The Ideal Women’s Health Doctor-Patient Relationship

As I wrote in the blog post Women’s Reproductive Hormones Matter More Than We Think, the menstrual cycle is a fifth vital sign for women. For men, vital signs only consist of heart rate, blood pressure, respiratory rate, and temperature (all of the things that are thoroughly assessed when you visit the doctor). These signs give a glimpse into the state of our health. If any of these signs are abnormal, your doctor will order lab tests and/or scans to determine the cause of the abnormal sign. For women, the menstrual cycle should also be included as a vital sign and thoroughly examined when we go to the doctor. If something is abnormal with the menstrual cycle, evaluation should be done through lab work and/or scans to determine the cause of the abnormality, just like with any other vital sign.

The issue in women’s healthcare today is that the menstrual cycle is not routinely evaluated as a sign of health. Doctors typically ask “is your period regular/normal” and if we are bleeding every month, we respond with “yes” and the discussion ends there. If we answer with “no”, there is usually a brief discussion that concludes with the use of birth control for symptom management. Since the menstrual cycle is truly a vital sign for women, it should be evaluated like the other vital signs that are assessed. In an ideal healthcare scenario, this is the dialogue I, as a nurse, would like to see between a doctor and a cycling woman:

________________________________________________________________________________________

Dr. Smith: “Hi Jane, your heart rate, respiratory rate, blood pressure, and temperature are all normal. Lets talk about your menstrual cycle. Are you showing signs of ovulation every month?”

Jane: “I’m not sure. I don’t bleed every month but when I do, it seems normal. Although, I’m not really sure what’s normal and what’s not normal and I have no idea how to know if I’m showing signs of ovulation.”

Dr. Smith: “Okay. Well, research suggests that ovulation is a sign of health and, even though we call the female cycle the menstrual cycle, it’s really the ovulation cycle. You menstruate (bleed) only because you’ve probably ovulated. Are you noticing slippery, egg-white type mucus every month?”

Jane: “Oh. That’s so interesting. No one’s ever told me that. I notice that mucus pretty much all the time.”

Dr. Smith: “That’s good to know. From our discussion here, it seems that we should do some lab work and further testing to identify what’s causing these irregularities in your cycle. Typically, after you bleed you should experience a few dry days and then go into a period of estrogenic-type mucus (the moist and slippery stuff) for a few days (about 5 to 7) and then return to dryness. It’s different with every woman, but these mucus signs tell us a little bit about the levels of estrogen and progesterone in your body without lab work. I will refer you to a fertility awareness educator so you can learn to chart your mucus and create a health record for yourself that way. I’ll evaluate the chart as part of your healthcare regimen once you have it. Also, when the ovulation cycle is irregular, there is typically an underlying reason. Let’s get to the root cause of it. When you are experiencing a state of optimal hormone health, you have the power to feel your best.”

Jane: “Wow, thank you Dr. Smith. No one’s ever told me any of that. I do feel anxious a lot. I wonder if that’s related to my cycle being irregular and my hormones not being regulated.”

Dr. Smith: “There is absolutely a possibility that your anxiety levels could be related. Consistent cervical mucus can be a sign of constant high levels of estrogen. When estrogen is at abnormally high levels, it can increase anxiety. We’ll work together over the next few months to help identify the root cause of your menstrual irregularities. I will contact you once I review your lab work and ultrasounds. Message me if you have any questions in the meantime.”

Jane: “Thank you so much. This has been so helpful. I can’t wait to work with a fertility awareness educator and learn more about how to be my healthiest self.”

________________________________________________________________________________________

You might have noticed in the dialogue above that birth control was never mentioned by Dr. Smith. If you are anything like me, you’re wishing this was the discussion you had with your doctor. When I was 15, I was put on birth control for acne and painful periods. I never had a discussion (like the one above) with my doctor about what that could have meant for my health. If you’re feeling frustrated and confused like I was in 2020 when I found out the power of the menstrual cycle, know that it’ll be okay. That frustration can be used to start a great movement in women’s healthcare. Also, know that it’s not your doctors’ fault. Doctors are highly trained individuals who desire to heal, they just weren’t given information about the fifth vital sign in medical school. My hope is that, as more and more healthcare professionals become acquainted with restorative reproductive medicine and the power of the female cycle, the medical and nursing school curriculum will change. When the curriculum changes, deeper evaluation of the menstrual cycle will become common healthcare practice.

If you’re now thinking that your menstrual cycle might not be functioning at its best, contact me and I’d love to talk with you through it. You deserve to be heard and, most especially, you deserve to heal. We’re in this together!