Hey, I'm hyper mobile and if you're listening to this, I'm
guessing you might be too. Hi, my name is Alex and I'm your
hyper mobile host and today on HELP I'm hyper mobile.
We are talking all about hyper mobility and your menstrual
cycle. So I work a lot with patient.
Obviously my my work is all with hyper mobile patients these
days, but I work a lot with hyper mobile patients and they
seem to more often than not have a variety of period issues.
I have patients who have irregular periods.
I have patients who have issues with excessive bleeding.
I have patients who have issues with excessive pain.
People with periods have a lot of issues with them.
And there was an article out today actually in the Guardian
talking about how often period issues are dismissed by GPS and
other medical providers. And this is a huge issue which
unfortunately I have to agree with based on what I see in my
patients in my work as auk registered osteopath, I'm often
telling my patients ghost. Have you told your doctor about
what you've just told me? And they say, yeah, I have.
And they told me that it's normal.
Well, do I have news for you? Because it's not normal.
Having a lot of period pain and having it really negatively
affect your life. Because for some people it is
disabling. They live in fear every time
that they're going to have another period happen.
Their symptoms are so severe that they can't go to work or
school when they're having them. So this is serious stuff.
But the Physiology and some of the science here, I think it's
really cool and I'm so excited to get into it in detail as
well. Today I'll be talking a little
bit about how you can literally read your body.
So if you're someone who has periods, you can use that
information to help you potentially be able to better
communicate with healthcare providers, or at the very least
so that you can understand more what's going on with your body.
And of course, throughout this episode, you're going to see me
coming back to this idea of test intervention retest.
And in my opinion, this is something which every healthcare
provider should be doing. I don't care if you're a top
medical specialist. I don't care if you're like me.
Maybe you're an osteopath. It doesn't matter.
Every single healthcare provider needs to be doing some kind of
assessment. Patient comes in with a problem,
you assess, maybe it's blood work, if you're a medical
doctor, if you're like me, maybe it's a type of orthopaedic test
or active resisted Muscle test or whatever.
Doesn't matter. You do some test.
You then do an intervention of some kind, and you have
hopefully good reasoning for why you're doing that intervention.
And then within a set window of time, you schedule a retest.
Do you want to see, was my hypothesis correct?
Did my recommendation have a positive effect on that
patient's symptoms? So you do test intervention and
retest always. But before we go any further, I
do want to stress, as always, this podcast is for
informational purposes only. This is not medical advice in
any way, shape or form as I do not know you or your unique
medical history. So on that note, let's get
started talking about Physiology.
So many patients who see me, they think they know what goes
on in their body when they have a period.
They think that all of their bleeds are periods, but they're
wrong. So when you have a period, there
is a very complex sequence of events that occurs.
And before we go any further, I want to clarify that a period as
is defined as a bleed following ovulation.
So if you're someone who's on hormonal birth control, you're
not having periods, you are having bleeds.
They're they're technically withdrawal bleeds probably or
breakthrough bleeds if you're taking it continuously, but they
are not technically periods because a period is defined as a
bleed following ovulation. Now, I do also want to say by
the way that I'm someone who is not anti a lot of things.
I guess I am pro good patient outcomes and I have patients who
are on hormonal birth control and that is absolutely the right
choice for that individual. I also have patients who are not
on hormonal birth control and for those individuals that's
often the right choice as well. So I'm just pro people doing
what's right for them. OK, because this stuff is all
very complicated. It might depend on where you
live in the world, how you handle things or what you have
access to. So this is just me speaking
about Physiology here, and what you do with that information is
up to you. But when you have someone who
has a uterus and ovaries and who is not on hormonal birth
control, in theory they're going to be having ovulatory cycles.
And this happens. And we start the cycle by saying
they're going to have a period, right?
So they have that bleed. And that bleed will last
anywhere from about 3 days to a week.
If it's longer than that, that starts to be of some concern.
So if you're someone who's having a bleed that's lasting 10
days, that's not normal. Now they'll have that bleed and
the bleed will stop. And their little, like their
usite, their little egg, it will start to mature.
And this happens every cycle and they actually compete because
your body's trying to find the best one that's that it's going
to use in the event that you were to get pregnant.
So that little egg starts to grow and get bigger and bigger
and the egg is inside something called a follicle and it's like
a little home for the egg, a little house.
So at a specific point in that cycle and in a in a textbook
normal cycle, it's gonna be cycle day 14.
Although people have cycles of varying lengths, that hormonal
threshold is going to be hit. So there will be the right
amount of estrogen and a few other things that happen, FSH,
follicle, stimulating hormone and so on that 'cause that
ovulatory event to happen, it's all or nothing.
So if that ovulation occurs, the little egg leaves its home so it
it it ruptures from the follicle.
And actually it's kind of like a physiologically violent event,
and that's why some people do have pain during ovulation.
The German word for that is middle middle schmertz, I
believe. But anyways, the egg goes on its
little journey down the Fallopian tubes to see if it's
going to end up becoming being encountering some sperm, to put
it that way, And the follicle in the meantime, it does something
incredible. The follicle within a 24 hour
window turns into a hormone secreting tissue that is 2 to 5
centimeters in diameter. It builds its own blood vessels
and it starts to secrete progesterone.
So just think about this for a second.
Not only every time you have a menstrual cycle occur where
you've ovulated, Are you creating the potential, you
know, for technically, for, for life if you're going to, you
know, end up getting pregnant there, right?
Like we have that egg forming and that is it's the biggest
cell in the body. It's the size of a period of at
the end of a sentence. It's a metabolically expensive
process to ovulate. Like it's really cool.
But the follicle is forming into essentially an an organ almost.
It's a set of tissues with a dedicated function to produce
progesterone. So you're building like a a
little mini organ every month. Every, well, not necessarily
every month, 'cause people have cycles of different lengths, but
you're building a little mini organ that secrets Progesterone
isn't that cool, and in the event that you were to become
pregnant, that follicle will secrete progesterone until week
10 of the pregnancy, when the placenta can take over.
That's how important that follicle is and it's actually
the quality of the the corpus luteum that determines the
length of the luteal phase. And that's important 'cause
we'll come back to that later. But sometimes people, when they
aren't super well, they might have shorter luteal phases
because they're not able to make the best corpus luteum.
So this is where the Physiology understanding is really, really
important. Anyways, the egg will go on its
journey and the progesterone that's being secreted from the
corpus luteum maintains the environment that is maintains
the endometrial lining essentially.
So it keeps it there, it keeps everything kind of like pause.
So the first part of the cycle, the follicular phase, that's
like grow, grow, grow. We're gonna thicken that uterine
lining, we're gonna get everything ready.
And then when the when ovulation occurs, everything freezes and
that's the progesterone half of the cycle.
Now the egg's gonna hang out there.
And in the event obviously that it encounters sperm and is
fertilized and we'll go on to have a pregnancy potentially.
But in the event that it does not encounter any sperm, it is
going to be shed as a period. And that's why that period is
defined as a bleed following ovulation, because otherwise you
might have something called a breakthrough bleed.
So let's say for example, that you're someone who has really
long cycles. I'm someone I've had 165 day
cycles. I've had 90 day cycles.
I now have like normal cycles, which is amazing and I'm really
proud of that. But let's say you're someone
with long cycles. You might be bleeding every
month, but it's possible that those bleeds are breakthrough
bleeds and are not actually periods.
And This is why you can have people who they're really
confused. They say that there's someone
who's trying to become pregnant and they can't get pregnant.
It may be because they're not ovulating, because they're not
actually having periods, they're just having breakthrough bleeds
and they're kind of stuck in that follicular part of the
cycle, the pre ovulatory part. And this is another concept
that's really important is that the pre ovulatory part of the
cycle can be any length of time. It could be hundreds of days
long. There is no limit on that length
of that first half of the cycle. However, the second part of the
cycle, I shouldn't say half because it's not always 1/2.
But the second part of the cycle, the luteal phase, there
is a limit on that and that limit is imposed because the
corpus luteum can only survive for so long.
It can only do its job for so long and that's why you really
will not have a a luteal phase that's longer than 18 days
unless if a pregnancy occurs. Now in terms of progesterone,
it's a cool hormone and it interacts with your thyroid
gland and it starts to affect your metabolism.
And This is why females or anyone who has a uterus and
ovaries, they do experience a ever so slightly increased
metabolism and increased body temperature for that luteal
phase of the cycle. Now, to be clear, it's not
enough that you can go eat like a million, you know, cakes or
desserts or whatever, but it's it's just enough that we can
actually really easily measure it.
And this is where we get to body literacy.
Now, body literacy is a term which was first used by a female
health advocate named Laura Worschler.
And this person, she describes body literacy as being able to
not only read the signs of your body, but to derive meaning from
those signs and to interpret them.
And it's something which has been present in the female or
people with uteruses and ovaries, this type of health
sphere, since 2005. But it's a concept which I use a
lot with my patients. That's why I'm so passionate
about body literacy, because if you learn what's going on with
your shoulder, what's going on with your ankle, or why it's
acting that way, it's really helpful for hypermobile people.
Because then you know what's happening and you know what's
happening. It's less scary.
But anyways, back to the female and uterus and ovaries, health
specific stuff. So with body literacy in this
context, what you can do if you're someone who's not on
hormonal birth control is you can chart your cycle using two
easy and accessible. Let's say easy but relatively
easy, accessible and low cost biomarkers.
You can measure your temperature using a basal body thermometer
and you can buy one of those for like 8 pounds £10.
Maybe there are more expensive devices, but it's something that
I was able to afford when I was a student.
And the second biomarker, cervical fluid.
Some people call it cervical mucus, but being able to chart
that biomarker just requires a bit of loo roll as they say
here, or toilet paper and being able to assess it visually for
the most part, although some people will assess it in
different ways. Anyways, what I have some
patients do who are keen to do this and and not it's not for
everyone and if it's not for you that's OK.
But what some people do is that they will use a method of
charting the signs of their body called the symptothermal method.
So symptom kind of refers to the cervical fluid component.
Thermal refers to obviously taking your temperature and they
will chart their temperature and cervical fluid findings and it
ends up being a line graph with the temperature and a bar graph
with the cervical fluid. And remember how earlier I
talked about how progesterone interacts with your thyroid
gland and how it increases that body temperature?
I like, I like to think of it actually as like preheating the
oven. You know, bun bun in the oven
joke about being pregnant. It's like this is like you're
preheating the oven anyways, so by taking your temperature every
morning and to be clear, it's not a normal thermometer.
You cannot get a normal thermometer, it has to be a
basal body thermometer that's accurate to ±0.05 degrees
Celsius. If you need to find some, you
can check my Amazon shop. But by charting your
temperature, what you will see is in the event that you
ovulate, there will be a sustained increase in
temperature of 0.2 degrees Celsius.
Now we are not robots, there will be some little ups and
downs, but there are specific rules for charting that and for
interpreting that data. And again, I will include a link
in the description for this and you can of course work with I
hopefully your medical provider, your healthcare providers.
But if not them you can work with various kind of coaches out
there. There are there are actual like
certified institutions that exist to support people who wish
to do this. And in the UK actually you can
supposedly access support for learning this type of charming
through the NHS. Whether or not it's actually
available, given some of the stresses on the healthcare
system right now is I'm I'm not entirely sure of the situation,
but that's how scientifically valid this is.
And I will always be clear if I'm talking about something
holistic, if, if I'm talking about something a little bit out
there, I will tell you. But this is hard science.
So you can chart your temperature and in the event
that you ovulate, you should see that sustained temperature rise.
Now with cervical fluid, what happens is that we start out
with the period. We then have cervical fluid,
which increasingly becomes more fertile and fertile.
Cervical fluid, it's clear, it's stretchy, it's lubricative.
The way that I have patients assess this is by taking a piece
of loo roll and wiping themselves before they go pee
when they're using the bathroom. And that way you can see what's
going on with your body and when that cervical fluid is looks
fertile and there are certain characteristics and certain ways
of charting. And you can go learn more about
this. There's there's a brilliant
website called the Cervical Mucus Library actually, if you
need support on that. But what we see is a change
throughout the cycle and the quality of that cervical fluid.
And once ovulation occurs it changes all of a sudden and it
becomes kind of like dry and pasty and it's an entirely
different texture and it looks visually different as well.
Anyways, and I I get that maybe some of you might be squeamish
with me talking about this, but this is science like this, this
is how it is. And you know what?
I was going to put a disclaimer, but why do we have to put
disclaimers on female bodies? Like this is the type of stuff
if I had a a 12 year old girl I'd be talking with her about
it. So I think that we need to stop
feeling ashamed of how female bodies work.
But anyways, you will then have the rest of that post ovulatory,
cervical fluid which should have different characteristics and
then eventually that cycle will end and a period will occur and
a period marks the beginning of that new cycle.
So that becomes cycle day one. Now this type of charting,
what's so awesome about it is firstly it can save lives.
I've had patients who after doing this type of charting have
have gone on to say, hey, I'm having irregular bleeding.
And to be able to show that to their medical doctor and say
this is not normal for me because these patients now know
their normal so well. And to be able to go to your
medical doctor and show that and say I'm really worried because
I'm concerned about maybe cervical cancer or whatever,
this bleeding is not normal. It helps people get listened to
sometimes it does seem to help patients be able to access care
and it helps to explain what's going on with their cycle again.
Should patients have to be as like educated and as much doing
as much like self advocating as they kind of have to these days?
No. Ideally, of course, that would
not be the situation. But that's the reality of the
situation right now. So it helps you to understand
your body. And because it helps you to
understand your body, it helps you to speak confidently about
your body As well. Though, remember that test
intervention, retest model we talked about at the beginning.
What I love about having people chart their cycles is we then
have a framework through which we can say like, hey, if we add
in this supplement, if you start taking myoinositol or whatever,
how does it affect your your cycles?
Do we start to get a bit of a healthier, longer luteal phase?
Do we potentially, you know, maybe are we going to start to
see ovulatory cycles like we have now have a way to challenge
things? For me personally, there was one
time where I was eating in a way that I wasn't getting enough fat
in, and it was really helpful for me to be able to see in my
charts in my cycles that I stopped ovulating.
And I said, well, I guess I need some more fat in my diet.
So I was literally just like having spoonfuls of peanut
butter or whatever it was at the time and that was how I fixed
that. So it it gives you a way to
check things. Also, I found it handy as well
during the pandemic I was able to see, hey, this is like a
weirdly high temperature for me. Something's not right here.
And so it kind of gave me a heads up in terms of how my
body's feeling. It's it's almost like a
barometer. And there are a lot of things
that suck about having a uterus and ovaries and periods.
There are many things that suck. I do not recommend it, but this
is one of the few things that makes me feel bad for my
patients who are unable to do this kind of charting, which is
like physiologically not a thing that they can do because it
gives you so much information and it helps put you in control
of your body. As someone who charts my cycles,
I've been doing it for close to 10 years now.
I'm excited, like, in the event that I ever got pregnant, I know
when that happened because I know when I ovulated within a
margin of error of I think like three to five days.
I know if in the future when I go through menopause, I'm going
to see that coming through changes in my cycle, I'm going
to be able to chart that change in my body, which is just so
incredible and so beautiful and so cool.
You know, I do want to say do not ever trust a machine to do
this kind of interpretation for you, especially if you're a
hyper mobile person and especially for someone who has
polycystic ovarian syndrome. Because those devices out there,
I don't know if I can name them. But the apps and the little like
electronic thingies that just magically tell you what you can
do on a given day or whatever, they do not work for people who
are not within that like norm category.
And if you're listening to this I hate to say, but that's
probably not you. So I I strongly, strongly
recommend against all of those devices.
The method that I recommend again is the symptothermal
method and it's just using a thermometer.
It's using your own ability to interpret and examine your
cervical fluid, and it's the ability to make a line graph and
a bar graph. And quite frankly, I could have
done this when I was 12. And supposedly they teach
schoolgirls into a few different countries like this type of
thing when they're doing their classes, you know, like their
sex Ed or whatever, like they're teaching them how to do this.
And it's something that I'm shocked and angry.
I was talking with another patient yesterday, and that
patient was angry that she never had anyone.
Explain this to her. And I you know what?
I've It's been a long time since I was angry about it, but I but
I am angry because why are we not teaching this stuff when
it's so cool and so and so truly empowering?
So anyways, I hope that you've learned something interesting
about your body today. I hope that regardless of
whether or not you have a uterus or ovaries, maybe the corpus
luteum is now your favorite tissue in the human body like
mine, 'cause I think it's pretty darn cool.
And I hope that if you're someone who is not on hormonal
birth control, or if you're someone who's considering coming
off it, of course, as always, please speak with your medical
doctor and do what's right for you.
But I hope that maybe this has given you something that you
want to look into and learn more about because.
Expect for people who just don't know what's going on and things
are confusing or they're stopping their hormonal birth
control and they they don't really know how their body's
going to behave. This can be a nice way to kind
of make sense of the hormonal chaos that sometimes happens in
different bodies. So if you're looking to learn
more, of course listen to future episodes again, we will talk
more about this and two books. I want to give a shout out to
The Period Repair Manual by Laura Bryden.
That was the first book I read on the subject and it was
hugely, hugely helpful to me. As well as The 5th Vital Sign by
Lisa Hendrickson Drax and she also has a podcast called
Fertility Friday. And I have listened to most of
those episodes and I really recommend especially the early
ones because she kind of goes through the details of charting
your cycle in those episodes. Anyways, thank you so much for
joining me today. This is truly one of my
favourite subjects and I look forward to having you join me
next time. Take care.
Bye.