Welcome to Part 1 of my Healthy Menstrual Cycle Series!

I decided to do this series because there is SO MUCH information we aren't taught in high school sex-ed about our menstrual cycles, and working with women in my practice, I've seen how confused some of them are with how their bodies work.

I'm here to help you understand your body better. I want to empower you so you can recognize signs and symptoms of something of something wrong and when to reach out to your doctor for guidance.

Without further ado, let's get into it! (This newsletter is a lengthy one, so get ready!)

What are the phases of the menstrual cycle?

First thing we need to touch upon is understanding the menstrual cycle, and we do that by learning about its phases:

Menstruation aka your Period (Days 1-5): The first day of your menstrual cycle is the first day of bleeding that needs a tampon, pad, or menstrual cup. (Spotting is not considered the first day of the cycle.) Estrogen and Progesterone levels drop causing the uterine lining to shed and bleed. The decreasing levels of these hormones also signal the release of Prostaglandins that are the hormone-like compounds that are responsible for uterine muscle contractions that cause menstrual flow and cramping. Bleeding typically lasts around 3-7 days.
Follicular Phase (Days 1-14): After menstruation, the follicular phase kicks in and is characterized by the maturation of ovarian follicles. FSH, follicle stimulating hormone, is released from the pituitary gland in the brain to stimulate follicle growth/development. Estrogen levels also increase to thicken the uterine lining. This phase typically lasts about 10-16 days.
Ovulation (Around day 14): The MAIN EVENT of the menstrual cycle and when an egg is released from an ovary into the fallopian tube awaiting fertilization. This happens around the mid-way point of the cycle between the Follicular and Luteal Phases. The steady increase in estrogen triggers Luteinizing Hormone (LH) to surge and a mature egg is released from the dominant follicle. Ovulation occurs usually 24-36 hours after the LH surge.
Luteal Phase (Days 15-28): Following ovulation, the luteal phase begins. The ruptured follicle transforms into the corpus luteum, secreting progesterone to support the uterine lining and prepare for potential pregnancy. Progesterone levels peak around day 21 of the cycle (This is typically the time when I like to have hormone tests run). If fertilization doesn't occur, the corpus luteum breaks down, leading to a drop in hormone levels and a new period begins, marking the start of a new cycle.

Normal Variations in Cycle Length: While the average menstrual cycle is around 28 days, variations are common and considered normal. A cycle length of 21 to 35 days is typically considered within the normal range. Shorter cycles may indicate hormonal imbalances or early ovulation, while longer cycles may suggest delayed ovulation or irregular hormone production.

Interpreting Cycle Length:

Too Short: A consistently short menstrual cycle (less than 21 days) may indicate inadequate progesterone production or a shortened luteal phase, potentially impacting fertility and the ability to conceive.
Too Long: Conversely, a prolonged menstrual cycle (more than 35 days) may be associated with irregular ovulation, polycystic ovary syndrome (PCOS), or hormonal imbalances, requiring further evaluation and management.

If you have concerns about the lengths of your cycles, please reach out to your doctor or myself to be properly evaluated.

Hormones Involved:

Estrogen: Primarily produced by the ovaries, estrogen plays a key role in stimulating follicle development, thickening the uterine lining, and triggering the LH surge.
Progesterone: Secreted by the corpus luteum*, progesterone maintains the uterine lining in preparation for embryo implantation and supports early pregnancy if fertilization occurs. *The corpus luteum is a temporary structure on the ovary that is made after ovulation and helps support the uterine lining during early pregnancy. If pregnancy does not happen, the corpus luteum breaks down and progesterone drops to signal the start of a new period.*
Follicle-Stimulating Hormone (FSH): Produced by the pituitary gland (in the brain), FSH stimulates the growth and development of ovarian follicles during the follicular phase.
Luteinizing Hormone (LH): Also produced by the pituitary gland, LH triggers ovulation by inducing the release of a mature egg from the ovary.

When are the best times to test hormones?

Wow, as you can see, there's SO MUCH going on! I hope you see that the menstrual cycle is a wonderful and well-orchestrated dance among our hormones, brain, and reproductive organs. Because of this dance, certain things, such as testing hormone levels, need to be timed.

Depending on your health goals and what your doctor wants to see, the optimal times to test hormone levels vary:

Estrogen: Estrogen levels fluctuate throughout the menstrual cycle, with peaks during the follicular phase leading up to ovulation. While there isn't a specific day during the cycle when estrogen should be tested, it's generally recommended to measure estrogen levels during the early to mid-follicular phase, before ovulation occurs. This timing provides insights into the growth and development of ovarian follicles and helps assess ovarian reserve and overall reproductive health.
Progesterone: Progesterone levels typically peak during the luteal phase of the menstrual cycle, approximately 7 days after ovulation. Therefore, the ideal time to test progesterone levels is around day 21 of a 28-day menstrual cycle, or 7 days before the expected start of the next menstrual period. This timing allows for the most accurate assessment of progesterone production by the corpus luteum.
Luteinizing Hormone (LH): LH is a hormone that surges just before ovulation, triggering the release of a mature egg from the ovary. The ideal time to test LH levels is during the mid-cycle, around 24 to 36 hours before expected ovulation. LH surge detection kits*, commonly used in fertility tracking, help pinpoint this surge, indicating the most fertile window for conception. *I will talk about OOVA test strips as part of this series. Stay tuned!*
Follicle-Stimulating Hormone (FSH): FSH is involved in stimulating the growth and development of ovarian follicles during the follicular phase of the menstrual cycle. The ideal time to test FSH levels is during the early follicular phase, typically on days 2 to 4 of the menstrual cycle. Elevated FSH levels during this time may indicate diminished ovarian reserve or other reproductive health issues.
Human Chorionic Gonadotropin (hCG): hCG is a hormone produced by the placenta during pregnancy. The ideal time to test hCG levels is after a missed period, as hCG levels rise rapidly in early pregnancy. Home pregnancy tests are designed to detect hCG in urine samples, typically around 10 to 14 days after conception. Blood tests for hCG may provide even earlier detection of pregnancy.

Phew! So much information! Kudos to you for making it this far!

I hope you gained a little bit more insight into what is happening in your body during your cycles.

The next 4 emails in this series will talk about cycle tracking, PMS, supplements, and my favorite FemTech products TempDrop and OOVA.

I am excited for this newsletter series because there is so much to learn about what is going on within our bodies. My goal is to empower you to know what you need to support yourself during your cycles.

Stay tuned for much more information!

Thank you for your support.

Until next time,

Dr. Francesca, ND