘surge’ is another method that may indicate ovulation. The rise in LH typically occurs 36 hours before ovulation. The type of rise in LH is not necessarily a rapid surge for all females though so tracking this can be difficult.
Some females have a dual (biphasic) surge in LH where LH will rise, drop off and then rise again, and some females even have a triphasic surge (three spikes in LH). It is also possible to have an LH surge but no ovulation, as seen in unruptured follicle syndrome. In unruptured follicle syndrome the communication systems to allow ovulation to take place are disrupted, often by inflammation and hormone imbalance.
If you have PCOS, LH tracking is not the most reliable method to indicate ovulation. Remember that it is likely your LH levels are already high so you may get a positive test result most days of the month.
One of the best ovulation tracking techniques to include is cervical mucus monitoring.
Cervical Mucus Monitoring
Under the influence of oestrogen, the water content of your cervical secretions increases and mucin content decreases. If your cervical mucus is very wet, stretchy and resembles raw egg white then ovulation is very close! This method of ovulation tracking is 74% accurate when compared to tracking ovulation via the gold standard of transvaginal ultrasound.
Type 1 and 2: dry or damp vulva
Type 3: thick, creamy, whitish or yellowish
Type 4: transparent, stretchy or elastic, wet slippery vulva
The odds of conception are at least two to three times higher when having sex with the intent of trying to conceive on a day with type 4 cervical mucus than when having sex on a day with type 1 or 2 cervical mucus [4].
Position of Your Cervix
Your cervix is the gateway for sperm to enter the uterus from the vagina. As you get closer to ovulation, your cervix rises and becomes softer. There is a small indentation in the middle of your cervix and this may also feel more open at the time of ovulation.
If you would like to track changes in your cervix across your menstrual cycle start with clean hands and in a comfortable position insert your middle finger into your vagina. If your cervix is low and feels hard like the tip of your nose, then you will most likely be post-ovulation.
If your cervix is positioned higher, feels softer and more open this may be indicative of ovulation. As with any ovulation tracking you want to be consistent with tracking changes in your cervix across your cycle. Once you have finished your menstrual period you may like to chart cervix position (high/low) and feel (soft/firm) to help identify when ovulation is likely.
4. Luteal Phase
After ovulation, the ruptured follicle transforms into the corpus luteum, producing progesterone to support a potential pregnancy. Progesterone is not just about pregnancy though.
A progesterone boost in the luteal phase also acts a mood booster. Higher progesterone levels after ovulation are associated with reduce anxiety, aggression and irritability.
Keep Track of Your Vital Signs
Are you ovulating? Is your luteal phase an ideal length? Is your volume of menstrual blood changing?
Keep track of the health of your menstrual cycle by monitoring ovulation indicators, cycle length, pain, premenstrual symptoms, bleeding and mood. There are so many great apps for tracking that are free to download.
If you are monitoring ovulation, use a combination of methods above to help you pinpoint when you may be ovulating. These vital signs may just be a clue to the improvements that are taking place on the inside as you nurture your gut microbiota.
Menstrual cycle tracking provides the opportunity to look out for different signs and symptoms which can help identify any irregularities or potential health issues such as polycystic ovary syndrome (PCOS), hormone imbalances or endometriosis. Menstrual cycle tracking provides valuable insights for making informed decisions surrounding fertility and reproductive health.
Remember that every woman’s cycle is different. If you notice any irregularities or have any health concerns about your cycle, consult with your healthcare professional.
References
- Donoso, M.B., et al., Normality Ranges of Menstrual Fluid Volume During Reproductive Life Using Direct Quantification of Menses with Vaginal Cups. Gynecol Obstet Invest, 2019. 84(4): p. 390-395.
- Dasharathy, S.S., et al., Menstrual bleeding patterns among regularly menstruating women. Am J Epidemiol, 2012. 175(6): p. 536-45.
- Su, H.W., et al., Detection of ovulation, a review of currently available methods. Bioeng Transl Med, 2017. 2(3): p. 238-246.
- Evans-Hoeker, E., et al., Cervical mucus monitoring prevalence and associated fecundability in women trying to conceive. Fertil Steril, 2013. 100(4): p. 1033-1038 e1.
