The Female Cycle: What is Normal, Anyway?

We all have a cycle.  For one reason or another, many of us are not aware of what constitutes a normal cycle, let alone how it all works.  How can you know something is wrong and seek out appropriate treatment unless you know what your cycle should look like?  Better yet, how can you be personally empowered to work practically with your cycle (i.e. keep your cycle regular) and/or prevent yourself from slipping into a pattern of imbalance? And further, how can you immediately recognize when you slip past the ability to self treat and need to reach out for help?  This is what this post is all about.  If you are interested in knowing more about yourself or your daughter’s cycles, read on!

Normal Cycle Overview:
Total cycle length from first day of bleeding until the next first day of bleeding should fall between 26-35 days, closer to 28 days during teens-forties, shortening a bit during early perimenopause in your mid-to-late 40’s (the timing generally follows the women on the maternal side of your family). It will then space out farther and farther until you notice you haven’t bled in over a year, at which point you’ve hit menopause (average age 51, with a range of ages 48-55, again following maternal bloodline).  Your cycle should follow the same approximate length every month, varying by 1-3 days but no more.

A normal cycle should be easy, and go fairly unnoticed (with no outstanding or cyclical symptoms of any sort all the way through). There are many variations in cycle, woman-to-woman, and for the most part women will find their normal within the first few years of their first period. It is most important is to know what YOUR normal is, and being sure it falls within normal variation ranges. So then YOU can realize when your cycle changes from your normal. For example: if your cycle is ALWAYS around 35 days and all of a sudden you’re bleeding every 26 days I would consider your cycle “short for you”  and possibly a sign of imbalance, even though 26 days is still within a universal range of normal.  

Cycles can shift and find a new regular after giving birth.  Sometimes previous patterns of imbalance, especially those of stagnation (more on this later), will resolve through a birth.  Sometimes a birth and the postpartum time will leave your body deficient which may create a new pattern of imbalance.  Your first cycle postpartum may be more painful or just plain different, but as long as it’s within reasonable limits it is still considered normal.  Your cycle should improve and be back to your previous or a new version of normal within 3 cycles, on its own.  

Although cycles may shift a lot during perimenopause, the entire process should be symptom free continuing to come and go fairly unnoticed with no outstanding symptoms.  
 

Normal Cycle Details:

First Half of Cycle: Follicular Phase
First day of bleeding is considered Day 1 and should start without symptoms: no pain or cramping, or stabbing pain, no pulling sensations or needing to sit, no fatigue, no mood swings and definitely no curling up in bed moaning and unable to function.  Slight or mild sensations such as being ‘aware that you have a uterus’ fall within normal.  If you’re tracking basal body temperature, readings will plummet just prior to menstruation and marks that bleeding is about to begin.

Bleeding should last 5-7 days.
First hours thru first day: spotting to light flow; slightly darker or browner or red.
Middle 2-6 days:  medium flow; deep blood red;  2-6 medium pads per day.
Last day or two: spotting; tapers off to slightly darker or browner again for a day or two.  

Cervical fluid--once bleeding has stopped--will be only slightly moist but increasing daily until 3-5 days prior to ovulation when the mucus is enough to cause tissue paper to glide or slip when you wipe after going to the bathroom. The day or two immediately before ovulation there is obvious, stringy, egg-white-like mucus.  In your teen’s and 20’s cervical mucus will be more copious and appear earlier than in your 40’s.  Basal body temperature throughout the first 2 weeks will remain low, usually in the range of 97-97.6.

Second Half of Cycle: Luteal Phase
Ovulation normally happens around day 14, give or take a day or two.  Basal body temperature will spike to 97.7-98.2.  Cervical mucus will dry upon ovulation, giving a definite signal that it has completed.  Some women can tell that they are ovulating, but cramping or sharp pain should not occur.  In other words, you may be able to feel something but it would be short lived and insignificant.

For those that conceive, the fertilized egg moves freely through the fallopian tube to implant in a healthy endometrium.  There should be no pain or outstanding symptoms during this part of the cycle.

Mood and energy should remain stable throughout the second part of the cycle.  Temperatures should remain high and should not fall below your highest pre-ovulation temperature until approximately 14 days after ovulation when, if you’re not pregnant, temperatures should drop, signaling bleeding to begin.
 

How Does Chinese Medicine Explain the Female Cycle?
Traditional Chinese medicine sees the female cycle as a reflection of the natural ebb and flow of yin (substance) and yang (energy) within the body.  The cycle is broken down into 4 phases with different processes taking place during each of these phases.  Understanding what process happens when, and what symptoms might arise if the process is not happening correctly allows you to treat any symptom that might arise at any phase. Of course the cycle is not seen as separate from the whole so other patterns of disease or imbalances that you’re experiencing can affect your cycle.  When this happens, it is a sign that the pattern of imbalance has gotten particularly deep.  In other words, being frustrated at work or at home should not get to the point where you’re packing it into your uterus and creating cramping and pain during your period, but it certainly can! Shouldn’t, but can! Teaching you how to manage your frustrations emotionally while simultaneously teaching your body how to manage your frustrations physically is key to balancing your cycle and exactly what Chinese medicine excels at.  There are books upon books written on this subject.  In fact, there are entire Graduate degrees on cycle health, imbalances, every cycle related symptom you’ve ever heard of and rare ones you haven’t, and how to treat each one.  

For the sake of this blog post I will stick to the simplest most common patterns and offer practical solutions for managing them.

The First Half of the Cycle: first day of flow to ovulation is the Yin/Blood part of the cycle, this is further broken down into:

Week 1: Menstruation and Free Flow (the uterus empties and the emphasis on the free flow of blood)
Imbalances in the first week of the cycle tend to have to do with blood not flowing freely (e.g. irritability, pain, cramping, clots and dark blood, are all signs that blood is not flowing freely).  In some cases fatigue and depression are more common, in this case you are deficient.

Self Care if not flowing freely:
Movement, especially cardio, will help keep things moving freely.  Often times, if your tendency is to stagnate, then working preventatively by finding time for extra movement in the week before your period is helpful.  For some this means walking daily for 30 minutes, for others this means hiking for a few hours a week, and yet for others this mean cardio kickboxing daily.  The point is to feel your blood coursing through your veins (free flow).  If you’ve adequately moved you will feel good, not drained.  If you find yourself drained then step it down a notch.  Beware of heavy greasy foods or complex meals with too many ingredients.  Vegetable rich and simple meals will help you stay flexible.  Adding vinegar to foods if you enjoy the taste can also help.

Self Care if deficient and tired:
Nourish yourself!  Eat well, go to bed on time, consider taking a blood tonic if you know you’re anemic, there are some fantastic herbs to build energy and blood quickly.

Week 2: Building of blood and yin.
This is the time of the month in which the body focuses on building the tangible parts necessary for reproduction: a rich endometrium, abundant and sufficient follicles and eventually a fertile and genetically sound egg.  All of this takes blood and yin to create.  

Imbalances in the second week tend to do with not having enough (quantity OR quality) blood or yin to produce a healthy endometrium, cervical fluid, or follicles.  In all of these imbalances you would see issues with the quality or quantity of the above things: :bleeding would be short, scanty or even dry and brown, or possibly light and pale and more runny.  Cervical fluid will be lacking or never get really slippery with stretchy egg-white mucus, or possibly only last 1 day.   In the case of fertility testing you might see a thin endometrium, low egg quality or quantity, low ovarian reserve (AMH), or high FSH or estradiol. You might also see an early or delayed ovulation (and therefore a short or long cycle) as the body tries to figure out how to ovulate with inadequate substance.

Self Care:
In these cases building yin and blood with acupuncture and herbs and/or seeing to it that your lifestyle doesn’t burn through your stores is important.  Eat well, eat regularly spaced meals, and consider more blood building foods. Go to bed on time and get rid of distractions or just do less at once.  Ponder life, journal, meditate, or spend time at a hobby that grounds you.  Take a good hard look if you tend to overdo it and make adjustments.

The Second Half of the Cycle: Ovulation to first day of flow is the Yang part of the cycle

At this point blood and yin should be full.  This is the active part of the month beginning with the bursting forth of the egg, the movement through the fallopian tube, the potential fertilization and implantation as well as creating and maintaining the warmth necessary to hold a potential fetus in place.  

Ovulation
Ovulation marks the beginning of week 3 and is the bursting forth of energy from substance or the switch from yin to yang in the cycle.  In order for ovulation to occur successfully, yin and blood must be full.

Imbalances in the small window of ovulation are difficult to self-treat without first addressing any issues that might be present in the first part of the cycle.  In theoretical terms, you can almost think of it as trying to light (ovulation) a fire (second half of the cycle) on a pile of wood (substance or first half of the cycle).  Do you have enough wood?  Is it too dry or too wet?  Is there kindling?  If you don’t spend enough time and attention gathering the right pile of wood, the fire doesn’t really stand a chance.  Ovulation will be delayed if there is not enough substance to fuel the energy (low follicle count or immature follicles or hormone imbalances) or if there is stagnation.  Ovulation can also be early if there is too much heat in the body.  

Week 3
In those who are trying to conceive, this is the time the fertilized egg is moving through the fallopian tube.  While free flow is still an important thing to ensure the egg travels freely, it also needs enough warmth and energy to succeed.  Whether or not you’re trying to conceive this is the warm/yang part of your cycle.

Week 4
In those who are trying to conceive, this is the time the egg has implanted and focus remains on keeping the body warm and maintaining yang.   

Imbalances within this second half of the cycle usually revolve around not having enough warmth or if there is stagnation and energy is not flowing freely there can be irritability, depression, anxiety, breast tenderness or pain, and abdominal pain or bloating.   

Self Care:
Dress warm, eat warm foods and warming foods.  Most fertility self help books have caught on to the idea of eating warming foods which are great for those that need to build warmth.  Keep active to maintain warmth!  Get out and get your energy moving while taking care to keep warm.  If the water feels cold, this is not the time to go swimming.  If you go for a run, make sure you keep your body warm especially after you sweat.  Take care not to overdo it but if you’re feeling stuck, angry, irritable, anxious, breast tenderness or crampy, then get moving!


Perimenopause and Menopause

The cessation of menses is a sign that yin and yang are waning.   Usually the start of perimenopause leans towards insufficient yin causing the cycle to shorten and be less fertile.  If yin wanes much faster than yang, typical menopausal symptoms arise. Hot flashes, night sweats, and irritability are common symptoms but are a sign of imbalance and can be addressed through Chinese medicine. Once menses have stopped for a year, any bleeding is abnormal and a sign of imbalance.  Although yin and yang wane to the point of being unable to support a menstrual cycle, yin and yang continue to ebb and flow through our lifetimes and many women continue to notice this monthly fluctuation from cold to warm way beyond menopause.

For anything that seems beyond your ability for self care, or if you simply have questions and want a better understanding of your own cycle feel free to contact me, I’d love to help.