Menstruating and ovulating are old news, but some new attitudes are circulating-attitudes that say a woman's cycle is optional, obsolete and possibly even harmful, and that drugs should be used to help stop the flow. So, are menstrual cycles as natural as tides and seasons or an unnecessary burden that requires medication? 

In most cultures, including Western civilization, menstruation is considered a private and somewhat shameful event. Women are expected to-and routinely do-hide evidence that we are menstruating. We even go so far as to call the menstrual flow strange names, like "the monthly curse." 

A healthier attitude is that knowing our own body's menstrual cycle patterns makes us feel whole, like we are owning-as well as living in-our bodies. This self-knowledge is not only empowering and healthful, but can also improve health and well-being.

Corporate interests in menstruation
For years, tampon and pad manufacturers have advertised to young women by providing free menstrual-­education materials in schools. But in the past ­decade, the media's menstrual cycle stories have shifted dramatically. Now we are seeing menstruation portrayed as a "treatable condition," something undesirable, unnatural and possibly even unhealthy. This change parallels the development and marketing of so-called "cycle stopping" oral contraceptives. These are not without side-effects.

Manufacturers tell us that regular menstruation is an artifact of modern civilization and that we evolved to be continuously pregnant and to rarely menstruate. If you don't want to be continuously pregnant, they say, you should take the Pill ­every day. Moreover, we are told we should feel "empowered" by the right to choose whether we ­menstruate. ­

These messages are a clever distortion of women's choices because true choice requires accurate knowledge. In the context of silence and stigma, it is very difficult to value a healthy menstrual cycle. Also, in this void of misunderstanding, it's easy to buy into the argument that menstrual suppression is normal.

It is important to recognize that our bodies are being fought over by commercial interests and to form our own perceptions without their influence.

The Pill a problem solver?
The current approach by physicians, pharmacists and even women is, if there's a period problem, an oral contraceptive, usually "the Pill," is a convenient and simple fix.

It is a whitewash to prescribe a high dose of a non-natural estrogen and a synthetic progestin to treat a fundamental disturbance of the menstrual cycle or ovulation. Although we call the current Pill "low dose," it has about 15–30 µg of synthetic estrogen and is four to five times higher than normal (the progestin is at approximately normal progesterone levels but continuous). No matter how you slice it, if you don't need or want hormonal contraception, treating menstrual problems with the Pill means replacing a flexible, natural rhythm with an unnatural pharmaceutical one.

Menstruation:  What is normal?
For most women, the first ­period starts between the ages of 11 and 14, with 12 being average. Because regular menstrual flow involves coordination of a complex system of brain, pituitary and ovarian signals, early menstruation is normally unpredictable and bleeding may be irregular for the first year. After that, menstruation becomes cyclic and continues monthly, on average, except for pregnancies and breastfeeding. This continues until the stuttering episodes of perimenopausal bleeding end with the last flow.

Flow usually lasts between four and six days. More than seven days is abnormal and needs checking. Menstrual cycles last normally anywhere from three weeks to five weeks (21 to 35 days) with the average being the 28-day lunar month.

Menstrual cycles are a tag-team creation of estrogen and progesterone. A regular period proves that we have adequate estrogen. Because estrogen is important for bone health, if cycles are far apart or absent, it is a sign worth paying attention to. Estrogen, however, is only the first of two important women's hormones. After the mid-cycle estrogen peak that triggers an LH (pituitary hormone) rise, ovulation occurs with its large plateau of the hormone progesterone.

Progesterone soars from its low during the first part of the cycle and remains elevated for 10 to 16 days. The luteal phase, this time of moderate estrogen and high progesterone levels after ovulation, is optimally 14 or more days, but as few as 10 days will still allow a fertilized egg to implant and grow in a prepared uterine lining.

Understanding ovulation
Many women commonly have cycles that are perfectly regular, with normal flow, that don't cause remarkable cramps, but instead they have what are called "ovulatory disturbances." Ovulatory disturbances mean two things: anovulation (no egg release and low progesterone) and/or short luteal phase ­cycle (an egg was released but there are too few days of high progesterone production). These ovulatory ­disturbances cause health risks such as bone loss, lumpy or sore breasts and possibly a ­later risk for heart disease. For more i­nformation on this important topic, visit the Centre for Menstrual Cycle and ­Ovulation Research website at www.cemcor.ubc.ca.

It is very common (even among doctors) to believe that a regular menstrual cycle means a woman is ovulating regularly. This is not true, nor is it true that ovulation always occurs 14 days before menstrual flow. In fact, the timing of ovulation within the menstrual cycle varies considerably among women, and also within any given woman. It also ­changes over the life cycle and in response to various stresses.

For about 12 years after the first ­period, young women's bodies continue to learn to ovulate. Ovulation becomes most robust (90 to 95 percent of the time cycles are normally ovulatory) between the ages of about 25 and 35 years. In the first years after menstruation starts, ovulatory disturbances are the rule rather than the exception. The first ovulatory ­cycle occurs about 10 months after the first ­period.

Not only is the start of menstrual life full of ovulatory disturbances, so is the end. As women approach the final period, ovulation becomes less consistent, and short luteal phase cycles occur very commonly. These changes begin while menstrual cycles are becoming shorter, but are still occurring regularly.

A natural balance
Most of our menstruating lives (­although perhaps not in perimenopause), our bodies respond to stressful life situations with changes in ovulation that may silently affect our health. Although exercise is often blamed for period problems, women who exercise and do not menstruate are often also not eating enough calories and are under social, economic or emotional stress. Ovulatory ­disturbances are silent and occur within regular cycles-this means our bodies are dealing with estrogen levels not normally counterbalanced by progesterone.

Progesterone and estrogen work ­together in the body, with progesterone keeping estrogen's exuberance in check. Progesterone requires ovulation, and ovulation requires an estrogen peak. If ovulation is absent or delayed, estrogen can become unbalanced. Just as too little estrogen can be a problem, so can too much.

In conclusion, menstruation is important for women's health. So is normal ovulation. Disturbances are useful as warning signs and should not be unnecessarily masked with the Pill, which does not address the root cause. A woman's unique natural rhythm offers her a way to understand her emotional, nutritional and physical health and to become connected with her body. 

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