The Menstrual Cycle: How, What, When, Where, and Why


Okay. Now that you know all the basics about two of the sex hormones involved in the menstrual cycle, and you’re familiar with how Traditional Chinese Medicine views the menstrual cycle, let’s round this out with the physiological explanation of this cycle.

Note: This graph, as well as the information below is based on an “average” 28 day menstrual cycle. I don’t meet many people whose cycle is actually 28 days. The range is somewhere between 20-40 days.

Those Couple of Days Before Your Period

We see A LOT of patients in the clinic who make it a point to come get acupuncture during this time – mostly because they are trying to deal with The Hulks (also known as PMS or in more severe cases, PMDD). Not a good time for many, but fine for some.

Protagonists in an age-old story. Check out nose dive at Day 28.
Protagonists in an age-old story. Check out nose dive at Day 28.

For a long time there was significant disagreement as to whether PMS was even a legitimate medical condition (insert long sigh). Then, in 2007, REAL LIVE evidence was found to explain the thing that women have been talking about/complaining about/insisting upon for hundreds of years! Go figure…

So, what happened? Well, the first significant genetic finding in premenstrual dysphoric disorder (PMDD) was reported. At this point, a number of theories have been put forward to help explain PMS – the most predominant being the most obvious (hormones take a serious nose dive).

Estrogen/progesterone/testosterone levels reside at rock bottom during those couple of days before your period starts. There is some evidence that these hormones have a strong effect on the serotonin, norepinephrine, dopamine and endorphine receptor sites (all of which are involved in mood regulation). Therefore, any disruption (nose dive!) in the balance of these hormones could contribute to the symptoms of PMS/PMDD.

For a another perspective on PMS/PMDD, and one that takes into account the range of PMS in intensity as well as symptoms, see the brilliant Traditional Chinese Medicine explanation.

Days 1-7: Surfing the Crimson Wave

Within a couple of hours after bleeding starts, estrogen and testosterone levels begin to climb (which helps boost the brain’s level of serotonin and may account for the relief that many feel once their period starts). Some experience an increase in menstrual cramping at the uterus expels blood and tissue. There’s a great formula called Corydalis 5 that is wonderful for menstrual cramping – I prescribe it a lot. People with uteruses LOVE it. Are you looking for a product that can make managing your periods easier? A menstrual cup is one solution that everyone is talking about. For further information, see more at

Leave me alone with my book. I'm menstruating.
Leave me alone with my book. I’m menstruating.

In the meantime, while you’re lounging on the couch watching Battlestar Galactica and sipping Raspberry Leaf Tea (or half-deep into a bag of chips, let’s be honest), the still-low levels of estrogen and progesterone at the start of the period signal the pituitary gland to produce follicle stimulating hormone (FSH). FSH begins the process of maturing a follicle (a sac in the ovary which contains a wee’ egg). The follicle also makes estrogen, which results in a slow climb of estrogen (estradiol) levels. By day 7, estrogen and progesterone have risen significantly. Many patients report feeling better once their hormone levels have risen from their former position at…rock bottom.

Days 7-14: Gilding the Red Room

Estrogen and testosterone continue to rise. During this time, the uterine lining (endometrium) begins to thicken. It’s now a tissue rich in blood vessels and an more optimal environment for the implantation of a blastocyst (i.e. the uterine lining is prepared for the possible embedding of a fertilized egg). High levels of estrogen make some feel energetic and social; however, for some, high levels of estrogen can result in headaches or spikes in anxiety.

Days 14- 21: Release the Kraken!

Progesterone is produced in the latter two weeks of the menstrual cycle to balance out the regenerative effects of estrogen and stops further endometrial growth (i.e. progesterone prevents the uterine lining from further thickening).

At ovulation (day 14ish), the increased estrogen levels from the previous follicular stage trigger a spike in luteinizing hormone (LH) from the pituitary gland, causing release of the egg from the follicle.

I don't know about you, but this is how I feel sometimes when I'm ovulating.
I don’t know about you, but this is how I feel sometimes when I’m ovulating.

Release the Kraken!!!”

Ovulation is an immediate cue to estrogen and testosterone to take a break for a bit. In the meantime, progesterone levels climb all week. Some feel sluggish due to the dip of estrogen/testosterone and the rising levels of progesterone. However, 3-4 days after ovulation, the hormones play nice and for a moment, they all rise together.

I’ve ran across an article in a crappy fashion magazine that said sex drive will dip due to the increase in progesterone levels, and that orgasms are more difficult to reach during this time. I personally don’t know what the hell they’re talking about, since….(cough cough). But isn’t that always the case? Each situation is unique, and dependent on the subtle details of your body (as well as on hundreds of other factors that might affect how you feel). The lesson: Use this as a general road map, and figure out how YOU react to these changes. Cuz one woman’s progesterone spike is another woman’s pleasure.

Days 21-28: It’s Not You, It’s Me, Or Maybe It’s You, Yeah It’s Definitely You

We already know that rising levels of estrogen are responsible for the build up of the uterine lining (endometrium), so if no blastocyst parks itself in this lining, the levels of estrogen decrease. Decreasing estrogen loosens the support for the endometrial lining and prepares the body for menses.

In general, during this premenstrual week, estrogen, testosterone, and progesterone begin to drop. Many patients find that this is the most

Stop talking and fetch me some salt n' vinegar chips. Please.
Stop talking and fetch me some salt n’ vinegar chips. Please.

difficult part of their cycle, especially the closer they get to their period. Their mood can vacillate from mellow-yellow to beet-purple in seconds. Dipping estrogen is associated with all kinds of crappy things, like migraines and insomnia.

Important to note: Some don’t experience these premenstrual issues, and fly through this phase like a pink-striped unicorn across a field of Monkeyflower and Beardtongue (common wildflowers, if you aren’t in the know). Anyway…

As the levels of estrogen decrease, it also decreases the brain’s level of the feel-good chemical, serotonin, while increasing the stress hormone, cortisol. This combo can make that already unpredictable thing called Life a little more tricky to navigate – like someone dumped a bunch of banana peels in your path. Low estrogen levels can also cause night sweats and low temperature, which can disrupt the quality of sleep.

If you can relate to this – it sucks, no doubt. Come get some acupuncture. It really helps. If you can’t relate to this, great! But if you run into someone who is dealing with The Hulks, perhaps offer ’em a foot rub. If you hate feet, well, a hot cup o’ tea and a bit of understanding can go a long way.