How to Read, Understand, and Address Your Cycle
Tara Greenberg L.Ac, FABORM, Doctoral Candidate
October 20, 2024
Do you have a regular, consistent menstrual cycle? Or does it jump around from 21 days to 28 days, to sometimes 38 days or 56 days? Do you have extremely painful cramps that keep you bed-bound for a day or two? Or experience nausea and migraines every month? Does your PCP tell you to just take Motrin or Ibuprofen? Does your Ob prescribe you birth control to help you cope? If you answered yes to any of the above questions, I'm here to tell you that you should not be experiencing this every month, and this is a sign that something is truly off in your body.
Just like our heart rate, body temperature, respiratory rate, and blood pressure, the menstrual cycle gives us a clue to how our body is functioning. If you had a fever or elevated blood pressure every month, you would not ignore it and continue your day like nothing was wrong. So why do we do that with our periods? My guess is because we have no education around our cycles. According to UNICEF, worldwide, only 39% of schools provide menstrual education (10 fast facts, 2024). That means that a large majority of women all over the world do not really understand their own body and have been conditioned by western medicine and the pharmaceutical industry that our only options are to use birth control and other drugs to mask our symptoms. We have never been taught that there is any solution besides medications and surgery to the myriad of issues women might have with their menstrual cycle. By teaching us nothing we grow up thinking that whatever we experience is normal and sometimes it is not until we are ready to try to have a family that our eyes are opened to the truth. And for some, it might be too late.
The first question I like to ask my patients is “do you know when you ovulate”? If you are merely inputting the first day of your period into a tracker every month and it is telling you when you ovulate by putting a star on the date 2 weeks before your next period starts, then you have no idea when you ovulate. Even if you have a regular cycle it does not mean you ovulate on the same cycle day every month, and it also does not mean you ovulate 14 days before your next period. There are 3 ways to sense if ovulation is occurring but using only one of them is generally not enough to confirm ovulation. Unless you have a very regular cycle and have paid attention for a few months it is going to be hard to pinpoint when exactly ovulation is occurring in the very moment. For most of us, using two or all three of these tools will be necessary to make an educated guess if and when we ovulated.
The first tool is the BBT chart. As a Chinese medicine practitioner this is my favorite tool because it gives us the most info. Not only can I tell if my patient ovulated or not, but I can tell if they might have had alcohol the night before, may potentially have a thyroid issue, are pregnant, might be overly stressed, might have a luteal phase defect, and it even helps me to diagnose the Chinese medical pattern that I will use to treat them. All you need is a thermometer and a tracking app. Most period apps allow you to input your BBT every day and some thermometers come with their own app and the thermometer synchronizes directly to the app.
Knowing how to distinguish the distinct types of cervical mucus you may experience throughout your cycle is the second key to deciphering when ovulation is occurring. For many of us, after we menstruate we might have what are called “dry days,” meaning no blood or cervical discharge. Then sometime shortly after that, or even right after our menstruation, we will experience “wet days.” “Wet days” are the days of the cycle when cervical mucus is present. If trying not to conceive and not using birth control it is best to abstain from any sexual activity during the entire time cervical mucus is present. If you are trying to conceive, then determining when, and if, fertile cervical mucus is present, is critical. Since an egg is only able to be fertilized for a short 24 hours after ovulation, it is fertile cervical mucus that increases the chances of falling pregnant each month. Fertile cervical mucus, or E-type mucus, is present before ovulation and stops once ovulation occurs and progesterone levels rise. There are 3 subcategories of E-type mucus: S (“sperm-transmission” or “string”) mucus, L (“locking-in” or “loaf”) mucus, and P (“peak” or “push”) mucus.
S mucus has “string-like” structures that facilitate sperm transport and get it into your cervical crypts where it waits to fertilize the egg after it is released by the ovary. It has a thin, watery consistency and is usually clear and resembles egg whites. L mucus is not as watery as S and P mucus, and its thicker consistency blocks abnormal, malformed sperm from swimming through and fertilizing your eggs. When L mucus is combined with S mucus the result is a mucus with the consistency to form a thread between your fingers. This mucus is very stretchy and often sticks to the toilet paper. P mucus production rises just before ovulation and feels very lubricative. This mucus can push the sperm out of the cervical crypts into the uterine cavity just before ovulation. When L is combined with P mucus at the beginning of your fertile window, your mucus plug dissolves initiating cervical mucus production (Henderson-Jack, 2019). Being able to distinguish fertile cervical mucus from infertile cervical mucus is key in determining when and if ovulation is happening.
Ovulation predictor kits (OPKs) are a third, and probably the most used, method of determining ovulation. It is also the most unreliable, in my clinical experience. These are the little strips that you urinate on that tells you if LH has peaked. Typically, ovulation will occur 24 hours after the peak reading. These are not fully accurate for many reasons. The user error rate is high, they can be hard to read, they have an expiration date, and patients with PCOS often have false positives because the constant elevated levels of LH make it hard to get an accurate reading.
If you are having trouble reading and understanding your cycle and determining if ovulation is occurring, or if you already know you have menstrual cycle issues, your local acupuncturist can be crucial in helping you find and correct the underlying cause of it.
Issues with anovulation might mean that your cycles are becoming more irregular or PCOS is to blame. Often women know they have these issues, but they do not know what to do about it. And they spend many years doing nothing until they are ready to start a family. Many women do not know that acupuncturists are basically period doctors! Among the many other issues outside of female reproduction that Chinese medicine and acupuncture can help, our tiny needle’s ability to redirect and nourish blood and energy within the body make acupuncture the most logical treatment for these ailments.
PCOS or polycystic ovarian syndrome is characterized by ovarian dysfunction (oligo-anovulation and/or polycystic ovaries), the presence of hyperandrogenism (clinical and/or biochemical, such as hirsutism, acne, hair loss, insulin resistance, and abdominal obesity), and the exclusion of related disorders (Azziz, 2009). Typical medical treatment for this condition is metformin, an off-label diabetes medication, to help regulate blood sugar and increase insulin sensitivity and birth control to stop the follicles from growing leading to the cystic ovaries that often characterize this syndrome. Blood sugar regulation is a main component of this issue because it is the high insulin levels that may overstimulate androgen receptors leading to the follicle atresia (Lewis, 2004). And while metformin is an attempt at addressing the environment that the follicles live in, the many negative side effects of this medication mean that many patients do not want to take it. If your irregular cycles are not due to insulin resistance then western medicine’s only answer is birth control to make certain that ovulation does not occur, and your monthly “period” is not really a period.
When this patient is ready to try to conceive drugs such as clomid and letrozole are often used to force ovulation. And if these drugs fail, IVF and other drugs are recommended. However, most women with PCOS do not respond well to hormonal manipulation because these drugs are not addressing the root - the health of the egg and the state of the ovary’s endocrine balance over the previous three or more months of development. The process to become an antral follicle (one that is ready to be ovulated by the body) takes about three months and these follicles produce the best eggs in an estrogen- and progesterone-rich environment, not an androgenic setting (Lewis, 2004). So, when these PCOS patients force ovulation to occur to get pregnant, the egg quality has not been addressed and they are often not successful in trying to conceive. Acupuncture, herbs, nutrition and supplements are ways in which you can address the environment your eggs marinate in throughout their lifetime. Upon reviewing a compilation of research in recent years on acupuncture for female infertility, Xu et al. found multiple examples of how acupuncture is beneficial in regulating female reproductive hormones and various cellular and immune signaling molecules leading to an improvement in follicular development, regular ovulation, and embryo implantation (Xu et al., 2022). Meaning it can address the root issues associated with PCOS, diminished ovarian reserve, and IVF/FET leading to improved ovum quality and a higher chance for conception.
Many of women's menstrual issues have no real solutions in the western medical model. The drugs recommended to address the issues really only mask them or override the body and force something to happen and have many side effects; and surgery does not mean the issues will not return. The main concept of TCM is to address the root cause of any issue using acupuncture, electrical stimulation, herbal, medicine, and nutrition to guide the body back to homeostasis.
One of the main ways Chinese medicine differs from allopathic medicine is that we do not focus on treating the symptoms. Our main concern is figuring out what the root pattern is of the issues and when we correct that, the symptoms resolve themselves. The extensive questions about your body and its systems and other clues, such as the BBT chart, are how we figure out the pattern. Your TCM provider will help correct these patterns using acupuncture to redirect blood flow, or tonify qi, clear heat, or resolve phlegm, to name just a few of the mechanisms of action. They will also guide you on dietary changes and may prescribe herbs or supplements to continue to address the root. The result is a better environment for your eggs, ovulating on time, having a longer luteal phase, and resolving blood stasis, clots, fibroids, and cysts leading to less pain and discomfort.
Tara Greenberg, L.Ac, FABORM, is a licensed acupuncturist and fertility specialist who helps women understand their cycles and guides them on the journey to conception.
Tara has helped countless women regulate their cycles, have more successful egg retrievals, and has been an integral part in helping these women realize their dream of becoming a mother. Her patients have come to expect the expert knowledge, guidance, and compassion that she brings to each treatment. After becoming a mom herself, at 40 and 42, she understands the myriad of struggles on the path to creating a family.
Besides helping women navigate the often confusing and emotional landscape of ART and continuing her education as a Doctoral student, Tara enjoys aerial silks and exploring new cities and countries.
You can reach Tara at tara@pointholisticwellness.com and learn more about her work at pointholisticwellness.com.
References:
10 fast facts: Menstrual health in schools. UNICEF. (2024, May 28). https://www.unicef.org/press-releases/10-fast-facts-menstrual-health-schools
Azziz, R., Carmina, E., Dewailly, D., Diamanti-Kandarakis, E., Escobar-Morreale, H.F., Futterweit, W., Janssen, O.E., Legro, R.S., Norman, R.J., Taylor, A.E., Witchel, S.F. (2009). The androgen excess and PCOS society criteria for the polycystic ovary syndrome: The complete task force report. Fertility and Sterility, 91(2), 456-488.
Hendrickson-Jack, L., & Briden, L. (2019). The fifth vital sign: Master your cycles and optimize your fertility. Fertility Friday Publishing Inc.
Lewis, R. (2004). The Infertility Cure. Little, Brown and Company.
Xu, J., Zhao, A., Xin, P., Geng, J., Wang, B., & Xia, T. (2022). Acupuncture for female infertility: Discussion on action mechanism and application. Evidence-Based Complementary and Alternative Medicine, 2022, 1–17. https://doi.org/10.1155/2022/3854117