The Menstrual Cycle: Physiology, Patterns, and the Four Body Seasons

From the Menstrual Cycle Series of Dr. Alex Dragan ND

In this webinar, Dr. Alex Dragan, Naturopathic Doctor, explores the menstrual cycle as a vital sign and a source of information about overall health. The presentation connects menstrual physiology with clinical observations, cultural context, and practical approaches to patient education.

1. Historical Context: From Sacred to Taboo

Dr. Alex opens by exploring how perceptions of menstruation have changed across cultures and historical periods. Some traditions associated menstruation with spirituality, reflection, and community, while others framed it through concepts of impurity, illness, or dysfunction.

The discussion considers how historical medical theories, religious narratives, and the later medicalization of menstruation have influenced attitudes toward the cycle. These perspectives provide context for the shame, discomfort, or uncertainty patients may bring into clinical conversations.

For students, this section invites reflection on how language and cultural assumptions shape menstrual health education and the patient experience.

2. Understanding Menstrual Patterns and Recognizing Red Flags

The webinar reviews cycle length, bleeding duration, blood loss, and predictability as key elements of a menstrual history. A 28-day cycle is used as a teaching example, rather than a standard every patient should meet.

Key points discussed include:

• Cycle tracking: Day 1 refers to the first day of full menstrual flow, rather than preceding spotting.

• Individual patterns: Consistency, changes from a patient’s usual pattern, and associated symptoms offer useful clinical information.

• Bleeding assessment: Ask about duration, product use, flooding, clots, and the impact of bleeding on daily activities.

• Pain and functional impact: Menstrual pain that disrupts work, school, sleep, or usual activities deserves assessment.

Dr. Alex highlights heavy bleeding, large clots, and debilitating cramps as findings that warrant further evaluation. This section emphasizes looking beyond whether a patient describes their period as “normal” and asking what their experience actually involves.

3. The Brain–Ovary Connection and Key Hormones

The menstrual cycle depends on coordinated communication within the hypothalamic–pituitary–ovarian axis. Dr. Alex introduces the hormonal feedback mechanisms that regulate follicular development, ovulation, and changes in the endometrium.

Follicle-stimulating hormone (FSH)
Released by the anterior pituitary, FSH supports the growth and maturation of ovarian follicles.

Estrogen
Produced by developing follicles, estrogen supports proliferation of the endometrial lining. The webinar also discusses its relationship with experiences such as changes in mood, focus, and libido.

Luteinizing hormone (LH)
The mid-cycle LH surge triggers ovulation and the subsequent formation of the corpus luteum.

Progesterone
Produced primarily by the corpus luteum after ovulation, progesterone supports secretory changes in the endometrium. Its relationship with sleep and mood is also explored, while recognizing that responses to hormonal fluctuations vary.

When pregnancy does not occur, the corpus luteum regresses and estrogen and progesterone levels fall. This hormonal withdrawal leads to shedding of the endometrial lining and the beginning of the next menstrual cycle.

4. The Four “Body Seasons”

Dr. Alex uses the seasons as a patient education framework for discussing changes throughout the cycle. The day ranges below illustrate a 28-day cycle; actual timing varies, particularly the timing of ovulation.

The seasonal framework encourages awareness of individual patterns. Energy, mood, and exercise capacity do not follow a fixed schedule for every patient.

Menstrual Phase | Winter | Approximately Days 1–5

Menstruation occurs as the endometrial lining sheds following the decline in estrogen and progesterone. Some patients experience fatigue, discomfort, or a greater desire for rest and reflection.

The webinar discusses comfort measures such as warmth, heating pads, nourishing meals, and movement adapted to symptoms and tolerance. Iron-rich foods are also considered in the context of menstrual blood loss.

Follicular Phase | Spring | Approximately Days 6–13

Although the follicular phase begins on Day 1 and overlaps with menstruation, “spring” is used here to describe the postmenstrual portion. Developing follicles produce increasing amounts of estrogen as the endometrium rebuilds.

Some patients notice greater energy, motivation, or interest in social activities during this time. Dr. Alex discusses using these observations to guide activity and planning, alongside consistent nourishment with protein, fibre, and dietary fats.

Ovulatory Phase | Summer | Around Day 14

Ovulation follows the LH surge and involves the release of an oocyte from the dominant follicle. Potential signs discussed include clear, stretchy cervical mucus and brief mid-cycle pelvic discomfort, known as mittelschmerz.

The summer analogy reflects the increased energy, libido, or social confidence some patients report around ovulation. These experiences are presented as patterns to explore rather than universal features of an ovulatory cycle.

Luteal Phase | Autumn | Approximately Days 15–28

After ovulation, the corpus luteum produces progesterone and estrogen. If pregnancy does not occur, these hormone levels decline toward the end of the phase.

Dr. Alex discusses premenstrual symptoms such as irritability, anxiety, breast tenderness, and food cravings. Supportive strategies explored include regular meals, sleep, attention to caffeine and alcohol intake, and adjusting demands when symptoms affect capacity. The webinar also introduces nutritional considerations, including magnesium, vitamin B6, and calcium.

5. Applying the Framework in Patient Care

The webinar encourages students to combine an understanding of reproductive physiology with curiosity about each patient’s lived experience. Tracking bleeding, pain, mood, sleep, and energy can help patients describe their patterns and support a more focused clinical history.

The body seasons offer an accessible starting point for education. In practice, the aim is to help patients recognize their own patterns, identify symptoms that need assessment, and make informed choices about how they care for themselves throughout the cycle.