Understanding your menstrual cycle can be complicated. Cycles may be irregular. That can make it hard to know what’s normal and what’s not. It can also make it hard to tell when the best time is to conceive.
Annevay Conlee, MD, a family medicine obstetrics physician at OSF HealthCare, is an expert in women’s health. She focuses on identifying the root cause of women’s health issues and treating them in a body-cooperative way. She shared guidance on menstrual cycles and getting pregnant.
Stages of the menstrual cycle
There are four phases of the menstrual cycle. Each phase plays an important role in women’s health.
Phase one: Menstruation
Menstruation is when you have your period. The day you start bleeding is day one of your cycle. It’s possible that you can be fertile during your period.
Menstruation happens if you didn’t get pregnant during your last cycle. The uterine lining sheds. That lining comes out of the body as a period. During this phase, you may feel fatigued.
“How long your period lasts depends. It usually falls in a range of three to seven days,” Dr. Conlee said.
Phase two: Follicular phase
The follicular phase of the menstrual cycle starts on the day you stop bleeding. This is the phase before ovulation. You likely aren’t fertile during this phase. However, your fertility increases as you get closer to ovulation.
You have more energy during this phase.
During the follicular phase, estrogen levels increase. The uterine lining thickens to get ready to support a fertilized egg if needed. Plus, the follicle-stimulating hormone (FSH) increases, which develops follicles in your ovaries. One of those follicles will develop into an egg.
Phase three: Ovulation
The ovulation period usually occurs between days 14 and 21 or your cycle. When the ovary releases the egg that has developed, this is ovulation. You are most fertile during ovulation.
“Day of ovulation is often referred to as peak day,” Dr. Conlee said.
Confused by your menstrual cycle?
Energy levels are highest during ovulation.
Phase four: Luteal phase
The luteal phase of the menstrual cycle is the last phase. It occurs between days 21 and 35 of your cycle. A normal luteal phase is 10-18 days long. You’re fertile for the first few days of the luteal phase.
During this phase, the egg released by the ovary travels down the fallopian tubes. During the luteal phase, the uterine lining tissue grows to support a baby.
If the egg is fertilized, it implants itself in the uterus. If the egg isn’t fertilized, the uterine lining sheds. Then, your menstrual cycle starts all over again with another period.
Progesterone and estrogen levels drop quickly after ovulation. This drastic drop is often what causes PMS symptoms.
How long is a menstrual cycle?
Every woman is different. We often say 28 days is a normal cycle, but really, it’s a range. A normal menstrual cycle range is anything within 21 to 35 days.
“For some women, 26 days is normal. For others, 34 days is normal. If it’s shorter than 21 days or longer than 35 days, it might be cause for concern,” Dr. Conlee said.
Your body can even respond to stress by delaying ovulation.
“If you have extra stress in a certain month, your body may go, ‘Oh hold up, I can’t have a baby this month. I’m too stressed.’ And ovulation will naturally be delayed,” Dr. Conlee said.
“As a one-time occurrence, that’s OK. But, if you’re often having painful or irregular periods, that may be a sign that something more is going on.”
Signs of menstrual cycle issues
Your menstrual cycle can be a window to your overall health – inside and outside. It can tell you if you have a pituitary gland issue, abnormal hormone levels and the best time to conceive. It can even alert you if you have a hidden medical condition, like heart disease or diabetes.
Certain signs may indicate an issue with your cycle:
- Brown or black bleeding at the beginning or end of your period
- Blood clots larger than a quarter
- Really heavy bleeding
Small blood clots are normal during your period. If the uterine lining is shedding faster than your body can keep up with, the protein in blood that causes it to clot will go to that area.
Endometriosis, PCOS and uterine fibroids
Endometriosis, polycystic ovary syndrome (PCOS) and uterine fibroids are common medical conditions women face. The symptoms can range from mild to intense.
Signs of endometriosis, PCOS and uterine fibroids often include:
- Menstrual pain
- Pain during intercourse
- Abdominal or lower back pain
- Cramping before or during period
- Heavy bleeding
- Gastrointestinal problems
- Irregular periods
- Acne or facial hair growth
- Weight gain
These conditions often interfere with regular ovulation and menstruation.
PMS
PMS stands for premenstrual syndrome. This syndrome happens when your body is getting ready to enter the menses phase. After ovulation, if you aren’t pregnant, your hormone levels that were really high suddenly drop.
Sometimes your body can be a little shocked by the sudden drop in hormone levels. That would cause PMS symptoms.
PMS varies from woman to woman, but common symptoms that happen before your period include:
- Abdominal cramping
- Acne
- Anxiety
- Back pain
- Bloating
- Breast pain
- Constipation
- Cravings
- Depression
- Diarrhea
- Headache
- Heightened emotions or easily crying
- Increased appetite
- Irritability
- Joint pain
- Lack of focus and brain fog
- Mood swings
- Trouble falling asleep
- Weight gain
Treating PMS
Unlike what we often hear as women, PMS is not normal. Women don’t have to just live with it.
There are many home remedies that can help with the symptoms of PMS.
Dr. Conlee suggests:
- Using a heating pad
- Taking over-the-counter pain medications
But it’s important not to dismiss PMS symptoms, especially pain. Talk to your doctor about what you’re experiencing. It doesn’t have to be normal to live with PMS symptoms.
PMS symptoms can actually be a sign that something isn’t quite right inside your body. For example, you may have low progesterone. After ovulation, progesterone sharply decreases, which can lead to PMS symptoms.
Your provider can suggest natural supplements or prescribe medications. You take these during certain times of your cycle to balance hormones and alleviate PMS symptoms.
Getting pregnant
If you’re thinking about getting pregnant, Dr. Conlee suggests making an appointment with your OB/GYN before even starting to try.
“Schedule a preconception visit. You and your provider can talk about your overall health and fertility. Pregnancy can be stressful on the body, so it’s important to be in optimal health if you’re thinking you’d like to get pregnant sometime soon.”
Your greatest chance of getting pregnant is on the day of ovulation or the three days after ovulation day. However, there’s sometimes a chance of getting pregnant on your period or at another time during your cycle. That’s another reason to learn to track your cycle – not just your period or ovulation day.
The best time to take a pregnancy test is around the time that your period is due. This is about 12 to 14 days after conception. You can also take it on the day of your missed period. Testing too early may give you a false negative or positive.
Home pregnancy tests detect hCG levels in your urine. This is also called the pregnancy hormone. The higher the level of hCG in your urine, the more accurately a home test is going to detect a pregnancy. And the further along you are into pregnancy, the higher your levels of hCG will be.
Last Updated: February 29, 2024