Zita West - Zita West’s Guide to Getting Pregnant

Progesterone also has an effect on muscles in the body, for example in the gut, making digestion less efficient. This can make some women more prone to constipation (another common problem for many women during pregnancy).

In addition, the progesterone effect on smooth muscle affects the ligaments, which soften. This is in preparation for labour, when the ligaments of the pelvis have to soften for the bones to ‘give’ a little during birth. Although this is not so extreme as during pregnancy, some women find they are more susceptible to minor injuries after ovulation, when progesterone levels are raised.

Some women whose blood pressure is naturally low may find these combined effects of progesterone can cause them to feel a bit faint, or more tired, in the run-up to their period. Ensuring an adequate intake of fluids, while avoiding those with diuretic effects like colas, coffee and large quantities of tea, can help with this.

Progesterone is the hormone that keeps the endometrium, or lining of the womb, in place. It keeps it thick and ensures a continuing blood supply – just in case a fertilized egg needs to implant. If implantation does occur, the production of progesterone from the ovary continues until around 12 weeks, when the placenta is sufficiently developed to take over production for the rest of the pregnancy. If there is no implantation, the body responds by reducing its levels of progesterone, and a period occurs – when the thick, blood-rich lining of the womb is discarded.

Progesterone deficiency is the most common hormonal deficiency in women of all ages. Many women are already familiar with the symptoms of a degree of progesterone deficiency, which may or may not affect their fertility. These symptoms include painful or lumpy breasts, cyclical headaches, anxiety and irritability, insomnia and sleep problems, unexplained weight gain, recognizable PMS, dysfunctional patterns of bleeding during a cycle, and finally, impaired fertility.

The causes of progesterone deficiency are often linked to imbalances of other hormones, and the effect of these. For example, if ovulation fails, no progesterone is produced in the luteal phase. There may also be defects during the luteal phase – either the corpus luteum fails to produce enough progesterone, doesn’t produce it for long enough, or the luteal phase is too short (fewer than 10 days). In addition, in some cases the follicle develops but doesn’t rupture and expel the egg, so too little progesterone is produced. Finally, the messages from the hypothalamus and pituitary gland may be faulty – there is faulty FSH secretion, inappropriate surges of LH or excessive prolactin.

Having identified a progesterone deficiency, there are a number of solutions:

• natural progesterone (should only be used under proper medical supervision)

• vitamin and mineral deficiencies can be remedied (supplements for low progesterone include vitamin B6, vitamin E, evening primrose oil and magnesium)

• herbs such as Vitex Agnus Castus, prescribed by a medical herbalist, can help regulate ovulation

• causes of stress can be identified and removed

• excessive exercise can be reduced

• low body weight can be increased.

I encourage women to see their period as a time of contemplation and renewal, and to see the process of bleeding as cleansing. Our modern lifestyles encourage women to disregard how they feel during their period, advocating the use of tampons and treating this phase of the cycle just the same as any other. I encourage women to use this time to reflect and to recharge their emotional and physical batteries. It is perfectly natural that very often women find themselves not wanting to socialize during this time, preferring to be quiet and reflective.

What is useful for me when I am working with a woman is to know what a ‘normal’ period is for her, so I can see how this relates to the rest of her cycle.

In Traditional Chinese Medicine (TCM), much more attention is paid to a woman’s period than in Western medicine. The length of a period and the colour, amount and quality of the blood flow are all considered, alongside other information and observations (see page 217). In my work I use the principles of Five Element Acupuncture, a feature of TCM that I find very useful in assessing each woman and her individual concerns or problems.

Period pains, if severe, can be indicative of the sort of hormonal upsets that suggest problems in the menstrual cycle. In TCM it isn’t considered normal to have painful periods; this is seen as an indication that some sort of hormonal rebalancing is needed. In the West, many women accept that their periods are painful, and take large quantities of painkillers in order to function, without realizing that these drugs can be detrimental to their fertility (see page 172). TCM, and acupuncture in particular, along with abdominal massage (see page 229) can all help in alleviating not just the pain but also the cause of it. This is a much better alternative to swallowing lots of painkillers, some of which are quite strong and anti-spasmodic, which can in turn interfere with the menstrual cycle. I also believe that it’s far better for women to use nutritional means to deal with painful periods. Taking an EFA (essential fatty acid) supplement, and one that contains evening primrose oil (GLA) can help normalize the hormones called prostaglandins . Period pains can be an indicator that prostaglandins are being over – produced, which can, in turn, have an impact on your overall hormonal cycle and may affect your fertility.

Women with severe period cramps often show a depletion in the mineral magnesium, for example, and taking a supplement of this – which helps with muscular tension – can help to alleviate the pain.

For women trying to conceive, the arrival of their period can be a time of sadness as it means conception hasn’t been successful that month. There is no question that the emotional response to this can be quite profound, and it can also be exacerbated by hormonal changes. However, the menstrual period can also be seen as a sign for optimism, as it can be used for contemplation, renewal and preparation – physically and emotionally – for the next cycle and another opportunity – with increasing knowledge – for conception.

I think it’s better for women to use pads rather than tampons during their period, especially if they suffer from endometriosis. I realize that this isn’t always practical, especially if the bleeding is very heavy, but women should be aware that tampons can be very drying to the vagina, absorbing normal vaginal moisture. If you are going to use tampons, opt for those made with organic, non – bleached cotton, and use pads on lighter days. TCM also recommends keeping the abdominal area warm, either with direct heat (from a hot water bottle, for example) or through warming, nourishing foods – especially when there is discomfort during a period.

First of all, without making a daily note of where you are in your cycle, it’s hard to gauge your individual pattern of fertility, either for yourself or for a health professional. Many of the women I see keep note of the length of their periods. Knowing roughly the length of your previous six cycles, the length of the shortest and of the longest can be a big help in identifying your fertile time: your shortest cycle minus 20 gives you your first fertile day, and your longest cycle minus 10 gives you your last fertile day.

Your diary should record the following:

• First day of your period (Day 1 of your cycle).

• Signs of cervical mucus (particularly noting the very fertile clear, wet, stretchy secretions).