Throughout history, the menstrual cycle has been shrouded in magic and mystery. In some ancient cultures, menstrual blood was imbued with magical powers, and menstruating women considered to have the ability to even see the future. In the middle-ages, a major religious and with it, cultural shift occurred. Menstruation and menstruating women were no longer treated with reverence,. Menstruation was considered dirty; menstruating women dangerous, and menstrual blood toxic enough to make crops wither, leave men impotent, and lead to natural disasters.
Vestiges of these attitudes have persisted over centuries and have led to long-held cultural shame and ignorance about periods. As a result, most of us started out on our menstrual journeys more or less in the dark – not knowing what’s normal, what we should be concerned about, or how to get that information. And we have largely internalized that periods are gross and dirty.
Only in recent years has the power of menstruation begun to be reclaimed, Talking about periods has gone from being completely taboo to something we might even say is celebrated – for example, the word period being uttered loudly and proudly on the stage of the Academy Awards when the important documentary film, Period. End of Sentence won Best Short Documentary in 2018 (I watched and tears overflowed – it felt like a win for women everywhere). And yet we’re still a far cry from fully understanding and embracing just how powerful and important the menstrual cycle really is, and how much attention it should actually be getting. Many of us continue to spend a good deal of our lives feeling just as in the dark about our hormones and cycles as our grandmothers. I'm all about changing that!
Fortunately, it’s never too late to gain a deeper understanding of your body and menstrual cycles, and in this article, I’m going to show you not just how to, but why it’s so important.
Introducing Your 6th Vital Sign
Perhaps referring to the magic and mystery of menstrual cycles sounds a bit “woo woo” to you, but it’s actually not “fringe” at all. In fact, they are now recognized as a barometer – a way to ‘measure’ – a woman’s overall health. Recognized as our 6th vital sign by the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG), our cycles can be used as a useful predictor of health problems just like blood pressure, temperature, pulse, respiratory rate, and pain (the 5 original vital signs.) It may even be one of the best ways to identify underlying imbalances not just in our female sex hormones, but throughout our entire body.
Unfortunately, most of our healthcare providers don’t know about this; and even if they did, without us having a deep knowledge of our own cycles and being in tune with our bodies, they wouldn’t be able to gather the information they need to really make use of this important marker of health.
So how do we make use of our 6th vital sign? I believe that getting in tune with our own bodies is the best place to start. For so long, our menstrual cycles and period symptoms have been thought of as the enemy. Today, I want to help you see your cycle in a different way – as your own personal vital sign that can teach you a heck of a lot.
What Your Menstrual Cycle Can Tell You About Your Health
As you get to know your cycle, you’ll learn that the many physical signs and mood shifts we naturally experience are actually hormonal signals. They are your body’s way of relaying information about what’s going on in your endocrine system, and in the many other branches of your body – your gut, adrenals, thyroid and more – that influence and reflect an ancient hormonal-biological blueprint that as women, we’re all hardwired with.
Our cycle gives us information about our physical, emotional, mental, and spiritual health. It also gives us intel on how the world we interact with might be affecting our cycles and hormones, from stressors to endocrine disruptors. While it’s common to experience small changes in your cycle from time to time, experiencing more persistent irregularities likely points to an underlying hormone imbalance or condition. The correlation between our menstrual cycles and our lifelong health is so intertwined and significant that the impact of these imbalances extends beyond immediate discomforts and challenges – like cramps or trouble getting pregnant – to potential lifetime health effects that may increase the risks of developing diabetes, autoimmune diseases, and even some forms of cancer. A recent study even linked irregular and long cycles with a shorter lifespan, showing how critical it is that we all pay attention to this vital sign.
In other words, our menstrual symptoms, and bigger gynecologic concerns, are our body’s direct messages trying to tell us that something’s setting your ancient blueprint off-course. If we don’t listen to these messages, they get louder and louder in the form of worsening symptoms or the onset of actual medical conditions that you’re all but forced to pay attention to. The beauty is that our menstrual cycles and our ongoing gynecologic health give us a monthly ‘report card’ on how we’re doing – and an opportunity, at any time, to course correct.
The Secret Language of Your Menstrual Cycle
When we have chills, a headache, body aches, and fatigue, one of the first things we might do is check our temperature. If the thermometer registers over 100.4 F, we have our answer. We may then take some vitamin C, echinacea and ginger tincture, have some miso or chicken soup, and get some extra rest. If we have more concerning symptoms, we may seek medical care. But bottom line, we know when to check for fever, and we know it means something’s going on.
So, too, is it with our menstrual cycles, but instead of checking our temperature, we’re checking our own cycles against an average, healthy, menstrual cycle blueprint that tells us that healthy menstrual cycles are typically 26-32 days long, vary by not much more than 4 days per month, don’t require us to change pads or tampons more than 6 times in a day, shouldn’t stop us in our tracks due to pain (or require us to take pain meds each month for period pain), and while our moods may shift, shouldn’t make us feel we’re going off the rails emotionally. I share the signs of a healthy menstrual cycle here so you can become familiar with this important aspect of your body and health if you’re within your menstrual cycling years – but even if you’re not, it’s a good checklist or barometer to reflect on as the health of our menstrual cycles has implications for how we experience menopause and also our health after it.
As a quick reminder, the menstrual cycle is not just your period – it’s the entire time between Day 1 of your period and the last day before your next period starts.
Here are ways that your menstrual cycle acts as a vital sign, trying to tell you something – and exactly what it might be saying.
Long menstrual cycles, periods that occur 35 days or more apart, can indicate anovulation, low estrogen, low body weight, stress, or PCOS. Long cycles are also often associated with heavier periods and more painful cramps. Anovulation, which I discuss below, can not only interfere with fertility, but if you don’t ovulate, you don’t get the calming, protective effects of progesterone so important to also balance estrogen. If left unchecked over time, long cycles are associated with an increased risk of endometrial cancer.
Short menstrual cycles, periods that occur less than 25 days apart (meaning you have more frequent periods), can be a sign of high estrogen, a sign of a short luteal phase (second half of your cycle) indicating that you’re not ovulating, or an indication of perimenopause if you’re in your 40s. If you’re under 42, short cycles may be a sign of premature menopause, which increases risk of bone loss, cardiovascular risk, and can impact long-term cognitive health due to the early loss of estradiol exposure. Your risk of anemia also increases due to more frequent blood loss. The risks of high estrogen are discussed here and are important to recognize and address.
Skipped periods, defined as missing more than three periods in a row: We all skip a period now and then due to stress, travel, or even the flu (and of course pregnancy) but skipping more than three periods in a row can signal that you’re not ovulating, can indicate PCOS, a thyroid problem, or can be a sign of premature menopause. Hypothalamic amenorrhea is a common reason periods go missing and can be due to: a BMI of less than 18.5, restrictive eating or a low-calorie diet, intense athletic training, preoccupation with weight, high stress levels, or a diagnosis of osteopenia or osteoporosis.
Skipped ovulation, irregular ovulation or not at all, also called anovuation, can be due to imbalances including hypothyroidism, PCOS, and hypothalamic amenorrhea, all of which also come with their own additional symptoms and risks. Without ovulating, you aren’t able to produce enough progesterone which supports overall cycle regularity, hormone balance, mood, the health of the uterine lining, and the ability to conceive.
Heavy periods, or blowing through more than 6 pads or tampons per day, or having a period lasting > 7 days): Almost always a sign of hormone imbalance (usually either high estrogen or low progesterone), heavy periods are also associated with heavy cramping, PCOS, endometriosis, adenomyosis, and uterine fibroids. Persistently elevated estrogen carries its own set of risks discussed here. Heavy periods can also result in iron deficiency anemia and can have a major impact on your energy and mood. Uncommonly, but not so rarely that one should ignore it, heavy periods can be due to a genetic condition called von Willebrand’s disease, a lifelong bleeding disorder in which your blood doesn't clot well, and which often gets missed when heavy periods are just chalked up to ‘normal.’
Light periods, extremely scanty menstrual flow, or periods that last less than 3 days, are often a sign that your estrogen is too low, which then in turn inhibits adequate endometrial proliferation and ovulation, which can interfere with fertility. Light periods may also be a sign of PCOS, hypothyroidism, or premature menopause. They may indicate very low body weight or body fat, and if associated with hypothalamic amenorrhea, carries those same risks.
Bleeding between periods is common when starting or stopping any form of hormonal birth control and some women experience an episode of ‘spotting’ shortly after becoming pregnant (in which case it’s called implantation bleeding). Bleeding between periods can be due to uterine fibroids, cervical polyps, endometriosis, and adenomyosis, and if it persists throughout the month, may also indicate a more serious problem, such as endometrial hyperplasia or even endometrial cancer.
Period pain: Your period should not make you spend days of the month on ibuprofen and should not make you cry because of the pain! If it does, there’s likely more going on. Especially when accompanied by symptoms including abdominal or pelvic pain or pressure, constipation, or pain with bowel movements, urinary problems, or pain during sex, it suggests an underlying condition such as endometriosis, uterine fibroids, or chronic pelvic pain.
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Learning to Listen to Your 6th Vital Sign
Hormones are one of the strongest signals in our body, and with approximately 400 periods in a woman’s lifetime, it’s an important source of personal data we can use to better understand the full ecosystem of factors that influence our health throughout our lives. Here are some of the ways you can become more attuned to this impotant vital sign, and use it you your personal and health advantage:
- First, get to know your cycle: There’s a chance you’re busy or distracted and you haven’t noticed that your 6th vital sign is trying to tell you something. Keeping a record of symptoms and tracking your cycle can help identify irregular periods, long or short cycles, or recurring symptoms. This is great information for you to get in touch with your inner knowing, but also to give to your healthcare provider when you talk to them about your concerns.
- Don’t chalk symptoms up to just “being a woman” or dismiss them as “just normal” unless you’re sure they are! Being a woman, having a uterus or breasts, having periods may cause us some discomforts here and there, but chronic symptoms or cycles that meet any of the criteria above that could be telling you something is up, should not be ignored or considered just “the reality of being a woman.” It’s important not to talk yourself out of it or self-gaslight, an urge that has been subconsciously instilled in women by a healthcare system that typically ignores the unique needs – and suffering – of women.
- Talk to your healthcare provider and communicate your concerns. Let them know you’ve done your research. If you are perimenopausal or menopausal and not cycling anymore, you can still share your menstrual cycle history with your healthcare provider because it can reveal a great deal about current risk factors. The same goes if you’re on oral contraceptives. If your healthcare provider doesn’t take this seriously, find one who does.
- Lastly, before you opt for pills or procedures, consider another opinion – and if possible, a gentler approach: I’m not against medication, surgery, or medical procedures when they’re needed, but the simple fact is that many of the 6th vital sign symptoms above can be resolved without them. Before you go straight for conventional medicine options that will cover up your symptoms, read up on what the underlying causes of those symptoms might be and how you might be able to correct them with dietary changes, herbal medicine, or lifestyle shifts. You can check out the many comprehensive guides on my website. or give yourself the gift or my new and already bestselling book Hormone Intelligence: The Complete Guide to Calming Hormone Chaos and Restoring Your Body's Natural Blueprint for Well-Being,
As we’ve learned here, ignoring the messages your 6th vital sign is sending you, or hoping they’ll go away with time, can leave you with a bigger problems to face later. And while pharmaceuticals, surgeries, and other conventional medical procedures can help with period problems like the ones above, it’s important to know that they aren’t the only solutions available.
Your period and the symptoms that come with it aren’t something to be embarrassed by or feel hijacked by – they’re a part of us – an innate messaging system designed to let us know how we’re doing – and they are worth respecting and listen to. Believing in the power of your 6th vital sign is also the beginning of a much needed paradigm shift – one in which we trust and respect our bodies, and expect the same from our care providers. Women deserve to be listened to and heard. We can start by listening to what our own bodies are saying.
ACOG Committee on Adolescent Health Care. ACOG Committee Opinion No. 349, November 2006: Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Obstet Gynecol. 2006 Nov;108(5):1323-8.
American Academy of Pediatrics Committee on Adolescence; American College of Obstetricians and Gynecologists Committee on Adolescent Health Care. Pediatrics. 2006 Nov;118(5):2245-50.
Brodin T, et al. Menstrual cycle length is an age-independent marker of female fertility: results from 6271 treatment cycles of in vitro fertilization. Fertil Steril. 2008 Nov;90(5):1656-61.
Cedars M, Taymans S, DePaolo L. et al. The sixth vital sign: what reproduction tells us about overall health. Proceedings from a NICHD/CDC workshop. Human Reproduction Open, Volume 2017, Issue 2, 12 July 2017.
Diaz A, et al. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign.
Master-Hunter T, Heiman, D. L. (2006). Amenorrhea: Evaluation and treatment. American Family Physician, 73, 1374–1382.
Solomon C,, et al.: Long or highly irregular menstrual cycles as a marker for risk of type 2 diabetes mellitus, JAMA. 286(19):2001; 2421–2426.
Yi-Xin Wang, et al. Menstrual cycle regularity and length across the reproductive lifespan and risk of premature mortality: prospective cohort study. BMJ, 2020; m346.