You may have heard that the menstrual cycle is considered the fifth vital sign for women. In addition to making pregnancy possible, the hormonal shifts that occur during a woman's menstrual cycle impact many other areas of health and vitality, including metabolism, digestion, mood and emotional regulation, energy levels, and libido.

With almost 50% of women worldwide experiencing PMS-related symptoms at some point in their life and nearly 1 in 4 women struggling with infertility in the U.S. alone, understanding how to support a healthy menstrual cycle is paramount for women.

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What is A Healthy Menstrual Cycle?

While the average length of a menstrual cycle is 28 days, a typical cycle can last anywhere from 21-35 days and varies amongst individual women. Your menstrual cycle is calculated by counting the days from the first day of one menstrual period to the first day of the next menstrual period.

Four menstrual cycle phases are triggered by the rise and fall of various hormones: menstruation, the follicular phase, ovulation, and the luteal phase.

‍Menstruation‍

The menstrual phase is marked by when you get your period, typically lasting 3-7 days. If pregnancy does not occur in a given month, there will be a drop in estrogen and progesterone, causing the lining of the uterus to shed. In addition to a decrease in female sex hormones, women also experience a rise in prostaglandins, inflammatory molecules that can contribute to cramping and discomfort as the uterine lining is shed.

Some women may experience symptoms during menstruation, including cramping, fatigue, low back pain, irritability, and bloating. These symptoms should be minor; otherwise, severe symptoms can indicate underlying health issues or hormone imbalances.

‍Follicular Phase‍

Technically, the follicular phase begins on the first day of your period, overlapping with menstruation, and generally lasts 10-16 days. During this phase, estrogen and brain neurotransmitters like serotonin and dopamine begin to rise again, bringing back a woman's energy levels and improving her mood and vitality.

The body also releases FSH (follicle-stimulating hormone) during the follicular phase, triggering the ovaries to create follicles containing eggs. One of these eggs will mature and be released in the next phase, ovulation.

‍Ovulation‍

Triggered by the rising estrogen levels in the follicular phase, the pituitary gland in your brain releases luteinizing hormone (LH), beginning ovulation. When a woman ovulates, the ovary releases a mature egg, which moves through the fallopian tube to the uterus, making conception possible at this time. You can usually tell if you're ovulating by noticing an increase in your basal body temperature and thicker cervical discharge with an egg-white consistency. Ovulation typically happens around day 14 of a 28-day cycle and lasts roughly 24 hours.  

Luteal Phase ‍

After ovulation, the mature follicle that has released its egg becomes the corpus luteum, a structure that produces the hormone progesterone. Progesterone rises to its peak during this phase. If the egg released during ovulation is fertilized, progesterone will remain high throughout the pregnancy to support gestation. If the egg is not fertilized, progesterone begins to drop later in the luteal phase, triggering the beginning of your next period. The luteal phase lasts about 14 days in an average menstrual cycle.

What Causes the Menstrual Cycle to Change?

It's common for there to be slight variations of a day or two from cycle to cycle. These variations are generally considered normal. Any abrupt changes to the length of your cycle, such as a swing of four days or more or skipping a period entirely, can indicate a need to investigate possible underlying health concerns. Estrogen and progesterone may be impacted by various things, such as stress, nutrition, exercise, or environmental impacts, all of which may contribute to changes in the length of your cycle.

Stress

Stress is one of the most common reasons for changes to menstrual cycle lengths. Both acute episodes of stress and chronic levels of stress can have an impact on a woman's menstrual cycle.  

When a woman experiences stress, a hormonal communication system known as the hypothalamic-pituitary-adrenal (HPA) axis is activated. It connects the hormone-producing endocrine system with the central nervous system to address the stressor by increasing stress hormones like cortisol and corticotropin-releasing hormone (CRH). When the HPA axis is overstimulated due to chronic stress, the elevated stress hormones can delay or stop ovulation altogether, changing the length of one's menstrual cycle.

Nutrition

There are a few considerations regarding how nutrition can impact the menstrual cycle. The overall quality of nutrition is an important consideration. An inflammatory diet (such as one based on many processed foods, sugar, and additives) has been linked with premenstrual syndrome (PMS). It has also been linked to changes in cycle length due to the impact of inflammation on hormones. Ultimately, your nutrition can positively or negatively impact your menstrual cycle, depending on your choices.

Chronic dieting with calorie restriction can be a stressor that impacts ovulation and cycle length if a woman continually fails to meet her baseline nutrition and caloric needs based on her metabolic rate and activity level.  

Additionally, missing macronutrient groups (carbohydrates, protein, or fat) or micronutrients (vitamins, minerals) can impact the menstrual cycle through effects on hormone production and metabolism.

Exercise

While exercising can positively influence hormone health, overtraining combined with inadequate nutrition can negatively impact the menstrual cycle, leading to loss of a period (amenorrhea) or cycle length changes. While regular exercise can benefit hormone health, balancing training with proper recovery and nutrition is essential.

Environmental Impacts

Environmental exposure to parabens and other xenoestrogens, air pollution, and other environmental toxins have been found to impact the menstrual cycle and should be considered part of a functional medicine approach when a woman's cycle has changed.

Abnormal Menstrual Cycle Symptoms

Examples of abnormal symptoms that may indicate a change to your cycle include:

• Fatigue
• Mood changes
• Irritability
• Anxiety
• Acne
• Joint pain or aches
• Fluid retention
• Bloating
• Headache/Migraine
• Brain fog
• Sleep changes

Functional Medicine Labs to Test for Root Cause of Abnormal Cycle

Specialty lab testing can help an Integrative Medicine Practitioner narrow down what is causing the abnormal cycle, while helping to make an individualize plan to support the patients hormones and menstrual cycle phases.

Comprehensive Female Hormone Testing

Hormones may be tested in a blood draw through a primary care provider. However, evaluating hormones through a 24-hour DUTCH Complete test or a DUTCH Cycle Mapping test can help provide insight into what's happening throughout an entire menstrual cycle. These tests can detect imbalances that contribute to changes in one's cycle.  

Gut Microbiome Testing

Changes in diet and lifestyle, as well as stress levels, can all impact the gut microbiome, which does play a role in hormone metabolism and can affect the menstrual cycle. Evaluating the gut microbiome through a test such as GI-MAP can help determine if gut health and nutrition are affecting the menstrual cycle and can help create a personalized treatment plan to support a healthy menstrual cycle.

How to Support a Healthy Menstrual Cycle

Nutrition, lifestyle changes, and supplementation can all go a long way to support a healthy menstrual cycle and decrease the incidence of PMS-related symptoms.

Nutrition for a Healthy Menstrual Cycle

An anti-inflammatory diet rich in vitamins and minerals (like zinc and vitamin D) that meets the caloric needs of each woman is a great starting place. Building a plate that has adequate protein, healthy fats, and fiber can help ensure a variety of macro- and micro-nutrient intake needed for hormone building and a healthy menstrual cycle. A diet that is diverse in food choices with a focus on quality has been linked to a healthier, more diverse gut microbiome, which can impact the health of the menstrual cycle.

Some examples of foods to include for a healthy menstrual cycle include:

• Olive oil, avocado, and other anti-inflammatory fats
• Cruciferous vegetables (broccoli, cabbage, etc.)
• Anti-inflammatory cooking herbs (ginger, turmeric)
• Fiber-rich carbohydrates (berries, root vegetables, potatoes)
• Quality-sourced animal proteins (organic chicken and turkey, grass-fed meat, fish)
• Probiotic rich foods can help build a healthy gut microbiome which is important for estrogen metabolism and for removing excess estrogen from the body.

Vitamins and Minerals for a Healthy Menstrual Cycle

Certain vitamins and minerals play an important role in a women's menstrual cycle. These include:

Vitamin D

Adequate vitamin D levels are essential for hormone production, with low levels linked to infertility and irregular menstrual cycles.

Magnesium

Magnesium may help reduce cramping and pain as well as migraines related to PMS, and it plays a vital role in producing thyroid and sex hormones.

Zinc

Zinc is an important mineral for hormone production and ovulation; zinc helps maintain a healthy menstrual cycle and may reduce symptoms of PMS.

Omega-6 Fish Oil

Reducing inflammation helps minimize symptoms of PMS and maintain a healthy cycle. One study showed that fish oil supplementation was better than ibuprofen in managing menstrual-related pain.

Vitamin B6 (pyridoxine/P5P)

This B vitamin is involved in progesterone synthesis and is essential for producing brain neurotransmitters that impact mood, like serotonin and GABA. It has been shown to improve mood-related symptoms of PMS.

Herbs & Supplements for a Healthy Menstrual Cycle

Chasteberry

Vitex agnus castus, also known as Chasteberry, is a safe and effective herbal treatment to reduce PMS hormonal symptoms.

Xiao Yao San

‍Xiao Yao San, a Traditional Chinese Herbal formula, is commonly used to help relieve cramps, irregular menstrual cycles, infrequent periods, and premenstrual syndrome (PMS). A combo of Chasteberry and Xiao yao san have shown in studies more than 70% improvement in pms symptoms. Xiao Yao San alone helped improve fatigue by 68% and insomnia during PMS by 74%.

Acupuncture for a Healthy Menstrual Cycle

Acupuncture has been shown through many studies to help regulate a woman's menstrual cycle. While science has difficulty explaining its mechanism, Traditional Chinese Medicine uses terminology to explain how their acupuncture points help regulate Qi, pronounced "chi," which is the body's energy flow.

There are acupoints on the body that help "move blood," "build blood", and break up stagnation "clots."

Acupuncture is commonly accompanied by Chinese herbal medicine to help regulate menstrual cycles by using herbs that also assist in:

• Moving blood: used for those with dark tongue, dark clots, no menstrual cycle, or delayed menstrual cycle with sharp pain due to "blood stagnation."
• Building blood: used for those with a weak pulse, pale tongue, or lack of or delayed menstrual cycle due to "blood deficiency."

*Note: if you are interested in acupuncture for menstrual regulation, it is essential to seek out a trained and licensed Acupuncture Physician. Some states allow other medical professionals to learn "dry needling" to treat pain. This is not the same as Traditional Chinese Medicine.  

Lifestyle Changes for a Healthy Menstrual Cycle

Prioritizing quality sleep, reducing stress, and exercising regularly (while balancing exercise with adequate recovery) are all important lifestyle habits to support a healthy menstrual cycle.  

Summary

Understanding how to support a healthy menstrual cycle is an essential tool every woman should have when it comes to optimal health and wellness. By gaining a better understanding of what happens hormonally throughout the cycle, women can cue into changes that may indicate underlying shifts in their health and address them promptly. While PMS-related symptoms and fluctuating cycles may be common, these symptoms are not necessarily "normal" and can be addressed using functional medicine principles.