Science Behind the Menstrual Cycle with Kavi Rajendran

Maybe you had a brief lesson on the menstrual cycle in middle school or high school. But how much do you actually remember?

In this episode, Val is joined by the incredible women's health physician's assistant, Kavi Rajendran, to discuss the science behind the menstrual cycle.

Follicular, Ovulation, Luteal? You may have heard of these, but what's happening in your body throughout each phase. What's up with your hormones as each stage progresses? What does this mean for your ovaries or the lining of your uterus?

Class is in session and Kavi is here to for a fun, educational lesson in all things related to the menstrual cycle.

More Links:

Learn more about our guest , women's health physicians assistant, Kavi Rajendran:
Advocate - Kavitha Rajendran, PA - Physician Assistant - Oak Lawn, IL 60453

Hear a bit more about this episode's community shout-out, The Period Collective:
The Period Collective

Transcript

Intro:

I have something. I am embarrassed. To admit.  I am not really sure what's happening in the. Menstrual cycle.  I realize this should be something that I understand. And, or at least I feel a bit of shame that something that's been going. Going on in my body for such a long time. It's still such a mystery to me.  It must be important.

Otherwise, why when you show up at the doctors do they always ask "When was your last menstrual cycle and how long did it last?"

I will be the first to admit that in the days where I wasn't. Tracking my cycle (because I never even knew that was a thing), I would just lie to the doctor and say some random date that I guessed.  I feel like I can't be the only one. I'm sure we spoke about it for a day or two in health class when I was in middle school or high school. From distant memory, I feel like they just played an old VHS tape. 

Not to mention, I didn't get my period until a little later than other gals, around 17, so when learning about the menstrual cycle in high school, it didn't feel personal. It felt like words on a page that I was trying to memorize for a pop quiz. Quiz, not very crucial information about my body.  And of course, because it always seems to take up the most space, the main concentration was on your period.  Not to period bash. Periods are important. (I'm on my period right now.) But it feels that any time I learned about the menstrual cycle, the period was the big star.

But what about all the other days in the month? What's going on throughout the entire menstrual cycle.  I want to go back in time. Time to middle-school and reset through a chat about the science behind the menstrual cycle.

And luckily today I have that chance.

  I am Val, and this is not so private parts.  Join me and let's find out. 

 ​Acknowledgement of Country:

 We would like to begin today's episode by acknowledging the traditional owners of the land in which we created, and recorded this podcast: the Gadigal people, the Bedigal people, the Potawatomi people, and Peoria people. We pay our respect to elders past and present and acknowledge First Nations people's continual culture and contributions they make to the life of these regions.

Indigenous women have played an integral part in women's reproductive health for millennia.  It is impossible to separate the achievements in modern women's health from the knowledge passed between women since the dawning of time.  Women acting as midwives, as mothers, as healers, as supporters. 

A sincere thank you from a modern girl like me to the women throughout time who have shared knowledge and stories to support one another to live healthy, fulfilled lives.

   
Medical Disclaimer:

Today, I am talking to a super cool women's health physician's assistant, however, please do not take any of this to be personal medical advice. If you have something going on in your body. Please seek treatment from your own doctor to be properly evaluated, counseled, and treated.

Raley Singing the Jingle:
When you know your body, you feel empowered. Open conversation, safe space, sharing stories, knowledge.  Learning together, growing and knowing not so private parts.

Just a girl and her gyno mom, let's get into it.

 
Intro to Guest:
 You may remember our guest for today's episode from our episode, Taking Charge of Your Discharge. She was our guinea pig guest on the show, meaning our first guest back in our first season, and we are so appreciative to have her back again. Joining us again on the show is the fabulous Kavi Rajendran.

Hello I'm so happy to be here. Thanks for having me back.

We are pumped to have you.

Just a refresher, Kavi is a physician's assistant who is very passionate about the women's health space. And has been working at the Women's Health Institute of Illinois for over six years. When I go to the gyno's office, I see Kavi.

I think many of her patients would agree that Kavi is such a kind, genuine soul, and a very intelligent lady. She explains everything thoroughly, but in a way that is not overwhelming. Even though she is a busy lady with a lot of patients, it always feels like she has time for you and your questions.

Start of Conversation:

 I just feel so grateful to have her as my main vaginal guru and also that she's here today to talk about a classic. Which is the menstrual cycle.

We are going to be talking about a lot of things, including periods. So it seems like that's a good place to start.  I was wondering, Kavi, if you remember your first period?

Yeah, so I know you actually asked me this earlier and I had to think, and it made me laugh because I am always asking patients in the room, like When was your first period? And they're like, Oh gosh, I really need to think back to that far ago.

 I believe mine was  in sixth or seventh grade. I think it was the classic bleeding through your jeans and then someone in the hallway, like a teacher or a counselor, just kind of pulling you aside and being like, okay, let's go to the nurse's office.

 I believe I was alone in the hallway though, if my memory serves correctly. So it wasn't, wasn't terrible. What about you?

 I wouldn't know if this is my first period, but I'll tell you an embarrassing period story, which is that when I was in college, my freshman year, I went to the gym  there was this area where you could lay down your mat and do weights or do abs or do whatever you wanted to do.

 I got my mat, I laid down and I decided to go through this ab circuit. In fact, it was the Victoria's secret abs workout.  I had it on my phone. I was so ready to do it. I was doing scissors kicks.  All of a sudden I noticed that this group,  across the way, was kind of looking at me and smiling the group of boys and me being me, I was like, gosh, I must look so good

I probably look so fit. They were genuinely looking and kind of pointing and I was like, wow, maybe they're super impressed by my Victoria secret workout. No. Then luckily a savior of a girl came over and was like, "Hey, I just wanna let you know  'cause I wanna, you've bled through your shorts"

So I generally was scissor kicking in their direction, smiling, feeling  flirtatious, but, and I got up and true, it was on my yoga mat. Yeah. Luckily by then I was in college, so even though there's some embarrassment, I was like, whatever, I'm just gonna wipe it off. Yeah, whatever.

Oh, and it's in college, too, so, it's a little bit better, yeah.

I'd already bled through stuff that had been embarrassing. So I was over. Yeah.

I want to tell you about a fun discharge moment that I had. Okay. Because I knew nothing about discharge before I had the chat with Kavi that's in our first season. If you haven't listened to it, I would highly  recommend.

Yes. I just look down there and when I see anything in my underwear, I pretty much just ignore it.  Getting to learn about discharge has been very empowering for me.

My moment. The other day was I was at work. I went to the bathroom, and then this  white, egg yolky  discharge came out, and I had this visceral moment where I thought, wow, if I had known, I would be so nervous right now.

I'd be going to WebMD thinking, what's wrong with me? But since our chat, I stretched it between my fingers and I thought, no, I'm just ovulating. Awesome.  I just wanted to tell you because that is directly from our conversation. Yeah. And that completely ties in with what we're chatting about.

I know during discharge, we talked about how it basically changes according to where you are in your menstrual cycle.  It's kind of full circle. Full circle.

 I wanted to share because I felt like I would have freaked out before. I'm like, what is this coming out of me?  I saw it and I thought, I know exactly what this is.

I know what this means and it made me feel so good. Good.

 To talk about the menstrual cycle first, I was just hoping you could explain how long is a typical menstrual cycle.

Yeah, absolutely.  When we talk about the menstrual cycle on average, it's usually about 28 days.  It can be as short as 21 days and as long as 35.

 It's really varies between gal to gal.   The way we know when it starts and when it ends,  the first day of your period is the start of the menstrual cycle, and then it goes all the way till the day before the start of your next cycle. 

 Is it normal for your cycle to vary in length ?

Because now that I started tracking, some will be. 28, some will be 15, some will be 30.  I'm thinking, is it wild that they're so different, but is that pretty common?

Yeah, sometimes it can be normal for it to fluctuate even within yourself. There's a lot of different factors like stress,  birth control as well can really impact that.

I would say if you do have   a really sharp decrease though, from something that's your average, it's always a good idea to, Go and chat with your doctor and see if there's something going on.

I've also heard that menstrual cycles begin to shorten as we age.

Have you heard that? Is that true?

You know what? I have heard that and I love that question. It kind of adds to the complexity as well as the nuance of the menstrual cycle. So once again, it's true for some women and it's false for some women.  Ideally  our menstruation starts at menarche, which is basically when you start having a period, which is on average around 11 years old or so.

 Then it goes until you go through menopause, which is the day where you've gone one full year without a period.  The average of that age is about 51 here in the US.  Ideally, yeah, you think in a perfect world, your periods kind of start to get a little bit more regular and lighter until they completely,  stop and go away.

 But that's not really the case.  There are a lot of women's in their 40s or 50s that actually start to have heavier periods.  It's actually something here at our clinic. clinic that we,  help a lot of women to manage because not only is it annoying, you're supposed to be living your best life around then  if you have kids, you're an empty nester.

 Ideally you  know what you like at that age. You want to enjoy your life.  Here at our clinic, we. Have options to treat it, but we also worry about anemia, heavy bleeding and things like that.

You're so smart, Kavi.

I can't believe you were nervous at all. You're so smart. Oh my gosh.

You're so well spoken. And actually what it reminds me of is like you just gave that great story of bleeding through in college. I have so many  40 year old women coming and they're like I can't believe I bled through like I was a teenager again. 

The other day I bled through my swimsuit, and I looked at I thought girl you should have this under control Yeah, but then there's so much going on in your day to day life that sometimes I think oh Keeping totally on track of where I'm at Especially when sometimes it comes at random and it doesn't follow the schedule

 Just to go off what you just said about bleeding through your swimsuit I actually just heard a fact, in my entire life, I'd never known this.

A lot of women when they go swimming, they actually won't use tampons or anything because the force of the water is sometimes enough to stop your period. Did you, have you heard that? I've heard that because. In swimming in high school, I remember there was a girl and she didn't know how to put in a tampon.

Yeah.  We were like, Oh, we can show you, we can help explain it. And another girl said, don't even worry. The second you hit the water, your period will stop. Yeah. And so she tested it and it was true. But I think the only thing is when you're out of the pool and the water is gone.  I feel like when I'm in my swimsuit, most of the time I'm just laying in the beach, not even going in the water.

So I popped one in.

 We're going to start to go through the different phases of the menstrual cycle.  The first one is the menstrual phase, which typically goes from day one to day five.

 I was wondering if you could tell us what's happening in your body at this phase in your cycle?

 I think one good thing to clarify also is Like we just discussed, menstrual cycle can vary from  21 to 35 days.  Our answers going forward will mostly be based off a normal 28 day cycle.  Day one through five is menstruation.  That's typically, when you are having your period.

What's happening is there's a lining endometrium.  The endometrium gets nice and fluffy throughout your menstrual cycle.   If there's not a pregnancy that it needs to support, this is the time that,  it starts to shed,  and that's when you,  have your bleed.

 A lot of women I know experienced cramping during this stage of their cycle.

 What is causing cramping or what is happening in your body to give that cramping sensation?

 This answer is  multifactorial,   a lot of inflammatory chemicals are being released at this time.  Your uterus is basically squeezing so hard to  get that,  uterine lining out.

Some people may even have cramps that are as bad as the second stage of labor, to  put a quantitative, number on this.  When you have a blood pressure cuff on your arm and you're pumping it up, when it gets to 120 millimeters of mercury, that's how much pressure your uterus can be squeezing, to get it out. So yeah, it's extremely painful.

That is a really good analogy. I feel like for those who don't menstruate, because I find it hard to explain to men in my life, what the feeling is like of that, like just this. This intensity. Yeah. That's a really good analogy.

Getting back to some of the chemicals that are released,  the most common is called prostaglandins.   Prostaglandins are going to cause,  uterus to contract. And so it's a really good idea to get on a medication  that will block these prostaglandins, like ibuprofen,  any anti inflammatory.

They directly work to block those.

 This is something we talked about in one of our painful period episodes, but It's smart to start taking medicine like ibuprofen before your period starts and before the prostaglandins start to get all

activated. Yeah, absolutely. If you are someone who  tracks your cycle and you know when it's about to start, you could take them a little bit beforehand.

Usually though,  if  You're not as prepared and you start to have cramps. The medication should  start working in about 30 minutes or so.  It is a higher dose that. We usually recommend than people are used to taking. I typically recommend anywhere from 600 to 800 milligrams of ibuprofen.

Is that four?  That's three to four. Yeah. Every six hours as needed. Yeah. That's my normal dose, but I'm

going I went and saw my asked a girl for Advil and she gave me one. I was like, what is this? Yeah. What is this going to do? But she was a small person. Yeah. And so she was used to taking one. I'm 6'1 and 160 pounds.

I'm popping 3. It's an important clarifying question. You know, even for me, if patients come in and you're saying, Oh, I've used ibuprofen, but it didn't help.  The dosing just really important.

 There's blood loss happening during this stage. I'm wondering what's a normal amount of blood to be losing during this time?

 A normal amount is about,  two to three tablespoons, or,  if you think of a shot glass, about one and a half shot glasses across the whole period. Yeah. So it doesn't even seem like that much.  We have this data mostly from  studies,  but you also have to think,  when you're having your period, you're also having discharge.

And some other fluids that can influence it. And once again, it can vary. It definitely varies woman to woman.

 Sometimes I wish when I hear that, that I could collect it and see all of mine at the end to see how big it was. But then I think,  I feel like the effort it would take. To be collecting my period blood for three days, plus the suspicious looks I would get from people at work or at home.

 You could technically use a Diva cup. Have you heard of those? Okay, I've heard of them. I've never used one.

Yeah, so I used one for a while. It was a little bit messy, but a Diva cup, I don't know how many milliliters it collects. But essentially that could be your measuring tool.

I am pro you doing this. 

Okay, I'll do it. There you go. All I needed to be backed by one scientist.

  Period poops.   This was such a huge learning for me and for others I know, because I had a couple girls write in saying, Oh my gosh, I thought I was the only one having diarrhea or feeling like I had to move my bowels more often when I'm on my period.

But it's actually a more common phenomenon than we might think.   What is causing that to happen?

 It's our good friends, the prostaglandins,  they also can,  act on the smooth muscle and your GI system,  and it can make digestion a little bit quicker, a little bit easier, and that's why some women can get diarrhea during their periods.

I do want to make note though, if your bowels are significantly changing during this time and. You also have a combination of  very painful periods. It's a good idea to chat with your doctor. Some of these can be signs of other conditions like endometriosis.

 We're going to dip a little into the hormones, but  not so full fledged because hormones can be confusing.

But what's happening to estrogen and progesterone during this part of your phase?

 During the menstruation phase, this is the lowest your estrogen and your progesterone ever are while you're bleeding.  So that might B. Y. Some women feel a little bit, you know, more tired  because your estrogen is very low.

You're also,  bleeding heavily, which can be pretty exhausting for your body.

 That's what's going to lead to people feeling sort of sluggish or maybe tired. It's just that those hormones are really low. 

One thing I want to add, too, to the digestion aspect, like I said, The menstrual cycle is complex.

A lot of it is multifactorial. The prostaglandins and then also your progesterone  gets very low. Like we, like I just said,  progesterone tends to be very constipating as well.  So you may even notice that it's like some of your PMS symptoms.

 When that goes lower, it's a little bit easier to move your bowels as well.

Everything is so connected.

Yeah, it really is.

 Before we move on to the next phase, I'm wondering if you have a period routine or this is something I'm trying to get better at tracking my cycle and knowing where I'm at and then knowing how I can care for myself or support myself when I'm at different parts of my cycle.

 I'm wondering, do you have anything that you do when you're on your period? Do you have any little self care tips?

Yeah, I,  I'm pregnant right now. So 

I think.  I do  the classic stereotype. If I give myself some sugar and some chocolate, I allow myself to relax a little bit more.

I don't really have a full routine. I think it's intuitive for me to just chill a little bit more and Indulge in some desserts, 

I'm getting so much better. I'm working this year to be better at setting boundaries and my period has been a good learning source for me around setting boundaries because I'm getting much better at telling the important people in my life.

Because I'm pretty uppity as a person and during those days I feel really low in energy and mood I just feel like I can't give as much as I'm normally giving and so I'm getting better at when it's my period About being open and telling people my life. I'm on my period. Yeah, can you actually do the grocery shopping?

Yeah, I will cover it The rest of the month when I'm feeling pumped and amazing.  That's one way I feel like I'm trying to give back to myself is being open about  what do I have the time for and the energy for, and not feeling so bad. I just feel like I get on myself  when I'm not feeling 100 percent my best self.

 I will admit my period is not when I'm feeling my best self in terms of  robust energy and feeling really lively, but I'm trying to give myself grace and patience And I appreciate that time when I'm having my more quiet days. I love that. And it's science backed. Yeah. Evidence backed.

  Let's go to our next phase, which is the follicular phase.  This is typically from day one to day 13,  if we're following that 28 day cycle.  My first question is, we already said day one, so is this overlapping? Yes.

Yeah, yeah, yeah.     Day 1 through 13  is the follicular phase and then later on, we're going to chat a little bit about the luteal phase.   These are basically just talking about what's going on in the ovary during your whole entire menstrual cycle, but,  technically day 1 through 5 is when you are bleeding and having menstruation.

 It's not technically a phase if that makes sense. 

Follicular  has.  Parts of the word follicle in it, and I know that follicles are important in this part of our face.  What is a follicle?

Basically a follicle is a immature egg, or it's called an oocyte,  which is a little bit more fun to say.

Yeah, O O C Y T E, and so a woman is born with a set amount of follicles  born with the most follicles you'll ever have. Those do decrease as we get older.  Basically during the follicular phase,   all the follicles on your ovaries are, trying to basically become the dominant follicle, the one that will,  eventually be released,   as an egg.

 How are they competing? Yeah, I know, that's kind of it. I always think of like the chosen one in Harry Potter. I think it's from Mario Kart

Battle where they're going around trying to pop each other.

 Basically there is a hormone called FSH. FSH stands for Follicle Stimulating Hormone. It comes from  the hypothalamus  and the pituitary.

It's sent down to our ovary, to stimulate the follicles and  just to The one that I guess grows the quickest, I actually don't have a really good answer for that.

  Phoning in. A friend and by my friend, I mean, my mom, Dr. Poulos. So mom, how. How  did the follicles decide which one is going to be the. Winner. Which one is going to be the one that gets to really see it. That's pretty. Much rice over. It gets biggest and most mature, fastest wins. Okay.

 You mentioned it, but is it FSH that is releasing the follicle or is there a hormone that comes and says, okay, now it's time for you to.

to drop. Yeah,

absolutely.  FSH is stimulating the growth.  And then when we actually talk about egg release, the luteinizing hormone, another hormone that's coming from our hypothalamus and pituitary,  surges up and that is actually a sign for the egg to be released.  We skipped a few steps here, but basically,  when the FSH is stimulating those follicles, they're releasing,  levels of estrogen as well.

So your estrogen is going up. Once estrogen gets to a certain point, that's when you have an immediate surge of the luteinizing hormone. It's kind of, it's like a, like an orchestra, if you will. It's,  pretty well designed our bodies.

It's almost like a level system in that LH knows, okay, once estrogen hits this level, then I'm going to come in.

Yeah. Okay. Exactly. Cool. So it's all connected.

 What's happening in the uterus at this time? I feel like we just had our period, and we flushed everything out.  We're starting from scratch.  What's happening in there?

 During the follicular phase, it's right before ovulation.

 Your body is essentially preparing for a pregnancy.  Like I said, your estrogen is rising. Your estrogen is what makes that really nice, fluffy endometrium  where you menstruate from, which is what we chatted about earlier. So it makes sure it can support an egg.

Okay. Next we'll hit. My favorite phase ovulation.  Ovulation time. Come on. I actually love ovulating.

 Do you? I love it. Oh, do you? You don't get middle schmertz then? I don't get middle schmertz. I It must be, 'cause you just said there's a surge in estrogen. Uhhuh. I feel like it's the time of my life where I step out the door.

I'm like, I'm hot. I am confident. Yeah. I'm amazing. Cool. The world is at my fingertips. Yeah.  Now that I've been tracking, that's what I noticed, that when I ovulate, I just feel sort of. On top of the world. Love it. On top of the world.

 What is it called when the ovary releases an egg?

Ovulation. Okay, easy.  Trick question.  We have two ovaries.   This is my confusion. Are they each releasing an egg every time we ovulate? Or is it only one egg? It's only one. So they're switching off? Yeah. Okay. Whichever one is the dominant follicle. Okay, so could it be that maybe you have two from your left one day because they grew faster?

Not one day.  During this transition. ovulation phase and then the next time you ovulate it'll be the right. Yeah,

it could be. I actually, I have a friend who she can feel, which I think we're going to get into. She can feel the side that she's ovulating from.

Me as well. I have a friend and it's amazing. She knows which ovary the egg came from.

 We talked about that Some women can feel when they ovulate as you just said of your friend and some women even experience pain when they ovulate Mittelschmertz Mm hmm fun word, which basically is a word of German origin when broken down means middle and pain So it is pain in your middle area.

What would be causing that?

 Okay, so middle smarts is. Is a pain that could be mild or severe. It's a lot like the pain that. People would feel from appendicitis.  Ovulation is actually. When the ovarian follicles really expands, that can cause pain. And of itself a big physical stretching when it grows quickly. But I relation. Has kind of like a little explosion or like sneeze where the egg is shot. Shot out of the follicle. And that causes a focal peritonitis or. Irritation inflammation of the pair deal covering of our organs. In the area, which are really rich with nerves.

So someone that can get mild, moderate, or very severe pain at the time. 

There is a really cool little video of this.  Mini explosion that happens in our ovaries at opulate. Relation. That my mom sent me. And both of us can't stop watching it over. And over again, it looks like a star exploding in the universe. To create a supernova. And that is happening in our bodies.  We'll link it onto our Instagram page.

 
 We spoke about this I want to see if I get this right so what hormone is released to release the egg  Estrogen hits a certain level.

Mm

hmm. And then it's the LH that comes. The LH surge. Yep. Surge is up And that's when your body knows. Okay, I'm gonna release the egg. Yeah, and

And Where does it go?

 That egg is released from the ovary, goes up through your fallopian tubes, and then,  ideally it implants in your uterus, in the endometrium.

   How is it moving through the fallopian tube? You know how the esophagus will sort of  Undulate to get your food to go undulate.

That's such a great word. Yes. I forget the word for that I think it's starts with a "P" But,  is the same thing happening in your fallopian tube?  Or does the egg just have an internal clock where it's like, I know where to go?

 Inside your fallopian tubes you have cilia of fimbrae, which are just hair like projections that are in there that just kind of scooted on through the uterus.

Kind of think of like a broom, just brushing it through.

I do love that word,

cilia of fimbrae. That phrase, cilia of fimbrae.

  The egg has moved to the fallopian tube and now it's coming to the uterus.  How long is it gonna, is it just gonna chill in there for a while hoping a sperm will come?

Just about 24 hours. Okay.

Whereas your sperm can actually live there for about

six days.

Wow.

Yeah. So that's why you should be careful. Even if you're tracking your cycle and doing the withdrawal method.

Yeah, especially during  this time period to,  if you don't want a pregnancy, it's, yeah, really important to use contraception.

 The egg is there, it's staying for about 24 hours.  Next we come to the, did we already hit the luteal phase?  No, not yet. I think we've hinted at it. Oh, Easter eggs. Yeah. Easter egg. Well, here we are. The luteal phase, which is from day 15 to 28.  What's going down during those days?

 If we're working off a 28 day cycle, we'll say ovulation about day 14. And so, like you said, luteal phase, we're at 15 to  28.

now, a few different things can happen, right? Because if you remember, your body's been preparing for pregnancy, the egg has been released.   Let's say,  your egg meets a sperm and it's fertilized and,  a pregnancy is going to happen.  So, yeah, like me, what exactly happened?  So that means basically the follicle that the oocyte  was released from is now, What's called a corpus luteum.

Okay, so it's basically like Harry Potter. They are basically Harry Potter.  It's basically,  a large cyst that's producing a large amount of progesterone,  to really support this pregnancy ongoing. Okay,

so the ooctye.  Now, got with the sperm  and something fell off of it that became the

corpus luteum.

So no. The egg and the sperm, they're in the uterus, but then we, let's go back to the ovary where your oocyte was released from , that follicle, that cyst, I use this kind of interchangeably. That follicle though becomes what's. The corpus luteum,  which creates a steady state of progesterone.

Okay.  The ones that had released the oocyte, like the follicle is still up there in the ovary. Yeah. It gets word that  the oocyte has got together with the sperm down in your uterus. Yeah, and will start to send progesterone. Exactly. Okay, cool. And the progesterone is coming to help the pregnancy.

Yep. Progestation helping to support. Progesterone.  Yeah, I love

that

when I learned it in college. Mm hmm. Oh my god. I've never put that together. Because progesterone is a hard one. Estrogen you hear all the time, so it's in my head. Yeah, no one really talks about

progesterone. Progesterone  plays a really big role too in our lives.

 This is its phase. Progesterone's phase is the luteal

phase.  Let's say that no sperm came to fertilize this oocyte.

 If the egg is not fertilized, your body will reabsorb some of these processes and start a breakdown.  So about 10 to 14 days afterwards, the corpus luteum that we were  chatting about, that's creating that progesterone, it will start to break down.

 Along with that breakdown becomes the hormonal decline.   You're going to start to have less estrogen and less progesterone.

Was it all kind of peaking up until this moment?

Yes, exactly.  I like to  say like mid luteal, you have  higher hormones.   Then right after your body realizes that the egg is not fertilized, that's when everything starts to decline.

 You  have some of those PMS symptoms. It sounds like your body. Kind

of gets pissed at you. Yeah  That's how my mom used to describe it is that if your uterus was this  gorgeous room   like your best friend has this really cool safe space in her house And she spends the entire month filling it with decorative pillows and nice candles and chamomile tea  basically just making it the coolest chill out zone all your favorite books all your favorite movies all your favorite snacks Are in there and then you basically come and be like, nah, I don't want to yeah, I'm over and so then it starts to get your friend gets really mad and starts to throw all of the pillows and all the books and all of the cute things she put in this awesome room for you out of your body and is a little angry because She's

been setting it up.

Yeah. Yeah, absolutely. I know some women who aren't ready for pregnancy are very happy for this anger  to kind of come.

 That's what someone told me.  You're either really hoping you get your period because you don't want to be pregnant.

So you see it and you're pumped. Or you're trying to get pregnant and every time you see your period it feels like a huge disappointment to you.

 When are you considered premenstrual? A couple days before your period?

Yes, so I love this question because it's something I chat with my patients about often.

 It's really important,  to note that premenstrual,  syndrome is otherwise known as PMS. It is going to occur in that luteal phase towards that late luteal phase right before you start your period. If you do have any of those PMS symptoms like fatigue, exhaustion, anxiety, feeling like down, earlier in the cycle, more in the follicular phase, it does just With me as a provider, I start to treat that a little bit differently.

 It's really important to note that most of those symptoms are occurring

right before  your next period.

 You mentioned some of those things, the PMS symptoms.  Headaches, Water retention, mood change. I myself find I'm very irritable during this time.  What would be causing a couple of those?

Yeah, so it's just the decline in the hormones really, estrogen and progesterone going down.  Along with estrogen and progesterone, there's also the neurotransmitter called serotonin.   This is, you know, typically the happy hormone,  and your serotonin can actually go down during this time as well for some women more than others.

That's also why,  some women  may notice their PMS symptoms are a little bit worse.  I do want to,  Say that it is  a stark difference to from PMDD, which is premenstrual dysphoric disorder, where everything is a little bit more intensified.

It's more rare and definitely requires medical. Attention

Stay tuned because we actually are going to have an episode on PMDD. Oh, great. Later on in the season. I can't wait to tune in.

 I just had a question I wanted to ask you. How do you feel about people  using their hormones to explain their mood and where they're at?

Mm hmm. My reason for this question is, I've heard people say before that people can just use hormones as a passing on the blame.  If they are feeling  irritable or maybe kind of sad, instead of looking at why they're feeling that way, they can be like, Oh, well, I know my hormones dropped during this time.

I don't know. I'm wondering what you think about that. It kind of pisses me off.

Yeah. I was going to say, I mean, I could see myself saying that to my partner and be like, be nice to me, like I'm in my luteal phase, but I find it's inappropriate to tell that to your employer, right?  That's not something that I would advise.

 I think it's really interesting. I personally have not witnessed anyone who. Doesn't take accountability for their actions and blames it on their menstrual cycle.   we all have one life to live and we just kind of got to manage, manage our symptoms, which is why you should reach out to your doctor.

You know, if it is really impacting your life that much,  reach out to your doctor and we can give you some tips  on how to manage it.

No, I was more so thinking of it in the sense of.   Like I said, I'm getting much more open about talking about it, that  I feel like,  I've gotten a little pushback of when I'm irritable or feeling tired, I'll just be like, oh, well, I'm experiencing my PMS because I'm at the end of my luteal phase, so please have grace with me.

 I feel like I've gotten a couple eye rolls, or, and, I think it's coming from people that don't know a lot about women's health or about the menstrual cycle, so they see it as like a passing of blame.

 Luckily, I don't know, I feel pretty mentally sound within myself. Yeah. That I always think I know what's going on for me, and if people, I'm just trying to be open about what I'm experiencing, so people don't think that I'm low energy because I don't want to see them or things like that, and I think if you're a true friend to a person in my life, you would want to get to know that part of me.

 I love Gen Z.  I think that's also,  why it's really good to be a effective communicator. I think the way you would tell people about your cycle would be different than maybe somebody just, You know, as a snap judgment saying, well, like, well, I've on my luteal phase, so I can't get this

done.

  This is a question I get a lot, which is, can you still track your menstrual cycle when you're on hormonal contraception?   Some women have less period symptoms or don't bleed when they're on hormonal contraception.

I have a lot of people wondering, are you still going through the menstrual cycle? And if you are, how can you figure out what you are if you're not having a telltale sign like bleeding? 

 This is a great question.  So most birth control, most hormonal birth control, you are not ovulating.  So basically we've been chatting this whole time about  rises and falls of your hormones.

 When you're taking birth control pills, it's usually a steady amount of hormone that's going into your system every single day to prevent these rises and these declines.

And these rises and declines are important. to have, you know, that LH search that we chatted about to have ovulation.  Most hormonal birth control is preventing ovulation.  When you actually have your period, which is when you have your bleed, it's actually not your real period, right? We don't call that a period.

I always say when was your withdrawal bleed.  So what is it then? It's still coming from the endometrium, but actually the longer you're on birth control, because you're just getting the steady state of hormones, endometrium actually thins out.  You may notice while you're on birth control, your periods get less and less.

  Is that same for the IUD? So, no,  so I keep saying most  hormonal birth control,  so a hormonal IUD, some women ovulate, some don't,  so that could be a way that you could figure it out is some people do still have a little bit of a bleed.

 If you do have a little bit of a bleed and on your IUD, can that be a sign that you're ovulating?

Yes.   The copper

IUD has no hormones and you are always

ovulating.

Okay.

 Going back to how can you tell, let's say we are on  the IUD.  Is the only way to know if you are one of those people that still ovulates is if you have a bleed throughout that time? Yes. Okay. That's something I'll need to double

check.

 Okay. We're doing a little fact check since we weren't totally sure. On that question. And I have my lovely mom, Dr. Pulos here. So now. It's the only way to know if you are one of the people that still Ave. when you have an hormonal IUD. Is if you bleed.

Well, you could ovulate and have a bleed. Recalculate. Not have a plate, so that's not really reliable. You could. I think about checking your server Columbia coast, but that's already going to be effected by. The hormonal IUD. So that's not gonna be reliable either. And you can get a blood test if you really want it to, but it's not indicated.

And probably what he. Covered by your insurance. So just know your ID is still protecting you from pregnancy, whether you're ambulating throughout. It or not. And if you really wanted to. You could check your temperature every day, right? Right.

 We're

talking about   a regular or more common or maybe just like by the book menstrual cycle But we also know that menstrual cycles can be irregular sometimes What can cause your menstrual cycle to be irregular?

Yeah, a

lot of different things  so immediately I think of stress,  if you're a human on planet earth,  we all undergo some type of stress. It may not be stress from like, doing your homework. That's going to cause a abnormal period. But,  maybe if you have,  tough days at work, or,  maybe a tough time at home,

that chronic stress can kind of build up and cause a change in your period. I just had a gal who moved here from Seattle and she said it was incredibly stressful and her,  period,  pretty much went away for about 3 or 4 months.  But talking about that, we don't always want to say, like, oh, it's just stress and kind of sweep it  under the table,  it can be,  over exercise, under eating, thyroid disorders, then when we're talking about your regular menstrual cycle, it can also, be  fibroids, PCOS,  lots of different things going on.

 When do you think you should go and check with your doctor? Because I know,  I don't want to rush to the doctor if I'm used to having a 28 day cycle and suddenly one day it's 30 and the next it's, you know.

25.  When do you think is a good time to think, okay, maybe I should actually go get checked out?

 I think if you're tracking your periods and you notice these changes are present for three months plus That's a good idea to just go and chat with your doc.

Okay  Tracking your period, yay or nay? Yay!

Yay?

Yeah, I like it. Okay. Me too. I think,  don't get too obsessed with it.   I have some ladies who come in, they're like, I had a 28 day cycle and then it was 29. You know, leave, leave a little room, a little margin for error, but I think it's good. It's good to be in touch with your body and understand what's going on. 

 



  Do you think it's important for women to share with each other?  If yes, why do you think it's important?

Yeah, absolutely. I think that sharing the human experience is,  so important to understand that it's not just you and you can also understand , okay, is this, are my cramps abnormal or is this normal?

Is this something  everybody  goes through? So just understand everybody's experience.

I also feel like I talk about this.  Constantly. But I feel  one of our biggest gifts as women is our ability to speak with each other and connect with each other. I just feel in general, I feel able to be very vulnerable and open with the women in my life.

 Half of what I've learned about my body, has come from just conversations with my friends or with loved ones when we're being open about what we're going through.  It's just that feeling of I know everyone goes through this, but there are times in life as a human where you think I just feel so alone.

Or I feel like I must be the only person going through this. Whereas then when you open up and chat, as you said, It just takes that away. It makes you realize, no, other people go through this. Yeah,

absolutely.

A lot of women they, for example, menopause, you go through menopause typically the way your mom goes through it too.

 It's also kind of just little hints at  what your menstrual cycle is like.

I

know.

I seriously have written down so many notes about my mom's menopause. 

So I couldn't be prepared. So funny. Okay. And you know what? I'm actually thinking back to what you were Just talking about with people  rolling their eyes when you're talking about the menstrual cycle I think it was just such a taboo topic for so long And now we feel so much more comfortable  chatting about it and really expressing it So I think it's awesome that you've  taken that upon yourself to make that your self care and really talk to people  Because you know a long time ago,  they thought of it as like dirty and toxic,  many many many years ago  it's just it's changing now and 50 percent of our population is menstruating.

So

I was thinking about this yesterday when I was on a walk, actually, which was. I can't wait to see what the future generation of women is going to look like.  Maybe this is a phenomenon for every generation of women . I just feel like each time, like you said, you love Gen Z's. I know we're so hippie dippie.

I mean No, I really love

it. Like, I should be Gen Z.

I'm like, I need more Gen Z people in my life. But I was thinking, what is the next generation of women going to be like? Because even I I feel like I'm learning about this now at this stage of my life in my 20s, but going online to research, there's so many books about periods for young kids.

There's so many school programs in which now people come in to have these big open chats about periods and about all the signs, about your emotions.  In general, like you said, just the way we talk about it is getting so much more open and less taboo that I'm hoping it translates.  It's making me think, wow, what will the next.

Generation of women coming who were born into a world, hopefully, depending on where you're living and where you're at, that has less shame about having a period. It just

normalizes it. It makes me hopeful. Yeah, me too. I'm excited to see, yeah, how things change and evolve and improve and get better for women, right?

 It's so crazy that, like, when I was in middle school,  A, those tampon and pad machines never had anything in it,  that you had to  put a quarter in. I don't have a quarter, and now you can go to even just like restaurants or bars or hotels and they just have that little stash of tampons and pads available for patients, which patients for, for people visiting their establishments, everyone's a patient to me.

 That's like dramatically change. It's something I don't really appreciate day to day. Now I'm just like, okay, why doesn't this place have tampons?  But yeah, you think about even for me, that was when I was 15. So that was like

over 15 years ago. Or even now, if there's some countries that have menstrual leave, paid menstrual leave from work.

 I know some places are also working getting tampons and pads subsidized by the government. That's happening in Australia at the moment. Things like that, they make me hopeful. I think it's easy to get really bogged down when you're reading the news and all that's going on in the world.

But there

are good hope stories. That is true. I'm so happy to talk to you. I get a little jaded by things like this.

I'll have to look it up, but I know there there's tampons and pads in schools.

That you can get for free and I'm not sure about here.

Thanks so much to Kavi for taking the time to talk with us today.  As I said before, I feel like Kavi has such a nice way of breaking things down and making it so easy to understand.

You're also just a pleasure to chat with, so 

thanks for being you.

Thanks for having me.  I'm always happy to be here,

 

Community Shout Out:

 I am very honored to be here with Ida Melby, who is the executive director of the Period Collective, and they are our community shoutout for this episode.  It feels really fitting because in this episode, we talked all about the science behind the menstrual cycle.

Kavi, who was our guest, actually remembers volunteering at the Period Collective when she was younger.  We're so glad to have Ida here to talk to us a bit more about the Period Collective and hear about what they do.

Hi Ida, it's so nice to have you here.

I was hoping today you could just tell us a bit about What is the Period Collective and what is the main mission of the Period Collective?

Yes, the Period Collective is an all volunteer non profit,  based in Chicago. We operate in the greater Chicago,  area. We provide menstrual products to homeless and others in need, and we distribute products through over 50 partners that we have in this area.

Our partners are homeless shelters, transitional housing facilities, employment networks,  schools, after school club, health facilities,  really any type of organization that are working directly with the clients that we are trying to reach. 

  If anyone's interested to go online, they have some of the partners listed.  Chances are, I'm sure you're going to see an organization or a not for profit that you care about in the Chicagoland area that the Period Collective is in partnership with

Something that comes up a lot when you're on your website or thinking about the mission is this idea of period poverty.  I feel from conversations that not everyone is sure what that is or has heard of that before. I was hoping you could explain what is period poverty.

Yes, very short period. Poverty is being unable to afford menstrual products for yourself or somebody that you're in charge over that depends on you. But we also like to include things like lack of access to education around menstruation. Access to places where you can,  have,  clean bathrooms,  the ability to wash up and also wash clothing,  things like that.

I feel mentioned on your website is always this word of dignity.  I used to work at a non for profit and it was all about clothing relief.   It was all about  that idea of everyone deserves this dignity of being able to have the products that they need and also the privacy and the space  to be using them

It's amazing to me that your organization is run completely by volunteers, and I think that just really goes to show that there's a huge collective of people in the Chicagoland area that care about this issue or care about supporting your mission. What are some ways Others can get involved or volunteer with the Period Collective.

I feel like period poverty is something that is often thought of as a problem in the global South and people are not necessarily aware that this is happening in our own neighborhood, but whenever they learn about it, they instantly understand how that affects somebody's day if they don't have access to the product that they need.

We are grateful to have volunteers that help,  throughout this process. on all levels of our organization.  In terms of volunteering with our organization, we have,  different levels of, Involvement. We have,  still positions on our main team that we are looking to fill and,  more ongoing volunteer opportunities, but then we also have one off opportunities.

For example,  we're always looking for drivers to deliver products to our partners.   We also have individuals that,  organize, product drives or packing events, and that is also a great way,  to be involved. For those that,  would like to donate, we always say that, because we  purchase product in bulk,  your dollar goes further if you donate it directly to us.

Versus, for example, going to Walgreens and,  purchasing products there and then donating,  those,

to donate,  you can go to our website. We have a link there to donate money.   Also we have a page,  called get involved where we highlight all the different ways that you can get involved with our organization.

We also,  like to, donate our products, in homemade bags.  We also have individuals that will make bags, fabric bags that,  we donate the product in and we feel like that adds to that dignity aspect where,  you know,  not only do you get the product that you need, but also,  in a way that's discreet and also in a bag that can be reused.

We love those that, , want to help make the bags.    We are lucky in Illinois that we have,  politicians that have been,   willing and able to work on bills to help with great equity. Causes and, one other way to get involved or to help with this issue is to contact your local representatives and let them know that this is something that is important to you.

We have passed,  several bills in the last 6, 7 years, including requiring products to be available in schools, in homeless shelters. being able to purchase products with SNAP and other government benefits.  And so there's a lot going on in Illinois when it comes to, legally helping those that are struggling with period poverty.

Congratulations. It's amazing those bills that you've been able to help get passed.  I think that's something that I myself and maybe others often forget is that there is the boots on the ground work and I've worked for a while in the non for profit space and it's so important to have boots on the ground and really bringing support to where people need it.

But it really does also help to have the people that are making our laws are dictating how much we have to pay for things and how we have access to it to let them know we really, really care about this. So that's such a nice call out.   It sounds like there's lots of ways to volunteer if you're interested.

I think when I come across people  that have blockages against volunteering, it's thinking that maybe it's going to take up a lot of time or that it's not going to be. Very fun, and I'm not saying period poverty is fun But I think the idea of even if you host something yourself of getting a group of like minded people together to Put together the period bags or even have a little sewing party There's a way that you can make it really fun and know that you're also contributing to a great cause

our workplace is having one in November a packing party and  I'm really excited for it because I also think it's a great opportunity to bring people together and spread the word, because if you're someone that  is lucky enough to be able to  have easy access to menstrual products that support you during your cycle, it may be something that without intention, you don't think about that it might be something that others are struggling with.

I think it's also a nice way to learn more about the issue and spread the word too. 

We've had people do fun things like, hosting a witches party for Halloween and instead of hostess gifts ask for a period products to be brought. So there's a lot of fun ways to, to help out.

I think one thing that I would like to highlight is,  The impact that period poverty have on people's lives.  I think anybody who's ever had a period understand that situation where you get your period and you don't have product.

But when you experience that on a regular basis, pretty much every time you have your period, it really affects the way you're able to participate fully in life and we see that in,   girls to start their period, you know, sometimes as young as nine years old,  in the long run, if they start missing school regularly,  they fall behind, they do,  They do worse on tests.

They maybe  don't qualify for the AP  or accelerated classes in high school. They do worse on their SAT.  They might not then qualify,  for a college that they otherwise would have, or maybe they don't have the grades to get the scholarship that they needed to attend that college. And so we see that period poverty.

It kind of has this  cumulative effect where it really can impact your entire life. Of course, if you don't have the product you need, you might not be able to go to work.  Or you might go to a job interview and worry about what's happening in your body, except for how to best answer the questions that,  are being asked of you in that interview, and so that is something that I just want to make sure that we highlighting that,  It really, truly affects somebody's.

Entire life if they don't,  have access to the product they need, 

that's a really good call up. Also I feel that. And with it comes the shame that's already attached to period, sadly, in our society.   I feel like this would just, like you said, that cumulative effect could add on to that shame of this idea of this is already happening, which the world is made to seem shameful, although it's not.

And then it just adds on to that.  I think it's really beautiful. I'm coming back to that word, dignity, on your website. I was reading that it is a human right to be able to have access to  what we need to support ourselves as humans in this world.  Menstrual equity really is a basic human, right?

For those who menstruate 

it really is. And we are hoping that 1 day, these products will be available in all bathrooms, just like toilet paper,  is and, but  it really does  makes an impact on people's,  mental health and,  their sense of, dignity and self. If you can't provide product for like your daughter or, you know, somebody in your immediate family or even yourself, like it really,  just affects.

It just takes a toll on how you feel about how you can provide and how you can take care of yourself. 

Thank you so much, Ida. This has been amazing.  If anyone wants to learn more about the Period Collective or learn about volunteering opportunities, you can go to theperiodcollective.  org. But I'll also put that up in our show notes and on the website so you can learn more.

They also have a really fun website. Social media presence. I find it really uplifting to see the volunteers highlighted and also some of the stories of those who the products are going to. So if you want to follow them, I'm sure you might also get a kick out of it. 

Thank you so much for having me. I appreciate it.

 ​
Outro:
Thank you so much for listening to this episode of Not So Private Parts, A Girl and Her Gyno Mom.  I hope that you've learned something from this episode or taken something away. I certainly know that I have.  So what can you do to support Not So Private Parts podcast?  You could leave us a rating or review wherever you're listening to this podcast.

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