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I Saw the (5th Vital) Sign

I Saw the (5th Vital) Sign

Robbyn Ingram | October 17, 2018 | Women's Health
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What Are Vital Signs?

For those of us who may not be as fluent in medical terminology, let’s do a quick layman’s lesson. Vital signs measure the body’s most basic functions. Physicians and healthcare professionals typically check four primary vital signs: body temperature, pulse (heart rhythm), respiration rate (rate of breathing) and blood pressure (Johns Hopkins Medicine Health Library). Vitals signs are used to detect and monitor medical problems. They can:

  • Identify the existence of an acute medical issue
  • Measure the severity of an illness and how well the body is responding to the physiological stress
  • Be a marker of chronic disease states (for example, hypertension is defined as a chronically elevated blood pressure)

These numbers provide critical information (hence the name "vital" or the phrase “Check for vitals” we hear so often) about a patient's state of health (UCSD School of Medicine).


The Science: Research Supporting Cycles as The 5th Vital Sign

In 2004, the Society for Menstrual Cycle Research (SMCR) co-sponsored a scientific forum called “The Menstrual Cycle Is A Vital Sign.” Medical experts presented research showing evidence that the menstrual cycle is, in fact, a vital sign as an indicator of well-being (Society for Menstrual Cycle Research, 2016). To build on this idea, the SMCR’s 2005 conference theme was Menstruation: The Fifth Vital Sign. Finally, ten years later in 2015, The American College of Obstetricians and Gynecologists’ (ACOG) Committee on Adolescent Health Care published the Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign.  

The study included an extensive evaluation of the menstrual cycle in adolescent girls as an additional vital sign and found that “Just as abnormal blood pressure, heart rate, or respiratory rate may be key to diagnosing potentially serious health conditions, identification of abnormal menstrual patterns in adolescence may improve early identification of potential health concerns for adulthood.” (ACOG Committee Opinion, 2015). The ACOG Committee’s 5th vital sign assertion says that if “the menstrual cycle does not function within normal parameters, general health is at risk because multiple body systems are impacted by menstrual dysfunction.” (ACOG Committee Opinion, 2015).

The ACOG Committee also determined that because the first occurrence of menstruation (referred to as the “menarche”) is such a significant milestone in physical development, clinicians should reinforce its importance in assessing state of health for patients and caretakers (ACOG Committee Opinion, 2015). Committee clinicians emphasized the critical role of menstrual patterns in reflecting overall health status, and the ACOG research recommends including this information with the other vital signs within the Review of Systems and History of Present Illness (ACOG Committee Opinion, 2015). Here is additional evidence from the ACOG report and other medical experts suggesting why your cycle should be considered a vital sign:


How Your Cycle May Identify Existing Medical Issues

“Regular periods are a sign that your body is working normally,” (Womenshealth.gov). In a 2018 interview with Cosmopolitan Magazine, Leah Millheiser, MD, an ob-gyn and director of the Female Sexual Medicine Program at Stanford University says, "Women who cast large blood clots generally have very heavy periods, which means they could have uterine fibroids, symptomatic anemia, or menorrhagia, which is the scientific term for very heavy bleeding," Millheiser says.


How Your Cycle May Measure the Severity of an Illness

Heavy menstrual bleeding is commonly associated with anovulation: when the ovaries do not release an egg cell during menstruation and ovulation does not happen (ACOG Committee Opinion, 2015). The condition has been linked with the diagnosis of a coagulopathy (also called a bleeding disorder); a condition in which the blood's ability to coagulate (form clots) is impaired (Cosmopolitan, 2018). The ACOG study found that heavy bleeding can detect other serious problems including platelet function disorders, and other bleeding disorder, and hepatic failure (ACOG Committee Opinion, 2015).


How Your Cycle May Mark Chronic Disease

Millheiser adds heavy bleeding can also indicate some other health conditions you may need to address, such as hypothyroidism, adenomyosis, fibroids, or Von Willebrand disease—a bleeding disorder that slows the blood clotting process and leads to prolonged bleeding. Learn more about charting for your health here


The Movement: Advocating for Cycles as the 5th Vital Sign

Over the last ten years, interest in natural family planning methods has been steadily increasing resulting in an influx of fertility monitoring and tracking applications (Current Medical Research, 2015). The need for comprehensive and accessible fertility awareness education is becoming more evident. The climate is changing, and collectively, we are moving in a “menstruation matters” direction; so much so that Cosmopolitan Magazine declared 2015 as “The Year of the Period.”

The following year, inspired by the pro-period publicity, Kelsey Knight, a registered nurse specializing in childbirth and a lactation consultant, and Emily Varnam, a reproductive health educator and body literacy advocate, decided to come together. The duo co-founded The Fifth Vital Sign, a grassroots movement promoting menstrual cycle literacy, to address important needs around body literacy and informed choice. Their mission is to “use education as preventative care, encouraging individuals to make informed choices about their health” (Society for Menstrual Cycle Research, 2016). Knight and Varnam took their project on the road and started offering free courses on reproductive health around the country in 2016.


“We drove 15,000 miles to connect with people in person, offer information and resources, and acknowledge the wonderment of our cycling bodies. We were able to listen to so many stories that spoke to the urgency and magnitude of the need to know more about our bodies.” (Society for Menstrual Cycle Research, 2016)


The organization takes its name, The Fifth Vital Sign, from the belief that “our natural cycle, like our blood pressure or pulse rate, often contains hints to bigger health problems--from stress to infertility to endometriosis” (Society for Menstrual Cycle Research, 2016). In a moment of what she calls “divine inspiration,” Varnam describes how the title for the The Fifth Vital Sign came to her: “It was perfect for the project: inclusive, not gendered, and scientific without being inaccessible” (Society for Menstrual Cycle Research, 2016). Varnam also created a fitting hand sign for the project that serves as a powerful symbol of the movement. Just as you would similarly check for your radial pulse with your pointer and middle fingers, instead you place those fingers above the mons pubis (where the uterus rests) so that you are checking on or “listening” to the uterus, to the menstrual cycle (Society for Menstrual Cycle Research, 2016).

The Fifth Vital Sign hopes to frame periods as a central indicator of health as important as your blood pressure or your pulse in giving you information about what your body needs and where you’re at. “We feel this will put people back in the driving seat in terms of their reproductive health and empower individuals to make choices that are safe, effective and make their lives easier” (Society for Menstrual Cycle Research, 2016).

Are you a proponent for your period as a 5th vital sign? To learn more about The Fifth Vital Sign project mission and message, visit their website here: http://www.5thvitalsign.com/



  1. https://www.hopkinsmedicine.org/healthlibrary/conditions/cardiovascular_diseases/vital_signs_body_temperature_pulse_rate_respiration_rate_blood_pressure_85,P00866
  2. https://meded.ucsd.edu/clinicalmed/vital.htm
  3. https://www.menstruationresearch.org/2016/11/03/the-fifth-vital-sign-a-grassroots-movement-towards-menstrual-cycle-literacy/
  4. https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Adolescent-Health-Care/Menstruation-in-Girls-and-Adolescents-Using-the-Menstrual-Cycle-as-a-Vital-Sign
  5. https://www.cosmopolitan.com/health-fitness/a19750523/what-your-period-says-about-your-health/
  6. http://www.usccb.org/issues-and-action/marriage-and-family/natural-family-planning/medical-research/upload/2015-Winter-Spring-CMR.pdf
  7. http://www.5thvitalsign.com/


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