# Why Ovulation Is The Key To Optimal Health (And Not Our Period)
- [[ovulation is the main event]]
Many women are coming to terms with how important it is to get to know their menstrual cycle. And so they track their period, whether it’s popping it into an app, making a note of it in their diary or adding it to their tracker. They may also keep notes of any other symptoms they experience. And this a great way to start to get to know your cycle. I have written about this in the [[The Beginners Guide to Menstrual Cycle Tracking|the beginners guide to menstrual cycle tracking]].
But our period is not the main event within our menstrual cycle. In actual fact, it is ovulation that we need to be paying attention to.
> - [[#What is ovulation?|What is ovulation?]]
> - [[#Regular ovulation is a sign of health|Regular ovulation is a sign of health]]
> - [[#Maintaining optimal health|Maintaining optimal health]]
> - [[#Ovulation is necessary for the production of progesterone|Ovulation is necessary for the production of progesterone]]
> - [[#Progesterone keeps oestrogen in check|Progesterone keeps oestrogen in check]]
> - [[#Anovulatory Cycles|Anovulatory Cycles]]
> - [[#Anovulatory Bleeding|Anovulatory Bleeding]]
> - [[#A true menstrual period|A true menstrual period]]
> - [[#Final Thoughts|Final Thoughts]]
> - [[#Next Steps|Next Steps]]
## What is ovulation?
- [[ovulation is the release of an egg from the ovary]]
- [[ovulation lasts between 24 and 48 hours]]
Ovulation is the when a mature follicle releases an egg (ova), an event which usually lasts between 24 and 48 hours and occurs around day 14 (based on a 28 day cycle).
![[menstrual cycle graph basic.excalidraw.svg]]
The egg (which will survive for 12-24 hours) enters the fallopian tube where it may be fertilised before moving to the uterus.
So obviously, ovulation is important for conception, right? But ovulation is not just about making babies.
## Regular ovulation is a sign of health
- [[regular ovulation is a sign of health]]
- [[regular ovulation tells us a lot about that woman’s personal environment, social context and health]]
Firstly, regular ovulation is a sign of health. After all, ovulation is only possible when the endocrine & reproductive systems are functioning normally. In a nutshell, only healthy bodies ovulate.
If there are any major issues in the body, our reproductive system is the first to tell us. Which makes sense doesn’t it? Evolutionary wise I mean?
If our body is not healthy enough, if we are experiencing high levels of stress, or if we are in danger, this is not the time to have a baby (remember that our body doesn't care if we actually want a baby or not, this is simply physiology).
And so our reproductive systems shut down and places the energy that would have been used on attempting to create another life into caring for our own.
## Maintaining optimal health
- [[healthcare providers have focused on menstruation without paying attention to ovulation]]
- [[regular menstrual cycles with consistently normal ovulation during the premenopausal years will prevent osteoporosis, breast cancer and heart disease in women]]
Despite the fact that healthcare providers often focus on bleeding patterns when it comes to reproductive health (ie your period), very little attention has been paid to ovulation in reproductive age women.
And that's a shame seeing as it's ovulation that is crucial for maintaining optimal health during our reproductive years. Which is exactly what The Centre for Menstrual Cycle and Ovulation Research aims to prove.
According to their research which is led by [[Dr. Jerilynn C. Prior]], regular menstrual cycles with consistently normal ovulation during the premenopausal years will prevent osteoporosis, breast cancer and heart disease in women.
## Ovulation is necessary for the production of progesterone
- [[progesterone production]]
- [[ovulation is necessary for the production of progesterone]]
Although progesterone is produced in small quantities by the adrenal glands, the majority actually comes after an egg has been released during ovulation. The follicle (the little sac that that the egg was housed in) now becomes a temporary endocrine gland known as the corpus luteum. And it is this corpus luteum that produces the hormone progesterone.
And progesterone, you see, is important for us for so many reasons including supporting the health of our breasts, heart, and nervous system, regulating our moods, as well as creating healthy brain function (which is why we can feel so much brain fog during perimenopause as progesterone levels decline).
## Progesterone keeps oestrogen in check
- [[progesterone mitigates effects of oestrogen]]
- [[oestrogen affects almost all cells and tissues in the body]]
- [[functions of oestrogen]]
- [[oestrogen drives endometriosis]]
Another reason that progesterone is so important is that it also mitigates the effects of oestrogen. Oestrogen is a hormone of growth as it thickens the lining of the uterus in preparation for pregnancy.
Oestrogen also has many other different functions in the female body. After all, there are oestrogen receptors on pretty much every cell in our body. And so it also provides protection for our brain, bones, heart and vulvovaginal health amongst a whole host of other benefits.
But, as with anything we can have too much of a good thing. So if there is too much oestrogen it can go astray which is what happens in hormonally driven breast cancer and endometriosis.
So we need our body to make what it needs and no more. Which is where progesterone comes in. To use an analogy, where oestrogen is like the fertiliser you put on your lawn, progesterone is the lawnmower that the body uses to keep the growth in check. And again, as you now know, we only get progesterone if we ovulate.
## Anovulatory Cycles
- [[definition of anovulation]]
- [[anovulation can be related to weight changes, stress or excessive exercise]]
- [[most women have a couple of anovulatory cycles every year]]
- [[anovulation common in perimenopause]]
An ovulatory cycle is a menstrual cycle in which ovulation takes place and an egg has been released. An anovulatory cycle is a menstrual cycle in which ovulation does *not* occur and hence no egg is released.[^1]
Anovulation can be caused by weight loss or weight gain, excessive exercise or illness. It can also be caused by psychological stress. As Dr. Jerilynn C. Prior puts it "A woman must be in good emotional, nutritional and social health to regularly ovulate. It makes sense that a woman who is under emotional stress is less likely to ovulate".
Although it's normal for most women to experience a couple of anovulatory cycles each year, and more so as we enter perimenopause, we need to remember that not only is ovulation a *sign* of health, it's also *vital* for optimal health. And so if we are not ovulating, if we are experiencing anovulatory cycles, this is an indicator of hormonal imbalance within our body and needs investigating.
## Anovulatory Bleeding
%% [[we can have a period without ovulating]] %%
Many women I have worked with believed that they didn't need to track ovulation as their periods were regular and they didn't experience anything out of the ordinary. They had normal periods and cycles. So that means that they must be ovulating, right? Wrong.
You can actually have a 'period' even without ovulation in what is called an anovulatory bleed. Notice how I put the 'period' in quotation marks. That is because if you do not ovulate, then you do not *technically* have a period. You can only experience a true menstrual period *after* ovulation.
## A true menstrual period
%% [[anovulatory bleeding is believed to be caused by a disturbance in the HPO-Axis]] %%
During the first half of the menstrual cycle, the ovaries release oestrogen which rebuilds the endometrial tissue and restores the base of our uterus after our last period.
During the second half of the cycle, and as a result of ovulation, progesterone is produced. Progesterone takes the functional layer that was laid down by the oestrogen and makes it receptive to implantation by causing the uterus lining to mature. It's a bit like oestrogen building the foundations of the house whilst progesterone furnishes it.[^2]
If we do not conceive during ovulation then both oestrogen and progesterone levels drop and we have a true menstrual period to release both the house and the furnishings (i.e. the uterus lining).
And so again a *true* period is where the uterus releases its lining after *both* oestrogen and progesterone have done their job.
If we bleed without ovulation this is believed to be caused by a disturbance in the hypothalamic-pituitary-ovarian axis (HPO-Axis) and is not caused by a normal functioning reproductive system.
## Final Thoughts
Ovulation, not menstruation, is the key event within our menstrual cycle. Not only is regular ovulation a sign of health but it also helps us to maintain optimal health including helping to prevent osteoporosis, breast cancer and heart disease in women.
Ovulation is also necessary for the production of progesterone which is vital for keeping oestrogen in check as well as providing protection for our brain, bones, heart and vulvovaginal health.
Being able to recognise and track ovulation provides us with insight into our own bodies and can allow us to take proactive steps towards maintaining optimal health.
## Next Steps
So the question remains, if we do not know if we are ovulating, how can we find out?
This is where advanced menstrual cycle tracking techniques come in, including [[Tracking Your Basal Body Temperature|tracking your basal body temperature]], [[Observing Your Cervical Mucus|observing your cervical mucus]] and paying attention to your [[Monitoring Your Cervix|cervix position]]. As we will see, all 3 change throughout our cycle and it is by using these biomarkers that can help us [[Why Ovulation Is the Key to Optimal Health|recognise ovulation]] and evaluate our own health status.
> - [[(Burger et al., 2008)]] Burger, H.G. _et al._ (2008) ‘Cycle and hormone changes during perimenopause: the key role of ovarian function’, _Menopause (New York, N.Y.)_, 15(4 Pt 1), pp. 603–612. Available at[https://doi.org/10.1097/gme.0b013e318174ea4d](https://doi.org/10.1097/gme.0b013e318174ea4d)
> - [[(Chantalat et al., 2020)]] Chantalat, E. _et al._ (2020) ‘Estrogen Receptors and Endometriosis’, _International Journal of Molecular Sciences_, 21(8), p. 2815. Available at[https://doi.org/10.3390/ijms21082815](https://doi.org/10.3390/ijms21082815).
> - [[(Chen et al., 2019)]] Chen, C. _et al._ (2019) ‘The roles of estrogen and estrogen receptors in gastrointestinal disease’, _Oncology Letters_, 18(6), pp. 5673–5680. Available at[https://doi.org/10.3892/ol.2019.10983](https://doi.org/10.3892/ol.2019.10983).
> - [[The Fifth Vital Sign by Lisa Hendrickson-Jack]]
> - [[(Jones and Sung, 2022)]] Jones, K. and Sung, S. (2022) ‘Anovulatory Bleeding’, in _StatPearls_. Treasure Island (FL): StatPearls Publishing. Available at[http://www.ncbi.nlm.nih.gov/books/NBK549773/](http://www.ncbi.nlm.nih.gov/books/NBK549773/)
> - [[(Prior, 2014)]] Prior, J.C., 2014. Preventive Powers of Ovulation and Progesterone [WWW Document]. The Centre for Menstrual Cycle and Ovulation Research. URL [https://www.cemcor.ubc.ca/resources/preventive-powers-ovulation-and-progesterone](https://www.cemcor.ubc.ca/resources/preventive-powers-ovulation-and-progesterone)
> - [[(Prior et al, 2015)]] Prior, J.C., Naess, M., Langhammer, A., Forsmo, S., 2015. Ovulation Prevalence in Women with Spontaneous Normal-Length Menstrual Cycles - A Population-Based Cohort from HUNT3, Norway. PLoS One 10, e0134473. [https://doi.org/10.1371/journal.pone.0134473](https://doi.org/10.1371/journal.pone.0134473
> - [[(Vigil et al., 2017)]] Vigil, P. _et al._ (2017) ‘Ovulation, a sign of health’, The Linacre Quarterly, 84(4), pp. 343–355. Available at[LINK](https://doi.org/10.1080/00243639.2017.1394053).
> - [[(Wend, Wend and Krum, 2012)]] Wend, K., Wend, P. and Krum, S.A. (2012) ‘Tissue-Specific Effects of Loss of Estrogen during Menopause and Aging’, _Frontiers in Endocrinology_, 3, p. 19. Available at[https://doi.org/10.3389/fendo.2012.00019](https://doi.org/10.3389/fendo.2012.00019).
[^1]: And remember, no egg released means no progesterone is produced.
[^2]: I need to thank [[Michelle Lyons]] for this analogy!