menstrual cycle Archives - Hormones Matter

How Hormones Rise and Fall Throughout the Menstrual Cycle

Published on October 31, 2023

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Fertility Awareness Method For Contraception

Back in 2012, I was really sick and while we were trying to figure out what was going on, my doctor recommended I discontinue hormonal birth control for a while. For about 6 months, I used conductivity monitoring to avoid pregnancy. Each morning, I’d record the conductivity of my salivary and vaginal secretions looking for a change to indicate I was approaching ovulation and another change to indicate ovulation had occurred.

Back then, it felt confusing to me and a little black box”ish”, so when I was cleared to go back on hormonal birth control, I went back on it and didn’t give another thought to Fertility Awareness Methods (FAMs), until I decided to ditch hormonal birth control again.

This time, I did a deep dive and discovered new methods alongside familiar methods of FAM, and I went head-over-heels into the science of it.

In the decade since I relied on FAMs last, at-home urinary monitors are now available, and being a data driven girl, this is the method I opted for. Qualitative devices such as the ClearBlue Fertility Monitor (CBFM) didn’t quite offer the numbers I craved, so I went with the Mira Fertility Monitor even though, to date, no FAM endorses the use of this monitor for contraception (though Marquette University is actively testing the Mira against the CBFM with its protocols).

This ability to monitor your hormones at home also revolutionizes maintaining healthy hormonal balance and body literacy. Indeed, body literacy and the natural rise and fall of hormones throughout a healthy cycle is the topic of this post.

Hormones of the Menstrual Cycle

In this article, we will discuss:

follicular phase and ovulation
- follicular development, how follicles are recruited and begin maturing throughout a woman’s reproductive life span
- how testosterone and estradiol are produced in the developing follicles
- the role of the hypothalamus and pituitary glands in follicular development and ovulation
- the role of progesterone in ovulation
luteal phase
- key changes in hormone production during the luteal phase (second half of the cycle)
finally, the entire menstrual cycle will be summarized in a single graph showing the rise and fall of hormones throughout the cycle

Why does all of this matter? When you understand how the menstrual cycle works, it becomes much easier to determine hormonal imbalances and much easier to navigate fertility. Women are only fertile for around a maximum of 5 days during any given menstrual cycle and when you have a condition like PCOS (polycystic ovarian syndrome) or experience delayed ovulation (or anovulation) for any reason during a cycle, menstrual cycle literacy makes it possible to pinpoint your fertile days when trying to conceive and naturally improve your chances of conception in each cycle.

For women who are not trying to conceive, cycle awareness is profoundly beneficial to overall health because you are better able to determine which part of your cycle is unhealthy and better able to address the underlying imbalance simply by knowing how your cycle works. Maintaining a healthy cycle throughout your reproductive years is of utmost importance even when your intention is to avoid pregnancy because the reproductive hormones impact every system within your body and are critical for everything from maintaining a healthy weight to a healthy heart.

This particular article (while containing lots of information) is an overview of the topics bulleted above. You will find a more in-depth discussion of these topics in this post.

An Overview of Follicular Development

Non-cyclical follicular development: Early follicular development of pre-antral follicles (follicles that don’t respond to follicular stimulating hormone) happens in a way that is not well understood by modern science and this part of follicular development is not governed by the menstrual cycle but instead occurs throughout a woman’s reproductive years beginning at the onset of puberty and ending with menopause.

Cyclical follicular development: A follicle is a structure within the ovary and it contains an ovum (immature egg). Each ovary houses several hundred thousand follicles at birth and throughout a woman’s reproductive life, these follicles mature and are responsible for releasing the reproductive hormones, estradiol and progesterone, which control release of these hormones:

GnRH (gonadotropin releasing hormone) released by the hypothalamus in a pulsed pattern
FSH (follicular stimulating hormone) released by the pituitary gland
LH (luteinizing hormone) released by the pituitary gland

The brain’s role in follicular development and ovulation: The tempo at which GnRH releases from the hypothalamus controls the secretions of FSH and LH by the pituitary, and these two hormones influence ovarian hormone patterns and those ovarian hormones affect the tempo of GnRH pulses by the hypothalamus. This feedback loop is what the term, hypothalamic-pituitary-ovary (HPO) axis refers to. It is important to know about the brain’s involvement in follicular development and ovulation because when there is a problem with the menstrual cycle, practitioners generally look at where in this axis the misfire is occurring. Conditions like hypothalamic amenorrhea (HA) arise due to an issue with the release of GnRH from the hypothalamus and we will revisit this condition along with others caused by a dysregulation of hormonal release in the brain rather than the ovaries in future articles.

Selection of one follicle for ovulation: Once follicles have matured into antral follicles, further development is governed by FSH and the follicles need FSH to not only continue growing but also to prevent atresia (follicular death). More than one follicle matures during each menstrual cycle and because of the well-designed negative feedback between estradiol concentrations and FSH, the fastest growing follicle generally outcompetes all other follicles by releasing more estradiol, which then suppresses FSH production and starves out the remaining developing follicles. The dominant follicle survives this period of FSH famine because it has more FSH receptors. The additional FSH receptors make it better able to sequester the small amounts of FSH released at this time. It is also larger and has more energy reserves than smaller and slower growing follicles. This is why women typically release only one egg (mature ovum) at ovulation.

Testosterone and estradiol in follicular development: During follicular development, follicles produce both testosterone (and several other androgens [male hormones]) and estradiol (plus small amounts of estrone). The androgens are produced in the theca cell layers. The theca cell layers are not able to convert these androgens into estradiol or estrone because they lack the necessary enzymes. Instead, through diffusion, these androgens enter the granulosa cell layer of the follicle where the necessary enzymes are found (aromatase) to convert testosterone to estradiol and androstenedione to estrone. A separate enzyme converts the estrone into estradiol within the granulosa cells. In conditions like polycystic ovarian syndrome (PCOS), there is an imbalance in the androgen and estradiol ratio with higher levels of androgens suggesting a problem with conversion of these hormones in that condition. We will revisit this in future articles on PCOS.

Ovulation

Progesterone prompts ovulation. Historically, it was thought that the LH surge caused the follicle to release the mature ovum (egg) in a reversal of the negative feedback loop between estradiol and the pulse of GnRH which suppresses release of both FSH and LH from the pituitary. New research suggests that the adrenals release a small surge of progesterone that stimulates ovulation and prompts a rise in LH. This pathway explains why women who are under stress experience delayed ovulation.

Based on my own at-home hormone monitoring of urinary metabolites of estradiol and progesterone plus LH and FSH, I can confirm this pre-ovulatory temporal rise in progesterone. In fact, if this new theory proves correct, it may help explain the sudden shift in the electrolyte composition of vaginal secretions at ovulation.

Progesterone concentrations just prior to ovulation are much lower than concentrations mid-luteal phase, and so it is likely that the adrenal cortex, rather than the developing follicles, are producing the progesterone necessary to prompt the surge in luteinizing hormone (LH). It is also of note that high concentrations of progesterone (like those produced during the luteal phase and during pregnancy) inhibit ovulation. In in-vitro fertilization, when progesterone is given at doses to simulate the blood concentration seen during the luteal phase, this prompts the “vanishing follicle” phenomenon suggesting that a low progesterone concentration is vitally important to successful ovulation.

This theory may also explain why women under stress do not ovulate. It is common for women who develop a cold or illness during the peri-ovulatory phase to have either delayed ovulation or an anovulatory cycle. Other forms of stress (mental, over-exercise, disturbances to the circadian rhythm) are also known to delay ovulation. Considering that pregnenolone is the precursor to both cortisol and progesterone, this progesterone rise theory as the key event leading to ovulation evolutionarily fits the concept of conserving eggs or preventing reproduction when conditions aren’t favorable to pregnancy. Elevated demands for cortisol during times of high stress would deplete the body’s ability to create progesterone.

Role of LH: LH (luteinizing hormone) transforms the follicle into the corpus luteum. While the follicle primarily generated the hormones testosterone and estradiol throughout follicular development and leading up to ovulation, the corpus luteum releases progesterone and estradiol to maintain the uterine lining after ovulation.

Key Takeaways From the Luteal Phase and Menstruation

Progesterone released by the corpus luteum throughout the luteal phase is vitally important for pregnancy because it sustains the uterine lining providing nourishment to the developing embryo until the placenta fully forms around 12 weeks gestational age. It is especially important that concentrations of progesterone be maintained until implantation of the fertilized egg occurs. Luteal phase deficiencies, which we will talk about more in future posts, is one of the common causes of implantation failure.

In the absence of pregnancy, the corpus luteum atrophies between 10 and 16 days after ovulation. As the corpus luteum atrophies, levels of progesterone and estradiol both fall, resulting in atrophy of the uterine lining resulting in onset of menses.

An Overview of a Healthy Menstrual Cycle

In summary, a slowdown in the rate of release of GnRH from the hypothalamus prompts an increase in FSH secretion from the pituitary and this awakens further development in antral follicles within the ovaries. As these follicles mature, both testosterone and estradiol are made by the developing follicles increasing the amount of both these hormones within the body. Estradiol quickens the release rate of GnRH by the hypothalamus which reduces FSH secretions by the pituitary gland.

Historically, it was believed that once estradiol achieved a critical threshold, this negative feedback loop reverses, and FSH spikes along with an LH surge to cause ovulation. New research shows a transient rise in progesterone ahead of the LH surge. This rise in progesterone is about one-tenth the maximum rise in progesterone seen during the luteal phase of the cycle and is presumably produced by the adrenal cortex. If this theory (that a transient concentration-dependent rise in progesterone) prompts ovulation, then this better connects the dots between why stress and undereating cause anovulatory cycles.

Luteinizing hormone, which spikes around the time of ovulation, elicits key changes within the follicle allowing for rupture of the mature egg from the follicle and conversion of the follicle into the corpus luteum. The corpus luteum produces both progesterone and estradiol and in the absence of pregnancy naturally atrophies resulting in falling levels of progesterone and estradiol. As circulating blood concentrations of these two hormones, which are necessary for maintaining the uterine lining fall when the corpus luteum atrophies, the uterine lining itself also atrophies and sloughs off the walls of the uterus leading to the onset of menses between 10 and 18 days after ovulation in a healthy cycle.

hormones across menstrual cycle — Figure 1. Hormone concentration throughout the menstrual cycle.

In Summary

This very quick overview of the menstrual cycle (aka ovulation cycle) forms the basis of every single fertility awareness method (FAM) today. Whether the method involves monitoring changes in cervical mucus, cervical position, basal body temperature, electrolyte composition of salivary/vaginal secretions, and/or at-home urinary hormone monitoring, these methods are highly reliable for predicting ovulation and are so reliable that their efficacy for avoiding unplanned pregnancy vies that of hormonal birth control.

These methods are also invaluable for shining light on a woman’s reproductive health and elucidating where hormonal imbalance lies within her cycle when things are a bit off. FAMs also provide real time data for women who are tracking their cycles so that you are able to adjust diet and lifestyle to support hormonal balance.

I will refer back to this article often in future posts on FAMs and hormonal health.

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Decreasing Dysmenorrhea: High Dose Vitamin D to Reduce Cramps

by Susan Rex Ryan

Published on August 31, 2017

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Women endure menses for an average of 40 years: once a month for 12 months for four decades—about half of our lives. Menstrual cramps (dysmenorrhea)—to varying degrees of discomfort—are also likely to occur in about 50 percent of reproductive-age women. The cramps are caused by contractions that occur in response to elevated levels of prostaglandin (fatty acids made prior to menses) in the uterine lining. Some over-the-counter and prescription drugs may alleviate these painful cramps, but why must women tolerate menstrual discomfort? Are menstrual cramps an inevitable fact of life?

Can High Dose Vitamin D Reduce Menstrual Cramps?

It is no surprise that a small medical study published in the Archives of Internal Medicinehas garnered a lot of attention around the virtual globe. Italian researchers at the University of Messina investigated the effect of mega-dose vitamin D₃ on women who had experienced at least four consecutive painful menstrual periods in the previous six months and had low, circulating vitamin D₃levels. The 60 women enrolled in the study were divided into two groups. Five days prior to the anticipated start of their periods, 30 women were administered a single oral dose of 300,000 IU vitamin D₃; the other half received a placebo. On the fifth day of the study, both groups commenced daily supplementation of calcium (1,000 IU) and vitamin D₃ (800 IU). After two months, average pain levels decreased by 41 percent for the women treated with mega-dose vitamin D₃. No difference in pain was reported in the placebo group. The researchers concluded that their data support the use of vitamin D₃to reduce menstrual cramps.

The Italian study itself is remarkable because it is reportedly the first research conducted to understand the effectiveness of a single high dose of vitamin D₃ on menstrual cramps. Moreover, the outcome is logical. Vitamin D₃’s anti-inflammatory functions combined with the fact that the uterine lining contains vitamin D receptors suggest vitamin D₃’s potential use to treat dysmenorrhea. Further, the 41 percent difference in experienced pain between the vitamin D₃ and placebo groups is significant.

Questions Regarding Vitamin D and Menstrual Cramps

Some questions remain. The single mega-dose of 300,000 IU vitamin D₃ is eyebrow-raising. It far exceeds a prescribed weekly dose of 50,000 IU of vitamin D₃. The safety of a single administration of 300,000 IU is unknown. Additional research should be conducted to ascertain the upper limits and safety of such a high dose. We also do not know how vitamin D₃ supplementation would improve menstrual cramps in women who maintain adequate levels of circulating vitamin D₃ across the menstrual cycle. Is it simply a matter of maintaining adequate vitamin D₃ that reduces menstrual cramps or is it the high dose? Another question regards the length of time pain reductions would continue with the lone sky-high vitamin D₃ dose. Even with these questions, however, the Italian study is positive and should encourage additional research on the role of vitamin D₃ in treating pain-related conditions in women.

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Editor’s Note: Susan Rex Ryan is the author of the Mom’s Choice Award®-winning book Defend Your Life about the extensive health benefits of vitamin D. For additional information about vitamin D, check out our series of Sue’s articles, and visit her blog at smilinsuepubs.com.

This post was published originally on Hormones Matter on July 30, 2014.

In the ER … Again! Heavy Menstrual Bleeding

by Lisbeth Prifogle, MFA

Published on October 28, 2015

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“You really shouldn’t be doing this,” the ER doctor informs me. As if I have any control over my body and its screwed up menstrual cycles. As if I choose this hormonal fate. I want to punch him, but I can barely keep my eyes open to look at him while he talks. “You really need to figure out why you are bleeding so heavy, this isn’t normal.”

If I had enough energy to lift my limp head up off the hospital bed, I would point out the fallacy in his logic – this is not my responsibility. I have been in and out of ER’s and doctors’ offices since I was 18 years old from menstrual bleeding so heavy that I pass out or nearly pass out. It always seems to be more of an inconvenience than a concern for doctors. Oh they are concerned at first. But as soon as I explain my history of this problem, his concern, like all doctors, turns into annoyance. As soon as I tell them I don’t want to take oral contraceptives or any other type of artificial hormone, the concern quickly evaporates like the sweat dripping down my forehead in spite of my shivering body being wrapped up in blankets. Even after I explain my experiences on oral contraceptives (OC) and how the four times I have tried to take it to regulate my periods, I bleed like this every single month, not just occasionally, and that’s on top of the other side effects: extreme depression, weight gain, and epic mood swings that cause my boyfriend to nearly dump me (and who would blame him – I’d dump me if I had to deal with the monster I become on OC).

“Ok” is all I have the energy to muster as I close my eyes to prepare myself for the next cramp I can feel billowing in my lower abdomen. I let the pain wash over me as he continues oblivious to the pain I’m in.

“You need to follow up with your primary or gynecologist,” he tells me. “I’m going to give you progesterone to stop the bleeding…” he goes on to explain the difference between progesterone and estrogen. I don’t stop him to tell him I write for a women’s health ezine or that I’ve done enough research that I likely know more about women’s health and hormones than most general doctors.

A few minutes later my nurse, I’m tempted to start a new religion just so I can appoint her as a saint, walks in with my discharge papers. “Ok honey, I hope you feel better. I’m so happy it’s not an ectopic pregnancy or anything serious.” Throughout the day she has brought in warm blankets and shown more compassion than any doctor I have ever met. I am a problem they can’t fix. They aren’t Dr. House so they’d rather just pass me off to another doctor and move on to a more exotic problem. I’m just a noncompliant patient with hormone problems. God forbid I ask them to think outside the box and figure out what is causing this excessive bleeding. My nurse takes out the IV as careful as you can take out an IV and in a motherly tone says, “I’m glad everything came back normal, but sometimes not knowing is even worse. You go home and take it easy.” I fight back tears. Exhausted and hormonal, I want to hug this woman for her simple acts of kindness and compassion.

“This isn’t really anything new.” I tell her, even though she already knows my medical history. “It sucks, but I’m used to it now.”

“But it shouldn’t be like that,” she says. Like I said, this woman should be appointed as the saint of Emergency Departments.

On my way out of the ER, I stop by the hospital pharmacy and pick up the prescription for hormones that I won’t take. I head back to my office to explain to my male boss that everything was fine and try to make it sound serious enough not to sound like a hypochondriac. He smiles and Okays me to work from home the next day.

I go home to my very concerned boyfriend. I throw the bag with the “magic” pills on the counter and exasperated say, “they gave me IV fluid and hormones, but I’m not taking them.” Naturally, this causes a fight that I don’t have the energy to deal with…again.

Boyfriend: You need to take the medication they give you.

Me: It won’t help and it just messes my system up even more.

Boyfriend: [throws arms in the air … like he’s more exhausted than me at this point?!] You’re not a doctor.

Me: I’m going to bed.

Like every time before, the bleeding slowly lets up in the following days. I’m not a prophet, but I can tell you how this story will end: For the next few weeks, I will walk around like the living dead. I will force myself to eat in spite of having absolutely no appetite. The doctor will call to follow up. “Do you want to take birth control now?” she will ask and when I tell her no, “there’s really nothing more I can do for you at this point…” I know this is how everything will play out because history is simply repeating itself. Sadly I have learned to accept it. In another month, or six, or maybe even a year, I’ll be back in the ER and the cycle will repeat itself again. As I write this I’m so faint that I’m debating going back to the ER to test my blood levels again, but resignation is the only emotion I can muster. Not concern for my own health, but resignation that this is as good as it gets so why fight the system?

So, why do hormones matter? Why don’t hormones matter is a better question. Why is this story an acceptable fate for me and so many other women?

This article was first published on Hormones Matter in July 2013.

When Should Teens Go to the Gynecologist?

by Jordan Davidson

Published on April 16, 2015

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When should girls start going to the gynecologist? The general consensus from the medical community and public health education is that a girl need not see a gynecologist until she becomes sexually active..I disagree.

Reproductive Care Should Begin with the First Period

Consider this; the average age of menarche in the United States is a little above 12 years of age. The average age a woman loses her virginity in the United States is 17. Based on what is taught in health class, that leaves 5 years of no reproductive care for the average American female. Although the average teenager may not need annual visits to the gynecologist, reproductive care should not be ignored. This means pediatricians must be better informed about gynecological care.

Just because a young girl is not sexually active does not mean her reproductive system does not exist. Amenorrhea, dysmenorrhea, endometriosis, polycystic ovarian syndrome and menorrhagia are all terms (or concepts) that young girls of reproductive age should be familiar with; and yet a majority of girls of reproductive age would not be able to identify any of these terms.

Abnormal Periods are a Sign of Trouble

Young girls should be taught that abnormal periods, painful periods (dysmenorrhea), an absence of periods (amenorrhea), or extremely heavy periods (menorrhagia) are not normal and should be evaluated by a doctor. In many cases, finding the causes of abnormalities in menstruation early on, could prevent further complications down the road.

Most women who have uterine or menstrual abnormalities do not get a diagnosis or proper treatment until they discover they cannot conceive. That is because by the time these women go to the gynecologist for the first time they have been lead to believe that abnormal is their normal.

My Story

When I was twelve I was getting my period every other week and I was told that was normal and that every girls’ period takes some time to regulate – which is true. However, it wasn’t true for me. I had endometriosis and uterine didelphys (two uteri) which required surgery, but because I was young, it was two and a half years before my painful periods were taken seriously. This is an all-too-common experience. Many women report suffering for decades.

In the case where a young girl’s menstrual problems are impacting her daily life – isn’t it better to be safe, rather than sorry? Read my full health story here.

The Need for Pediatric Gynecologists

Pediatricians and family doctors alike need to sit down with their female patients and have a detailed discussion about menstruation. No one should assume that health education in secondary schools is adequate to teach a young girl to stand up for her own reproductive care. The stigma of being too young (or not yet sexually active) to go see the gynecologist should be disregarded. Regardless of age, if any other part of the body wasn’t working one would go to the doctor to get it looked at; the same should go for the reproductive system.

How old were you at your first gynecologist appointment? When did your menstrual problems begin?

Migraines and Hormones: Behind the Curtain

by Angela A Stanton, PhD

Published on December 15, 2014

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Before puberty, migraines are three times more frequent in males than in females but after puberty the tides turn and females are more likely to suffer from migraines than males. An Oxford study found that females are twice as likely to have migraines and that

“brains are deferentially affected by migraine in females compared with males. Furthermore, the results also support the notion that sex differences involve both brain structure as well as functional circuits, in that emotional circuitry compared with sensory processing appears involved to a greater degree in female than male migraineurs.”

The overwhelming belief is that the connection is clear: the hormones kick in for women at puberty and that must be the reason. This begs the questions: 1) Do males have the same hormonal problems before puberty as females do after puberty? If hormones are at root of the problems, then there must be some similarities, right? 2) If female hormones are responsible for migraines, do all females have migraines when they reach puberty? 3) Do migraines cease when hormones stop changing after menopause? 4) What about pregnancy or postpartum, how do hormones impact women then? And finally, 5) Do men stop having migraines after puberty?

Some of the answers to these questions will surprise you and may make you wonder if hormones have anything to do with migraines at all. In this post, I show you that while there are some connections between hormones and migraine they might not be the primary drivers of migraine. The relationship between hormones and migraine is not in the presence of hormonal changes but what those changes require in terms of brain energy, the lack of which causes migraines.

First, I would like to respond in quick the five questions I asked earlier: 1) Do males have the same hormonal problems before puberty as females do after puberty that causes them migraines? The answer to this is no. 2) If female hormones are responsible for migraines, do all females have migraines when they reach puberty? The answer to this also is no. 3) Do migraines stop after menopause? Many women have more migraines and some even start migraines in their menopause, so the answer is no. 4) Do migraine increase or decrease during pregnancy or postpartum? The answer is no during pregnancy, but yes postpartum. 5) Do men stop having migraines after puberty? No they do not.

It is not obvious that the cause of migraines must have anything to do with female monthly cycles and their associated hormones. Given also that many women have migraines after puberty, we are safe to assume that some other factors may play a role. It would be hard to envision a world full of children in which our evolutionary road took women to necessarily experience migraines with their menstrual cycles. So what is the connection to hormones; how do women end up with migraines; and why?

Rather than listing all the hormones that activate throughout the monthly cycle of a woman, let’s take a look at what is happening in the body of that woman backstage, during the hormonal changes. First, in a small review I cover in a few sentences what a migraine is.

Migraine is a collection of symptoms that have an underlying physiological mechanism based on chemical (ionic) imbalance in the brain. Migraine is a neurovascular event that Dr. Charles at UCLA called “spectacular neuro-physiological event” that changes the neurophysiology or chemistry of the brain itself. This can be seen using fMRI technology where oxygenation of brain regions shows where activity occurs during migraine—albeit this does not show why it occurs. The same article also suggests that though medications are available to treat the pain associated with migraines, half the sufferers do not receive any pain relief benefit from the drugs. I find this statement alone interesting because if migraine was truly understood, the pain medication would work for all. This clearly is not the case. To understand what is happening, we must think out of the box and leave behind the hormonal theory of migraines.

Moving Beyond the Hormone Migraine Theory

We now visit the female body all through a month. Let’s start two days after her menstrual cycle has ended. As female, we feel great, no pain, no bleeding, life is awesome. But what we don’t see works hard in the background using up important energy: the brain. Our hormonal changes are happening every moment of the day only we don’t feel it—hormonal changes are directed by the brain. Because we don’t feel the changes, we are ill-prepared for the inevitable day when it reaches a threshold point of not enough brain energy and the migraine starts. This typically happens 2-4 days prior to menses. I do not think migraines are caused by hormones, but rather they are triggered by the lack of energy available to the brain as the hormones cycle. When the brain runs out of energy, a wave of cortical depression begins in some part of the brain. This is what we feel as a migraine.

What actually happens that uses all that energy? After the menstrual cycle is over, the female body immediately prepares for the next menstrual cycle. There is no downtime for rest. The brain turns off one group of hormones and turns on others thereby manipulating how women see the world prior to and during estrus (fertile time). After a menstrual cycle is over, the brain turns on the estrogen to do a few things:

Prepare the uterus with a new fertile lining to accept the fertilized egg should one arrive and start a new life.
In order to make such fertilized egg happen, the egg must be prepared in the ovaries so hormones initiate the ripening of a new egg.
The woman’s body goes through amazing visible changes at this time of the month. If she had pimples, they magically disappear. If she was bloated, her bloating goes away. Her face becomes the most symmetrical it possibly can; the more symmetrical the more sexually appealing she becomes to the opposite sex.
She becomes extremely attracted to high testosterone males requiring her pheromones to change and to be able to sense a high testosterone pheromone male’s presence. This high testosterone attraction changes after estrus to attraction to low testosterone males for the safety of the child, should mating end in a baby.

With all this activity going on in the female body that she cannot feel, she is in danger of exceeding the threshold of brain energy-shortage without prior notice or preparation. The cost of all of these activities behind the curtains in the female body is very high in terms of brain energy and hydration. These are sex-hormonal functions that only exist for a certain period of time during the female life. Females are known to be born with all of their eggs they will ever ripen for possible babies. Only these eggs are not “ripe” at birth. Every month one egg ripens in one of two ovaries (sometimes in both and sometimes in none). This egg breaks out of the ovary and starts its journey down the ovarian tube where it either gets fertilized by a sperm or not. If the egg is fertilized, it attaches to the wall of the uterus lining—later to become the placenta of the baby—and a new life cycle begins in the mother-to-be. If however there is no sperm able to penetrate the egg, while it descends in the ovarian tube, the egg will have to be cleared from the uterus together with the nutritious blood vessel rich lining created. This happens with the menstrual bleeding. This we can see and feel.

My Theory: Why Hormone Changes are not the Cause of Migraines

As shown earlier, migraines are not equally present in everyone’s life. Other factors, such as genetic predisposition to sensory organ hyper sensitivities (SOHS) that require more energy, may be the cause. Recent research hints at ionic balance (meaning energy available for use) is crucial in maintaining optimal function and the slightest imbalance can cause major problems (Wei et al.).

When the body is tasked with demanding activities the cells responsible for completing those extra tasks are doing extra chores and need extra energy. The brain regulates the creation of extra hormones for the menstrual cycle. The brain manages the clearing of the uterus after the fertile layer was not used.

By the third day after the cycle, the brain is ordering an egg to ripen—this takes extra energy. This is a once a month event. The brain must have extra energy to complete this task. Ever tried to run a marathon on empty or run your car the extra mile without fuel in your tank? Not possible. Something must break. The brain is the logical one for those who are predisposed to SOHS. If their brain runs out of energy, the neurons cannot generate voltage and stop creating neurotransmitters that instruct the production of hormones in the body. This leads to cortical depression and migraine.

Migraine during Pregnancy

Hands up: how many of you had migraines during pregnancy? Up to 75% of migraineurs do not have migraines during pregnancy. Why you may ask? There is more than one reason for this. The first and most important reason is that while the mom-to-be is pregnant, she has no menstrual cycles so the brain has no monthly cyclical job and it need not use extra energy. Even if the pregnancy comes with a menstrual flow here and there—as it sometimes happens—there is no egg that ripens and there is no uterus layer to remove. It is only a bit of bleeding but no extra energy was needed by the brain for this menstrual flow.

The second important factor is that during pregnancy the mom-to-be seems is more cognizant of what her and her baby-to-be needs. She eat more, tends to eat what she craves and is less likely to be good-looking-body conscious during this time. Pickles with ice cream are famous cravings of women. All the nutrients the brain craves for re-creating energy and feed the brain to prevent migraines: salt, calcium, magnesium, and fat that converts to sugar in the brain.

Migraine during Postpartum

After giving birth nearly, nearly all women immediately revert to eating for a good looking body, lose all the baby fat, and get back into the size zero genes. They stop eating brain-healthy after pregnancy (they never realized they ate brain healthy the first place). Nearly all women return to their migraines postpartum as they return to their old dietary habits.

Post-Menopausal and Menopausal Migraines

We are often told that after we enter menopause or are post-menopausal, our migraines will disappear. Yet, I talk to many women, who have more migraines after their fertile period of life has passed. I am one of those women who experienced more migraines in menopause than in early life. Thus, being no longer fertile, no longer ‘hormonal’ does not mean that we become migraine free; further pointing to the lack of connection of migraines to hormonal fluctuations. In menopause, many women are still very body conscious and watch their dress size more than their health. Others, however, recognize the value of a body supporting diet that may not create a body to fit into such small jeans but may be healthier for an older woman. This second group probably stops experiencing migraines (like I did) whereas the first group remains dehydrated and lacks brain nutrition to work those SOHS brains. They end up continuing their migraines as they had them before.

Of course, we already know from my previous posts that migraines are genetic so not everyone abusing her body will end up as migraineur. To be migraine free, everyone, male or female, must follow the rules of brain fuel.

Fuel for Migraines (Hormonal or Not)

What exactly is the fuel for migraines of any kind? I am leading you back to the first post on migraine that tells you what nutrition the brain needs to return to energy and fuel-filled comfortable homeostasis. The brain works on electricity, which requires specific charge differences inside and outside the cell’s membrane. This voltage is created by salt (sodium and chloride) in ample supply. Sodium also retains water inside the cells for hydrations and opens the sodium-potassium gate to allow nutritional exchange. I am also linking you back to the second post on migraines that explains the anatomy of migraines and what actually happens when the brain in not in homeostasis. How a migraine starts is now visible in fMRI. If you follow the posts I linked to and read the book on how to prevent and fight migraines, chances are, you may never have to face another migraine in your life.

Sources:

Fighting the Migraine Epidemic; A complete Guide. An Insider’s View by Angela A. Stanton, Ph.D. Authorhouse, February 2014. https://www.amazon.com/Fighting-Migraine-Epidemic-Complete-Migraines/dp/154697637X/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=1518636023&sr=8-1
Why Women Suffer More Migraines Than Men by Patty Neighmond, NOR April 16, 2012 3:17 AM ET http://www.npr.org/blogs/health/2012/04/16/150525391/why-women-suffer-more-migraines-than-men
Her versus his migraine: multiple sex differences in brain function and structure by Maleki et al. BRAIN. 2012: 135; 2546–2559, http://brain.oxfordjournals.org/content/brain/135/8/2546.full.pdf
Hormones & desire Hormones associated with the menstrual cycle appear to drive sexual attraction more than we know. American Psychological Association By Bridget Murray Law. March 2011, Vol 42, No. 3 Print version: page 44 http://www.apa.org/monitor/2011/03/hormones.aspx
Human Oestrus by Steven W Gangestad, Randy Thornhill. The Royal Society, Proceedings B May 2008 http://rspb.royalsocietypublishing.org/content/275/1638/991
Ovulating Women are STRIPPING Men of their Money. Cal Poly Bio 502 class lecture notes article. A blog about human evolution, economics, and sexual physiology. Why do strippers make more money at different times of the month? By Hayley Chilton http://physiologizing.blogspot.com/2013/01/ovulating-women-are-stripping-men-of.html
Migraine and Children. Migraine Research Foundation http://www.migraineresearchfoundation.org/Migraine%20in%20Children.html
Prevalence and Burden of Migraine in the United States: Data From the American Migraine Study II; Richard B. Lipton, MD; Walter F. Stewart, MPH, PhD; Seymour Diamond, MD; Merle L. Diamond, MD; Michael Reed, PhD. Journal Headache; 646:657
Population-based survey in 2,600 women. Karli et al., The Journal of Headache and Pain October 2012, Volume 13, Issue 7, pp 557-565 http://link.springer.com/article/10.1007%2Fs10194-012-0475-0
Multisensory Integration in Migraine Todd J. Schwedt, MD, MSCI. Curr Opin Neurol. Jun 2013; 26(3): 248–253
Unification of Neuronal Spikes, Seizures, and Spreading Depression. Wei et al., The Journal of Neuroscience, August 27, 2014 • 34(35):11733–11743 • 11733

The Instant Menstrual Cycle

by Lisbeth Prifogle, MFA

Published on November 7, 2014

2745 views

My uterus decided to end her 6-month vacation yesterday. This is nothing new; I’ve never had regular periods and have tried nearly everything to make my body function on a regular schedule, but it just doesn’t cooperate. Synthetic hormones prescribed by numerous doctors have always made things worse. Acupuncture, when I am working and can afford it, is the only thing that makes them more regular and manageable.

Take a moment to empathize with me – 6 months worth of bloating, fatigue, cramps, blood, etc. in one lousy week. Oh and this would be the second week of a new job – I’m onto you uterus, I’M ONTO YOU!

I’ve tried diet changes, more exercise, less exercise, meditation, medications, channeling my inner moon goddess – everything. I’m finally learning to accept that this is the way my body functions. I don’t like it, but I accept it. What I can’t accept is that we put a man on the moon 45 years ago, but we can’t figure out how to give women some relief. Women have been in science for some time now. Marie Curie won the Nobel prize for Chemistry in 1911. You’d think we could help ourselves, but the most we have advanced in menstrual related relief and technology is OTC pain relievers marketed in pink boxes with a different name and wads of cotton so toxic to our bodies that they can kill us! Don’t you think we need entire labs dedicated solely to easing the pain of menstruation and child bearing. The women scientists can wear brightly colored lab coats and eat an endless supply of chocolate while figuring out new ways to deal with age old biological functions.

Yesterday, I couldn’t leave the couch. I was supposed to go to a barbecue with friends, do all the chores I can’t do during the work-week, and hit up the grocery store, but I was couch-ridden with a heating pad, smelly Chinese herbs, red raspberry leaf tea, and a book. I’m afraid that my friends thought I was lying to get out of the social gathering (I tend to be reclusive), and more than one male employer has given me that “uh-huh, sure” tone when I’ve called in sick over womanly problems. Thankfully, I’m a generally healthy person so that’s the only time I call in sick (and I’m extremely thankful for my health). Take a minute to imagine being in the military and having to tell a male superior that you can’t go out to the field for an exercise because of earth-shattering cramps and excessive bleeding. Then going to a male doctor at sick bay to get a ‘chit’ as proof you weren’t lying.

And I’m supposed to channel my inner moon goddess and be thankful that I’m a woman and can bring life into this world? I’m going to channel my moon goddess alright, channel her and beat her. Don’t get me wrong, I love being a woman and everything that entails, but in the name of science and entrepreneurial spirit – don’t you think it’s about time we figured out a way to ease the pain and suffering that women have to endure monthly?

In an essay originally published in the Boston Phoenix in 1990 and republished posthumously in a collection of essays titled, The Merry Recluse in 2002, Caroline Knapp, wrote, “What Women Really Need from Science.” Here is an excerpt that I think of EVERY time I have an earth-shattering, couch-ridden period, like today:

“So now women can have babies at the age of 90. Big whoop. Roll out the Pampers and Geritol. Open a Cribs ‘n’ Canes shop. And thank you, thank you, thank you, modern medicine.

Something is very wrong here. While a teensy-weensy proportion of women over the age of 75 might welcome the opportunity to procreate in their golden years, and while this development might help ease the pressure some women feel as their biological clocks tick away, most of us shudder at the news. Babies when we’re 90? Postmenopausal midnight feedings?

This news also seems to indicate a slight problem modern science has with focus. What about the here and now? What about the daily realities women face in our younger years?
Any doctor or scientist who truly understood the lives of modern women would be looking in an entirely different direction for ways to ease our burdens and make our lives more manageable. Forget about extending our childbearing years. Forget about finding new and medically thrilling was to complicate our later lives. We need help now! Here, for ambitious doctors everywhere, are a few suggestions.

The Instant Menstrual Cycle

Consider how much simpler life would be if scientists could develop a way to enable women to menstruate in a mere five minutes. No more messy, five- to seven-day bouts of bleeding. No consecutive nights curled on the couch with heating pads to ease the lower back pain. And no more worrying: Will you run out of tampons? Leak? Bleed on his sheets? The five minute menstrual cycle would pack all that discomfort and inconvenience into much more manageable form. One huge cramp. One enormous mood swing. A single flood of tears, and then – whoosh – a single rush of blood into a single, extremely absorbent tampon. If science can come up with an instant coffee, instant breakfast, and instant cameras, instant menstruation couldn’t be that hard.”

Amen sister. She goes on to list other brilliant scientific ideas for some, young scientist to snatch up and make our lives easier including: egg-laying capabilities, clones for working mothers, anti-gravity skin enhancers, and more.

Someone, somewhere, PLEASE hear my plead: We can genetically modify animals to create spider goats and jellyfish pigs, we can travel to space, we can harness the power of nuclear fusion to create electricity and bombs – so why can’t we make advancements in women’s health that would bring relief to half of the world’s population? It’s past time for the Instant Menstrual Cycle – it’s time for a revolution, ladies!

Hypersensitivity to pain, my ass!

by Chandler Marrs, PhD

Published on October 10, 2014

2228 views

A multitude of reports have emerged in recent years denoting the over use of pain killers and other medications. With narcotic pain killers, in particular, data suggest a four-fold increase in opioid use since 1999, and over 100,000 deaths by opioid overdose during same time period. The data also indicate a close correspondence between the increase in prescriptions for pain killers and pharma sponsored marketing, ‘research’ and policy changes that have inculcated medical agency guidelines over the last decade.

For women, this is a particularly troubling trend, as other research indicates we are the primary targets of narcotic prescribing; women take 50% more pain killers than men. We also take 36% more medications than men in general. Speculation about why women take more pain killers than men, often involves psychosocial characteristics including a reduced sensitivity to pain, a predisposition to pain causing diseases, and a predilection to report the pain to one’s physician. Women seek out medical treatment at a much higher rate than men.

What often fails to get mentioned is that:

Pain medications don’t work as well in women because as we’ve reported before few females, rodents or otherwise, are used in the development of these medications.
Even when female animals or women are used in drug development research, cycling hormones are not analyzed as factors in the effectiveness of the medication.
For the myriad of pain related disorders affecting women, many lack evidence-based diagnostic criteria (less than 30% of Ob/Gyn practice guidelines are based on actual evidence) and frequently physicians and the lack of effective diagnostic criteria hastens many to presume an underlying psychosocial or mental health issue.

I personally think the psychosocial arguments that women are more sensitive to pain than men are nonsense. Rather, I think there is a lot more inherent to our physiology that makes pain related conditions not only more likely, but more difficult to treat.

Consider for example, the menstrual cycle and childbirth. These amazingly complex, biochemically radical, pain-inducing, often life-altering experiences are just a ‘normal’ part of female existence. I dare any man to experience the exponential and repeated cyclic change in biochemistry, akin to a repeated drug addiction and withdrawal pattern, that is the female menstrual cycle. The myth of female hypersensitivity to pain, based largely upon the ineffectiveness of pain or medications that were never designed for her changing biochemistry, is just that, a myth. And though I do admit, some humans are more sensitive to pain than others, the contrived experimental methods that designate women as hyper-sensitive do great damage to our understanding of women’s health and the differing pharmacokinetics across the menstrual cycle, pregnancy, postpartum or menopause.

And then of course, there is endometrial sloughing, necessitating a cramping mechanism to propel the tissue outward or the grandmother of all pain experience, childbirth where women deliver 8lb humans through a cavity opening that expands only to 10 centimeters, often times choosing to not utilize pain medications. These ‘normal’ events of a woman’s life are not indicative of a ‘hypersensitivity to pain’.

No, I don’t buy this mumbo jumbo that women are somehow more sensitive to pain than men. If anything, most women have a higher tolerance to everyday pain than most men. But there is a rationale to perpetuating this myth; it limits innovation in women’s health.

Why innovate when a company can make billions prescribing the same old medications at higher and higher dosages, to more and more people? Why address the needs of half the population, when one can blanket the market with drugs for the entire population? And to that point, why develop more accurate diagnostic criteria or more effective medications for conditions that only effect a small subset of the total population; especially when medications developed over 50 years ago can be used? If these medications are addictive, have side effects that necessitate other medications and are extremely difficult to withdraw from, well then, those are just added bonuses. It’s a wonderful business model, albeit a little less than ethical.

Despite the obvious marketing excess, we as consumers bear as much responsibility for the increase in narcotic prescriptions as does the pharmaceutical industry. We are letting this happen. Let’s face it, it is much easier to take a pill to make the pain go away (or eat a pint of ice cream to alleviate stress) than go after the root problem. It is difficult to address root causes. It is especially difficult if one is suffering from a medical condition that is chronic, pain-inducing, poorly understood, not easily diagnosed, and for which there are no effective medications. Women disproportionately suffer from these types of conditions – think fibromyalgia, endometriosis or even migraines. We also make 80% of all family medical decisions. So ladies, we need to stand up and begin educating ourselves and our families about health and disease. We must demand more research and we will probably have to lead it ourselves.

Can the Pro-Choice Community Embrace a Birth Control Dichotomy?

by Laura Wershler

Published on September 23, 2014

3591 views

In 2004, when I was executive director of Planned Parenthood Alberta, I gave an introductory presentation on fertility awareness for women looking for alternatives to hormonal birth control. One young woman who’d been on Depo-Provera for five years had been recently diagnosed with severe osteopenia. After quitting the drug, she said she realized in retrospect that for those five years she had felt like she was living “under the surface” of her life.

Another told the story of how she had struggled with serious mood issues while on the birth control pill. She would stop taking it, rely on condoms and emergency contraception for a while, then visit her doctor who would urge her to go back on the pill. After a few of cycles of on-off-on, she quit the pill once and for all. She said she decided to “just stop talking to this doctor about birth control.”

I’ve heard scores of stories like these over the past 30 years, and read hundreds more from women commenting on blog posts and online articles. For decades women have stopped using hormonal contraception to improve their health and well-being. Advocating on their behalf has been a major focus of my work as a pro-choice activist.

The Birth Control Dichotomy

I’ve been a pro-choice sexual and reproductive health advocate since I was 15 years old. Today I turn 60, celebrating a 45-year commitment to pro-choice values. But I mark the occasion with frustration and disappointment because the sexual and reproductive health (SRH) community to which I belong has failed to adequately–unreservedly–serve women who won’t, don’t or can’t use hormonal birth control.

I believe that what is keeping them from doing so is failure to acknowledge and embrace the dichotomy that exists within the pro-choice contraceptive framework.

A dichotomy is division of a whole into two mutually exclusive, opposed, or contradictory groups. If pro-choice contraception is the whole, two mutually exclusive groups are:

women who use and like, or want to use hormonal birth control (HBC)
women who use and like, or want to use non-hormonal birth control (NHBC).

Both groups deserve equal attention, support and services to use the birth control methods they decide are right for them. But this is not happening.

Just as we who hold pro-choice values don’t judge or hassle women for the reasons they choose to have abortions, we should not judge or hassle women for the reasons they choose not to use HBC, nor try to deter them. Yet anecdotal evidence abounds that women who want to quit the birth control pill, have their IUDs removed, or learn fertility awareness based methods (FABM) are often actively dissuaded from acting on their choices. It takes extreme self-assurance to do what one young university student told me she did when her doctor questioned why she didn’t want to use HBC. Her response: “My reasons are none of your business.” She said she knew the doctor would try to overcome her objections to the side effects she refused to incur.

I believe that pro-choice sexual health advocates and care providers can and must find a way to do their work effectively within this birth control dichotomy. We must acknowledge the right of women to choose HBC or NHBC depending on which best serves their health and contraceptive needs. And it’s our obligation to help them use their chosen method effectively and confidently, without persuasion or dissuasion.

This is not being done to the standard I believe it should.

Media, social media, and the blogosphere tell us that young women are ditching HBC, but not finding much information or support from their doctors or sexual health clinics for doing so. So why aren’t SRH organizations researching this identifiable “unmet need” or offering workshops on successfully transitioning from HBC to NHBC?

A one-size fits all diaphragm is in the works, and another silicone version is on the market but incredibly hard to find, as is the spermicidal gel required to use with it. So why don’t SRH clinics have programs in place to make them more accessible to women who want them? After all, the diaphragm was the contraceptive of choice for arguably the most influential sexual role model of the last 15 years – Carrie Bradshaw.

Evidence-based medicine proves that pro-choice FABM are as effective as HBC methods, and can be used with condoms to prevent STIs and emergency contraception if indicated, just as for HBC users. So why doesn’t every SRH clinic or organization provide certified FABM training on site or seek collaborative partnerships with certified, secular-based instructors?

Bottom line? The SRH community is failing to fully meet the needs of women who won’t, don’t or can’t use HBC. The current hoopla over LARCs – long-acting reversible contraception including copper and Mirena IUDs and hormonal implants – as the next best birth control “technology” is mere tangent, not solution. Other than the copper IUD, these are still drug-based methods many women want to avoid.

Women who want to use NHBC effectively and confidently, or seek treatments for menstrual cycle problems that do not require hormonal contraceptives, are turning to care providers and information sources outside the SRH community. Is this what we want?

I don’t get it. If I can embrace the birth control dichotomy and retain my pro-choice commitment why can’t other pro-choice health-care professionals, non-profit organizations, and advocates do the same?

My pro-choice values have co-existed for decades with my advocacy for NHBC and menstrual cycle education. But I admit that because of my chosen focus, it is often wrongly assumed that I seek to deny options rather than to increase them, that somehow I cannot possibly be pro-choice.

Successfully using fertility awareness for birth control from age 27 through menopause (See p.4-5) did not keep me from serving 10 years on the board of Planned Parenthood Federation of Canada, or from bringing me back as a current board member of what is now the Canadian Federation for Sexual Health.

Promoting body literacy – acquired by learning to observe, chart and interpret our menstrual cycle events so that we become fully informed participants in health-care decision making – as a life skill that all girls and women should learn, did not keep me from being executive director of Planned Parenthood Alberta. The organization, which became Sexual Health Access Alberta and closed in 2010, distributed educational resources that included the most comprehensive Birth Control Demonstration & Sexual Health Promotion Kit still available for SRH professionals.

Sharing evidence-based medical information about the value of ovulation to women’s health and how to treat menstrual cycle disorders without the use of hormonal contraceptives, did not keep me from writing commentaries in support of abortion rights.

Within the pro-choice sexual and reproductive health community, I’ve chosen to focus on body literacy, menstrual cycle education, and advocacy for increased access to NHBC. At 60, I’m more committed than ever to promote a broader perspective within my community, one that will fully acknowledge and embrace the birth control dichotomy, one that will serve equally, without reservation, the contraceptive needs of all women.

About the Author: Laura Wershler, B.Sc., is a veteran pro-choice sexual and reproductive health advocate and women’s health critic who has worked for or volunteered with Planned-Parenthood-affiliated organizations in Canada since 1986. Laura graduated with a Certificate in Journalism from Mount Royal University in 2011. She has contributed columns on women’s health to Troymedia.com and blogs regularly for re:Cycling, the blog of the Society for Menstrual Cycle Research. Follow her on Twitter @laurawershler.

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