There are a few facts in this life that we can count on. Men lie. People who say “I’ll pay you back” will never pay you back. Your period will arrive like clockwork every 28 or so days. And before you come at me for that first assertion being untrue, I have enough text message receipts to fill the Old Testament to prove it. The bigger issue is that a new study led by UCL and Natural Cycles, a contraceptive app, found that a basic assumption we take for granted about menstrual cycles is not actually a given. And by that I mean, this “rule” that your period comes every 28 days? You know, the premise that a lot of hormonal birth control packs are based off of? Yeah, it doesn’t even apply to a vast majority of women. Cool cool cool cool cool. Good thing we don’t base a whole slew of other science on this premis—oh wait.
The study, published in Nature Digital Medicine earlier this week, examined over 600,000 menstrual cycles of 124,648 women who used the Natural Cycles app. These women were from the United States, Sweden, and the UK. Researchers set out to look at how menstrual cycles were influenced by factors like age, BMI, and body temperature, in order to try to understand when women are more or less likely to get pregnant. Now, to be clear, the sample size of this study is not a complete accurate representation of the general population. For one, the sample only consists of app users. For another, only 8% of the app users in the study are obese while 15% of women in the general population are obese. Finally, the study excluded those with a pre-existing condition that would impact fertility, like PCOS, hypothyroidism, or endometriosis, as well as women who were experiencing menopausal symptoms. This makes sense considering the study was specifically concerned with pregnancy, but it does mean its findings are not applicable to everyone.
i can always tell when i’m going to start my period by how close i get to cutting my own bangs at 3am
— gabbie hanna (@GabbieHanna) November 6, 2017
Now that we’ve gotten all the disclaimers out of the way (shouts-out to the AP Psych class I took senior year of high school), let’s get into what the study found, because it’s actually very interesting. Researchers collected data from women ages 18 to 45, with BMIs between 15 and 50, who were using Natural Cycles from September 2016 to February 19. The women had not been using hormonal birth control within 12 months from registering for the app. So, remember how I said that it’s basically taken as gospel that menstrual cycles last 28 days? Yeah. Guess how many of the cycles actually lasted that long.
Just 13%. Thirteen percent of women in the study had 28-day menstrual cycles, and yet that timeframe is the basis for a lot of birth control methods and, equally importantly, fertility windows. If you literally Google “when does ovulation occur”, the top answer will tell you that ovulation typically occurs about 14 days before your period starts, if your average menstrual cycle is 28 days. The problem with this model is that, according to this study, very few women do have a 28-day cycle, and in fact, researchers actually found the average cycle lasts 29.3 days. And, furthermore, 65% of women had cycles that lasted between 25-30 days—but that means 35% of people (or over a third) do not. That is a good chunk of people who do not even fall into this window that we take for granted as “standard”.
I love period dramas, I have one every month
— Karen Chee (@karencheee) August 11, 2019
So why does this matter? Researchers’ big takeaway was that this has significant implications for people trying to get pregnant. As Professor Joyce Harper, one of the researchers of the study, put it: “ovulation does not occur consistently on day 14 and therefore it is important that women who wish to plan a pregnancy are having intercourse on their fertile days.” More specifically, these results are important for people who are trying to conceive and are using apps or cycle dates to predict fertility days. “An individualized approach to identify the fertile window should be adopted,” said Dr. Simon Rowland, Head of Medical Affairs at Natural Cycles. “Apps giving predictions of fertile days based solely on cycle dates could completely miss the fertile window and it is therefore unsurprising that several studies have shown that calendar apps are not accurate in identifying the fertile window.” Harper added, “In order to identify the fertile period it is important to track other measures such as basal body temperature as cycle dates alone are not informative.”
On the surface, it’s not a particularly shocking conclusion that all reproductive systems are not identical, or that in general, biological functions and processes are complex and unique to the individual and cannot be generalized to a neat window or category that fits every single person. But then again, this is done all the time—whether we are talking about menstrual cycle lengths, body mass index, diets, or anything else. Am I surprised we are only now just being confronted with data that confronts the standard 28-day menstrual cycle, given that understanding of the female anatomy seems to be so low on the priority list that the clitoris was not even fully discovered until 1998? No, I am not surprised. But this study is giving me, and the researchers, hope that more studies will be done on the menstrual cycle, particularly, clinical trials done in controlled settings. “These initial results only scratch the surface of what can be achieved,” said Professor Harper. “We hope to stimulate greater interest in this field of research for the benefit of public health.” She added that with increased interest in and dedication to doing empirical studies, “there is enormous potential to uncover new scientific discoveries.”
Images: karencheee, GabbieHanna / Twitter
So, you’ve heard about the pelvic floor before: you tried kegels a few times but weren’t sure if you were doing them right… you heard how giving birth can damage your pelvic floor muscles and afterwards you might pee when you sneeze… your friend has maybe told you about their jade egg… or you might’ve read about other kegel toys on O.school. But, when you get down to it, what’s the deal with the pelvic floor?
Well, this group of muscles may just be the unsung hero of your body. The pelvic floor plays a critical role in bladder control, bowel function, childbirth, orgasms, ejaculation, erections, and more, so having a healthy pelvic floor is a pretty big deal for your health and your sex life. When the pelvic floor is healthy, these processes go smoothly, but when the pelvic floor is not healthy, there can be issues.
What Is Your Pelvic Floor?
The pelvic floor is a group of muscles in the pelvis that sits like a sling between the pubic bone at the front of the pelvis and the tailbone at the back. The muscles support the organs inside the pelvis, including the bladder and bowel, as well as the uterus (for people who have one).
In case you need to know for a trivia quiz in future: levator ani, ischiocavernosus, bulbospongiosus, and coccygeus are the names of the muscles that comprise the pelvic floor. They sit at the base of the pelvis under all the pelvic organs, and wrap around the urethra, anus, and vagina, controlling the opening and closing of these passages.
Everyone has a pelvic floor—regardless of gender, age, body type, or any other kind of difference. So, pelvic floor health is not just about vaginas. We can all benefit from maintaining a healthy pelvic floor.
What Does Your Pelvic Floor Do?
Firstly, the pelvic floor keeps your organs inside your body, so gravity doesn’t let them fall out when you’re standing upright and walking around. Yikes. Ok, it’s not a very sexy thing to think about, but it is kind of an important job.
Secondly, the pelvic floor muscles squeeze closed and relax open to allow the passage of waste (both kinds) and, when relevant, babies. Being able to squeeze and relax the muscles is also essential for arousal, orgasm, erections, ejaculation, and pain-free sex.
Why Should You Care About Your Pelvic Floor?
Did you not read when I said “pain-free sex”? But for real, having a healthy pelvic floor is important because it controls so many important bodily functions. Peeing when you want to, and not when you don’t? Thank your pelvic floor. Same with poop control—thanks, pelvic floor! Being able to achieve orgasm? You can thank your pelvic floor for that too. Having sex without pain? Yup, I mentioned that one already. See what I mean about it being the unsung hero?
On the other hand, if you’re having any of these problems, an overly weak or overly tight pelvic floor might be the culprit:
- Accidentally peeing or having trouble getting all your pee out
- Accidentally pooping or often getting constipated
- Pain in your back, abdomen, pelvis, or genital areas
- Difficulty achieving orgasm
- Pain during sex (especially painful penetration)
- Difficulty inserting anything into the vagina
- Penis problems like erectile dysfunction and rapid ejaculation
How To Care For Your Pelvic Floor
Let’s get one thing straight first, being “tight” down there is not actually a good thing. Sure, you want those muscles to be strong, and to be able to clench when you want them to, but you also need to be able to relax them too. An overly tight pelvic floor can cause as many problems as a weak one.
The right balance of strength exercises, like Kegels, and relaxing exercises, like stretching, keep the pelvic floor in tip-top shape. According to pelvic floor physical therapist Dr. Uchenna Ossai, “If you don’t strengthen your pelvic floor, if you don’t work on relaxing your pelvic floor, if you don’t work on lengthening your pelvic floor, it’s not going to be functioning the way you need it to”. So how do you exercise your pelvic floor? Here’s how.
How To Do Kegel Exercises
Doing Kegels is basically like going to the gym, but for your pelvic floor. And on the bright side, it takes way less effort than the gym, and you probably won’t break a sweat doing it. But before you dive into Kegels, it’s important to know that they’re not suitable for everyone. If you have a healthy or weak pelvic floor, then go for it. On the other hand, if you have an overly tight pelvic floor, Kegels can make things worse. Seeing a pelvic floor physical therapist will help you work out the state of your pelvic floor and which exercises are best for you. Below is a step-by-step guide to Kegels for people with vaginas.
Step 1: Isolate The Correct Muscles
You’ll want to be in a neutral spine position, that means you aren’t too arched and you’re not too flexed. Find somewhere in the middle where everything feels natural and comfortable. You can isolate different parts of your pelvic floor by focusing only on the anus, vagina, and urethra! But for general purposes, focus on engaging the entire muscle group.
For more info on how to isolate the correct muscles click here.
Step 2: Squeeze AND Lift Your Pelvic Muscles
Think about picking up a Kleenex with your pelvic muscles. Imagine squeezing your urethra, anus, and vagina to pick up a Kleenex and pull it up towards the ceiling.
Step 3: Keep Breathing Throughout Your Kegels
Breathe normally while you do your Kegel exercises. Don’t hold your breath, pull your belly in, tighten your inner thighs, or arch your back. You are just trying to work those specific pelvic floor muscles and keep everything else relaxed.
Step 4: Release The Muscles
After a few seconds, release the muscles. Imagine you are letting go of the Kleenex and let it float down to the floor. You should completely relax the muscles at this stage. But don’t push down with your muscles when releasing. Remember, the goal is to have good pelvic floor tone, which means muscles that are able to relax as well as squeeze.
Step 5: Repeat
Before you decide on how many reps you need to do, you first need to figure out where you stand. Start with a 10 rep max; lay down and repeat the above instructions for a max of 10 reps. If you get tired after four reps (it will feel like you cannot find your muscles), then that is your starting point. Begin with two to three sets of four reps, once a day for general maintenance and then build yourself up to two sets of 10 reps.
You also might want to work on your endurance, which means you should practice holding the contraction for a few seconds, and then release and relax the muscles.
Some Final Notes
Many people think “tight is right,” but that’s not always the goal. Your pelvic floor needs to have rhythm—it needs to be able to tighten when you need it to tighten and relax when you need it to relax. Having good muscle awareness and coordination are key ingredients to a healthy pelvic floor.
If you want to delve deeper to work on your own muscle awareness and coordination, Dr. Uchenna Ossai suggests talking with a health care provider that can do a pelvic floor assessment and help you come up with a program that is right for you.
Images: Openstax, Rice University; video courtesy of O.school