Being aware of your body will always give you power. Whether you are using Western medicine and manipulating your cycle with drugs or using all natural means, it is essential to know what a healthy menstrual cycle looks like. But what exactly is “regular” anyways? In all honesty, it depends on each woman individually.

Throughout your treatment, we will monitor and break down your menstrual cycle into phases. By meticulously observing your temperature and hormone levels, we will be able to familiarize ourselves with the specific menstrual phase you need help with. Once we regulate and know how your cycle functions, it will be a breeze to pinpoint your ovulation date and plan for a night of baby making!

The ideal cycle should last 28 days, but as established above, anywhere between 25-35 days is a good range. A balanced menstrual cycle will present little, to no PMS; as well as bright red blood that has no blood clots. There should be no breast tenderness or cramping, which points to stagnation in the liver and gallbladder channels. Lower back pain and bloating, or edema, which are related to the kidney channel, should not be experienced either once the cycle is balanced.

I realize that some of you may be all too familiar with this information, but for those who are starting from scratch and want to understand the basics of their cycle, the following section is for you! Regardless of your familiarity with this material, I urge you to read through and learn how acupuncture and herbs address each menstrual phase individually.

Phase I: The Yin Phase

The time period before ovulation (days 1-14) is known as the follicular phase. This is the phase in which follicles grow and one follicle becomes dominant. At ovulation time, the dominant follicle releases an egg. The follicular phase is considered the yin part of the cycle in Traditional Chinese Medicine, and is closely associated with the Kidney yin and blood. The yin hormone, estrogen, dominates this phase. During this phase, elevated BBT readings could indicate Kidney yin deficiency; on the opposite end, low BBT reading point towards a deficiency of Kidney yang.

All women have cervical discharge throughout the month. The discharge is healthiest when it is clear to white, not any other color. The discharge that indicates fertility is called S-type and is that which begins approximately 6 days before ovulation with the rise of estrogen. This discharge will be clear, stretchy and have the consistency of raw egg white. A moderate amount of discharge means increased fertility, since you are basically creating a straight pathway for sperm to enter the uterus! This discharge is considered yin in nature. If you are lacking this type of cervical discharge, you might be yin deficient. (Later, in the Diet and Lifestyle Tips, note the tips that enhance yin). Some drugs, such as antihistamines, atropine, N-SAIDS, and antidepressants dry up or interfere with cervical fluid.

Phase II: Ovulation

Ovulation is the release of the precious egg from the follicle! Given that the egg lives for 6-12 hours after it is released, and the sperm lives for up to 5 days, the prime time to start engaging in intercourse would be 3-4 days prior to ovulation, 48 hours being the optimal time. But remember, no intercourse on the day before ovulation! We want to ensure that his ejaculate has a high amount of sperm, which could be decreased by a recent emission. So, hands off the honey pot!

This phase is closely related to the Liver qi and blood in Traditional Chinese Medicine. Pain and bloating during this phase indicate blood and Liver qi stagnation. BBT readings should reflect the gradual temperature increase in the body as yin starts transforming to into yang.

Phase III: The Yang Phase

Approximately 5-7 days after ovulation, we reach the luteal phase, which lasts about 14 days. This phase is more yang, or warmer, in nature and is identified by a rise in progesterone. As you probably guessed by now, BBT readings should reflect this warmer stage of the menstrual cycle by remaining about 4/10 of a degree higher than in Phase II.

At this point, as the egg travels down the fallopian tube, the ruptured follicle becomes a corpus luteum, which in turn will cause the progesterone spike. The purpose of progesterone is one, and one only: prepare, prepare, prepare! As progesterone triggers the small blood vessels lining your uterus to increase blood flow, the endometrium is nourished for safe implantation of your precious, fertilized egg. In TCM, this phase is governed by Kidney yang and Spleen qi. Women suffering from luteal phase defect would benefit from acupuncture to boost progesterone levels during this time. Any spotting during this stage would indicate qi deficiency and/or blood stasis, while extreme breast tenderness reflects qi stagnation in the absence of pregnancy.

If there is a pregnancy, the embryo begins secreting human chorionic gonadotropin (hCG) in order to produce more progesterone. At this point, BBT readings might show a slight temperature increase and progesterone continues making that uterine lining as thick and rich as possible. On the contrary, the corpus luteum ceases progesterone production and along with a drop in BBT, the uterine lining is shed and menstruation begins.

Phase IV: PMS

Without fertilization and implantation, your body moves into the premenstrual phase for the following 2-7 days depending on your constitution. At this point, the warm yang energy transforms back into yin; this will show in BBT readings as a dip in temperature. In this stage, both qi and blood must be flowing freely in the body to reduce those nasty symptoms, such as irritability, pain, constipation or diarrhea, headaches, bloating, nosebleeds, mouth sores, muscle aches, dizziness, vaginal irritation, nausea and appetite changes. By using acupuncture and herbal medicine to regulate your cycle, you can eliminate many of these premenstrual symptoms, while restoring health and balance to your body naturally.

Phase V: Menstruation

Aunt Flo is in town! While some of you might roll your eyes at the fact that you are once again, on your period, it’s not entirely a bad thing. It might take a couple of months to regulate your menstrual cycle, but the closer we get to a “regular” 28-day cycle, the higher the probability of a pregnancy. Your period is nature’s way of telling us that everything is working in there!

Think of the first three days of your period as a hormonally neutral period; it’s a fresh start! This stage is considered a time of resting and begins on the first day of bleeding, so spotting doesn’t count! In order for the uterine lining to shed, enzymes must liquefy the endometrium. While BBT should drop during this first day, women suffering from endometriosis might notice elevated temperatures during their period.

In my professional opinion, unless you are suffering from severe cramps, you should take a break from treatment during these first days. According to TCM, women should not exercise strenuously or have intercourse for the first three days of menstruation. Simply put, listen to your body and use these days as a much-deserved-time-out.

The more we learn about your menstruation, the better we can understand the state of your endocrine and ovarian balance. Once you are regulated, your flow should be smooth and free of clots; blood will be red, not brown or black and the consistency should not be sticky nor watery. The bleeding should last approximately four to six days and be free of any pain. Abdominal cramping and lower back discomfort are indicative of imbalances in the Kidney channel. The difference between sharp, stabbing cramps, and dull, achy pain differentiate between qi deficiency and qi stagnation.

Watery and pink blood could be indicative of Spleen qi deficiency, which might lead to luteal phase defect. If the blood flow is scanty or lasts a day or two, this means there is a blood deficiency affecting the uterine lining that has been linked to a lack of estrogen during the follicular phase. Scant, sticky brown blood shows the need to tonify and invigorate the blood; this is evident in women diagnosed with endometriosis. Menstrual cycles shorter than 28 days, along with bright red and heavy bleeding indicate heat. Excessive bleeding lasting more than seven days, or occurring at times other than menses, can be attributed to qi deficiency, blood stasis, or excess heat. My article, “A Bloody Mess”, expands on several characteristics of menstrual flow and explains how PMS differs across these TCM patterns.

Love and serenity,

Dr. Zakes

About Dr. Carolina Zakes, DOM, AP

Fertility in women's health specialist.