Understanding the menstrual cycle

Jessica Garcia, MD
Gynaecologist & Fertility Specialist, Clinica Tambre

Fertility Assessment, Lifestyle and Fertility

Dr. Jessica Garcia delves into the intricacies of menstrual cycles. Accompanied by an image of a smiling woman in a white lab coat.
From this video you will find out:
  • What’s the definition and importance of understanding how the menstrual cycle works?
  • What are the stages of the ovarian cycle?
  • What are the 4 phases of the endometrial cycle?
  • How long are the typical ovarian and uterine menstrual cycles in a female?
  • What is happening each day of the menstrual cycle?

What are the 4 stages of menstrual cycle?

In this session, Dr Jessica García, Gynaecologist, Fertility Specialist at Clinica Tambre, Madrid, Spain, has discussed the menstrual cycle. Dr García explained all the phases of the cycle.

- Questions and Answers

What are the different methods of monitoring ovulation, and which are most accurate?

One way of checking ovulation is by measuring the LH. When we do the ovulation test, it detects the LH levels because before the ovulation, we will have a peak in this hormone, and this is the one that we can check with the ovulation test.  Another method is checking the temperature daily because when we have progesterone, the temperature rises a little, it’s not so accurate, though. We can also check the vaginal mucus, and because it will be changing during the whole cycle, maybe we can notice it because, during ovulation, it can be super flexible, and you can check if you’re ovulating.

The ovulation can be monitored with the levels of progesterone, it’s also one of the best methods to see the ovulation, and I would say the most accurate one is to follow the ovulation or the development of the follicle with scans. It’s impossible to do so when we’re trying at home to have a scan every other day, so I would recommend doing what we can do at home.

The best thing is to do the ovulation test, but I always recommend not to focus that much on the ovulation, but to try to have sexual intercourse around those dates, in the middle of the cycle without trying to check it that much because they will be more relaxed, and I think the pregnancy is more likely to happen when we’re relaxed and not focusing on finding the right time for the ovulation.  

This Luteal phase, which is happening just after ovulation,  usually lasts 14 days long. When we have a cycle that lasts more than 28 days, usually, the ovulation happens 14 days before we have the next menstruation. That’s why it’s not so easy to know when we don’t have the cycle is not always 28 days, but when we’re trying to conceive, try to do it when we know that it’s going to be 14 days before the next menstruation as well.

If my periods are irregular, are ovulation pee sticks to measure LH accurate?

Yes, they are. I think they are not the most accurate, as I told you, but doing it at home is helpful. Depending on the kind of periods that you have, we can try to have sexual intercourse like 14 days before when we expect the next period, but I always recommend having it very frequently, maybe between two and three times every week, just to try to have some sperm right there. Having sexual intercourse two or three times every week, we will always have some sperm in the area ready. In case we have the ovulation, it will be waiting for the egg.

If your cycle lengthens to, for example, 40 days and this isn’t the norm, could this be a cycle with missed ovulation?

Not necessarily. Usually, if you have long menstrual cycles, but you are having them regularly, so if you have them every 40 days, maybe that’s normal for you. It’s a little longer than normal, but not necessarily it’s a cycle without ovulation.

Sometimes you may first check the mucus because it will change during the whole time, then also knowing if you are ovulating or not is by feeling some pain around the ovulation days, a pain that comes and goes.  I would recommend doing a progesterone test after day 21, just to check if you’re ovulating or not, that will be a good idea.

How many days lasts the Luteal phase (14 days)?

Not exactly, in all women. That’s the average, the Luteal phase is always more stable than the first part of the cycle, so we can think about it that it lasts 14 days, not exactly every month and in every woman, but the majority of us will have a more stable Luteal phase for 14 days.

What can be done to regulate periods?

I would recommend staying as healthy as possible, try to eat healthily, try to exercise. Some patients with PCOS, for instance, tend to have longer periods or irregular periods and sometimes the medication can help them to have more regular periods. Some medication, with vitamins, will help them as well, such as Inositol is good to regulate the periods.

When we don’t have PCOS, I will say a healthy lifestyle will be the best option to have a regular period. The period can be affected by the stress as well, or maybe we’re exercising too much, is also not good, so everything done in moderation will help us to have a regular period.

My period is a 26-day cycle, but when I use the ovulation kit, it is strong on day 16 instead of day 14, is it normal?

Usually, when you have a 26-day cycle, you’re supposed to have ovulation around day 12. The LH can variate a little, so the ovulation kit is not that accurate as I would like it to be. We cannot trust it 100%, about that period of 26 days, I think your ovulation will occur around day 12. 

You could do the ovulation test a little earlier and check what happens because I don’t think you’re going to ovulate on day 14. The luteal phase is usually 14 days long in the majority of the patients, but maybe you are a little different.  I would recommend checking other things, such as the mucus, the temperature, also try to understand your body a bit more and try to be more receptive, and maybe you can feel something around the day of the ovulation. 

What is the usual reason for a short luteal phase? Low levels of progesterone? Weak ovulation? Is there a way to lengthen it?

It’s very rare to have a short luteal phase. Some patients have low levels of progesterone, in that case, you could have a little bleeding during the luteal phase. It’s not necessarily weak ovulation, maybe the corpus luteum is not functioning in the right way.

What we can do when we have this kind of short luteal phase is that we can support it with progesterone, after the day of the ovulation, we can start using a very small dose of progesterone to support the luteal phase. There are just a few patients that have this issue, but sometimes it could happen.

If you have had egg retrieval and your next period is early by eight days, will the next month go back to your usual cycle, so 36 days later?

Usually, what happens after the egg retrieval is that you will have menstruation earlier than expected. Having it eight days earlier will be normal because of the drop of the hormones.

The cycle will start with this menstruation, so if the length of your menstruation is 28 days, the next cycle will be very close to the normal, and we can count this menstruation even when it was earlier, we can count it as day one. Usually, every cycle after the egg retrieval will be more and more regular until we have a normal cycle back again, so I will say maybe your next menstruation will arrive around 28 days later.

On which day should progesterone be tested?

On day 21.  We can check the progesterone two days after ovulation, and the progesterone will be rising. The day just to confirm when we’re doing an ovulation test is to check it on day 21, that will be a perfect day because the progesterone will be picking, and we will see the levels are higher. You can check it since day 16 when we’re talking about a 28-day cycle. 

Why do some periods hurt more than others?

That depends on many factors. A lot of pain during menstruation is not normal, so if the pain is super high, I would recommend checking it and maybe doing one scan or just checking it with your doctor. The pain during menstruation occurs because the endometrium is like contracting.

It’s normal to have some more painful periods than the others, and this is by the contractions of the uterus. The hormonal levels could also be implicated in the difference in the pain in two cycles, but it is normal to have a different amount of pain during menstruation. 

What are the premenstrual symptoms?

These are the symptoms caused by the progesterone levels, so we can feel a little bloated, there can be some more humour changes. We can be a little sadder or feeling like crying, or we’re a bit moody. Some patients don’t have any symptoms at all, some others are very sensitive to progesterone. You might feel depressed, you might feel some discomfort, so these are the premenstrual symptoms, and they’re caused by progesterone. 

Is it normal for your breasts to hurt during the period?

Most of the time, it is more normal to have it the days before the period. Maybe it can occur at the beginning of the period as well because of progesterone.

It could also be because the progesterone levels are dropping, and that could cause a little pain in the breast. It is normal, it’s a part of the hormonal changes during menstruation and the menstrual cycle.  

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Jessica Garcia, MD

Jessica Garcia, MD

Dr Jessica García is a specialist in Fertility. She earned her M.D. degree at Universidad de Guadalajara and did her residency training in Obstetrics and Gynaecology at Hospital Civil of Guadalajara and University of Guadalajara. She did a fellowship in Reproductive Endocrinology and Infertility and also holds a master’s degree in Reproductive Medicine from Madrid Complutense University and the Spanish Fertility Society. Dr. García speaks fluent Spanish and English and knows a little of German and Italian. She is currently part of the medical team of Tambre Fertility Clinic in Madrid. She is very empathetic, caring and prides herself on offering personalized patient care.
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