I find it quite interesting that one of the most important subjects that governs female bodies is almost always missed and never talked about. I am talking about female fertility and how it all works. How much do you know about your menstrual cycle?
It is interesting because lots of subjects that used to be absolute taboo like homosexuality, or inter-racial marriages or even suicide, are no longer taboos, yet something as perfectly natural, common and incredibly important as menarche, ovaries and just general female reproductive organs topic is hardly ever discussed.
There is a reason why. First of all, it’s because of our historical background. A look back to our history shows that most nations have placed restrictions on menstruating women. Men from all over the world made statements about menstruation and its negative effect on women, leading to prohibitions about physical intimacy, cooking, attending places of worship, and sometimes requiring women to live separately from men at this time.
So despite the fundamental differences across various nations, cultures, the topic of menstruating women was just something incredibly unclean, dirty, almost evil. Women were considered not just inferior due to this particular frequent ‘ailment’, but dangerous and must have been isolated for the time being to make sure that none of this curse and contagious uncleanliness could be spread onto perfect men. Basically, everyone thought that these menstruating creatures are simply supernatural witches. If they are supernatural, it means they are a creature of the devil and back in the super religious times, any connection with the devil’s business was something you would want to avoid at all cost.
As much as ridiculous and ironic it all was (and still is in some countries), especially bearing in mind how much stronger the female body is in terms of pain tolerance and longevity, and the fact that women do live longer providing they survive childbirth, there are still plenty of men and even women that think menarche is something utterly gross and is more of a curse than a gift.
Understandably, the reason behind bad attitude towards menstruating women throughout different times in our history was simply lack of knowledge and pure ignorance about the subject. It was very mysterious and obviously incredibly hard to explain the fact that all women of certain age are bleeding monthly for no apparent reason, yet never die from it. Of course it is suspicious! Yet if we can understand the poor attitude in the past, there is no excuse for any attitude these days.
Today my mission is to try and break all the mystery around the subject and try to reach to all the men and women out there to show them the beauty of something as powerful and magical as female fertility.
There are lots of papers out there talking about different stages of menstrual cycle. Some are completely incompetent, some overly simplified, but we are clearly lacking a bit more easily accessible information about it since 95% of women still have no clue what the menstrual cycle is and how it actually works. Okay, I am exaggerating, may be not 95%, but the number is very, very high because I don’t have a single female friend that actually knows what’s going inside her every single month.
Straight from the very beginning it becomes complicated. It’s complicated because the menstrual cycle actually includes two cycles that overlap with each other. Yes, these are two different cycles that go hand in hand in your lady parts.
The ovarian and uterus cycle
As you can guess from the name, they do happen in slightly different places.
We will start with the more complicated one – the Ovarian Cycle.
The ovarian cycle consists of three phases: 1) Follicular phase; 2) Ovulation phase; 3) Luteal phase
1) Follicular phase
During this phase, the ovarian follicles mature and get ready to release an egg. The latter part of this phase overlaps with the proliferative phase of the uterine cycle, but we will get to that.
Through the influence of a rise in follicle stimulating hormone (FSH) during the first days of the cycle, a few ovarian follicles are stimulated. These follicles, which were present at birth and have been rapidly decreasing ever since you were a 20 week embryo (when you have 100% of your reserve), compete with each others for dominance. Under the influence of several hormones, all but one of these follicles will stop growing, while one dominant follicle in the ovary will continue to maturity. The follicle that reaches maturity is the one that wins the competition and eventually will be released and will turn into a baby if it gets conquered by a spermatozoid. In rare occasions, two eggs will be released at the same time and that’s how you get to have baby twins!
2) Ovulation phase
I hope by now people are more aware of what ovulation is. In case you are still not entirely sure, then the summary of ovulation is rather simple.
An egg is released from the follicle and swept into the fallopian tube by the fimbria, which is a fringe of tissue at the end of each fallopian tube. It it will stay there for 12-24h (not really that much) waiting to be fertilised by some noble ‘swimmer’ in white armour, that is the spermatozoid. If that doesn’t happen, then the egg goes into a suicide mission and simply dissolves and it means that you won’t have any babies that particular month. End of story!
For someone who is more interested in the technical side of it and wants to know how exactly hormones orchestrate the process, I will go into a bit more detail.
During the follicular phase, estradiol (primary sex hormone) suppresses the production of the luteinizing hormone (LH) from the anterior pituitary gland (part of a pituitary gland, major organ of the endocrine system). When the egg has nearly matured, levels of estradiol reach a threshold above which this effect is reversed and estrogen stimulates the production of a large amount of LH. This process, known as the LH surge, starts around day 12 of the average cycle and may last 48 hours. The release of LH matures the egg and weakens the wall of the follicle in the ovary, causing the fully developed follicle to release its egg, so the magic just happened! Once the eggs is fertilised, which usually take place in the ampulla, the widest section of the fallopian tubes. A fertilized egg immediately begins the process of embryogenesis, or development.
The developing embryo takes about three days to reach the uterus and another three days to implant into the endometrium. This is why the morning after pill can be taken up to 72 hours after. Because you don’t just suddenly have a baby straight after intercourse and it doesn’t get implanted onto you like a parasite in no time! Everything takes time.
What is interesting is that which of the two ovaries—left or right—ovulates appears essentially random; no known left and right co-ordination exists!
3) Luteal phase
The luteal phase is the final phase of the ovarian cycle and it corresponds to the secretory phase of the uterine cycle (I will talk about it in a short while). During the luteal phase, the hormones FSH and LH cause the remaining parts of the dominant follicle to transform into the corpus luteum (look for the yellow ‘bubble’ on the picture), which is basically a temporary endocrine structure that produces progesterone, estradiol and inhibin A. 1
So what does it all mean? Well, the progesterone prepares the body for pregnancy in the event that the released egg is fertilised. Progesterone stimulates the growth of blood vessels that supply the lining of the womb and stimulates glands in the womb to secrete nutrients that nourish the early embryo. Just one hormone and does such an important job! If the egg is not fertilised, the corpus luteum breaks down, the production of progesterone falls and a new menstrual cycle begins. 2
From the time of ovulation until progesterone withdrawal has caused menstruation to begin and menstrual cycle to start again, the process typically takes about two weeks, with 14 days considered normal. Which gives as a standard menstrual cycle of 28 days, which is very average, as every woman is different and it is the norm to have menstrual cycle every 24 – 32 days. Remember, menstrual cycle starts on the first day of menstruation!
Menstruation or a period is the first phase of the uterine cycle. Regular periods last for 3-5 days, but anywhere from 2 to 7 is considered normal. The average blood loss is 35 millilitres, but anything between 10 – 80 ml is considered normal as well. In terms of millilitres, it is very hard to measure your blood flow really, as it is not like you are measuring it with a measuring cup every month. But it just points out that it’s not really that much (normal cooking cup is 200ml) even though sometimes it might feel like you are losing all your blood! You can relax, because it’s not even your normal blood. Menstrual blood consists of the shed layer of the uterine lining (broken down and expelled) as well as tissue particles and hormone secretions. Throughout the cycle you will have all sorts of colours, as is kindly demonstrated here by a bunch of cranberries.
2) Proliferative phase
The proliferative phase is the second phase of the uterine cycle when estrogen causes the lining of the uterus to grow, or proliferate, during this time. As they mature, the ovarian follicles secrete increasing amounts of estradiol and estrogen. So this proliferative phase overlaps follicular cycle, so this is basically Stage 2 of your cycle.
The estrogen initiate the formation of a new layer of endometrium (womb) in the uterus, which you just safely secreted during your period. So the whole thing just started again. The estrogen also stimulates crypts in the cervix to produce fertile cervical mucus, which is noticed by women practising fertility awareness. I will get back to this.
3) Secretory phase
The secretory phase is the final phase of the uterine cycle and it corresponds to the luteal phase of the ovarian cycle. So just to sum up, during the secretory phase, the corpus luteum produces progesterone, which plays a vital role in making the endometrium receptive to implantation of the blastocyst if the eggs was fertilised and supportive of the early pregnancy, by increasing blood flow and uterine secretions and reducing the contractility of the smooth muscle in the uterus. It also has the side effect of raising the woman’s basal body temperature, which is another major element you would want to understand more if you care enough about your body to at least look into fertility awareness practice.
Have you got all the time in the world?
The short answer is no. It is better to have babies, if you want any, as soon as is practically possible – It’s not like you have got much choice.
As I mentioned, you get 100% reserve of follicles when you are a 20 week old embryo. Just before you are born, the number starts decreasing. Yes, you are not even born yet, but you are already losing follicles! By the time you reach puberty, on average, you will have 180,000 follicles. At the same time, a clutch of follicles begins folliculogenesis3, entering a growth pattern that will end when they die or in ovulation. What happens next? Basically, just slow decline and the beginning of your journey into turning into one old grey lady and subsequent death! I am not even joking.
Due to us being not exactly perfectly working machines, out of those 180k, you will only get 400 follicles that will ever reach the preovulatory stage. The sad statistic is by the time you are 30, you will only have 12% left out of your follicle reserve! Just 12% at the sweet age of 30 and you are not even anywhere near old! But nature seems to think differently of your age. At the menopause only 1,000 follicles remain. It seems likely that early menopause occurs for women with low populations at birth, and late menopause occurs for women with high populations at birth, but there is as yet no clinical evidence for this. 4
The saddest part is that men, unlike women, can make babies up until they are dead, even if they are 90 years old. What a joke.
Fertility Awareness Method and Lady Comp
Since we now have learnt everything we needed to know about menstrual cycle, what do we do with this new knowledge? Embrace it and make the most out of it!
Now you have a very clear idea that it is possible to predict your fertility and it scientifically proves that you can only get pregnant once the egg is released! Men’s sperm can live in your body up to 5 days, which means you can get pregnant if you had unprotected intercourse 5 days before the ovulation and a day after. Which is in total 7 days. That is all! Just 7 days out of the entire menstrual cycle.
Before ovulation, during your follicular phase, basal temperatures are relatively low. After ovulation, your basal body temperature rises sufficiently that you can see the difference between your pre-ovulation and post-ovulation temperatures when they are plotted on a graph.
Your temperature sign is the sign that will best help you to precisely pinpoint the day that ovulation occurred. This is because progesterone, and hence your temperature, increase quite dramatically just after ovulation takes place.
If there is no pregnancy, your temperature will stay elevated for 10-16 days, until the corpus luteum regresses. At this time, unless there is a pregnancy, progesterone levels drop dramatically and you get your period. Your temperature normally drops at this time as well, though it is not unusual to have erratic or high temperatures during your period.5
This is when my beautiful, reliable, perfect best friend kicks in – the Lady Comp! Lady Comp should totally rule the world because this tiny, easy to use and incredibly pretty machine tells me everything I need to know about my menstrual cycle every morning – whether I am fertile or not. I talked about it in more details here, but I just wanted to emphasise again that Lady Comp is the most convenient, reliable and quickest device out there that helps me with my Natural Family Planning method. They have recently launched a new version of Lady Comp, which is a little bit more advanced than the previous one and I am so totally going to get myself one!
Since I am the biggest fan of LC, they are still willing to give my readers 6% discount when you use my code “maria-luisa”. So feel free to do so!
Once you have your Lady Comp, it gets even more exciting. Now since you know almost everything about your lady parts, you can observe all sorts of things and they will make sense.
The Mucus Pattern
Yes, there is such thing as mucus pattern. It’s not just some random discharge, but it is all nicely structured.
It all starts with your mucus during your period. You still have the mucus, but your flow covers the mucus signs. After your period, there are usually a few days without mucus. These are called “dry days.” These may be safe days if menstrual cycle is long, but Lady Comp will tell you all about it in case you are not sure. When an egg starts to ripen, more mucus is produced. It appears at the opening of the vagina. It is generally yellow or white and cloudy. It also feels sticky or tacky. It is not gross at all, your body is just telling you that it is not ready to make any babies right now and even if you try, your man’s swimmers won’t get through because the mucus works as a barrier and it’s too thick for them to swim through. Very clever.
Usually, you will have the most mucus just before ovulation. It looks clear and feels slippery — like raw egg white. When it can be stretched between the fingers. These are the “slippery days.” It is the peak of your fertility. This is the time when your body is more than ready to make babies and your mind too, believe it or not. Women’s libido is much more active during ovulation than any other time of the month, so whether you want to ignore your nature or not, it cares very little as to what you think.
After about four slippery days, you may suddenly have less mucus. It will become cloudy and tacky again, no more babies making-time, thanks! Then you may have a few more dry days before your period starts. These are also safe days.6
There are several methods that can teach you how to chart your cycle, how to manually check your mucus and see at which stage in your menstrual cycle you are at and the rest of it.7
Sadly, I don’t have that much free time on my hands and refuse to chart and manually write down my temperature every morning at 8am, so Lady Comp will be with me and do all this hard work for me for the rest of my fertile days!
Next time I will tell you how to get the best out of your hormones and why your endocrine system is a super powerful tool and not something that should be treated as a disease.