Amy Galvan, DOM, L' Ac, FABORM
Comprehensive Women's Health
Acupuncture Infertility Specialist
Periods & Pregnancy 101
What is a Period?
A period is a normal discharge of blood from the uterus that naturally occurs in an ovulatory menstrual cycle.
A menstrual cycle is more than just your period. A menstrual cycle is defined from the first day of menstrual bleeding (called cycle day 1 or CD1) of one menstrual period to the first day of menstrual bleeding of the next. An average menstrual cycle lasts 28 days, but is considered healthy in Chinese medicine if it is within 26 to 32 days.
In a healthy natural menstrual cycle, an ovary matures follicles which mature eggs (ova). This is called the follicular phase. One follicle will take the lead and release one egg (ovum). This is called ovulation. This is followed by the empty follicle producing a yellow form called the corpus luteum, which makes progesterone. This is the luteal phase. It continues until the next period bleed.
In an average menstrual cycle of 28 days, the follicular phase can vary in number of days, but the luteal phase typically does not. To calculate ovulation, it occurs about 14 days counting backwards in time from the start of the FOLLOWING period. It is NOT measured from the PRECEDING period. That is, you cannot calculate ovulation until after it happens. Anything else is just a guess.
Once again, the timing of ovulation each month (follicular phase) can be uncertain or fluctuate; what IS consistent is the number of days (usually 14) between ovulation and the start of the NEXT menstrual period (luteal phase).
Because ovulation is calculated AFTER THE FACT by counting days backward from the last day of the cycle, NOT counting days forward from the first day of your cycle, it can be difficult to predict when ovulation will occur. To help you predict when ovulation occurs, you can use indicators such as basal body temperature (BBT) or ovulation predictor kits (OPKs) or counting days (an app), but you cannot confirm ovulation occurred until a week later with a progesterone test.
Ovulation does not confirm the health of the egg or how long it is viable.
After the egg is released, it moves down the fallopian tube to the uterus. The tubes must have the ability to move freely to catch the egg when it is released into the pelvic cavity. The tubes have fine moving hairlike structures (cilia) to wave the egg down the tract of the tube. The tubes must have fluid or mucus in the proper consistency to help the egg slip along the tract without getting stuck.
After the egg is released from the follicle with the help of luteinizing hormone (LH), the remaining follicle starts producing progesterone hormone. When the follicle is spent, progesterone levels drop and the period starts again.
If the egg is fertilized, progesterone levels remain high with human chorionic gonadotropin (hCG) and the period is absent.
What is a Healthy Period?
A typical period lasts 2 to 7 days, with the heaviest bleeding in the first 3 days. In Chinese medicine, the first day (CD1) should begin in the morning with light fresh red flow, and progressively get heavier by CD2 before tapering off.
What is Not a Healthy Period?
- Your periods were regular each month and then they stopped being regular
- Your period comes more often than every 21 days
- Your period comes less often than every 45 days
- Your periods come more than 90 days apart, even for one cycle
- Your period lasts more than 7 days
- Your periods require changing a pad or tampon every 2 hours
Menstrual cycles in teens often are irregular, especially in the first few years after they start. Having an irregular cycle means the number of days between your periods changes a lot from month to month. There may be a problem if:
- You are 15 or older and have never had a period
- It has been 3 years since your breasts developed and you have never had a period
- You are 14 or older, have never had a period, and you have an eating disorder, exercise a lot, or have hirsutism (excessive body hair growth)
In Chinese medicine, the following conditions are considered unhealthy and treated with herbal medicine or acupuncture (not birth control). These are relevant even if your Ob/Gyn did a workup and found no underlying medical problem.
- brown, black, purple, or pink color
- spotting before or after your period
- heavy bleeding
- passing clots
- passing tissue from uterine lining
- cramps
- pain (back,ache, headache, genital pain)
- PMS
- bowel changes with periods
When Can I Become Pregnant?
An egg can survive in the fallopian tube for about 24 hours after ovulation. A man’s sperm can survive inside a woman’s body for about 3 days (and sometimes up to 5 days) after sexual intercourse. You can become pregnant if you have sex anywhere from 5 days BEFORE ovulation until 1 day AFTER ovulation. Your chance of pregnancy is highest when live sperm are present in the fallopian tubes when ovulation occurs.
To increase the egg survival rate after ovulation, it needs a good supply of energy inside the cell. This energy is supplied by structures inside the egg cell called mitochondria. Eggs can have 200-500 times MORE mitochondria than other cells of the human body. Production of mitochondria is part of egg cell development in the follicles. You can increase the number of mitochondria with dietary supplements.
To increase the sperm survival rate after ejaculation, a good supply of fertile cervical mucus produced by the woman is helpful. Eggwhite quality mucus nourishes sperm and helps them move faster toward the fallopian tubes.
What is Fertility Awareness?
Fertility awareness is knowing and recognizing when the fertile time (when a woman can get pregnant) occurs in the menstrual cycle. If you are practicing fertility awareness as a birth control method to PREVENT pregnancy, you need to avoid having sexual intercourse or use a barrier of birth control, such as a condom, during the fertile period. Sexual activity apart from sexual intercourse is also safe if there is no opportunity for sperm to enter the vagina.
If you are trying to get pregnant, you should have sexual intercourse on your fertile days, ideally every day or every other day. Fertile days are 5 days before ovulation and 1 day after ovulation.
What Is Fertility Awareness Method (FAM)?
There are a variety of fertility awareness methods used to help influence becoming or avoiding becoming pregnant. These include
- Standard Days (rhythm) method
- Cervical Mucous (CM) method
- Basal Body Temperature (BBT) method
- Symptothermal method
If you are interested in learning fertility awareness, I recommend the book Taking Charge of Your Fertility by Toni Weschler. If you do not learn well from books, then it may be best to learn the method from a qualified teacher or group. Look for one through your church, healthcare provider, state or county health department, or an online search to find a teacher. Tools such as smart phone apps and web sites also are available to help you record information about your menstrual cycle and predict (but not guarantee) your fertile periods.
Pros and Cons of FAM
Pros: Fertility Awareness Methods cost very little to use. Many women like the fact that fertility awareness is a form of birth control that does not involve the use of medications or devices.
Cons: Fertility Awareness Methods take time to learn and implement with confidence. They do not help protect against sexually transmitted infections like barrier methods can. Not everyone can rely on FAM. If you cannot control sexual behavior, or cannot discern periods from midcycle bleeding, or cannot discern fertile mucus from vaginal discharge occurring throughout your cycle due to a health imbalance.
Other: You can combine FAM with OPK urine tests at home to help get a clearer picture of when your fertile time is. If you are trying to conceive (TTC), using BBT will help you see signs of pregnancy (continued high BBT) before a pregnancy test can be taken.
References
American College of Obstetricians and Gynecologists (ACOG)
The Foundations of Chinese Medicine text by Giovanni Maciocia
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