Understanding Your Menstrual Cycle

Understanding_Menstrual_Cycle The menstrual cycle is a series of physiological changes that your body goes through every month in preparation for a possible pregnancy. It is often described in terms of the hormones produced by the ovaries, oestrogen and progesterone. The pituitary gland also produces hormones (FSH and LH) and has its effects on the follicles, the fallopian tubes and the lining of the uterus, the so called ‘endometrium’.

A normal menstrual cycle consists of two main phases, known as the follicular (pre-ovulatory) and luteal (post-ovulatory) phase. The follicular phase is featured by growing follicles that will eventually result in the production and release of a mature egg. Whereas the luteal phase is characterized by the thickening of the uterine lining for potential implantation of a fertilized embryo.

The Menstrual Cycle; Key Events

The key events during a ‘typical’ 28-day menstrual cycle, starting from the first day of period, can be summarized as follows:

Day 1-5: Levels of the major female hormones oestrogen and progesterone are very low at the start of the cycle. This results in:

the start of period flow as the uterine lining is no longer maintained
the pituitary gland to start making hormones FSH and LH to stimulate the growth of new follicles in the ovary

Day 7: One of the follicles outgrows the others, becomes the dominant follicle in the ovary and starts to produce considerable amounts of oestrogen.

Day 7-12: The elevated levels of oestrogen stimulate:

the endometrium to proliferate
the glands of the cervix to produce and excrete fertile mucus, this increase in mucus means you’re most fertile on these days

Day 12 and 13:

The continuing high levels of oestrogen act on the pituitary gland, inducing it to produce LH. The surge of LH then stimulates the production of enzymes and prostaglandins in the dominant follicle.

Day 14:

The egg gets released when the enzymes break the follicle wall and the prostaglandins trigger its expulsion. This process is known as ovulation.

Day 15-25:

The follicle becomes the so called corpus luteum and produces progesterone (and oestrogen) to:

stimulate the endometrium to secrete nutrients
inhibit the pituitary from making more FSH and LH to ripen more follicles

Day 25-28:

If the eggs is not fertilised, the corpus luteum dies and the levels of progesterone and oestrogen drop, causing:

the start of menstrual bleed as the endometrium disintegrates
the pituitary to recommence the production of FHS and LH for the development
of the next lot of follicles

The Menstrual Cycle from the Traditional Chinese Medicine (TCM) Perspective

In TCM, the Kidney is the primary organ that governs reproductive function. It stores Jing (also called Essence) which transforms into Tian Gui or ‘heavenly water’. Tian Gui fills the reservoirs of the vessels (Chong and Ren Mai) and finally the Bao Gong (uterus), Bao Mai and Bao Luo (the uterine vessels and collaterals, including the blood vessels that supply the pelvic reproductive organs). When Tian Gui becomes abundant and the Bao Luo is patent, the menstrual cycle (menarche) will start in the early teens.

According to Chinese medicine theory, the menstrual cycle can be divided into four stages based on a ‘typical’ 28-day cycle, reflecting the changing status of Yin, Yang, Qi (energy) and Blood.

Stage 1: Purging of Blood through menstrual bleed, day 1-7 of cycle

If pregnancy hasn’t occurred, Yang begins to decline and transforms into Yin as the uterus starts to purge, or ‘flow without storage’.

Stage 2: Post-Menstrual growth of Blood and Yin, day 3-14 (follicular phase)

After menstruation the Bao Gong (uterus) closes, the Sea of Blood is empty and the growth of Yin and Blood begins. This phase is characterized by ‘storage without discharge’. Kidney Yin, Jing and Blood gradually flourish as it approaches ovulation.

Stage 3: Ovulation, day 14-15 of cycle

Yin reaches its peak, marked by the appearance of cervical mucus, and then transforms into Yang. Yin fullness and the resultant movement of Yang allow for the possibility of conception.

Stage 4: Premenstrual, day 16-28 (luteal phase)

On the basis of sufficiency and abundance of Yin, Yang grows and peaks, the Chong and Ren Mai fill, and the uterus prepares to embrace and nourish a developing foetus.

Since the Kidney stores Jing and governs reproduction, it is the foundation of fertility. The role is supported by the harmonious functioning of other organs, particularly the Liver and the Spleen. Disruptions in their regulatory and transformative function can result in disharmonies of Qi, Blood, Yin or Yang and formation of pathological products such as internal Heat/Cold, Wind, Dampness and Phlegm.

Menstrual Health and Female Fertility

Having a healthy menstrual cycle is vital for female fertility. Signs and symptoms that may cause concern include:

Irregular, too short (less than 21 days) or too long (more than 35 days) cycle
Extremely light or heavy bleeding
Dark or purplish blood with multiple clots
Moderate to severe menstrual pain
Premenstrual or mid cycle spotting
Ovulation pain
Prominent premenstrual syndrome (PMS) e.g. mood swings, breast tenderness, food craving, fatigue, irritability and depression

Do you experience any of the above symptoms? Or do you have any other issues or concern regarding your menstrual cycle or fertility? During a full initial consultation we will get to the bottom of your menstrual cycle and provide you with a treatment plan to get you back to menstrual health again. You can book in for your consultation here!

This blog post was written by Dr. I-Li Ho.

References:

1. Lyttleton J. (2004). The Menstrual Cycle. Treatment of Infertility with Chinese Medicine. Churchill Livingstone.

2. Wu Y, Leonard C, Haeberle M. (2019). Basic theories of Chinese medicine gynaecology and infertility. Female Infertility and Reproductive Gynaecology: A Comprehensive Clinical Manual of Integrated Chinese Medicine and Biomedicine. The Journal of Chinese Medicine Ltd.