Ms. Misunderstood

Disclaimer- I am not a doctor, and I do not assume that I know better than one, so please, fact check anything you have doubts about. All the information in this post is my personal knowledge that has come from reading studies, books, chats with my own doctors, and talking with fellow women.

What society often tells us about our periods

What our periods actually are

Lets talk about the menstrual cycle.

I believe that as women, we aren’t educated enough on how our bodies work month-month. We aren’t told that we are not designed to be the same hormonally day to day. We aren’t told that our menstrual cycles are a reflection of our overall well-being and that fertility is not something to fear. Heck, sometimes we even learn that our cycles are dirty, embarrassing, something to speak in hushed tones about in front of the opposite sex.

Much of everything I was told growing up about my cycles was in the context of coping with the physiology of being a woman, instead of learning about its importance in my health.

If your experience in puberty was similar to mine, you were probably told to start tracking your cycle on a calendar, handed some pads or tampons, advil, and warned about some PMS you may experience. Now- in no way am I saying your average 13 year old should commit a research review about their body to memory. But….when we as women grow up, begin trying to have children, or not have them, are prescribed synthetic hormones for years, struggle with autoimmune conditions, low sex drive, hair loss, depression/anxiety, low appetite, recurring BV/ yeast infections, acne, gut issues, etc… THAT is when I believe we need to be more informed about our bodies. In fact, I think we are told so little about our biology that we have little backbone to stand up to a society that tells women that our biochemistry is a burden, that periods can “set us back” and that we need to constantly fight our fertility to be successful (Vitti, p. 62).

I realize that choosing to celebrate our bodies instead of fighting them comes with privilege and that many women struggle with extremely difficult reproductive issues such as endometriosis, vulvodynia, vaginismus, PCOS, etc. I understand that having the ability to celebrate your body when it feels like it is working against you is something easier said than done. This post is in no way to undermine the struggles of those conditions. The fact is, I’ve heard so many stories of women struggling with issues such as PCOS or endometriosis who haven’t been fully informed about their bodies by their medical providers and are left confused, frustrated, and without answers. I struggled with idiopathic vulvodynia for a year before finding a provider who listened to me, educated me, and let me present my own research to even begin finding a solution. Even then, finding answers is an uphill battle and I hope that in my writing, I never come across as preaching ‘one size fits all’. I want to insert here that having issues with your menstrual cycle or fertility doesn’t make you “unhealthy”. Health is personal, often subjective, constantly changing, and multifaceted- a combination of your physical, mental, emotional, and spiritual state.

The menstrual cycle is an incredible, harmonious process, where 7 hormones work symphonically together to one day (depending on your goals) create a life (Vitti, p. 17).

Take that in…. regardless of if you ever want to, your body was designed with the ability to literally bring life into this world, and even more, that it is your choice to carry out that ability or not. To make this possible, each hormone involved in this intricate system carries out its own reproductive function at its own special time during the (average) 28-35 day cycle in order to prepare an ovarian follicle to release an egg, build the uterine lining, and then shed that lining if pregnancy doesn’t occur (aka your period). Even more, the female menstrual cycle is not only responsible for human reproduction and the release of a mature egg, but also responsible for regulating vital bodily functions within a female. The health of your bones, skin, hair, brain, heart, and many more functions rely, in part, on your sex hormones.

Whether or not you want to get pregnant, your body intrinsically wants to function as a fertile entity.

Often as women we view the concept of fertility as purely a medical term, something that you don’t worry about until you want to have a baby. But think about it this way- a fertile female body is *usually* a healthy, unstressed, well-functioning human body. Have you ever experienced a later period during a stressful point in your life? When you lost or gained weight? When you went through a significant illness? Our bodies are extremely sensitive to external factors and can sense stressors from a mile away. If you’re constantly in a stressed state, your body is gonna be like…… “yeah…. lets not try and bring another life into the world with the current situation at hand”, which can often cause a late period (obviously this is much more complicated at a chemical and physiological level but you get the gist). Or perhaps you had a much more heavy and painful period after a stressful event or a month of poor sleeping habits, over working yourself, or not eating enough. Inflammation increases in our bodies when we are physically or mentally stressed, so the state of your period can give some insight as to overall, how your body is dealing with life at the time.

What doctors (speaking from my own experience) often to fail to educate their patient’s on is the fact that reproductive health and fertility are intertwined into so many different aspects of overall female well-being. When medications are taken that affect the functioning of the reproductive system, they consequently affect other functioning systems of the body. Everything in your body is connected, that is what makes your body the incredible and complex being that it is.

We can break the female cycle up into four parts:

the menstrual phase (your period). This phase marks day one of your cycle, when you start bleeding.

the follicular phase (preparing for ovulation). The follicular phase also starts the day that you’re bleeding.

the ovulatory phase (ovulation)

the luteal phase (usually the 10-15 days before your period, directly following ovulation)

This graphic shows the shifts in 2 main hormones, estrogen and progesterone, over time.

Very simply put, here is a snapshot of your cycle in terms of hormones (much of this information is paraphrased from Alisa Vitti’s book, In the Flo, chapter 3)

Your “period” begins in your brain.

The hypothalamus receives intricate and detailed information about the endocrine system constantly. With this information, the hypothalamus sends an inhibiting or releasing chemical signal to the pituitary gland. The pituitary gland then sends its own hormonal signals to the thyroid, parathyroid, adrenal glands, and ovaries. These organs and structures then, under the influence of the pituitary’s signals, either produce or decrease their own hormonal secretions. Each actor in this symphony of chemical signals work together, and when one actor is “off beat”, it affects the functioning of the other actors. Simply put, everything is connected, no structure in this system functions without the influence of another. This is why you hear the term “hormone balance” so frequently- each participator in the menstrual cycle works together like a symphony, if one hormone is ‘quieter’ or ‘louder’ than they other, you may experience some less than ideal symptoms.

So- lets apply this to how your body has a period!!! When your period starts, this marks day 1 of your next cycle, and your body is already thinking ahead to the release of another egg. Follicular Stimulating Hormone (FSH) is released by the pituitary gland and triggers the ovaries to begin maturing follicles (eggs) for ovulation. This is the very beginning of the follicular phase. Estrogen builds, reaches a threshold, which triggers Luteinizing hormone (LH), which is responsible for releasing an egg from the ovaries. This is called ovulation, and its the star of the show in regards to the menstrual cycle. Additionally, testosterone builds right before ovulation, making you feel energized and spikes libido right before you’re likely to get pregnant. After ovulation, progesterone builds, which maintains the uterine lining in case an egg was fertilized. This is the luteal phase, and it typically lasts 10-15 days after ovulation. If no egg was fertilized, progesterone eventually drops, which breaks down the uterine lining and expels it, which we know as a period.

That’s just a snapshot of how the menstrual cycle functions. Below, I’m going to describe a bit about the benefits of the 3 highlight players in : estrogen, progesterone, and testosterone.

Lets begin with Estrogen. Now this gal gets a bad rep sometimes, because in excess, she’s responsible for a much higher risk of cancers, heavy and painful periods, and weight gain. This hormone is responsible for SO MANY important things in our daily life.

Most of your estrogen will be produced in your ovaries, but it is also produced in adipose tissue. During and after menopause, when ovaries stop functioning, the adrenal glands make a hormone that can be converted into estrogen. It is important to our quality of life to have healthy levels of estrogen throughout your lifetime. Estrogen stimulates the production of osteoblasts, cells that synthesize bone (osteo=bone, blast=immature cell), which is why in menopause, when estrogen levels drop significantly, women are at a greater risk of developing osteoporosis. In a 2017 study done by Zarate et al, depleting levels of estrogen due to menopause correlated to a higher risk of developing Alzheimer’s disease. Additionally, in the brain, estrogen is neuroprotective, meaning it has receptors widely spread throughout the brain, regulating processes such as cognition, anxiety, appetite, libido, and body temperature (Zarate et al. 2017). It is widely received in the brain, affecting a wide range of functions such as your mood, to the way you think, to what mate you find attractive. Estrogen is one of the main hormones responsible for building feminine curves in puberty, which is one reason why when women take synthetic forms of it in the pill, breast pain, changes, and growth are likely.

In the first half of your cycle, the follicular phase, estrogen levels rise, which builds up your endometrial lining so that a fertilized egg can eventually nestle its way in there. This also can determine how heavy your periods are- the more your endometrial lining builds before ovulation, the heavier your period will be. Keep this in mind- despite how amazing estrogen is for the body, in excess, it can cause heavy, long, and painful periods. Estrogen also changes the cervix and its fluids. Leading up to ovulation, estrogen is responsible for raising, softening, and opening the cervix, as well as producing cervical fluid (aka discharge) that is more alkaline, has a higher water content, and very, very sperm-friendly. Generally, the environment down there is acidic (pH of around 3.8-4.5) and toxic to sperm (who are deceivingly fragile), but estrogen has a huge part in changing the pH to be more basic so sperm can survive long enough to reach an egg. Super fun to talk about, right?!

So anyways, while estrogen is responsible for the release of an egg and making sure sperm can live long enough to get there, it is also vital to your bones, skin, hair, and nails, as well as your energy, cognition, and mood. Remember, your body WANTS to be fertile. Estrogen is your friend in this regard, no matter what your goals are in your life at this time.

progesterone = happy uterus! Yay!

Alright- if estrogen was the party girl doing tequila shots on the table, progesterone is the girl outside in the moonlight enjoying much more ‘herbal’ refreshments. When this hormone is in healthy, balanced levels, she gives good, calm vibes and offers good sleep, healthy appetite, and the ability adapt to stress.

The name itself can tell you a bit about this hormone’s reproductive function. Pro= for, gest= to carry or bear, meaning progesterone is responsible for making sure the uterus is a hospitable and stable environment to “carry” a child. This hormone is dominant in the luteal phase, after ovulation, but is present in small amounts throughout the entire cycle. Research suggests that the benefits of progesterone reach far beyond reproductive function- progesterone benefits cardiovascular health, breast health, promotes a healthy nervous system, and plays a crucial role in brain function (Groves). According to Dr. Brighten’s book, Beyond the Pill, progesterone, when in balance with your other hormones, makes you calm, less anxious, in love with life. It promotes healthy sleep, healthy appetite, allows you to use your body’s fat stores for energy, and gives a calming effect in the body (Brighten, p34).

In the nervous system, cells in the central AND peripheral NS (brain and nerves in the body) actually synthesize progesterone from cholesterol. A study done in 2008 by Brinton et al. states that progesterone has receptors in all neural cell types. This means that progesterone circulating in the blood also has direct access to the brain and nerves (Groves). Progesterone regulates the formation of new synapses (synaptogenesis) in the brain, supports the development of crucial cells the cerebellum, and promotes myelination (a process which allows neural pathways to travel extremely fast) in the peripheral nervous system ( Tsutsui et al., 2011 and Rossetti et al., 2016 in Brinton et al., 2008). Additionally, progesterone is required for optimal brain function, and its affect on myelination promotes the growth and protection of nerve fibers, even after injury like TBI or stroke (Groves). In the brain, progesterone becomes the metabolite, allopregnanolone, which promotes calming and anti-anxiety effects (Groves). Like estrogen, natural (not to be confused with a synthetic progestin) progesterone is a crucial part in the female body, not only for fertility, but also for a well-functioning nervous system and brain health.

So- though progesterone is known to be a sex hormone vital for pregnancy and fertility, its importance spans far beyond creating life in the female body. It is important to understand that progesterone is extremely important in maintaining a healthy pregnancy, but also in maintaining your mood, your appetite, your uterine health, and brain health, even when pregnancy is not present or a goal.

Turning back to its role in reproductive cycles, when progesterone is in proportion to estrogen in the luteal phase (progesterone’s time to shine), your menstrual cycle will likely feel easier to handle. However, due to many different factors including diet, sleep, liver health, environmental toxins, alcohol consumption, medications, hormonal birth control, and much more, cortisol rises, estrogen often becomes the dominant hormone, which overshadows the production of progesterone. When this happens and your progesterone is low, you often experience symptoms in PMS- sore breasts, annoying spotting, irritability, nausea, fatigue, depression, weepiness, and mood swings. You know those days before your period when all you want to do is listen to All Too Well by TSwift and lay in bed? Yeah…. your dropping progesterone and estrogen levels are probably to blame.

Testosterone!

Next up- lets talk about testosterone. Yes, ladies need it too, even though this hormone is a male sex hormone, or an androgen. This hormone spikes a bit around ovulation when females are most fertile, making us feel confident, sexy, and attractive (I’m sure you can infer how this is advantageous for human reproduction). This hormone is responsible for so much that we as women take for granted. Energy levels, brain function, muscle growth, strength, bone health, libido, and mood are all tied to testosterone in the female body (Brighton, p 34). When T is in excess, this is when you begin to see acne, hair loss, and excessive body hair growth. This hormone can also play a big role in hormonal acne, as T can lead to excessive sebum production in the skin. In my hair loss journey, my T and I have had some ups and downs. I was told my testosterone levels were causing the excessive loss. As a result, I was put on a testosterone lowering medication, which did many funky things to my body. Specifically, I experienced fatigue, water retention, muscle weakness, breasts that hurt when I did any movement…. all bad things for me as a D1 athlete! I’m approaching this issue with a more naturopathic approach, because say it after me: there. is. more. than. one. way. to. heal. So ladies! don’t be afraid of testosterone- in healthy levels. It helps you to be athletic, confident, and energized, with a healthy libido and mood.

Finally, I just want to mention DHEA- or dehydroepiandrosterone. That mouthful is produced in the adrenal glands, and can be converted to estrogen or testosterone. This hormone is just another reason why we need to have healthy adrenal glands to support healthy, balanced hormones. It is responsible for many functions, some of which include keeping our skin firm, energy high, memory strong, while reducing body fat and promoting a strong libido (Brighton, p.35).

These four hormones are just a glance into the complex web of chemicals in our body that make us tick. . However, I want to make a few points here to wrap up this hormone-huddle up. Firstly, your hormones are your friends. They are chemicals that can either make your life difficult or they can benefit your health, wellbeing, and mental health in profound ways. I was never given this information growing up, and would likely not encountered it had I not ran into some unfortunate health issues. I believe that often, we are responsible for our own learning, as it is uncommon in this country for women to be fully informed about their bodies.

And if you’re reading this and you’re like…… “cool. But I’m fine, I just don’t really care, or need to care about this right now”. That is 100% fine. I felt the same way at one point, until I felt like crap and my hair started falling out, and then I started to really, really, learn and care greatly about women’s health. The important part is that women have accessible information about their bodies whenever they need it or desire it.

And that’s why I’m writing 🙂

“The new feminism includes being so well informed about your body that you can be 100% confident that you are making the best decision for you” -Dr. Jolene Brighten, Beyond the Pill

As always, this quote hits the nail on the head. Education is the first step towards empowerment. I decided to post this in hopes of setting a precursor for my next few posts that dive into more body-literacy and body education. I believe that fully understanding your body allows you to make the best decisions for yourself, be that in health care, athletics, work, and every day life. If you can’t tell already, I am, perhaps to a fault, incredibly passionate about sharing the intricacies and miracles that make up the female body, thus I hope that this information is helpful and empowering- we all deserve to feel empowered by our physiology and the knowledge of our body instead of hindered by it.

Keep and eye out for more! And as always- please reach out for comments, concerns, questions, arguments, etc. I greatly appreciate any feedback or comments from those who choose to take the time to read what I have to put out to the world.


Referenced:

1.
Zárate, S., Stevnsner, T., & Gredilla, R. (2017). Role of Estrogen and Other Sex Hormones in Brain Aging. Neuroprotection and DNA Repair. Frontiers in aging neuroscience9, 430. https://doi.org/10.3389/fnagi.2017.00430
2.
Brighten, J. (2019). Beyond the Pill. HarperOne.
3.
Progesterone receptors: form and function in brain.Brinton RD, Thompson RF, Foy MR, Baudry M, Wang J, Finch CE, Morgan TE, Pike CJ, Mack WJ, Stanczyk FZ, Nilsen J
Front Neuroendocrinol. 2008 May; 29(2):313-39.
4. Vitti, Alisa. (2019). In the Flo. HarperOne.
5. Margaret N. Groves, Scientific Writer, ZRT Laboratory. https://womeninbalance.org/resources-research/progesterone-and-the-nervous-systembrain/

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