Is Ovulation The Fifth Vital Sign? (Episode 646)

Full Transcript: Episode 646

Lisa Hendrickson-Jack:

This is the Fertility Friday podcast, episode number 646.

In today’s episode, I am going to be diving into an important question: why the menstrual cycle should be considered the fifth vital sign.

If this is your first time tuning in, I’m Lisa Hendrickson-Jack, certified fertility awareness educator, founder of the Fertility Awareness Institute. And I’ve been teaching women to use the menstrual cycle as their fifth vital sign via the fertility awareness method for over 20 years now. I literally wrote the book on it. I’m the author of The Fifth Vital Sign, as well as co-author of Real Food for Fertility. So let’s go ahead and jump into today’s topic.

As women, we’re basically taught nothing about our menstrual cycles. And the very little that we hear about it is typically just that it’s only relevant to ovulate and have a menstrual period when you’re trying to have babies. But of course, I’m trying to kibosh that and help us to understand that our menstrual cycle is actually a very important vital sign that we should be paying attention to.

So then that brings us to an important question, which is: what is a vital sign anyways? A vital sign is a way that we measure how the body is functioning. And the most common vital signs that we’re used to would be our heart rate, our blood pressure, our respiratory rate.

And so we all have a general understanding that if you have high blood pressure or if you have an elevated temperature, not only does it give general information that there’s something going on, but when you see your practitioner, it also gives them a roadmap of what could possibly be going on. So it gives general information as well as some specific ideas as to where we should be investigating. And the menstrual cycle acts in the very same way.

It’s really interesting when we track the menstrual cycle in a detailed way. And when I say track the menstrual cycle, I don’t just mean look at periods. I mean track the whole cycle. So the first day of your cycle is the first day of your menstrual period. After your period is done, we’re in the pre-ovulatory phase. If you’re tracking your cervical fluid, there are normal patterns versus abnormal patterns that should be leading to ovulation. If ovulation is delayed or if it’s not happening at all, that’s something we should be paying attention to.

And after ovulation, we enter into the post-ovulatory phase or luteal phase, which should be about 12 to 14 days. And we shouldn’t be seeing loads of cervical fluid during that period of your cycle. And we also shouldn’t be seeing a lot of bleeding or spotting or anything like that. So when we break down the menstrual cycle into its various parts, we can see that, A, it’s not just your period, but B, it actually gives us a lot to work with.

And so the reason that we can consider our menstrual cycle as a vital sign is because not only does it provide this information, but there’s a lot of things for us to look into. We can look into the period. We can look into the quality of your cervical mucus. We can look into the overall cycle length. We can look into if ovulation isn’t happening at the right time, or if it’s delayed, or if it’s missing entirely. We can look into the luteal phase and the quality of it. And so there’s a wide variety, a breadth of information that we can actually glean directly from our menstrual cycles.

And if this is something that’s relatively new to you or you haven’t heard before, rest assured that this is actually not a new concept. Back in 2006, the American College of Obstetricians and Gynecologists, ACOG, made a statement that medical professionals should be looking at the menstrual cycle as a vital sign in adolescent girls.

And of course, the reason is because there are several flags that we can reliably look at in adolescent girls as they’re going through the process of puberty, where if they’re not reaching these milestones at particular times, it can be a significant indicator that there’s something deeper that needs to be looked at. For example, ACOG’s red flags were listed as cycles shorter than 21 days or longer than 45 days, 90 days between periods, even one time, and bleeding that lasts more than 7 days.

So there are actually several specific markers that ACOG listed that practitioners should be looking out for in adolescent girls. And one of their recommendations was that in every session when they are seeing their adolescent patients, they should make a point of asking about their menstrual cycles. Now, of course, we know this doesn’t happen as much as we’d like, but I’m sharing this with you so that you know this is not a new concept. It’s not a new concept that we should be considering the menstrual cycle as a vital sign. It just hasn’t been popularized as much as it really should be.

I also want to read you a quote from that ACOG position paper on this statement. Quote, “Just as abnormal blood pressure, heart rate, or respiratory rate may be key to diagnosing potentially serious health conditions, identification of abnormal menstrual patterns in adolescence may improve early indication of potential health concerns for adulthood,” end quote.

So this is a whole thing, and it’s very important that we understand it. I’ve already stated this a little bit, but I want to be really clear on this point that it’s not just that you have a bleed, because many women think that when they’re on birth control, that bleed that they’re getting every 28 days is their period. Therefore, they think they’re having a cycle.

The most important aspect of your menstrual cycle is actually ovulation, because that is a sign that our body’s functioning normally, and that is actually how we make our hormones. And you can have a bleed from time to time, an abnormal bleed or an anovulatory bleed that is not related to ovulation. And so ovulation is actually what we should be considering as that fifth vital sign, although we look at the cycle in its entirety because there’s so much that we can glean from it.

So you might be thinking, of course, this sounds great. It’s catchy. But what’s the evidence? What’s the evidence that our menstrual cycle really should be considered as a vital sign? There are several examples that really help to illustrate this.

And one of those examples is in the case of hypothalamic amenorrhea. So HA, which is a lot easier to say. HA in women occurs when women are going anywhere from three to six months or more without having an ovulation or having a menstrual bleed. So essentially, ovulation has stopped and we’re just not bleeding.

Now, one of the common causes for this is a combination of over-exercise, under-nutrition, and stress. And in cases like that, when women have lost their period due to under-nutrition or over-exercise or even stress, what’s happening is they’re essentially starving, and their body has taken reproduction off the table so as to conserve their energy.

And if you think about what’s happening in that state, when you’re literally starving to the point that your body has stopped ovulating, your body’s kind of in damage control mode. And what happens to women who experience HA for extended periods of time is that they experience rapid bone loss in several areas of their body, to the point that if this is prolonged, these women are at a greater risk of developing osteoporosis. I have worked with clients in their twenties who have had extended periods of HA, and that resulted in them being diagnosed with osteoporosis, even at a young age, even in their twenties.

So again, if we think of the menstrual cycle as a vital sign, then instead of just looking at periods as annoying or irritating or whatever we’re talking about today, we’re actually looking at them as an essential aspect of life for women of reproductive age. And if the period goes missing or it becomes irregular, or if there are other abnormal parameters, and it’s not just happening that one time but they are consistent, then it does mean that we should be looking deeper into it. In the case of HA, for women who have lost their periods for several months at a time, that is an indication of this other greater health risk.

Irregular cycles are another example of that. Now, the definition of an irregular cycle may be different to what you think, because we have been programmed to think that all cycles are always 28 days, and everything except 28 days is literally irregular. But when we look at the actual definition of what an irregular cycle is, it’s cycles that vary about eight to nine days from cycle to cycle. So if you had a cycle that was 35 days, and then one that was 45 days, and then one that was 41 days, and then it fluctuated again to 54 days, that would be an example of an irregular cycle.

Now, women who experience irregular cycles are more likely to experience metabolic issues. There’s a link between irregular cycles and the risk of type 2 diabetes. I’ll share a quote from a paper from 2020. Quote, “Irregular menstrual cycles may be a marker of chronic conditions such as diabetes and polyendocrine metabolic ovary syndrome.”

In fact, women whose cycles on average are 40 days or longer between the ages of 18 and 22 have been found to have about twice the risk of developing type 2 diabetes. So this is serious stuff.

And what happens when we experience some of these cycle irregularities and we seek support for it? Well, what typically happens is we’re told to just go on hormonal contraceptives. For the record, hormonal contraceptives may hide the symptoms, kind of sweeping them under the rug.

The most common would be the combined oral contraceptive, which is a combination of synthetic estrogens and progestins. And what that particular formulation actually does to your body, it doesn’t trick your body into thinking that it’s pregnant. What it does is it actually suppresses ovulation as its primary mode of action. It also prevents the full development of your endometrial lining, so that if there was an egg that managed to poke through, there wouldn’t really be anywhere for it to implant. And it also blocks your cervix, which is where the sperm would have to enter, with a thick mucus plug. So there are three ways that this formulation is preventing you from conceiving.

But the main point that I want to make is that it’s suppressing ovulation. So when you suppress ovulation, you’re not fixing an issue with the function of your menstrual cycle. You’re simply stopping it altogether. It’s like you have a leak in your pipe and your basement is flooding, and instead of fixing the leak or replacing the pipe, you’re just going to shut off the water. And then what? Hope that when you turn it on, it’s not going to leak again, right? So there’s a fundamental shift that happens when you start looking at the menstrual cycle as a vital sign.

This knowledge is transformative, of course, on a personal level, as a woman, as a health provider, whatever space you find yourself in in your life right now. It’s transformative to discover that your menstrual cycle is always conveying information to you and that you can actually pay attention to it and glean important information about what’s happening health-wise. Seemingly unrelated menstrual cycle issues can be an important key to unlock what’s going on and to really help you get a handle on what’s happening hormonally, especially if you’re going through a challenging phase of life.

But there’s a whole other level available for women’s health practitioners who not only want to get a handle on this for their own cycles and for their own personal understanding, but want to share this knowledge with their clients and actually use this as a tool to be able to better understand what’s happening in the cycle. I mean, imagine having a day-to-day tool where you can have your clients tracking, or you yourself could be tracking, on a day-to-day basis, and you have a steady supply of hormonal information that’s happening in real time, where you don’t always have to wait for a lab test. And essentially, that’s what the menstrual cycle does.

And of course, this is where fertility awareness charting comes into the conversation: the ability to actually track what’s happening on a daily basis. And the most common signs that we track include our cervical fluid, as I mentioned already. Basal body temperature changes can let us know if we’ve ovulated, so it’s a way for us to confirm ovulation. We can track cervical position changes. You can track hormonal changes. And so there’s a lot of different ways that we can start tracking and paying attention to what’s happening in our bodies in real time.

If this is all piquing your interest, I have a few resources to share if you’re ready to go down the rabbit hole in all things fertility awareness and using the menstrual cycle as a vital sign. The first resource I want to share is my book, The Fifth Vital Sign. You can head over to fifthvitalsignbook.com and grab the first chapter for free. So that’s a great resource.

And if you are a women’s health practitioner who is intrigued about how you may be able to incorporate this with your client work, then we’ve created a special resource, How to Interpret Virtually Any Chart Your Client Throws at You. You can head over to fertilityfriday.com/chart and grab that for free as well.

So whether you are a long-time listener or a new listener to the show, one of the most important ways that this podcast has really grown has been through word of mouth. So all of you out there who’ve been sharing the podcast with other listeners around the world, that is really how we have grown all these years.

If you have not yet had an opportunity to leave a review on Apple Podcasts, I would be absolutely thrilled and honored if you left an honest review. It’s really helpful. It helps people find the show and, of course, lets people know what to expect. And I do try to read all of the reviews. I think we’re up over 700 at this point, which is really, really incredible. So I’d really appreciate it if you took the time to leave a review if you’ve never done that before.

So with that said, I hope you have a wonderful weekend whenever you’re tuning into the show. And of course, as always, until next time, be well and happy charting.