(LH). This surge stimulates the egg to grow to 18–28mm in diameter and also signals the ovary to expel the mature egg (ovulate) out towards the Fallopian tubes. The mature egg is then sucked up by the Fallopian tube so that the sperm can fertilize it. Ovulation usually occurs on the 15th day of the cycle. If the body does not ovulate, then the LH surge may not be happening as it should, implying that the hypothalamus is not functioning efficiently. The hypothalamus requires vitamin B6 and zinc to produce GnRH. If it is not working efficiently, the right message is not passed to the pituitary gland for the LH release. All these hormones and the health of the egg are nutrient-dependent, and good blood flow is essential during this stage of growth.
After ovulation, the empty follicle undergoes a dramatic physical change. It turns a yellow colour (because of its oil-rich tissue) and is called the corpus luteum (which means ‘yellow body’). The corpus luteum is very important as it secretes the hormones progesterone and relaxin, which send the message to the endometrium of the uterus to become receptive for a possible pregnancy (see figure 2.4). As its names implies, progesterone (which means ‘for gestation’) is required for the pregnancy to be maintained. In response to the progesterone, the endometrium starts to produce the nutrients the embryo will need for its development, and the myometrium (muscle) layer of the uterus relaxes. Without sufficient levels of progesterone, relaxin and magnesium, the uterus would start to contract and expel the developing embryo. Therefore, if the corpus luteum is poorly developed, a pregnancy may fail. Again, oils are implicated here. Studies show that ‘Vitamin B6 (pyridoxine 5 phosphate) is necessary for the formation of the hormone progesterone’ and the same source indicates that ‘vitamin B6 is also required after ovulation when the body has a high level of oestrogen. B6 acts as a natural diuretic and helps alleviate some of the bloating associated with PMS. It is a precursor to progesterone’.10 Moreover, ‘the action of steroid hormones is balanced by B6 – it has an effect on endocrine diseases’.11
The fate of the egg is dependent upon whether or not it will meet up with a sperm in the Fallopian tube (see figure 2.3). If no sperm are present, both the unfertilized egg and the corpus luteum will degenerate (die) and be reabsorbed. The slow destruction of the corpus luteum leads to a decrease in progesterone and oestrogen secretion (see figure 2.4). Without these steroids, blood flow to the endometrium decreases and the lush endometrium cannot be maintained. The endometrium starts to degenerate from a lack of oxygen and nutrients, and it begins to separate physically from the uterus and is shed. This withdrawal of oestrogen and progesterone is the cause of the menstrual period (blood flow). With the onset of the menstrual period, a new menstrual cycle starts all over again and a new lining of endometrium is made for another attempt at pregnancy.
Figure 2.4
Graph of the day-to-day changes in the reproductive hormones during the menstrual cycle and the appearance of the endometrium during these changes. Note the endometrium becomes thick, and develops numerous blood vessels and glands because of the increase in oestrogen. The progesterone continues this build-up and makes the glands secretory, and prepares the endometrium for pregnancy. When the steroids decline at the end of the cycle, the endometrium sloughs off (menstrual period) and the cycle starts over again at day 1.
Women often accept a very heavy menstrual flow as the norm because that is what they have come to expect. Dr Casmir Funk, the man who isolated vitamin B1 in 1912, described the effect of vitamin B-complex in reducing a woman’s menstrual flow from five or six days to three or four days. He reported that menstruation came on ‘completely without warning’ (i.e. with no symptoms of premenstrual syndrome, or PMS) while these women were on B-complex vitamin therapy. He treated PMS successfully through nutrition, rather than drugs.12 Large blood clots may be prevented when vitamins C and E are used together with evening primrose and fish oils as ‘these all have oestrogenic properties, and certain oestrogens produce changes in blood clotting’.13
The amount of blood lost is usually about 60ml (2 fl oz).14 At the beginning of the menstrual cycle, rich red blood should be the norm, whereas brown granular blood with chopped-liver-like clots implies poor nutrient uptake. The nutrients used to improve periods include iron EAP2, vitamin B6, B-complex vitamins, magnesium, chromium, vitamins C and E, and evening primrose and fish oils. If blood loss is excessive to the point of flooding, then a well-absorbed iron supplement such as EAP2 or citrate may be used for 1–2 months to normalize the flow.
• CASE STUDY •
Gabi B of London
I’m 34, married with no children and live in London. I work as an IT consultant.
My periods were never a problem, more a slight inconvenience really. My story starts nine years ago, when I was around 25. My periods had become very heavy and painful. I thought this was how periods should be and that I’d been lucky up until then. So I put up with the pain, cramps, headaches and general grotty feeling for about a year. I then saw my GP, who referred me to a gynaecologist. My first visit was disappointing, to say the least. I was told that periods can be pretty unpleasant, and to come and see them again if the symptoms persisted. Well, after about two years, a laparoscopy confirmed that I had moderate endometriosis. I was put on a course of tablets to reduce the pain and inflammation. These tablets didn’t really help with the symptoms, but added side effects to my list of complaints. After about a year, I was put on a course of Zoladex injections, very painful injections into the abdomen once a month. Now, at no time had I been told that there is no cure for endometriosis. The drug treatments can only ease the symptoms. Zoladex in effect makes you menopausal, thus stopping your periods. The lack of bleeding causes the endo-sites to decrease in size and shrivel up. This seemed to make sense to me and so I put up with the side effects – hot flushes, night sweats, headaches, nausea, exhaustion, mood swings and depression – because I genuinely thought this treatment would cure me. How naïve.
All was well for about a year, then the symptoms came back. So another laparoscopy confirmed endometriosis was still present. I was put on the pill to ease the bleeding and pain, and given Coproximal as needed, which I’m afraid I did.
About two years ago, I was finally given laser surgery to burn away the endo-sites. My condition was moderate-to-severe, my left ovary had become stuck to the cavity wall and there were a lot of adhesions. The surgery was a success, and I was skipping about with joy I felt so well. But then, nine months later, it was back with a vengeance.
I returned to my gynaecologist to discuss my options. I understood this was not going to go away, but wanted to know if there was anything I could do to help myself. I was told that surgery was not an option so soon, but they could prescribe a contraceptive pill which can be taken constantly, thus stopping my periods for six to nine months, which might decrease the size of the endo-sites. That sounded like good news to me. But when I read the booklet that came with the pills, the side effects sounded so severe that I decided to put up with the pain.
By this time I was a very unwell bunny. I felt ill for three weeks a month. Before my period, I felt like I was about to give birth to triplets. There were many different symptoms:
constant severe ache in the abdomen
shooting and throbbing pain on my left side
shooting pains in my bottom
headaches
extreme bloating most of the time
exhaustion
nausea when the pain was really bad
ovulation was like a full-blown period
I couldn’t use tampons and the pads just made me feel even bigger
the blood was