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The menstrual cycle is a crucial aspect of human biology, with different phases contributing to the process of reproduction. The two main phases are the follicular phase, marked by increasing estrogen levels and follicle development, and the luteal phase, characterized by ovulation and rising progesterone levels. Ovulation, the release of the egg, typically occurs midway through the cycle, signaling the fertile window. If fertilization does not occur, estrogen and progesterone levels drop, leading to menstruation.
Menstruation is the shedding of the endometrium, triggered by the withdrawal of progesterone in the absence of pregnancy. This process involves inflammatory cascades, release of prostaglandins, and the separation of the decidua from the uterine lining. Menstrual fluid consists of decidua, inflammatory fluid, blood, and other mucosal secretions. The upper limit of normal blood loss during menstruation is around 80 milliliters, with heavier bleeding potentially leading to iron deficiency.
The idea that the color of menstrual blood reflects one's hormonal balance is unsubstantiated. The color of menstrual blood varies based on factors like dilution, oxidation, and quantity. A few drops may appear pinkish due to dilution, while larger quantities result in darker colors as blood oxidizes. There is no scientific basis to link hormonal status to the color of menstrual blood.
Heavy menstrual bleeding can impact iron levels, potentially leading to iron deficiency if not managed properly. While normal menstruation may not result in iron deficiency, substantial blood loss can affect iron stores and overall health. Iron deficiency can manifest in symptoms like fatigue, cognitive issues, hair loss, and unusual cravings such as ice consumption.
Twin pregnancies typically arise from the simultaneous ovulation of two dominant follicles, resulting in the fertilization of two eggs. Identical twins occur when a single embryo splits into two, while super fettendation involves conceiving two fetuses on different days within a short timeframe. These phenomena contribute to multiple pregnancies and variations in conception mechanisms.
Hormonal changes play a pivotal role in orchestrating the menstrual cycle. Increasing estrogen levels in the follicular phase prime the uterine lining for ovulation, while the surge of luteinizing hormone triggers the release of the egg. Subsequent rises in progesterone signal the luteal phase, preparing the uterus for potential implantation. This intricate hormonal interplay governs the reproductive cycle and influences fertility.
The color of menstrual blood is influenced by factors like the decidua shedding, but it carries no medical significance regarding hormonal status or health. Normal periods can last up to seven days, but even light spotting should be monitored, especially in relation to energy balance and caloric intake. Prolonged periods or very light bleeding might signal hormonal issues or energy deficiency, particularly in active individuals like young female athletes.
Menstrual cycles range from 24 to 38 days, with bleeding lasting up to seven days considered normal. Variability in cycle length, onset, and flow is common and doesn't necessarily indicate problems. Studies suggest a shorter menstrual cycle could relate to an earlier menopause with associated health risks, but specific cycle lengths are not inherently problematic.
COVID vaccines have no negative impact on fertility, and they are actually recommended to improve pregnancy outcomes and reduce risks associated with contracting COVID during pregnancy. Some data suggest a slight lengthening of the menstrual cycle post-vaccination, primarily noted in individuals receiving two doses close together, but these changes are within normal ranges.
The belief in menstrual synchronization among individuals spending time together is debunked with scientific explanations. There is no biological basis for this phenomenon, and studies disproving its existence have not found any valid evidence to support the claim. Misconceptions about hormonal influence on menstrual synchronization are challenged, emphasizing individual hormonal agency.
Hormones like oral ethanol estradiol play a crucial role in women's health, particularly during menopause. The absence of estrogen can lead to concerns regarding bone health. While ethanol estradiol may not be ideal for bone protection in some individuals, options like estradiol, transdermal, or conjugated equine estrogens can help maintain bone health during menopause.
Oral ethanol estradiol has been associated with a slight increase in the risk of breast cancer, but the overall absolute risk remains low, especially in younger individuals. On the other hand, the pill provides protection against endometrial and ovarian cancers. Individual factors, such as genetic predispositions and medical conditions like polycystic ovarian syndrome, play a significant role in assessing cancer risks.
The contraceptive pill carries a risk of blood clots, especially in individuals over 35 who smoke, highlighting the importance of individualized care and risk assessment. Despite the potential risks, the pill remains a safe and effective contraceptive method when used appropriately. Contrary to misconceptions, the pill also plays a positive role in treating conditions like iron deficiency anemia.
Emergency contraception methods like Plan B and Ella are highly effective in preventing pregnancy by inhibiting ovulation. These options serve as vital tools in preventing unwanted pregnancies when used within a specified time frame. Copper or hormonal IUDs offer even greater efficacy as emergency contraception methods, providing a safe and reliable alternative.
Episode #313. Is your menstrual cycle normal? How is the pill affecting your body? Join me as I sit down with Dr Jen Gunter, a renowned expert in women's health, to answer these questions and many more as we take a deep dive into contraception, the menstrual cycle, and common female health myths.
You’ll learn about the key phases of the menstrual cycle and the associated symptoms, discover how different forms of hormonal contraception work and whether they’re safe, debunk a series of pervasive female health myths, and much more. Whether you personally menstruate or use contraceptives or know someone who does – effectively everyone – this episode is an essential listen on female health.
Specifically, we discuss:
Connect with Dr Jen Gunter on Instagram, Twitter, and TikTok. Order her new book, Blood: the Science, Medicine and Mythology of Menstruation, here. For even more comprehensive information, you can read Dr Gunter’s other books, The Vagina Bible and The Menopause Manifesto. Head to her blog, https://vajenda.substack.com/, for frequent newsletters and articles.
This episode is brought to you by:
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Simon Hill, MSc, BSc (Hons)
Creator of theproof.com and host of The Proof with Simon Hill
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