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In this blog series, we delve into Apple's groundbreaking Women's Health Study, conducted in collaboration with prestigious institutions like Harvard, which explores the intricate link between menstrual cycles and health conditions. We also discuss how Apple's technology, including the Apple Watch, empowers users to monitor their reproductive health. We emphasise how stress, insulin, and sex hormones are interconnected. Oxytocin, at the top of the hormonal hierarchy, plays a crucial role in hormonal balance. Apple's Cycle Tracking features on iPhone and Apple Watch help users monitor their cycles and receive timely alerts. Temperature data enhances the accuracy of ovulation estimation.

Apple has embarked on an extraordinary journey in women's health research. The Apple Women's Health Study is a pioneering initiative aimed at unravelling the intricate relationship between menstrual cycles and various health conditions. Recent discoveries from this study have shed light on the profound importance of understanding and tracking menstrual cycles in the broader context of overall well-being.

Apple Women’s Health Study

The Apple Women’s Health Study, conducted in collaboration with the Harvard T.H. Chan School of Public Health and the National Institute of Environmental Health Sciences, focuses on understanding the relationship between menstrual cycles and various health conditions. Preliminary findings from the study highlight the significance of paying attention to menstrual cycles in the context of overall health.

Key findings based on analysis of over 50,000 participants include:

• 12% of participants reported a polycystic ovary syndrome (PCOS) diagnosis, which was associated with more than four times the risk of endometrial hyperplasia and more than 2.5 times the risk of uterine cancer.
• 5.7% of participants reported that their menstrual cycles took five or more years to become regular after their first period. Those in this group had more than twice the risk of endometrial hyperplasia and more than 3.5 times the risk of uterine cancer compared to those whose cycles regularised in less than a year.

The study aims to raise awareness about menstrual cycle physiology and its impact on uterine health, encouraging individuals to consult healthcare providers when experiencing persistent changes in their menstrual cycles. The research also explores various menstrual symptoms and their prevalence among participants.

The Apple Women's Health Study invites Women to contribute to scientific research by using the Apple Research app, allowing them to share cycle-tracking data and other health information. The study emphasises privacy and data security in its design. Additionally, Apple's Cycle Tracking features in the Health app and on Apple Watch provide users with tools to monitor their menstrual cycles and gain insights into their reproductive health. The Apple Watch Series 8 and Apple Watch Ultra introduced temperature-sensing capabilities for estimating ovulation, which can be helpful for family planning. Overall, the study seeks to advance our understanding of menstrual cycles' impact on health and promote early detection of potential health issues through cycle tracking and analysis.

Hormonal Hierarchy

The secret to achieving hormonal balance is rooted in the idea of a hormonal hierarchy, which might come as a surprise to many. Essentially, certain hormones wield greater influence than others. To clarify, if you're aiming to regulate sex hormones, which occupy a lower position in this hierarchy, it's essential to focus on optimising oxytocin, cortisol, and insulin levels. Therefore, if you find yourself grappling with challenges related to hormonal equilibrium (such as PCOS, mood fluctuations, or menopause), it's crucial to grasp a few key concepts.

Let’s take a closer look at hormones:

1. Oxytocin - the "cuddle hormone," holds the highest position in the hormonal hierarchy, making it the most influential hormone. Its release is associated with social bonding and affection. Increasing oxytocin not only positively impacts sex hormones but also offers metabolic benefits, including improved glucose uptake, enhanced insulin sensitivity, appetite suppression during fasting, and fat breakdown.
2. Cortisol - known as "the stress hormone," tends to be elevated in busy, rushed individuals. Women can assess their cortisol and hormone levels through a DUTCH Complete Hormone Test available at my office, a valuable recommendation for all women.
3. Insulin - The third hormone in the hierarchy is insulin. To maintain healthy insulin levels, it's essential to steer clear of foods that trigger insulin spikes, such as refined sugar, unhealthy fats, flours, vegetable oils, and diet drinks. Additionally, fasting plays a crucial role in regulating insulin by promoting the utilisation of stored insulin in fat cells.
4. Sex hormones - progesterone, oestrogen, and testosterone, which occupy the lowest position in the hormonal hierarchy. Their levels can be significantly influenced by the hormones higher up in the hierarchy

Insulin resistance, a condition where your body's response to insulin is compromised, has a significant impact on women's sex hormones. When a woman experiences insulin resistance, it disrupts the balance of her sex hormones. Stress is a key player in this scenario, as persistent stress elevates cortisol levels, further exacerbating insulin resistance, meaning the body needs more insulin to manage blood sugar spikes. As a consequence of insulin resistance, women may face challenges in balancing their key sex hormones, including oestrogen, progesterone, and testosterone.

At the top of this hormonal hierarchy is oxytocin, often referred to as the "cuddle hormone". Building oxytocin levels through social connections can help in calming cortisol. When cortisol is lowered, the body becomes more insulin-sensitive. This enhanced insulin sensitivity, in turn, facilitates a better balance of sex hormones, promoting overall well-being.

What does the term 'Menstrual Cycle' exactly mean?

The menstrual cycle is a naturally occurring phenomenon, a sophisticated process regulated by female hormones leading to consistent menstrual bleeding, commonly known as periods. This cycle comprises four distinct phases:

1. Day 1-10 - “Power phase” -   During this phase, the body is focused on building hormones. Oestrogen is low so we need to build it through diet. Keep glucose low by eating low-carb. Power up your lifestyle, you may feel you can run a marathon! It's a great time to exercise. We are cortisol forgiving at this stage, which means that we may tolerate higher stress.
2. Day 11-15 - “Manifestation phase” - Oestrogen is at its highest, along with a surge in testosterone and the presence of progesterone. This is the only time in the cycle when all three hormones are present, making it a great time to start new projects, you'll feel motivated and super productive! You crave more carbs at that stage, which is normal as they are required to create progesterone.
3. Day 16-19 - “Second power phase” - This phase supports the body's natural cycles of repair and rejuvenation. You can switch back to a lower carb diet. 
4. Day 20-28/30 - “Nurture phase” - In this stage, the body becomes insulin resistant, meaning you need more glucose to produce progesterone - enrich your diet with healthy whole foods, leafy vegetables and smart carbs. Avoid fasting and slow down with gentle exercise like yoga. Cravings for chocolate often indicate a need for magnesium (opt for >70% Dark Chocolate).

Cycle Tracking App on iPhone & Apple Watch

You have the option to monitor your menstrual cycle using either the Health app on your iPhone or the Cycle Tracking app on your Apple Watch. Furthermore, you can activate notifications to receive alerts as your next period or fertile window is coming.

Upon opening either the Health app or Cycle Tracking app, you can quickly and effortlessly view your menstrual cycle information. Here's a breakdown of the symbols and colours used in the app:

• Light Blue Oval: This represents your anticipated six-day fertile period.
• Light Purple Oval: A light purple oval indicates the estimated day of ovulation, calculated retrospectively.
• Red Stripes: The presence of red stripes encircling a circle signifies the predicted start of your period.
• Solid Red Dot: Solid red circles indicate the days when you have logged your period.
• Purple Dot: Purple dots are used to mark days when you have entered additional information.

For Apple Watch Series 8 or newer models, as well as all Apple Watch Ultra versions, the temperature data collected from your wrist can be utilised to estimate the probable date of ovulation and enhance the accuracy of period predictions. Cycle Tracking can notify if the recorded menstrual history over the past half-year indicates any consistent patterns of irregular, infrequent, extended periods, or continual spotting. If you receive an alert or notification concerning a potential menstrual irregularity, you can review your documented menstrual history for accuracy. If the information aligns with the identified deviation, you can access details about the detected cycle irregularity and export the preceding 12 months of your menstrual history as a PDF, which you can then share with your healthcare provider. When you have recently logged a menstrual factor or are currently experiencing one, the cycle irregularity detection feature will automatically deactivate.

The Apple Watch has received numerous requests from Natural Cycles' large user base, drawn to its body temperature-based ovulation tracking introduced in 2022. The method, known as the fertility awareness method, monitors bodily changes to determine fertile and non-fertile days, offering a non-hormonal alternative to contraception. However, its effectiveness depends on consistent and correct usage, with a 98% efficacy rate when used perfectly, dropping to 93% with typical use. Imperfections in temperature data collection, influenced by various factors such as alcohol consumption, battery levels, sleep patterns, and irregular cycles, have raised concerns about the method's reliability. Natural Cycles has faced criticism in the past for not adequately addressing these realities of typical use, leading to unwanted pregnancies among some users. The CEO of Natural Cycles maintains a low risk of unintended pregnancy but advises users to consider their circumstances before relying solely on the algorithm.

If you own an Apple Watch Series 8 or Ultra and are a user of the Natural Cycles app, you can now integrate temperature data from your smartwatch into the birth control algorithm, as announced by Natural Cycles. Natural Cycles is the sole cycle-tracking app authorised by the US Food and Drug Administration for contraceptive use. Unlike typical menstrual tracking apps, Natural Cycles mandates daily and unwavering monitoring of basal body temperature to identify ovulation and forecast an individual's 'fertile window'—the few days during which pregnancy is possible.

Did you know? Before ovulation, a woman typically maintains an average resting temperature ranging from 36.1°C to 36.4°C. After ovulation, there's a minor increase in average body temperature. If a woman is pregnant, this temperature rise remains elevated. However, if a woman is not pregnant, the temperature will drop again, signalling the start of a new cycle.

Balancing a busy life and maintaining good health can be challenging. At MegaMac, we've got your back with our stylish Nomad Slim strap for Apple Watch. How about an elegant AirPods case or a smooth WOOLNUT Sleeve for your laptop?

Keep an eye out for the upcoming blog post in the series, we'll explore how Apple's innovative technology can transform your sleep experience, bringing you closer to the ultimate night's rest you've been dreaming of. Stay tuned for a sleep revolution!