The Chinese Medicine Approach to Fertility: Part 2- Understanding the Menstrual Cycle through TCM

I ask all of my cis female patients about their menses, and if they are using a period tracker app or another similar tracking method. Tracking your period is useful for many reasons (whether you have issues surrounding menstruation, or you are tracking to plan or avoid pregnancy) and the information you collect from tracking helps me gain a deeper understanding of what is going on in your body week to week. Day one of your cycle is your first day of bleeding; the entire length of your cycle begins when you first bleed and lasts until the next time.

Phase 1- Menstruation phase. This generally lasts 3-5 days. If your menstruation phase lasts longer or shorter than this, it will be one area where we work on cycle regulation. You bleed because the endometrial lining of your uterus is being sloughed off, because last month a fertilized egg failed to be implanted in the uterine lining. During this time, your pituitary gland is simultaneously producing more FSH (follicle stimulating hormone) and LH (luteinizing hormone) so your body produces new follicles (can be thought of as ‘pre-eggs’). Avoid vigorous exercise at this time. Since this phase is a sign that you are not currently pregnant, my treatment principle will focus on invigorating qi and blood in order to reduce menstrual cramping and ensure the uterine lining is fully sloughed off. Time to start fresh!

Phase 2- Follicular phase. This is the time period which lasts from right
after you bleed, up until when you ovulate. A follicle becomes dominant and begins producing higher amounts of estrogen. Uterine lining thickens and cervical mucosa thickens, so at this time you may experience some slight vaginal discharge (healthy and normal). You may feel more outgoing and creative at this time—allow yourself to make connections, start new projects, exercise and have more sex. My treatment strategy during this phase focuses primarily on building healthy yin substance, which will make up the new tissue and blood needing to sustain a pregnancy, while subtly boosting yang to promote the growth of a dominant follicle at this time.

Phase 3- Ovulatory phase. Although ovulation is generally considered to be a window of 12 to 48 hours (which can often cause significant stress on both woman and man who are trying to conceive), the window for conception can extend beyond that period by multiple days. An increase in cervical discharge is a good sign! Avoid eating cold substances without being careful to balance with hot/warm, cooked ingredients, and avoid raw vegetables. From an Eastern dietary perspective, cold raw foods can damage qi and yang which are essential in this phase to ensure the necessary warmth to initiate pregnancy. If you become pregnant, your basal body temperature will spike and stay higher than if you are not pregnant.

Phase 4- Luteal phase. If you are pregnant, progesterone levels stay higher, and in accordance so does your body temperature. Often, women may experience a subjective sensation of increased warmth. My treatment at this stage focuses on maintaining the warmth provided by higher levels of yang, and supporting yin to help the body maintain the new pregnancy. If you have not become pregnant, your uterine lining should NOT producing progesterone, and you may feel withdrawn, irritable, or emotional: now is an important time to be soft with yourself, avoid overexertion, and come in for some gentle bodywork.

When your focus is on fertility and becoming pregnant, it is important to be in touch with your care provider weekly (even if you are not able to make it in for treatment) to provide updates on what you are experiencing. My selection of acupuncture points and of herbal formulas will be different each week (though I will work with you to ensure this is as convenient as possible), and they always vary depending on the individual presentation.

As always, please reach out to me with any questions!


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