Episode 2: Your Menstrual Cycle- The Fifth Vital Sign

Hi, I'm Dr. Tabitha, the functional gynecologist. I'm a board certified OB, GYN and functional medicine physician. I've embraced the world of functional medicine and wellness through my own personal health journey. And I'm super excited to share my wisdom and unique perspective as it pertains to women's health. So if you're struggling with hormone imbalance, weight gain, period issues, anxiety, insomnia, you name it, then you've come to the right place. I want to be your functional gynecologist. So welcome. Hi, guys. Welcome to the functional gynecologist. I'm your host, Dr. Tabitha. Today on episode number two, we're going to be talking about your menstrual cycle. It is actually known as the fifth vital sign for women. Back in 2015, the American College of Obstetrics and Gynecologists, which I am a member, they released a committee opinion entitled menstruation and Girls and Adolescents using the menstrual cycle as a vital sign. This was a long time coming. We have known that it matters what your menstrual cycle is doing. It isn't a clear indicator of whether your body's imbalance or not. So when ACOG came out with this committee opinion in 2015, it was a huge win for gynecologists around the country because they're finally acknowledging female hormones and the menstrual cycle and how important it is as an indicator of our overall health. So just like our blood pressure and our pulse and our temperature are taken at the doctor's office or in the emergency department to give the physician key information about how your body is functioning, they should also be asking about menstrual cycles. So why is it important? Like I said, it's an indicator of your overall health. If you are not having a regular scheduled cycle and you're not on any kind of hormonal birth control, that can be an early warning sign for conditions developing something like polycystic ovarian syndrome. It's important for your physicians and providers to be asking about your cycle and for you to be tracking it so that you know that answer. So we're going to get into all that today. We're going to talk about the difference of when you are on birth control pills or maybe have hormonal IUD or you're in perimenopause. But I just want you to understand that if it's not anything that we need to be ashamed of or not be talking about, we need to just see the menstrual Cycle as part of the normal female physiology and understand how important it is and how much information it provides for us. Just some background information. I'm sure most you guys know menarche is the first period that women or girls have and that's usually the Average age is 12 and a half and that's usually two to three years after Thelarche, which is breast bud development. ACOG recommends that anticipatory guidance start at age 8 from physicians and health practitioners. So when you are taking your girls to the pediatricians or the family practice offices, they should be asking girls about any possible signs of the larchy and menarche and doing a physical exam. We should be explaining to girls what's going to happen before it actually happens. You reduce a lot of fear and anxiety by doing that. We want to empower our girls to know their body and know what's going to happen to them. We also want to empower them to be their own health advocates so that when they have questions, they don't have to be scared to come to us and ask about it. And it helps if we give them the language and start that conversation for them so that they know how to even ask us those questions. If they don't have the words and the language and they're ashamed or they don't know that it's normal and going to happen, then they have a really hard time asking for help. In this day and age, another awesome way to empower girls is to have them track their periods once it does, start with an app on their phone or their tablets. The normal menstrual cycle usually runs on a 28 day cycle. So the first day of full bleeding is what we call cycle day one. So that's where your brain and your ovaries and your uterus are communicating through hormone signals. The the pituitary gland in your brain releases follicle stimulating hormone and luteinizing hormone. And these hormones talk to your ovaries and tell them to release estrogen and progesterone in a certain fashion and when to ovulate and release an egg. There's two main parts that we think about when we talk about the menstrual cycle. One is related to the ovaries, so the ovarian phases or and then one is related to the uterus or the uterine phases. The ovarian phases are the follicular and luteal. So the follicular phase prepares the ovary to release an egg and that is usually around cycle day 14. That's when ovulation occurs. What happens is estrogen rises, you get more cervical mucus production so that they can. That mucus can actually grab the sperm once it gets ejaculated and can pull it up into the cervix into the uterus to help it swim up to the fallopian tube to meet the egg. So when estrogen levels get high enough, your brain releases the luteinizing hormone and the ovulation occurs. Your egg gets released from the ovary, gets picked up by the tube and taken into the tube to meet the sperm, and then the luteal phase. So the leftover part of the ovary where your egg was released starts to produce progesterone from your corpus luteum. Progesterone is usually highest on cycle day 21. So it's typical for us to measure that hormone on day 21, especially when we are doing stuff with fertility. The corpus luteum is the cyst leftover in your ovary. Like I said, it produces progesterone. If no fertilization occurs, meaning the egg and the sperm don't meet while they're in the tube. The then this corpus luteum breaks down and estrogen and progesterone levels fall, and that causes you to bleed. Then that starts your new menstrual cycle back at cycle day one. So that is how the ovary is functioning as far as the uterus. The uterus is shedding its lighting and bleeding cycles, day one through five or seven, typically. Then it begins this proliferative phase where the lining starts to grow again inside the uterus called the endometrium. I don't know about you, but a lot of women have had endometrial biopsies, sometimes for abnormal bleeding, perimenopausal type things. That is where we take a sample of the lining inside the uterus that's growing in the proliferative phase every month. So if you've had that, you might be cringing a little bit. It is a little uncomfortable, causes some cramping. It can be pretty int, but it only lasts a minute or so. So if you need to have an endometrial biopsy done, don't fear it. You know, it's not that terrible. I've been through it. Anyways, once it gets through the proliferative phase and you ovulate, then it begins the secretory phase where it actually produces chemicals, prostaglandins. And these either support implantation, meaning the egg was fertilized and will turn into an embryo and needs to implant into this lining for pregnancy or it will start to break down and you will shed this lining as you bleed with your menstrual cycle. Prostaglandin F2alpha and E2 cause uterine muscle contractions. This cramping helps trigger the period if pregnancy occurs. Hopefully those prostaglandins are inhibited, but sometimes you can get some cramping with implantation because you're. It might not be clear cut what, what's going on in that uterus, but just know that it's pretty common and it doesn't mean you're going to have a miscarriage. It just means those prostaglandins are working. If there's no pregnancy, the estrogen progesterone drop. Like I mentioned before, these prostaglandin levels to the point where the blood vessels actually constrict and the tissue of the endometrium sloughs off. It's kind of a lot more complicated than that, but that's the gist of our 28 day cycle. So, okay, women, we are actually born with about 2 million eggs. And by puberty our numbers have already decreased to about 400,000. So every month about 415 to 20 follicles or tiny little cysts in our ovaries try to mature. And the most mature one releases the egg. That's the one that ovulates. So from puberty through menopause, we can release 400 to 500 eggs that reach maturity. That's a lot of potential pregnancies. Good lord. Reasons for not having a regular cycle right after menarche or your first period is that your HPO axis hasn't matured yet. That is your hypothalamic pituitary ovarian axis. That is just your brain and your ovaries talking to each other in a feedback system. And a lot of times it takes three to six months for that system to respond to correctly to each other and for, you know, your cycle to know what to do and do it every month. So it's common in the beginning to skip a couple months and not to be regular. Once you reach, you know, the six month mark, then you usually should be regular by that point and it should be anywhere between 21 and 45 days. You know, everybody's a little bit different, some are shorter or longer, but you should kind of fall in that window of three to five weeks. If you're not, then that might be reason to come see a gynecologist. It should only be seven days or less. And typically it's three to five days. I would say an average of three to six pads or tampons a day is a normal flow. A heavy flow would be if you're changing every hour or two. Reasons to see the gynecologist after you've, you know, started your period or you haven't started within three years of developing your breasts, you haven't started by the age of 15 or the age of 14. If you're having signs of too much testosterone, like coarse chin hair growth and severe acne, that type of thing. Also, like I mentioned, if it's happening more than, like less than 21 days apart, longer than 45 days, or if you're continuing to skip cycles, if it's super heavy or long, or if there's a family history of a bleeding disorder or excessive bruising, the those would also be reasons to come and see me. So why is it important to have a normal period? We have estrogen and progesterone receptors in almost all the cells of our body. We need our hormones to be cycling the way God or nature intended to protect our bones, our brain, and our cardiovascular system in particular. We need them to be regular in a cyclical fashion to maintain homeostasis. In our modern society, our bodies are just bombarded with toxins all day long. And so our cells have real difficulty allowing hormones to bind to their receptors and be activated appropriately. We're bombarded with toxins in our everyday lives through our cleaning products from xenoestrogens and phthalates, in our cosmetics and our sunscreens and our hair products, the BPA from our water bottles, the chemicals in our water system. All these toxins are affecting how our cells are functioning. And our body is continually trying to detoxify and do what it needs to stay in homeostasis. However, when it comes to hormones, these often get imbalanced. And why is that? It's because our body is going to survive before thrive. It will always choose to do what it needs to do to survive before. It will do what it needs to do to thrive. And that is meaning like reproduction. Imagine you're faced with a harsh environment. You know, you are living in Antarctica. You are haven't eaten in two months, or you are just faced with these toxins. Your body's response is, I don't want to reproduce. I can't create another human life. I need to function and survive and do what I need to do to get through this harsh situation. And so that is why hormones are always the first to go awry, because they get Abandoned first. When it comes to your body trying to maintain homeostasis. Homeostasis, it would much rather make cortisol to help you function and survive than to make estrogen and progesterone and reproduce when you are having a nice regular cycle. That tells me that your body feels happy and safe and content in homeostasis and is in thrive mode, not survive mode. So often we see the menstrual cycle being affected if our thyroid isn't functioning well, if we have a sugar problem like prediabetes or diabetes, certain medications, if we're under major stress, either physically or emotionally. Physically, we see this with high intensity athletes who are exercising and working out multiple hours a day. They're producing so much cortisol and aldosterone that they are really, they don't have any ingredients left to make estrogen and progesterone. Also low body weight. We also need some fat cells to make estrogen as well. So we see a lot of conditions disrupt our cycle. And so that's why it's a good indicator of, hey, something must be going on if you are not having a regular cycle every month. Some good lifestyle recommendations to support hormone balance and get your cycles back on track. And obviously this, this is referring to if you're not on hormonal birth control or anything interrupting it. So intermittent fasting is a really awesome way to get your cycles back on track. Why? Because it helps regulate your blood sugars. You're not pumping out insul all the time, you're not trying to make your liver work over time getting that sugar balance in your blood system. So intermittent fasting will help balance your hormones and that usually looks like not eating for 12 to 16 hours a day most days, or having some days where you're doing a three day water fast. We can get into those details in later episodes. But just know that getting away from snacking and eating every couple hours is going to help balance your hormones. That's huge. We really need to get control of our blood sugar and insulin regulation. Keeping sugar intake down in general. This is super important for teenagers, but also, you know, women, older women like myself. I'm about to turn 45, so I'm like feeling like I'm about to be in a different category. So now I'm actually excited about it. I'm looking forward to it. But all of us, no matter what our age, we really should be watching how much sugar we intake. Another thing you can do to help get your hormones back in balance is to start eating organically, get rid of the pesticides in your food and the chemicals that you're exposed to. Like stop buying, you know, the Glade plugins, the air fresheners, the harsh cleaning products. Minimize your cosmetics. Try and get clean cosmetics that are chemical free or at least decrease in the chemicals. Manage that stress with exercising regularly, doing some self care, showing yourself some love. Breathing techniques are an awesome way to bring down that cortisol level. Five deep breaths. It's as easy as that. Like just inhaling and exhaling deeper and longer each time. That can physically drop your cortisol production. Meditation is an awesome one. 10% happier is a really awesome app that I love. That's how I started doing meditation. 10% happier with Dan Harris. Healthy communication with your partner, your family, your friends. Start processing and dealing with your crap. That is going to be huge for you emotionally to get control of your hormones. Lots of good things that you can do to help balance your hormones, okay? And like I promised, I'll also mention being on hormonal birth control like birth control pills or Depo shot or anuvaring or Nexplanon rod or Mirena iud. These all are synthetic hormones that your body is taking in. So this will directly interfere with the HPO axis. So your brain and your ovaries communication is going to change. Birth control pills typically just shut that communication down. They override the system so that you are taking synthetic hormones and your ovaries are no longer producing the hormones the way they're supposed to. A lot of women have breakthrough bleeding and don't feel the greatest on it because of that. But either way, what I want you to understand is that that withdrawal bleed that you have during the placebo week is not an actual true period. So it's not a good indicator of your overall health. It is a result of the hormones that you are ingesting and during the placebo week, you're no longer getting those hormones and so you have a withdrawal bleed. Honestly, it's really difficult to find a birth control pill that most women feel good on and have regular withdrawal bleed and don't have spotting, breakthrough bleeding or annoying side effects. But that's going to be a whole nother episode because it is a big deal. It's an amazing tool for women to, you know, be able to control their reproduction and go out and conquer the world and do what they need to do. But it has its limitations and I want you to understand the effect that it has on your body. So just understand that the bleeding that you have on a birth control Pill is not your cycle. It's the result of the hormones that you're taking. The same goes for the Depo shot, the nexplanon rod, the NuvaRing, the Mirena IUD, all of that. So those are interfering with your body's own hormone production. And that's why it doesn't always feel the greatest, but sometimes you feel better on it, and that's why as well, because if your system was dysfunctional and you weren't producing hormones correctly, sometimes that can help. Overall, I just wanted this to be a good introduction of, hey, we're women. We have menstrual cycles, hopefully every month, and we should not be ashamed or embarrassed of the fact we need to educate and empower our girls that. That this is an amazing, unique thing that girls get to experience because we get to create and carry life and bring life into the world. So it's an absolutely amazing honor to have your period every month, and you should embrace the fact and use it as a sign or an indicator of your overall health. So I would love for you guys to follow me on Facebook @ Dr. Tabitha or on Instagram @ Dr. Tabitha and shout me out some questions. I want to hear what you guys think about this and, like, am I wasting my time? Is it good information? Are you interested in this? Or what questions do you have from it and, you know, what kind of thoughts are stirring through your mind? So I just want this podcast to empower women, and I want you to have a voice and not be afraid to take control of your health and be proud to love yourself and to love your body, and I want us to teach our daughters the same. Follow me at Dr. Tabitha and join me next time at the functional gynecologist. It's so awesome hanging out with you guys, and I really appreciate you listening. So it would be really awesome if you gave me a review on iTunes. You know, five stars would be amazing, but anything, just let me know that you're listening, and let's keep this information going. Have an awesome day. Until next time. Bye, guys. Sam.