Alot Actually…

The usual routine at OB/GYN’s office likely involves the question “When was the first day of your last period?” The answer to this question is actually very important as it provides details about your menstrual cycle and conception.  If you have been unsuccessfully trying to conceive an adequate evaluation of your cycle is critical to identifying hormonal balances and ovulation.

My investigation into infertility goes far beyond this. I am detail oriented and want to know about the person in front of me. The first day of your last period is not enough information to understand the whole person. To treat you as an individual I also consider diet, lifestyle, digestion, stress, energy, mood and much more. Infertility is just a word. It does not define you. What defines you is your strength, hope and perseverance. You are valuable, whole and matter.

Menses 101: 

Your menstrual cycle extends far beyond a once a month event. It is a complex interaction of various hormones that orchestrate major changes to your body throughout the month. If you consider the common PMS complaints; irritability, breast tenderness, cramps, cravings, weight gain, headaches, bowel changes etc, it is obvious the hormonal effects occur all over the body.

The main highlights of the menstrual cycle are the release of an egg from the ovary and the uterus developing a lining that can support a pregnancy. There are two phases of the cycle the follicular phase and the luteal phase.

Your cycle starts at day 1. Day 1 is the first day of your period and the start of the follicular phase. In this phase follicle-stimulating hormone (FSH) is released from the hypothalamus in the brain and causes a follicle to grow in the ovary (hence the name).

Approximately 15 follicles that encase an egg grow and mature.  One lucky follicle is chosen and continues to grow for approximately 14 days until a surge of luteinizing hormone (LH) is released from the brain. The spike in LH causes ovulation and the egg is released into the abdominal cavity. This marks the end of the follicular phase and beginning of the luteal phase.

The luteal phase then continues the cycle until the onset of menses or the start of pregnancy. After ovulation the egg is picked up by the fallopian tube and ideally will be fertilized here by a sperm. The egg (fertilized or not) will make its way down towards the uterus. During this phase the ovary releases progesterone, which further matures the uterine lining and prepares for the fertilized egg to implant. If pregnancy does not occur, the levels of progesterone drop and bleeding starts. This phase is also an average of 14 days.

The length of your cycle, specifically the length of each phase, can provide key insight pointing to hormonal imbalances, and if and when you ovulate. This information is important because without ovulation, pregnancy cannot occur. Keep in mind the only accurate way to decipher your menstrual cycles true length is without any form of hormonal birth control.

Hormonal birth control essentially sets your body into autopilot. Hormonal contraception provides external hormones so your body doesn’t need to think about it. I hear people say “my periods were irregular until I took birth control and they are fine now”. This is not necessarily true because you have just masked the underlying problem.

1) What classifies a healthy and normal menstrual cycle?

Definition: 21-35 days

What does this tell me? A regular cycle suggests that sex hormones are balanced and ovulation has occurred. Chances of natural conception have been optimized.

2) What does a short menstrual cycle mean when it comes to fertility?

Definition: less than 21 days

What does this tell me?

When your cycle is less then 21 days it is likely that ovulation will not or has not occurred.  A short cycle may be indicative of lower ovarian reserve or fewer eggs. Other causes include improper diet, stress, over exhaustion, extreme anxiety and more. A full workup including lab work will be beneficial in determine whether or not conception may be more difficult.

3) What classifies a long or irregular menstrual cycle?

Definition: more then 35 days. 

What does this tell me?

A long or irregular cycle the may be due to lack of regular ovulation. During the luteal phase it is the fall in progesterone after no implantation (pregnancy) results in bleeding. If a follicle fails to mature or ovulation does not occur then progesterone is never produced and the uterine lining continues to thicken in response to estrogen. This is known as an unopposed estrogen state. In this state the lining is not only overgrown but also irregular. Different sections will grow their blood supply at different times and shed and bleed erratically. This often leads to unpredictable, often heavy prolonged bleeding.

Many irregularities that disrupt the brain-ovarian communication result in erratic ovulation. Conditions such as; polycystic ovarian syndrome (PCOS), hypothyroidism, stress, excessive exercise, malnutrition, medications, cervical dysplasia, premature ovarian failure, menopause, and chronic illness to name a few.

These hormonal imbalances are important to understand in detail as they potentially can lead to lack of ovulation and thus lack of pregnancy. Furthermore, unpredictable drops in progesterone, which result in uterine shedding, may increase the risk of miscarriage.

 4) What classifies prolonged bleeding?

Definition: bleeding that lasts more then 7 days

What does this tell me? 

There are so many factors that go into determining the root cause of prolonged menses or heavy menses. Structural causes include fibroids, infection, cancer and polyps which create a potential issue with the physical implantation of the embryo. The inability to effectively implant results in lower conception rates and increased risk of miscarriage. Other causes include medications as well as a rare clotting disorders.

5) Lack of periods all together

Definition: rarely or never experience a period

What does this tell me?

A careful evaluation will need to take place to determine the root cause. Have you ever have a menses? Do you have a long history of birth control use and in what form? Are you on any other medications? These are only a few of the many important details.  If you are rarely getting your period and you are not ovulating you will likely experience difficulty conceiving naturally without intervention. Causes include excessive exercise, low bodyweight, and structural issues with the uterus, premature menopause.

When to seek medical care?

In my opinion, everyone looking to conceive should seek Naturopathic care to ensure health optimization. In addition if your cycle is any variation from normal even if you are not looking to conceive you should seek care.

The current infertility guidelines state; women under 35 should have frequent intercourse without contraception for 12 months prior to infertility being assessed. In contrast, women over 35 need to be referred for additional testing after 6 months of failure to conceive.


To learn more about your menstrual cycle or to schedule an appointment, CONTACT ME.