The menstrual cycle as the fifth vital sign

Summary

Some healthcare professionals believe that the menstrual cycle can be viewed as a fifth vital sign. Similar to the other vital signs, body temperature, heart rate, respiratory rate, and blood pressure, your menstrual cycle can be used to gain an understanding of your health.

Irregular cycles, painful periods, or excessive bleeding can all be symptoms of health concerns. If you notice irregularities or discomfort with your cycle, it’s important to reach out to a healthcare provider for support.

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Periods play a central role in women’s lives. Most women get their period once a month, for about 2-7 days – over the course of a lifetime, that’s nearly 7 years spent on their periods.

Some healthcare professionals believe that the menstrual cycle can be viewed as a fifth vital sign. The four vital signs are body temperature, heart rate, respiratory rate, and blood pressure. These markers are used as measurements of the body’s basic functions, providing an inside look into a person’s health and wellness. Similar to the vital signs, your menstrual cycle can be used to gain an understanding of your health.

Even though getting your period is a completely normal and healthy response from your body, periods still remain a taboo topic. This has a direct impact on how women experience them. A 2023 survey by PERIOD., a non-profit organization working to eradicate period poverty and stigma revealed that:

• 78% of adults feel that periods are associated with being “gross and unsanitary.”
• 53% report that they’ve felt too ashamed or embarrassed to seek help when they have questions about their body.
• 60% of adults say period stigma impacts their comfort with their body.

The stigma around periods can cause people to overlook key indicators about their health. Periods aren’t random, they’re actually a sign that many systems in the body are functioning properly. A period is the result of a process, (your menstrual cycle), that occurs every 21-35 days. It’s a sign that hormones such as estrogen, progesterone, and testosterone are doing their jobs correctly. While your period may feel like an annoyance at times, it’s something to celebrate.

What is your period?

The menstrual cycle

Every 21-35 days, the body goes through a cycle made up of four phases, regulated by the rise and fall of reproductive hormones. Here’s what happens:

1. The menstrual phase: The first day of your period is the beginning of your cycle. It marks day 1, and can last 2-7 days. During this phase your estrogen and progesterone ‘reset’ and are at the lowest point. This is when you experience the shedding of the lining of your uterus.
2. The follicular phase: This phase begins on the first day of your period and ends at ovulation, lasting about 10-14 days. During this phase, estrogen and follicle-stimulating hormone (FSH) rise, causing the lining of your uterus to begin thickening and follicles in your ovaries to grow. By the end of the follicular phase, one of these follicles will form a mature egg (ovum).
3. Ovulation: Ovulation occurs roughly 14 days after the period, about halfway through the cycle. This phase only lasts a day, but it’s an important moment in the cycle. There is a sharp increase in luteinizing hormone (LH), causing the ovary to release the egg.  
4. The luteal phase: The last phase of your cycle lasts about two weeks. During this phase, the levels of progesterone rise to help prepare the uterine lining for pregnancy. The egg travels through the fallopian tubes to your uterus. If the egg becomes fertilized by sperm and attaches itself to the uterine wall, pregnancy will occur. If not, estrogen and progesterone drop, the lining of your uterus sheds (your period), and the cycle starts over.

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What to look out for

Your menstrual cycle is a way for your body to communicate with you, and it’s important to pay attention to what it’s saying. Irregular periods may feel like no big deal, but that’s far from the truth. Missed periods, irregular cycles, heavy bleeding, or intense pain could be your body’s way of letting you know that something’s going on.

Having an “irregular” cycle can mean a few different things – it can refer to missed periods, or, cycles can be long, short, or vary greatly from month to month. Oligomenorrhea (pronounced uh-li-gu-meh-nr-ee-uh), for example, refers to cycles longer than 35 days. Approximately 80% of women with oligomenorrhea have PCOS. Irregular or inconsistent periods may also be caused by other health conditions such as endometriosis, thyroid disorders, uterine fibroids, or pelvic inflammatory disease.

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Amenorrhea, or the absence of periods, can be linked to many different factors.

• Disordered eating, such as anorexia or bulimia, can cause periods to stop occurring. A missing period could be a sign of malnourishment.
• Heavy or prolonged stress is another cause of missed periods, because it can alter your hypothalamus function. This area of your brain controls the hormones that regulate the menstrual cycle.
• Excessive or competitive exercise may also cause skipped periods. This may be due to a combination of weight loss, stress, and high energy expenditure.

Your period can also tell you a lot about your fertility. 10-20% of women struggling with their fertility have infrequent periods. This can be due to many factors, such as hormonal conditions, health concerns, or anovulation (not ovulating).

Extreme pain and excessive bleeding can also point to health conditions. In one study of almost 30,000 women with endometriosis, the most frequently reported symptoms were painful periods (61.8%), heavy/irregular bleeding (50.8%), and pelvic pain (37.2%).

Irregular cycles, or extremely heavy or painful periods, are not just “part of being a woman,” they’re signs that something may be going on with your health. Just because something seems common does not mean that it’s normal. If you’ve noticed irregularities in your menstrual cycle, it’s important to reach out to a healthcare provider who can help you figure out what may be causing them.

When to seek help

If you’re experiencing any of the following symptoms, a healthcare provider can help you figure out what may be going on.

• Regularly going more than 35 days without a period
• Skipping periods
• Severe pain (cramping) during or between periods
• Very heavy bleeding (soaking through a pad or tampon every hour for two to three hours) or passing large clots (larger than a quarter)
• A period lasting longer than 7 days
• Spotting between periods
• Changes to your cycle
• Nausea or vomiting during your period

If you don’t feel comfortable speaking to your doctor about your period, it’s time to find a new healthcare provider. Feeling safe, heard, and supported by your provider can make a big difference in your care.

The menstrual cycle as the fifth vital sign

Periods are an important indicator of health, and we should not shy away from talking about them. The stigma and shame surrounding periods can cause women to ignore symptoms, delay care, and suffer in silence.

Women deserve healthcare that’s built with their needs in mind. Centering the menstrual cycle as a vital sign sheds light on a woman’s hormone levels and fertility. It can also illustrate other health concerns, such as malnutrition, stress, or sleep disturbances. Healthcare providers should ensure that women patients feel comfortable discussing their periods, and any concerns they have about their cycles.

Periods should be celebrated: each time they arrive, it’s a sign of a healthy menstrual cycle. For many people who have gone through times of high stress, struggled with disordered eating, or are managing hormonal health conditions, a period is one of the first signs of healing. Periods can feel like an inconvenience, but they’re a crucial indicator of your health. Next time your period arrives, take it as a positive message from your body, to you.

Takeaways:

• Irregular cycles, heavy bleeding, or painful periods, are not just “part of being a woman,” they’re signs that something may be going on with your health. If you’ve noticed irregularities in your menstrual cycle, reach out to a healthcare provider.
• If you don’t feel comfortable speaking to your doctor about your period, it’s time to find a new healthcare provider. Feeling safe, heard, and supported by your provider can make a big difference in your care.
• Periods are a crucial indicator of your health. Each time they arrive, it’s a sign of a healthy menstrual cycle.

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