Menstruation

Everybody knows that menstruation is part of being female, but many people don’t quite know how it works or why it happens.

WHAT IS MENSTRUATION?
Different women have different feelings about their periods. Some women think that menstruation is fascinating and wonderful, and other women would just as soon not have periods.

Women begin menstruating at puberty, usually when they are between 9 and 13 years old, though some women begin sooner than that and some women begin later. Women continue menstruating until menopause, which usually occurs when they are between 45 and 55 years old, though some women enter menopause earlier than that and some women enter it later. The average menstrual cycle is 28 days long, BUT it’s perfectly normal to have cycles that are longer or shorter than that.

The beginning of the menstrual cycle is the woman’s actual period – the shedding of blood, fluid, and tissue that built up in preparation for the implantation of a fertilized egg (a pregnancy). This occurs before ovulation. Once a month, a woman’s ovary (there are two, one on each side) releases an egg that it has been ‘ripening’ for fertilization – this is called ovulation. The egg is very, very tiny, and if it is not fertilized it dissolves. When a woman ovulates, an egg is released from the ovary, into the Fallopian tube, of which there are two, one on each side. There are tiny hairs in the tube called cilia (pronounced SILLY-uh) that move the egg through the tube toward the uterus. By the time the egg arrives at the uterus, the lining will have already built up. If the egg is not fertilized by a sperm or the egg is fertilized but does not implant (that is, no pregnancy has occurred), the lining of the uterus is shed. This is a period. The total amount of fluid released is usually less than a cup.

When counting the days of a period, the first day of bleeding is considered Day 1. The period usually lasts 3-7 days, with varying amounts of bleeding on each day, though most women say that the first and second days are the heaviest. Ovulation generally occurs 12-14 days before a woman’s next period. If a woman has a 28-day cycle, ovulation occurs around Day 14. If a woman has a cycle that is shorter or longer than that, ovulation occurs on a different day (maybe Day 7 or Day 20), but will generally occur 12-14 days before she has a period.

A woman is fertile around the time that she is ovulating. Some women can tell when they are ovulating by watching for changes in vaginal discharge or body temperature. Some women feel pain when the egg is released. Ovulation may be accompanied by a bit of blood. This is perfectly normal but is not a period.

Some women have very regular periods – that is, their cycles are always the same length. Some women do not. It is normal for young women to have irregular periods, and that is also true for adult women. Lots of things can interfere with a woman’s regular cycle – stress, illness, and more. Typically, a woman will not have periods while she is pregnant.

SHOULD I USE TAMPONS OR PADS?
Whether a woman uses tampons or pads to catch her menstrual flow is a personal decision. Tampons are made of absorbent material and inserted into the vagina, where they can stay for up to 8 hours, depending on the heaviness of a woman’s menstrual flow. Tampons catch the fluid before it leaves a woman’s body. Pads are also made of an absorbent material, but they applied to the inside of a woman’s underwear and catch the menstrual fluid after it has left her body. Because women shed different amounts of fluid each day of their cycle, pads and tampons come in different absorbencies.

Some pads and tampons come scented or with ‘deodorant’ products on them. Women should never use these products. The chemicals can cause irritation and infection.

In addition to tampons and pads, there are other, newer options available to women for protection during their periods. The product called The Keeper™ is a reusable rubber cup that is inserted into the vagina (where it can remain for up to 12 hours). It catches menstrual fluid and must be emptied by the wearer. The initial cost is $35, though they can be washed and reused for up to 10 years. There is a disposable cup, marketed under the brand name Instead™. It works in a similar way, but cannot be reused. Some women really like these products, and others find them uncomfortable or inconvenient.

Women should try a range of different products to see what fits best with their lifestyle.

WHAT IS NORMAL AND WHAT IS NOT?
It is perfectly normal for women to:
o Have pain or cramping before and during their periods
o Gain weight before and during their periods – due to water retention or “bloating”
o Feel moody or irritable before or during their periods
o Have menstrual cycles of varying lengths
o Have periods that are different from day-to-day and cylcle-to-cycle
o Have intercourse during their periods
o Choose not to have intercourse during their periods
o Break out (get pimples) before their period is due
o Get diarrhea or upset stomach during their periods

Many of these symptoms are due to the hormonal and chemical changes that a woman’s body experiences during menstruation. Most of these can be managed with things like over-the-counter pain medication, rest, heat, and gentle exercise or stretching.

It may be a sign of a more serious health problem if a woman:
o Stops menstruating (not due to menopause or pregnancy)
o Regularly has periods that are extremely heavy
o Has periods that regularly last more than 7 days
o Has not started her period by age 16
o Has very severe cramping with her periods
o Feels extremely depressed or moody before or during her periods
If a woman experiences any of these things, she should consult her health care provider, who can tell her more about what’s going on.

I HAVE HORRIBLE PERIODS. WHAT CAN I DO?
First of all, it’s important to remember that menstruation is not a “curse” or a “punishment.” A woman doesn’t have to be uncomfortable while she’s got her period.

Some women find that they are most uncomfortable before their periods, a condition most people call “PMS” – Pre-Menstrual Syndrome. Other women find that the period itself is the worst part. Some women have PMS and uncomfortable periods.

There are a lot of things a woman can do to deal with PMS. Exercise tends to help women manage the physical and emotional discomfort that can come with PMS. Women who have problems with bloating (water retention) before their periods should avoid foods and drinks with a lot of caffeine or salt. Some women find that they can manage their PMS by being gentle with themselves – getting enough sleep, eating well, doing comforting things. Women who have severe symptoms as a result of PMS might want to talk to their health care providers about medications that can help.

There are also a lot of things women can do to deal with discomfort related to their periods. Over-the-counter pain medications like Advil™, Aleve™, and Midol™ can help relieve cramping and pain that some women experience during their periods. Heating pads, hot baths, and rest can help as well. Women can exercise during their periods, and many find that physical activity helps make their periods more comfortable. If a woman doesn’t feel up to doing anything high-impact, she can try more relaxing activities like yoga or stretching.

If a woman has very uncomfortable periods that don’t seem to get better when she tries the things listed here, she might want to talk with her health care provider. She may be having uncomfortable periods because of a medical condition, and there may be medications (like birth control pills) that can help.