#292 | The Wisdom of Our Menstrual Cycles with Lisa Hendrickson-Jack

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Onto the show:

Lisa Hendrickson-Jack is the author of The Fith Vital Sign, a book detailing normal and abnormal parameters around menstruation and fertility and what your menstrual cycle reveals about your health. She refers to her period as "her secretary", who once per month brings her all the unfinished business in her life and plops it down on her desk to deal with. Most of us think of PMS as an annoying, unavoidable side effect of our monthly flow. Lisa challenges us to see it as a dutiful assistant encouraging us to face the pesky tasks, emotions, people, relationships, jobs, etc. that we tend to brush off or continually avoid during our less open, vulnerable weeks of the month.

Additionally, we discuss the abnormal societal normalization of period pain, what your cervical position can tell you about where you are in your cycle, and how your period flow volume can clue you in to your fertility health.

Finally, Lisa responds to your most pressing questions on whether or not you need to tailor your exercise routine to your cycle stages and what it might mean if your postpartum period is mysteriously absent.

You can learn more about Lisa on Instagram or her website Fertility Friday

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Transcript

Women who do report period pain tend to have prostaglandin levels upwards of four times the levels of women who don't. So I shared this information so that we can kind of start thinking differently about the pain. It's obviously extremely common for women to experience pain with their period.

And you mentioned a little bit ago about understanding how much you're bleeding and that too little. We think that a light period means better, right? But too light of a period is associated with a higher risk of fertility problems and miscarriage, because so many women struggle with early miscarriage or fertility issues, and if you aren't bleeding enough, that's a sure sign that you have insufficient hormones stimulating the uterine lining.

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Lisa, Hi, I'm Lisa Hendrickson-Jack, author of the Fifth Vital Sign and Real Food for Fertility. And I have been a fertility awareness educator for many, many years. Really excited to chat with you today about all things menstrual cycle.

So how did this become a passion topic for you?

Well, I mean, it's a long story, so I will truncate it, but my first periods were heavy and painful, and so I was put on the pill by choice at an early age because I was super active. I was I was in ballet. No one wants to be in a leotard, bleeding out, right? So that wasn't going to work. But what happened in my case was that I wasn't taking the pill for birth control, so when I started taking it, and my periods, my fake periods, my withdrawal bleeds, became easier to manage. I thought to myself, great, I'm fixed. And so I would periodically come off of the pill, and lo and behold, my actual period kept coming back, and it would be just as ravenous as it was initially. So I didn't have the language or the understanding to explain what was going on, but I did experience that the pill periods were not the same thing as my real periods.

Lisa, how extreme was that you said these heavy periods? Can you just get into some details on that, how frequently it came and how heavy they were, and how long they lasted? Well, so at the time, my periods were about like 35 days, ish to 40 days. So my cycles were on the longer end in those early men's training years. And the heaviness of the periods, I mean, they were heavy from the get go, I would have to change my pads every two to four hours. And, like, it was pretty significant. And the pain was also pretty significant. I always needed to take, you know, a Tylenol or an Advil. And in my early 20s, I would, you know, be on the floor, typically, at least once or twice a month. So it was, it was pretty significant. And the thing is, though, that when I actually needed birth control, I didn't feel comfortable taking the pill, because I had read the insert and it tells you to take it at the same time every day, and I hadn't been doing that because I had never been taking it for birth control. And so I had decided, being a child of the 90s, that was the HIV AIDS era, where they talked about condoms all the time, so I actually felt like condoms were a legitimate choice, which is very different to a lot of the younger generation. So I decided that I wanted to kind of figure out what was going on with my cycles. I didn't want to be on the pill forever. I so I decided I was going to use condoms. And then it was right around that time that I discovered fertility awareness charting. So that changed everything, because then I felt a lot more empowered. I could actually identify when I was fertile when I wasn't. And so using condoms became less of a scary thing, because I was able to actually identify my window, start using the method for birth control, all these great things. And then along my journey, that's when I learned a lot more about the menstrual cycle and how the cycle is a vital sign. And it took a while for me to actually change my cycles, because my first foray into fertility awareness charting, ultimately was the charting, and it wasn't the actual improve your cycle hormone balance piece of it, until a bit later, but it certainly did change everything for me, and eventually I was able to see significant improvements in my overall cycle length. I don't have painful periods anymore. I just I don't have those kind of issues that I used to because of all the different changes that I've been fortunate to make over the years. But that's essentially how I got into this work. I just want to comment on the title of your book, which is the fifth vibe. Sign, which I think is a brilliant, brilliant title. Did you come up with that?

Well? So I am not the first person to identify the menstrual cycle that way. So there's a bit of a like a movement in that respect. And in the book, I talk a little bit about that, about how there's a variety of different health organizations that are now identifying the menstrual cycle as a vital sign, particularly in the realm of teenage girls. So a lot of the research talk about that specific teenage years and how medical professionals should be asking questions about the menstrual cycle and should be screening these girls so that if they're 1617, they're not having their periods yet, that they should really be looking into that because of the effects that it could be having on health. So for me, I didn't necessarily invent that idea, but it was a very profound shift in the way that I was looking at the menstrual cycle, and that was essentially what I wanted to focus on. I wanted to focus on, you know, obviously it's important to have healthy cycles when you're trying to conceive, for fertility and everything like that. But what had been the most profound shift for me was to actually think about your cycles positively. You know, instead of thinking of that dragon week or shark week or whatever it is that however we talk about it negatively, to be able to think about it positively and to understand that it's an integral part of our health, and to understand that we can monitor it like we monitor other vital signs, if we know what the normal parameters of the cycle are, then if our cycle is falling outside of those parameters, it actually tells us something. And if we are able to improve our overall health and our situations, we're able to get that cycle into normal parameters. That is not a message that I had received. I remember when I was younger, I mentioned that my cycles were on the longer end, and I went to a doctor and asked about that, and they told me to go on the pill, and they said there was nothing I could do, right? So I had the experience like most women, where you're literally told that regardless of what cycle issue that you're facing, nothing can be done about it, and the pill is the only option. So there's a lot of reasons why I definitely wanted to focus on that aspect of it. And of course, titled my book The fifth vital sign.

It's such a it's such a great concept, because it's, it is one of the things that a teenage girl can actually visually see, engage and learn about herself. And it truly is a vital indicator of what is going on in your body, metabolically, it is an indicator of your health. And young girls aren't looking at their respiratory rate or their blood pressure, or they're not they're not going to the doctor and looking at those things, but their period is something that they can track. It's something they can see, it's something they can understand. It's something they can get educated about and start to learn about what's working well in their body and what possibly is not. So we would really love to talk to you today about the what the menstrual cycle has to teach us. You have a chapter in your book titled The wisdom of the menstrual cycle, and you start the chapter off by saying, my menstrual cycle has been one of the greatest teachers in my life. So can you start to talk to us a little bit about what a normal menstrual cycle looks like, and how we know if we need to pay more attention to it, what, what are the, you know, abnormal things that might come up, and what we can learn, what we can learn about our body and our health from observing our menstrual cycle. Absolutely, I have a thought that I want to share with you, because, you know, a lot of my work is really focused on the science heavy part of it, what we're going to get into and the cycle parameters and things like that. And when I wrote that particular section of the book, and I mentioned that it's been one of the greatest teachers in my life. I was actually talking about an aspect of the cycle that I don't always hang out and talk about a lot, and that is the kind of experience of being a woman with a menstrual cycle, you know, having those ups and downs over the course of your cycle, and how that can affect you emotionally. So when I was kind of writing that section and thinking through that, that's part of the book, I was thinking and reflecting on, you know, some of the challenges that I've gone through in my life. So everyone goes through things that are good and things that are bad, and I think about some of the things that were really hard that I had to deal with when I was teenager, you know, family issues or relationship problems or whatever it is, right? And what I always found was that, you know, as I went through my menstrual cycle, I would joke that my period was like this inner secretary, and anytime it was time to have a period, she would just throw all this stuff on my desk, the stuff that I didn't want to think about, the stuff that I didn't want to deal with, the hard things that maybe there was, like, some feelings that I didn't want to address, but it was always there. It was just throw it on my desk, and then it's like, okay, well, I guess we're doing this now, right? And so what I found, and I know this is a little bit of different direction, but like, we can talk about both aspects, of course, but what I found was that having that monthly experience. Experience of going through the different phases of different emotions. So, you know, one of my, two of my favorite people, Alexander Pope and Shawnee Hugo werelitzer, wrote this book, wild power. And they talk about this concept of, you know, the seasons of the menstrual cycle. So ovulation being your summer, you know, as your your period being the winter as you move into that follicular phase being the spring leading up to the summer, and then as you kind of come down off of that ovulation and that fantastic ovulatory energy moving into the autumn, right? And so having that experience, I feel like, has forced me to deal with a lot of things over the years. Has forced me to kind of go through the emotions. I couldn't stuff them. I had to go through them. I had to work through them. I had to kind of deal with that stuff and and grow up, really. And then there's also the practical aspects of it. So when you're charting in a kind of a system, systematic and detailed way, you see, I see the cycle ups and downs. So I've charted through now three pregnancies, well, four pregnancies, one miscarriage, three children, three postpartum phases. I'm breastfeeding my youngest daughter, so I'm still in there. I've charted through a variety of just, you know, different life events and things like that. And so you learn to have essentially, a conversation with your body. You know, it's like your body's always talking to you, but unless you're charting, you're not really listening to what it's trying to. Not really listening to what it's trying to say. So you notice that if I don't sleep very well, if I don't eat very well, if I don't, you know if there's certain supplements that help my body, if I don't take those, like, if you don't get into those things, you notice that your cycle is different. And so when I say that menstrual cycle is one of my greatest teacher teachers, I mean it in both that emotional kind of way, forcing me to kind of grow up and deal with things that were hard, but also helping me to understand my limits, what works for my body, and to always encourage me to stay on top of my habits and always continually improve my habits so that my cycle never gets out of control. I can absolutely relate to that feeling. I think most people probably can. They just don't think about it in that way. We just sort of write it off as well. The week of my period, I have less energy, or I feel more sad, or have PMS and things like that. But what it really is, is what you're saying is it's bringing to light, it's bringing to head the hardest things that you're dealing with that in your earlier part of your menstrual cycle, or particularly in your ovulatory phase, you kind of just sail through those things, and you feel like you have good solutions to everything, but maybe you haven't solved those problems. And then you hit that week leading up to your period, or a few days before, or especially during your period, where it like, kind of hits you like a truck, and you're like, Oh, dang. Like that feeling is still there, that hard thing is still really hard, and you have to face it more head on. I hadn't really thought about it that way myself, well, and sometimes it gets pushed off. You're just like, Oh, I'm just irritated with my husband or, Oh, it's the kids. But like, I always say, it's not like, when you have your period, or leading up to your period, you're not mad that the sky is blue, you're not looking at the toaster, and you're just like, hey, like, you're not insane that there's those are things that were bothering you. Anyways, it's just that usually you kind of like, let it ride, right, like you have more patience, whatever. But during that time, the things that irritate you, they really irritate you more because the secretary puts them on your desk, and I feel like that forces you to kind of deal with those things that you might not have dealt with. And if I hadn't had my period to kind of force me to do that, I feel like I would have tolerated a lot of people, you know, bad boyfriends, bad jobs, like all these things that you know, like, if you're kind of attuned to what's going on and you're paying attention to what your cycle is trying to tell you, you gotta get rid of some of that stuff. I feel like I feel like I have a better quality of life because there's certain things that just didn't make the path, like, if you can't make the period cut, you can't stay. If you can't make the period cut, you can't stay. That's great line. It's so interesting. Is this what you meant in the book, in your chapter, the wisdom of, well, the wisdom of the menstrual cycle. That was that chapter in particular, was the kind of so like I said, most of my work is really focused on the very tangible scientific aspects, right? But that chapter was my nod to this additional aspect of the cycle, and that's why I brought in so many of those interesting pieces into that chapter, the concept of the seasons of the menstrual cycle, and just that concept of that wisdom, that inner wisdom, this inner guidance system that's telling you so it's both. And what's fun about it is I don't always talk about this aspect of it, because ultimately, I've just chosen my my path. I've chosen not to make all of my work about this more esoteric aspect of it. But it is there, and it has had a profound effect on me personally as well. And it, and again, the IT intertwines with the health aspects that we can get into a lot more, because a big part of it as well is that. So for example, having had painful periods, you know, it throughout my early 20s, and. My teens, I learned that if I consume only gummy candies, or if I eat all of this bad stuff, or if I write all the things, that that's going to make it worse. So I also had to learn how to work with my body, and I was paying attention to, like, what is what happens when I do this, or what happens when I do that, like, what actually helps me to have balanced hormones feel better? And this is what I help my clients with and my practitioners with as well. Because when you can track the cycle, you can actually start participating. Like, your body's always giving you feedback, but most of us aren't paying attention, but when you start charting your cycles, you can actually see that feedback. It's like, oh, wait, I actually have three days of spotting every time I'm leading up to my period. But if you look at the whole picture and identify some of the things that you might be doing to contribute to that, eventually you might be able to have that stop, because now you know what you were doing to contribute to that. So it's both, it's the health aspects, but it's also the emotional aspects and the awareness of it all. What do you have women track other than the day their period begins and ends, and obviously, if they have spotting or something, do you have them track their cervical mucus, if there's if they're ovulating? Do you have them go so far as to take their temperature, like, what? What's in your whole tracking system?

Yeah, that's a great question. So I mean, I teach a version of the Cynthia thermal method. So the core signs that we track are the ones that you mentioned. So you do track your periods, you track your cervical fluid. So whether it's the creamy white type cervical fluid or the clear, stretchy like raw egg white type cervical fluid. So you would track whether you are having dry days with no mucus, or whether you're having mucus days, or whatever's going on there, you can track your temperature, of course. So taking your temperature first thing in the morning, before you go out of bed, before you get out of bed, and then putting it on your chart. Cervical position is an optimal optional sign that you can track. So for women who are comfortable, they can insert their finger into their vagina once a day and check their cervical position. I was actually just talking about that with some clients before this call, and we were going kind of in depth say more about that. What do you mean? Check their cervical position so they're they're touching their cervix, and wouldn't they? I, I'm naively am thinking, doesn't it always feel the same every time you touch it? Or does it What are you looking for?

Yeah, that's a great question. So with the cervix, similar to the mucus and the temperature, these are signs that we track, because they do shift and change based on where we are in the cycle. So these signs are receptive to what's happening in our hormone cycle. So when you have your period, once your period is done, you're entering into your pre ovulatory phase. And what's happening in the pre ovulatory phase is that your ovaries are essentially preparing to ovulate. So in your in your ovaries, you're having these follicles that are developing and growing, and eventually one is chosen to reach maturity, that's the one that's going to ovulate. And as these follicles develop and grow, they're making estrogen. And then once you ovulate, the follicle then changes into the corpus luteum, getting into the science piece of it, and starts making progesterone. So we have estrogen in the pre of primarily progesterone is dominant in the post of and so when it comes to the mucus part, the estrogen is what triggers that mucus production. So when we're clear, stretchy or creamy hand lotion type cervical mucus that's a result of the estrogen, in terms of the cervical position, the estrogen softens the cervix and opens it, and the cervix ends up higher in the vagina. So it's super fascinating. I know that was one of the first things when I started charting that I found like, I'm a super nerd, and I found this to be so interesting that you could actually feel the change in your cervix. So you would think that it feels the same all the time, but if you actually check it once a day throughout your cycle, it actually feels different.

You mean it feels farther away, it's a farther reach. You mean that? Or do you mean the angle of the cervix is, is tilting both. Wow.

So when you are so if you have not had any babies come out of your vagina, then your cervix feels, when it's closed, like the end of your nose. So right now, if people are listening, I am touching my nose, and if you want to touch your nose, you can touch your nose, but this is what your cervix feels like the end of your nose when you have not had a baby, and it is in that kind of closed position. And when we say higher or lower, it's like, if you literally picture inserting your finger into your vagina, it's like, how far do you have to insert it? So if it's lower, you insert it like, you just boop it's there. And then if it's higher, then it's like, you have to put your finger in higher. And then it's like, Oh, wait. And then I've had some clients that are like, can barely feel it because it's so high at different times of the cycle. And then once you're in that fertile window, and the estrogen has softened the cervix, this is when you're leading up to ovulation, and the mucus is also flowing. Then if you were to put your lips together and touch your lips, that is kind of the softness that you may feel when you're touching the cervix. So it's quite different. It's that. Actually very interesting. It takes at least a cycle of checking for you to get the hang of it, and it is optional, because not every woman is comfortable inserting their finger into their Regina and checking their cervix. But it is a real thing. It's a secondary sign, and it helps to corroborate the other two main signs, which are the cervical mucus and the basal body temperature after ovulation, the cervix tends to go back to that low, firm, closed. So it's quite a dramatic difference between the softness and openness and height and all of that during the window, versus the kind of like closed, low in position and like firm to the touch. So it can be really helpful when you're learning to chart to be able to identify that piece of it.

Does the angle change? You were saying the angle changes as well. Yeah. So, So picture this. So this is the like the bum, right? Like this. This my hand here is the uterus, and this would be the cervix. The cervix is the opening to the uterus, right? And this is her bum, okay? And this would be the vagina coming out. So when you're in the midst of that fertile window, the uterus typically is is pointing down. So if you were to insert your finger into your vagina, you would actually just feel the cervix here like and it would feel like the mouth, like I said, the opening. But after ovulation, or when the cervix is close it like the the uterus actually changes in terms of its placement. And so sometimes what you'll find is, when you're reaching in, you might have to reach around.

So that explains, in part, why we get more bloated in the week before our period. Because you just demonstrated the fundus, or the top of the uterus really moving toward the belly, like protruding out into the belly, and the cervix goes back and behind, so that you're less likely to, you know, get anything up and in there, and it comes forward during ovulation to meet the sperm. Mm, hmm. One of the most striking stories about the because you don't think about your like the movement of your uterus like you don't think about it moving at all. But I've had many conversations with abdominal therapy practitioners that talk about the important role that they're playing when women have different issues, whether it's pain or adhesions due to other issues, for example, where the uterus doesn't have that freedom of motion because that can contribute to period pain and things like that. So I've had conversations with practitioners of these arts who are talking about how they'll, you know, viscerally manipulate the uterus and kind of gently move it so that the adhesions are lessened, so that it has that freedom of motion. And there's this one story, and I've heard this many times, where if you have a woman who has had an ectopic pregnancy and lost one of her tubes, you know, and then proceeds to get pregnant later on. And, you know, women who ovulated on the one side without the tube, where the the uterus actually moves around, and it can kind of collect the like, the egg even on the other side, so there's, actual, like, you know, records of this happening. So the uterus moves more than we think, and has when it's when it's healthy, and when you're able to, like, when there's no adhesion, so when there's no issues and things like that. That's really interesting. My physical therapist actually told me, I'm obviously women can get headaches premenstrually Because of the hormonal shifts. That's probably the biggest contributor. But she also said, Well, it's also because your uterus is tilting, and when your uterus is tilting, it's pulling more on the fascia, and your uterus is connected to your neck, shoulders, head, and so it all creates more strain in the body, and especially when the uterus is contracting, trying to, you know, expel the lining, it's going to be more prone to triggering headaches, so maybe that explains that a little bit as well. But I'm really curious, when you're talking about tracking, we talked about the physical signs that that girls and women can write down to understand their period, but what emotional parameters do you encourage people to write down, or lifestyle parameters, like, should they be writing down how many hours they sleep, what time they go to bed, what about what they're feeling, what are, what are a few key things that they can track outside of just the physical aspects?

Yeah, I love that question, because it's, it's very custom to to each client. So what I shared was the basic kind of, you know, things that that we would track from that fertility awareness method standpoint. But I have clients track a variety of different things based on what is important to them. So what I find is, when I'm working with clients, there's typically they have specific goals, they have specific things that they're trying to work on, or they have specific concerns, things that they're, you know, wanting to learn more about. So some clients may track their headaches because they're concerned about that they're experiencing headaches, and we want to find out when they're happening in the cycle, so that we can see if there's a hormonal influence there. There's women who might track things like breast pain, tenderness, ovulatory pain, things like that. Because again, once you start looking at things cyclically, it kind of changes things. You may be experiencing a variety of different symptoms, but if you've never put them on your chart based on what day of the cycle you're on, you wouldn't necessarily think that it could have something to do with the cycle. But then when you start tracking breast tenderness, and you notice that it only happens on the days leading up to your period, you realize that there's a hormonal component to that, and then you can have more you can feel more empowered to do something about it. So certainly, things like when you're getting up in the morning, how many hours that you're sleeping, what you're eating. I have a lot of clients that might track when they have a glass of wine, because that can have an effect on temperature. So it's kind of endless. One thing I say is that I don't require my clients to track any particular things other than what you know, the basic things, the things I suggest the most tend to be like, what time you're waking up and things like that. But it really comes down to what factors could be affecting what you're seeing on the chart. What issues or symptoms are you concerned about and wanting to monitor, and what are you curious about? What is happening for you? So there's a wide variety of things that you can track. I think some women could find it overwhelming, like I have to track everything, but typically, with my clients, I'm encouraging them to track things that they're already concerned about and they're wanting answers about, and they want to see if it is related to their cycle.

Lisa, you made a reference earlier to a girl who might get her period at age 16 or 17. I know there's definitely a legitimate concern around the trend of girls getting their periods at increasingly younger ages, and we know some of the reasons as to why that is. But what's the concern if a girl happens to get her period at 16 or 17, and what does that tell us, potentially about her health?

Well, so the average age of menstruation is somewhere between about 13, maybe 12 or 13. So one of the issues with girls potentially not having their period by the time they're 16 is that it's typically a sign that there's something going on. So I've spoken to many women over the years who didn't get their cycle until they were 16, 1718, Yesterday, I spoke to someone who didn't get her period fully regularly until she was 19. And you know, it's a pretty serious medical issue for someone to just not be going through puberty. So, I mean, there could be bigger issues if the person is actually not experiencing any of the, you know, Tanner stages of development by the time they're 16. So typically you would see some of the like the breast development and, you know, different fat composition, things like that. So, so if, like, that's one thing where that could be a more serious issue. If a person isn't even experiencing any of the changes that you would expect to see in puberty, right? That would be go to the doctor and make sure you don't have any genetic issues. But in terms of the period coming late, often it can be related to the fact that you are actually of menstruating age, but you are exercising or under eating to the point that you're actually preventing it from happening. So it's like primary amenorrhea, where you're just not having a period because you're not eating enough. So when I have had these conversations, and I've had, you know, many over the years, it's kind of like you hear that reflection of, like, yeah, I was, I was on the soccer team, I was this, I was I was dancing, I was in gymnastics. I wasn't overly concerned with my weight, but I definitely was trying to not gain weight, or, you know, like I would, I probably could have eaten more. So going back to when we were talking about that. When I brought that up, we were talking about just the concept of the menstrual cycle as a vital sign, and I was sharing how it's grow. Like a growing number of health professionals are actually bringing this up and talking about how we need to be monitoring this. And so these organizations are basically saying that doctors should be paying attention to teenage girls, because when a girl is not menstruating by 16 or 17, that has to be looked at like it's either there's a medical issue there or there's a issue related to how she's interacting with her food and exercise. But Lisa, can I just make sure if anyone listening is in a situation like I'm in, we're just late in my family. I do want to just make sure that you agree that obviously genetics can mean you're perfectly healthy. You just get them late in your family. Because it almost sounded like there's always a concern, but there isn't always a concern when we obviously can rule out all those other things genetics can play a factor that just everyone gets it a little bit later in this family.

I mean, obviously there's no one size fits all. I think that it is important, though, for people to just be aware that when we get into that age range, we should be looking at it so it doesn't mean that everybody has a problem. Obviously, that. But because the problem is that there are a lot of girls who aren't getting it by 16 and 17, who do have a problem, and no one has even asked them, yeah, when if they've had their period yet, right? Or women are like, 18, no period and they're just being put on the pill. Wow. So there's like, we're so far in the other direction, that I don't necessarily feel bad about putting it out there in that way, because if she's fine, she's fine.

So just, just to go back, you know, for everybody who's now thinking, Oh my God, my daughter doesn't have her period yet. She's 16 and a half. Like, what's wrong with her? Maybe, nothing, very, very possibly, nothing. But it does warrant an investigation, and the most common reason that you stated is something called hypothalamic amenorrhea, meaning that the over exercising, under eating has caused sort of a shutdown in the communication between the ovaries and the pituitary gland, and that's causing the lack of ovulation.

It's one possibility. And to be clear, I don't want to say that these girls are all intentionally under eating so I want to, I want to clarify that, because it's not intentional most of the time. Sometimes it is intentional if a if a young lady has an eating disorder or disordered eating patterns, but it's often unintentional. And I think that I've just had a lot of these conversations recently. So when I was writing the hypothalamic amenorrhea, the HA chapter in my most recent book real food for fertility that I co authored with Lily Nichols, I was going through all these, all this research, and there are certain sports that are just associated with higher levels of menstrual cycle, disruptive disruption and like, issues with menstrual cycle, cyclicity and things like that. And certainly, like soccer, gymnastics, ballet dancing. And there's certain sports like gymnastics, just to pick on that for a minute, where the sport itself is intense, but the actual physique of the woman is part of the sport. So like, right, like the the ballet dancing, like the, I was a ballet dancer too, and I'm a black woman with, like, a curvy, like a big bomb and like that, that was, like an issue, even though I was a child, like it was, and I knew it. I didn't do anything about it. I just kind of ignored it, and eventually stopped dancing, even though I had, I really loved it, because I just anyways. But the point is that there's certain sports that have this emphasis on the body type as well that that kind of make it worse.

Yeah, and then throw the body image stuff on top of that, for young girls that they face. And if they are exercising a lot and trying to just even be conscious and watchful about what they eat, they run the risk of having this hypothalamic situation or amenorrhea situation. Amenorrhea meaning absence of period. Other things that older women, women in between in their childbearing years should think about our thyroid issues or polycystic ovarian syndrome, which seems to be an increasingly common diagnosis and even pre polycystic ovarian syndrome, where women are experiencing a lot of insulin resistance that they don't even know that they have and aren't being asked about, and they're having trouble becoming pregnant because of it, which has a lot to do also with diet, lifestyle and exercise.

And those conditions present very differently. I think there's often we think that it's similar, because there's menstrual cycle disruption in both cases. But I would say one of the main differences is with the HA, like with the hypothalamic amenorrhea, if it's full blown, the woman is just not menstruating at all, if it's full blown, and there's not even a lot like with with PCOS, it's characterized by irregular cycles, but she's still cycling. She's still getting her period, whether that's 40 days in between, 50 days in between, 90 days in between, she's still having periods, and often she's approaching like her body's trying to ovulate. So we often see cervical fluids. So from that charting perspective, if a woman has PCOS, it's kind of characterized, not always, right So, but generally speaking, we would see cervical mucus. So either patches of it, like it seems like she's going to ovulate, and then maybe ovulation doesn't happen, and then another patch, or sometimes, like, lots, like days and days of mucus, like week two weeks of, you know, a little bit of clear, stretchy mucus, because her body, like, there's a lot of follicular development, but it's just not resulting in the ovulation because of that insulin resistance, because of the other issues that contribute to the ovulatory dysfunction and disruption. But with the over exercise scenario, it's bit different, because we're in a low hormone state, like we're not moving towards ovulation, like there's a it's an impasse, like we're there's no mucus, or not a lot of mucus, like there's just, there's nothing happening and that. And so those conditions can seem different on outside, but when we add the charting piece of it. They they really do present very differently. So what does a perfect cycle look like, and what does an abnormal cycle look like? So I will push back on the word perfect, because I always encourage, well, I always say that to my clients. I say there's no such thing as a perfect cycle, because we are human beings, and we are always changing and moving and things like that. So I really kind of try to talk a little bit about that expectation when we start charting, so that instead of trying to, because that's what we all want, like, I always say, like women who get involved with menstrual cycle charting, we tend to be, and I include myself, we tend to be a little type A, we tend to be willing to like chart all these little details, right? So we're kind of already, like, obsessed, right? And so what we want is we want the cycle to look pretty imperfect, and we want everything to just be pristine. And so it doesn't look like that in the real world all the time. So I really encourage a broader perspective, if you will, on that. So the way I talk about it then is just like, what are those normal parameters? Because the great thing about talking about it that way is that there are parameters. Your cycle doesn't have to be exactly 28 days all the time. You don't have to ovulate on exactly on day 14, because most women don't have 28 day cycles and don't ovulate on day 14. But there is a range, right? So a typical healthy cycle can last anywhere from about 24 to 35 days. So there's a bit of a range there. We would be starting with the period. You know, a healthy period has, I always say it's like, it should be like a sentence. It should have a beginning, a middle and an end, and then it should be over. So we would expect it to start off maybe moderate to heavy and gradually taper down, maybe a couple days where there's like, light spotting, and then it comes to an end. So that means that if you have bleeding all throughout the cycle, or it's very common to have spotting leading up to the period, but it wouldn't be optimal. So it wouldn't be something that we would consider to be an optimal situation. And if you have bleeding throughout or you know different bleeding that is not related to your period, that also is not considered optimal. And in terms of the period itself, having bleeding within a volume range of about 25 to 80 mils, is considered optimal. Again, it's quite common. Some women bleed more than that. It's pretty common, but it is like important to know that there is such thing as too little bleeding, and there is such a thing as too much, and women who tend to bleed on the heavier end, if it's quite heavy, they it can be associated with things like fibroids or polyps or different things. So it is actually important to say that out loud, because as as women, we have our own periods, we have our own cycles, and we just see we experience whatever we do. And so we think whatever we experience is normal, and you might bleed heavy, and everyone you probably but you don't necessarily like you could have a fibroid or something like you. So it's helpful to know that there are ranges, and when you're outside of those ranges, you just want to be aware of that. So that's one thing I'll say about periods as well. The last thing I'll say is that it's very common for women to have pain, moderate to severe pain that requires pain medication. And although it's very, very common, it's not optimal. And someone needs to say that you know pain with your period, it can be a sign of inflammation, it can be a sign of something as serious as endometriosis. So we should be talking about that. And many women go through their lives thinking that pain is totally normal period pain is so normalized. Like, I've had people come at me and say, like, oh, well, how could you say that? You know, no one like you shouldn't have any pain. So I just what I want to say about it is that it is actually possible for many women to have periods that aren't painful. And so one way to just kind of put it out there and just it's kind of just a challenge, because we all know that, you know our culture, we all think that having Period Pain is totally normal, because most, like so many women, have it. But imagine a man in your life who, like, for a couple days every month, had like, moderate to severe pain in his penis that he required medication, right, right? And we're just going to tell him, like, yeah, it's just part of being a man. It's so I feel like it's been overly normalized. So I don't say these, like, I struggled with period pain for years. So, like, I don't say these things to it's not about, like, causing strife or anything. I say these things to kind of challenge you as the listener, right, to think about what like, just to think about that for a minute, like, why do we think it's just totally normal to have pain? Why isn't anyone looking into it? So I'll share a couple stats with you that you might find interesting. So I was researching this one. I remember this one. I was like, so mad. I was reading this article. And I saw in this article that they were talking about the the pressure of the contractions. And they were, they were saying that during labor, the and they measured these contractions in millimeters of mercury, and they said, during labor, a good, strong contraction is like. 90 millimeters of mercury. So this is how they're measuring it. And they said that for a woman that has like severe period pain, it measured it like 400 millimeters of mercury. Wow, when you look at much more intense than labor, and it's insane. And I remember I was so mad because the the the author of the article said, so maybe when women say that their pain is more intense than than labor, maybe there's something to that. Like, it was so like, flippant, and I was just like, like, I would argue that that level of period pain, that that kind of period pain, is never normal. There's some underlying reason for that, whether it is like an endometriosis or it's just a significant stress that's happening in your life, is stress can play a big role in period pain because of the various ways it activates prostaglandins in the body and things like that. Well, and that's another one of the steps I wanted to share, which is that women who do report period pain tend to have prostaglandin levels upwards of four times the levels of women who don't. So I shared this information so that we can kind of start thinking differently about the pain. It's obviously extremely common for women to experience pain with their period but we're at the point where I think we can start talking about it more and rethinking our normalization of this pain, like we're just supposed to all be okay with this, as opposed to looking at it. If we know that women who have pain have these higher markers for inflammation, then that should be something that we should be looking at. And in my experience working with women all these years, when women have like, mild to moderate pain that maybe requires, like a Tylenol or whatever, that tends to be easier to totally get rid of with changes in diet and some supplementation, key supplementation, addressing inflammation so women who have that kind of, like, not totally, like, eight out of 10 pain, nine out of 10. I'm in a vomit, but, like, they have that, kind of, like, persistent, mild to moderate pain. That's that just requires a couple Tylenol that I've seen be pretty easy to, like, totally get rid of. So I think that there, and if that's possible, it means that when you address the inflammation, it can go away. So we should be talking about it then, as opposed to just saying, Yeah, that's totally fine, and as long as it's not too bad, like I just this is what I have a different opinion about that. I want to bring up one thing that I saw in your book, and I didn't have a chance to read very much of your book at all, but I happened to open to a really interesting segment where you talked about the lining, the thickness of the lining of the uterus. And you mentioned a little bit ago about understanding how much you're bleeding and that too little. We think that a light period means better, right? But too light of a period is associated with a higher risk of fertility problems and miscarriage. And in this chapter of your book you talked about the the having your uterine lining measured by ultrasound. I definitely don't think that women should go out and have their their uterus ultrasound measurements to look at the lining of the uterus in advance of having a fertility problem. If you're having struggling with fertility, then that's probably a great tool. But I'm only bringing it up because I think it's really interesting for people to take note of measuring their bleeding, which can be done, especially if you use a menstrual cup. It's really easy to tell, because so many women struggle with early miscarriage or fertility issues, and if you aren't bleeding enough, that's a sure sign that you have insufficient hormones stimulating the uterine lining. So I just, I found that to be very interesting point that nobody ever talks about.

Yeah, and of course, I don't share any of this information to freak anybody out. I think that, in my experience, most women do bleed enough. It's not something that's like super, super common where people are bleeding like nothing. And basically the kind of the guideline in terms of, like, what we're looking at when I said lower end 25 milliliters. So typically that would be that over the course of your entire period, if you use a menstrual cup, you fill that cup once if you added it all up, or you would fill maybe, like five pads if you added it all up. So the bar is not like intense or crazy to hit. So if what I'm like, I don't know everyone bleeds differently. So my clients who bleed heavier, they can't even fathom that there are women who bleed that little, and then women who bleed kind of moderate, or, you know, who have typical, normal bleeds. I think we can mostly recognize that that would be really little like if you own if your period lasted, like a day and a half, and you barely filled anything, I feel like we can appreciate that that is is quite low. So one of the things with charting is that you can identify if it's a true menstrual cycle bleed or not. So if you truly ovulated prior, then we know. That it's a true menstrual bleed. So sometimes that light bleeding someone's having could be spotting, or an ovulatory bleeding, or something that's not necessarily related to an ovulatory event. So I mean in terms of my reference in the book that was sharing research where they were actually measuring the uterine lining. So it wasn't like women were just going through them, like having their lining measure, but they were measuring the uterine lining and determining if there was a certain thickness that was associated with greater chance of pregnancy, and they found that there was, like a minimum lining, and if I remember correctly, it was a minimum of at least seven, eight millimeters, like at least that, that sounds right, that was associated with, like, a better chance of conception. And so when you look at the pill research, and the one of the ways that the like hormonal contraceptives, one of the ways that they work is by thinning the lining. So when you're like, when they measure the lining of women who are on like, whether it's IUD, or, like the combined pill or something like that, like their lining could be like, 234, millimeters. So it's like, in order for it to actually be thick enough and juicy enough and fully developed, you need to have a certain level of this lining. And so the way this plays out for like, clients who I've seen, who have really been like, Well, I'm not measuring their uterine lining, but who have very light, light periods, again, going back to that like, often this high activity level, low food consumption scenario, where they're kind of presenting with low hormones across the board. So if you're seeing like a super light period, you're often seeing like scant cervical fluid, and maybe the luteal phase is a little bit whether it's short or you're seeing some signs of potentially low hormones. Because in order for us to have a thick lining, like a normal lining, we have to make enough hormones. And in order for us to make enough hormones, in order for that follicle to develop fully to a normal size, to produce the estrogen that we need, in order for the corpus luteum to develop and produce sufficient progesterone in the luteal phase, we actually need to eat food. We have to have sufficient protein and fat. And you know, it has to be in line with our activity level. We have to get good sleep. There's a lot of things that need to happen for these basic functions to take place.

Fascinating before we end because there's so many things we could talk to you about, but we're getting short on time. We do have a few questions from our community, and a few people, a ton of people wrote in questions, but there were a few questions that predominated the conversation. So I want to make sure that we ask you those quickly. One of the questions that came in from our community was about how to optimize our exercise and related to our cycle. So should we be doing more yoga type exercises during the bleeding week and more high intensity interval training during ovulation. Would you agree with that? Does it matter? I think that, I think that there is a benefit to paying attention to how you feel, what your energy is like. If you are really into exercise, you could, I'm sure, track across the cycle when you do better with weights, when you do better with cardio and things like that, and kind of optimize it. I think that there's a potential for that. Generally speaking, I feel like, if you're attuned to your energy levels, respect that. I think that a lot of women feel this need to do really heavy workouts on their periods. And I don't know what that's about, but like, if that's what you want to do, like, do you but I will just tell you right now that I give you permission to, like, listen to your body, and if you are tired and if you're bleeding out of your vagina today, you could literally just, like, take it easy. And that would be completely fine.

Sounds good. Okay, one question that so many people wrote in about you can answer quickly, and you might have personal experience with this, many mothers are eager to get their period back when they're exclusively breastfeeding and they're not getting it at 12 months, 13 months, even 18 months. We had one mom write in today who's 18 months postpartum and she wants her period back and because she wants to conceive again, what do you recommend?

I think that it's not always necessary to wean to bring your period back. I think that there's a lot of different reasons why it might not be happening when you're a mom, especially if you're a new mom, if it's baby number one, it can be really hard to kind of find yourself again and get yourself in a groove and even feed yourself, because you might just be living off of your toddler scraps. So I think before we jump into all of these quick fixes, we do have to look at like, how's your sleep? I mean, probably not good, right? Is there anything we can do to improve that? Are you literally like, are you literally eating? What's your exercise level? Like? I know it's hard when you're a new mom, right? It's really hard to kind of find time to do those things. But often we want that, the results, we want the period back. We want the this, the one with that. And then, of course, the first question is always like, should I wean? But ultimately, I think for a lot of women in that phase, they have to look at some of those foundational factors. And most women don't go into pregnancy fully nourished, so there's often a lot of nutrient deficiencies post. Partem, and then there's just so much to think about. And for example, like, thyroid issues are most common postpartum, so there's a lot and no one takes care of them. Like, everyone's concerned about the baby, but, like, no one's concerned with the mom. So it's like, it's like a whole conversation. So I don't have any quick advice, but I just have a lot of things to highlight so that you can start thinking more broadly about how you can nourish yourself and take care of yourself so that we can ensure that your body is healthy. And when your body is healthy, your period should be coming back.

The concept of postnatal depletion is very overlooked, and I think that's what you're alluding to, is that that's that's a very common reason that someone might not get their menstrual cycle back. Lisa, I just want to say the two things that I got from this conversation, because we've had, we've had women on this podcast talking about this issue, and I got two really big things from this conversation with you that I really value. One is we should not normalize women feeling discomfort. I mean, what a thought, What a concept. I think that will change everything if we stop normalizing that. And I'm so happy you said it. And then the second thing is the charting things we all love to chart. We love the data. We love to keep track. And I picked up from something you were, I think saying earlier that you don't want them to get lost, like, Oh, let me check my spreadsheet and see how my body is doing. You want them to check it and get this outside look at it. But then I think what you're I think what you were saying was you want to get them to just feel it in their body. They wake up and they feel it. How am I feeling emotionally? What do I feel is happening inside my body? You want us to develop this vibe and this rhythm of understanding our bodies without even the dependency of an app and a spreadsheet? And I think that that's a really beautiful thing. And I see why women get who are into this topic as you are, they get so passionate about it. I think there's a feeling of self love when you know your body that intimately. I think it's a beautiful thing.

Yeah, absolutely. There's seasons, right? There's times when it is helpful to dive into the weeds and look at all the little things. And you know, there are times when that's really helpful. But what I try to impart, especially on my practitioners in the program that I run is that we want to be able to step back and really like incorporate this into what we do, so that we can have this guidance. It is guidance, and it's customized to you.

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