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Ovulation as the 5th Vital Sign?

Did you know that a woman's menstrual period is her 5th vital sign? Our vital signs are documented as:

  1. Blood Pressure (BP): healthy is <120/80

  2. Heart Rate (HR): between 60-100 beats / minute

  3. Respiratory Rate (RR): 12-16 breaths / minute

  4. Body Temperature (Temp): 36 - 36.8 degrees Celsius

  5. Ovulation in the Menstrual Cycle: non-menopausal women should be able to identify that ovulation has occurred. This is seen by ovulatory mucous which appears as thick, egg-white like substance at ovulation time as well as an increase in moistness levels. Ovulation is seen as a positive health indicator due to the subsequent rise in the hormone Progesterone. In a healthy cycle, ovulation should occur roughly on Day 14 of the classic 28-day cycle. A normal menstrual cycle is considered to be between 21-35 days apart. Teenagers cycles can be longer until cycles settle.


Ovulation, or its absence, as the 5th Vital Sign


If ovulation is the 5th Vital sign, then what is it letting us know if it's not present, or delayed? It will draw attention to:

  • Inflammation in the body

  • Thyroid issues

  • Insulin Resistance

  • Excess stress

  • Nutrient deficiencies - Magnesium, B vitamins, Vitamin D, Iodine, Zinc, and Selenium.

  • Dietary and lifestyle choices that need adjusting

  • Hormonal imbalances from the above

If you make changes to your lifestyle, it will take on average 100 days for those beneficial changes to show up with your ovulation, as the follicles our eggs come from are developing in our ovaries over a 3-month period.


Menstrual Cycle and Ovulation Explained - 101


The information above assumes most people have a working knowledge of the female reproductive system, and this is not often the case. A summary of what happens over the course of the month, that discusses the details in the chart below, is provided highlighting the multiple elements at play in the female reproductive system. When you see so many changes each month, it is little wonder that women are often deemed hard to understand. We often feel we don't understand ourselves!


Graph showing the typical 28 day menstrual cycle and mapping the ovarian cycle and basal body temperature changes.
Ovarian cycle and Uterine cycle correlations

The sequence of events in our female reproductive system can be broadly summarised. It may come as a surprise, but 'the brain is the boss, and our hormones are just the actors.' Our cycle is regulated by the HPO axis (Hypothalamic, Pituitary, Ovarian axis). This means, it is regulated by both the hypothalamus and pituitary in our brain, as well as our ovaries.


We often think of the female reproductive cycle as the menstrual cycle (or uterine cycle) as shown by the 4th line in the chart above. A normal menstrual bleed is between 3-5 days, with approximately 50ml blood loss (2.5 Tablespoons). Days 1-5 are the menstrual bleed (Menses), where we shed the unnecessary lining of the uterus if a pregnancy hasn't occurred. The lining is required for a healthy pregnancy, and hence why we don't menstruate when pregnant, and why bleeding during pregnancy is a concern and possible miscarriage risk. In a non-pregnant cycle, the uterine lining builds up over the remainder of the month (the Proliferative and Secretory Phases) under the influence of Oestrogen. Day 1 is deemed when the heavy flow starts. Light flow is simply the leftover shedding from the prior month, but often incorrectly referred to as Day 1 by some women.


Simultaneously, our ovaries produce ovarian follicles, as shown by the Ovarian Cycle in the line 2 of the chart above. The ovarian follicles produce our hormones oestrogen, progesterone and testosterone. One of those follicles should proceed to ovulation each month, if our health indicators are good.


In the Follicular Phase (the first half of our cycle), Follicle Simulating Hormone (FSH) from our brain will decide which follicle proceeds to ovulation, and Luteinising Hormone (LH) in our brain triggers the release of the egg from that follicle, as can be seen by the top row of the chart. Some women feel the 'twang' or burst of pain from LH triggering the release of their egg. Ovulation kits are testing for the presence of LH.


Our Basal Body Temperature is our body temperature immediately on waking in the morning without movement. If you are charting your basal body temperature, then you may notice a small drop in temperature at ovulation, then followed by an increase in the latter half of the cycle (as shown on the 5th line of the chart above). There is a chart in my Resources section to use for this is you are interested.


In the Luteal Phase, once the follicle releases the egg at ovulation, the emptied follicle (Corpus Luteum) becomes the progesterone secreting gland. We can see this correlation in line 2 and 3 of the chart above. Progesterone secretion is primarily to ensure we can 'hold' a pregnancy (it is the 'pro-gestation' hormone). If we do not fall pregnant during that timeframe, then the progesterone levels fall away, and this along with a decline in oestrogen levels will trigger menses again.


If we are pregnant, the hormone bHCG (beta Human Chorionic Gonadotropin) enters the arena from the cells of the newly developing placenta. The hormone bHCG is the hormone measured in pregnancy test kits. As well, bHCG alerts progesterone to stay elevated for 'pro-gestation' to occur so we can 'hold' a pregnancy.


A cycle which is anovulatory (no ovulation), and hence no progesterone, is a common infertility issue. As such, good levels of progesterone are vital for pregnancy, as well as FSH and LH levels, along with oestrogen. It's all a delicate balancing act, and the Goldilocks story once again.


Our reproductive hormones (males included) all stem from cholesterol. It is the main LEGO piece! This is one reason why we don't want cholesterol levels falling too low. Depending largely on our diet and lifestyle, our hormones are shunted down different pathways as shown by the Steroid chart below. You will notice that if stress is present, a higher requirement for cortisol will divert hormone production to cortisol and not to our reproductive hormones. This is one reason why stress, in whatever format, interferes with our reproductive hormones.


As we have discussed, ovulation signs are the 5th vital sign for pregnancy. Ovulation signs are also the 5th vital sign for good health as described below with the 'personalities' of our hormones, and what can go wrong if they are too high or too low.


Personalities of our Hormones


The two major players for our reproductive hormones are Progesterone and Oestrogen. They are the Yin and Yang respectively. Testosterone is also discussed.


Progesterone

She is like a good friend who you can sit down and have a 'calming cup of tea' with. Progesterone leads down a pathway to a metabolite called allopregnanolone, that acts like GABA (one of our calming neurotransmitters). See my blog on neurotransmitters to learn more at https://www.m-pathnaturopathy.com.au/post/food-choices-and-mental-health


Progesterone, as well as being the 'pro-gestation' hormone, is also a wonderful hormone that has positive impacts on our mood, pain-free periods, boosts thyroid metabolism, reduces inflammation, builds muscle strength, and promotes relaxation and sleep.


As we now know, a cycle without the subsequent rise in progesterone is termed anovulatory (no ovulation). This can lead to a relative imbalance between progesterone and oestrogen.

Anovulation = no progesterone made = unopposed oestrogen = oestrogen excess.

This is where oestrogen gets the nickname 'The DIVA' where if unopposed she can become out-of-control and very demanding!

The Oral Contraceptive Pill (OCP) removes the ability to ovulate and hence generate progesterone. Certain health conditions also interfere with the ability to make progesterone - for example, Polycystic Ovarian Syndrome (PCOS), as well as being underweight or overweight, being stressed etc (see below).


As an aside discussion, PCOS has many causes. Hormonally it is described as low FSH, high LH, and low progesterone relative to oestrogen. It can arise if you are:

  • Insulin resistant - magnesium from an alkaline diet is important to help here

  • Have chronic low grade inflammation - Omega 3 is important here, and a good healthy gut microbiome from eating fibres, and ensuring your gut integrity is intact by minimising inflammation (alcohol, sugar etc).

  • Have androgen excess signs (male hormones) which will arise when our follicles fail to mature. We may see facial hair, nipple hair, acne etc

  • PCOS can occur post stopping the Oral Contraceptive Pill (OCP) as often this condition was present before taking the OCP and it simply re-presents itself. Ta-da! I'm back!

  • It can arise if you are too stressed, emotionally and physically. Ultra-fit girls who lift power weights can develop PCOS due to the increase in testosterone, and from the physical stress on the body.

Low Progesterone symptoms can include:

Anxiety, insomnia, infertility, irritability, PMS (Premenstrual Syndrome), PMDD (Premenstrual Dysphoric Disorder), and Menorrhagia (Heavy Periods), PCOS.


Oestrogens

Oestrogens are actually a group of hormones.

E1 is Estrone which produces oestrogen from our adrenal glands and fat stores. This continues even after menopause.

E2 is what we classically think of as Oestrogen. It is called Oestradiol and is the main Oestrogen hormone produced from the ovaries.

E3 is Estriol and this increases in pregnancy. We can see the various forms at the bottom of the pathway chart below, in purple.


Oestrogen (Oestradiol) is SASSY! She acts on Serotonin to make us happy and have good libido. She also acts on Dopamine to motivate us and seek pleasure. Oestrogen also improves our sensitivity to insulin so our glucose regulation improves. However, she can become a 'DIVA' and be too demanding when her levels are too high relative to progesterone.


High Oestrogen symptoms can include:

Acne, painful periods (dysmenorrhea), menorrhagia (heavy periods), mood issues, tender breasts, swelling in the body, weight gain. High oestrogen is a consistently observed feature of endometriosis. What causes that imbalance? Inflammation, and an immune response is a likely cause. Dietary and lifestyle changes can help.


Low Oestrogen symptoms can include:

Bone loss, hot flushes in menopause, insomnia, joint pain, skin issues, low libido, mood issues, brain fog, night sweats, vaginal dryness, weight gain.


Oestrogen Detoxification

Occurs in the liver so we need good liver detoxification for that to occur. Please see my blog on liver detoxification at: https://www.m-pathnaturopathy.com.au/post/liver-the-detoxification-process


Oestrogen gets broken down into different components. We want the healthy breakdown products as well, and once again our dietary and lifestyle choices can help here. The DUTCH test (Dried Urine Test for Comprehensive Hormones) is a great functional test to determine this, along with other insightful information. I can order this for you, and interpret if you have the interest to. I feel it is a test that every woman should review in her lifetime. It can give early insight into breast cancer potential as an example.


Testosterone

Testosterone is like 'Sporty Spice'. She keeps us athletic, helps our muscles, bones, motivation, courage, and has a nice impact on dopamine and serotonin. We need ample amounts of testosterone to build muscle, so we can burn body fat.


Flow chart showing steroid hormones emanating from cholesterol all the way to progesterone, oestrogen, testosterone, cortisol etc
Steroid Pathway Chart

What Can Go Wrong with the Female Reproductive Hormones?


Quite a few things actually. A Naturopath will ask a lot of questions, and order tests to identify where in the symphony things are going astray. It's important to track your cycle to have a history to be able to answer them. Questions can include:

  • Do you Ovulate?

  • Do you have irregular periods, or no periods? Causes may be pregnancy, perimenopause, stress, illness, under-eating relative to exercise (Hypothalamic Amenorrhoea), Thyroid illness, Coeliac disease, PCOS.

  • Do you have late periods (longer than 35 days in length)? Causes may be stress, illness, PCOS.

  • Do you have short periods (shorter than 21 days in length)? Associated with a reduction in progesterone from anovulatory cycles, or perimenopause.

  • Do you have signs of low Progesterone? PCOS, heavy periods, uterine fibroids, acne, hair loss, PMS, PMDD, perimenopause.

  • Do you have signs of high Oestrogen? Heavy periods, clots, breast tenderness, PMS, uterine fibroids, impaired liver detoxification pathways, nutrient deficiencies, constipation, histamine issues, heavy metals or endocrine disrupting chemicals from plastics, fragrances.

  • Do you have light periods? Are you underweight, a smoker, consume too many phytoestrogens.

  • Do you have heavy periods? Considered as >80mls over >7 days. Causes may be endometriosis, adenomyosis, thyroid illness, anovulatory cycles, PCOS, polyps, uterine fibroids, coagulation disorders.

  • Do you experience pain on menstruation? From increased prostaglandins to shed a thick uterine lining from inflammation, adenomyosis, endometriosis.

  • Do you have any infections? Pelvic inflammatory disease, yeast/ candida infections.

  • Do you have spotting at ovulation? From low oestrogen

  • Do you have spotting mid-cycle? Uterine fibroids, endometriosis, infections, polyps.

  • Do you have spotting at the end of your cycle? If longer than 2 days, progesterone is dropping too quickly at the end of the cycle.

  • Do you suffer from PMS? Low progesterone relative to oestrogen, irritability, breast tenderness, fluid retention, food cravings, acne, inflammation.

  • Do you suffer from PMDD? Extreme moods changes noticeably after ovulation, not just prior to menstruations is the case with PMS.

  • Are you pregnant? You never know - take a test.

  • Are you on the OCP? What brand will provide information on what artificial hormones are present.

  • Are you in menopause? No menstrual period for >12 months. Roughly around age 50. Less than age 40 is considered premature menopause.

  • Are you in perimenopause? Anovulatory cycles, heavy periods from high oestrogen relative to low progesterone. This can occur up to 10 years prior to actual menopause.

  • What is your diet like? Too many phytoestrogens (tofu and other soy products) can interfere. Inflammatory foods and alcohol can as well.

  • What are your stress levels like? Physical, mental, emotional stressors are all stress to the body.

  • Do you have issues falling pregnant? Not just a potential female issue.

  • Do you have issues holding a pregnancy?

  • Are you on any medications?

  • What other health conditions are present? Hypertension, anaemia are just 2 examples that can impact. Excess oestrogen is a risk factor for breast cancer.

  • Are you exposed to environmental oestrogen? Certain chemicals can disrupt our hormones.


Ovulation and the Oral Contraceptive Pill

The Oral Contraceptive Pill (OCP) suppresses ovulation by shutting down the ovaries and switching off the hormones, so the 5th vital sign with ovulation disappears, and the wonderful benefit of progesterone disappears.


Rather than correcting hormonal issues, the OCP simply shuts them down. This means there is a great chance they will resume once the OCP is ceased. Progestin in the OCP acts more like a male androgen than progesterone. Is the OCP the best form of birth control for you?


The good news is that hormonal imbalances can be rectified. This is where herbal remedies and homeopathic remedies really do make a difference. If you would like to discuss your personal circumstances, or have your pathology results reviewed in line with your current situation, feel free to make a booking with me on the bookings tab on my website.



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