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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.

      A Time to Reflect

      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.

      Keeping a Diary

      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).

      • Lifestyle notes (evenings out, alcohol intake, stress at work, travel, holidays, etc.)

      • Use of any medicines – such as painkillers for headaches, antihistamines, antibiotics, etc.

      • Occasions of full sexual intercourse.

      • Libido.

      • Physical feelings – abdominal cramps, headache, energy levels, breast tenderness, etc.

      • Emotions – moods, happiness, irritation, etc.

      Most women need to observe their secretions for about three cycles before they feel confident about recognizing changes. Do bear in mind that keeping a diary is designed to provide you with an overview of your cycle, not a foolproof means to conception. It is all too easy to get obsessive about these things – try to keep a sense of perspective.

      One of the reasons keeping a diary is so useful is that it is only possible to evaluate your cycle length retrospectively. It’s only after keeping a note of several cycles that any sort of recognizable pattern will begin to emerge. If you have been on the contraceptive pill, or have no idea of what your cycle length might actually be, then keeping a diary noting down this information before trying to get pregnant can be enormously helpful and quite revealing. It also provides you with an objective record of events, which can be equally helpful in identifying problems such as a fluctuating cycle length, inadequate frequency of sexual intercourse, use of medication, etc.

      Even though fertility awareness seems to involve a lot of information, as you become more aware of what is happening during your cycle, it soon becomes second nature. What is important, however, is to remain aware without becoming obsessive. When all’s said and done, the single thing that is most likely to improve your chances of conception is having lots of sex, not just sex at specific times. If you can do this without focusing solely on procreation, but keeping the pleasure in mind, it can only be beneficial for both you and your partner.

      Questions and Answers

       What if I have a brown discharge for a few days before my period starts? Does this count as Day 1?

      No, Day 1 is the first full flow of blood, the first day of red bleeding.

       I have just come off the Pill and want to get my system cleaned up before starting to try for a baby.

      Don’t, because research shows that you are more fertile in the first couple of months that you come off the Pill. Getting pregnant can become harder in following months.

      Most women get pregnant very quickly after stopping the Pill – in fact, some fertility clinics put women on the Pill to get the ‘rebound’ fertility effect. With newer lower-dose pills, there is no reason to wait for the Pill hormones to get out of your body. There are no adverse effects shown if

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