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Periods Matter
- By Sharon Erdrich
- Womens Health
The menstrual cycle is more than just a monthly occurrence—it’s a key indicator of overall health in a woman.
Understanding how the cycle works, what’s normal, and when something might be off can help identify changes in your reproductive health. Each cycle involves a complex interaction of hormones that prepares the body for a potential pregnancy. But periods aren’t just about fertility; they can also highlight conditions like fibroids, endometriosis, or hormonal imbalances. This article will break down the basics of the menstrual cycle, signs to watch for, and what happens during the transition to menopause, when periods come to an end.
Understanding PERIODS: the Basics of the Menstrual CyclE
Understanding your menstrual cycle is key to managing reproductive health, identifying potential issues, and avoiding or planning pregnancy. It involves a complex interplay of hormones that prepare a woman’s body for pregnancy every month. Here’s an overview of how menstruation works, what’s considered ‘normal,’ and how to track it effectively.
What is Menstruation?
Menstruation, or getting your period, occurs approximately once a month. During this time, the uterus sheds its lining, resulting in menstrual bleeding. This happens because the body prepares the lining of the uterus for a potential pregnancy each cycle. If pregnancy doesn’t occur, the lining breaks down and exits the body as menstrual blood. A typical period lasts between 3 and 8 days, and the time between the first day of one period and the first day of the next one can range from 21 to 35 days.
How Does the Menstrual Cycle Work?
The menstrual cycle is regulated by hormones produced by the brain (the pituitary gland and hypothalamus) and the ovaries.
A full cycle involves three main phases:
Follicular Phase (Days 1-14)
Day 1 is the start of menstrual bleeding. During this phase, the pituitary gland releases follicle-stimulating hormone (FSH), stimulating the growth of follicles in the ovaries. One follicle becomes dominant and produces oestrogen, which thickens the uterine lining with nutrient-rich blood.
Ovulation (Around Day 14)
A surge in luteinising hormone (LH) and FSH causes the dominant follicle to release the now-mature egg. The egg travels down the fallopian tube, where fertilisation can occur if it is met by sperm.
Luteal Phase (Days 14-28)
After ovulation, the now-empty follicle that released the egg shrinks and becomes the corpus luteum, producing progesterone to maintain the uterine lining. If fertilisation of the egg doesn’t occur, the corpus luteum breaks down, progesterone levels drop rapidly and menstruation begins.
Period Cramps or Pain
Having light cramping in the lower belly, thighs, or in your lower back for a day or two every month, just before or as the bleeding starts can be common. But it’s important to know that pain requiring strong (some would argue “any”) medication or interfering with your daily activities is NOT normal.
In such cases, investigation for underlying causes such as endometriosis, uterine polyps and so on are important.
Heavy Period Flow and Feeling Tired
When your period is heavy, you are losing blood and iron-containing blood cells. Prolonged heavy periods, or a heavy period every month, or even a moderately heavy period that comes more than once a month, can lead to iron-deficiency and anaemia. These are 2 different things – what’s important to know is that iron deficiency is very common in menstruating women, and if left untreated, it will lead to anaemia.
Period pain that interferes with your daily activities is NOT normal.
What is Normal Bleeding?
A normal menstrual period varies for each woman but typically includes the following features:
- Lasts between 3 and 8 days.
- Occurs every 21 to 35 days.
- The total blood loss averages about 2-3 tablespoons (30 – 45mL).
WHAT IS A “HEAVY” PERIOD?
“Heavy” means:
- changing your tampon or pad every hour or so
- bleeding that lasts longer than 7 days
- passing large blood clots.
This can happen due to the presence of fibroids (benign growth in the uterus), and some types of intrauterine contraceptive devices (IUD or IUCD). There are also some blood disorders or blood thinning medications (even aspirin) that can cause excessive menstrual bleeding. Also, being anaemic or having very very low iron can also cause periods to be heavier.
If you are breathless (you might think you’re just a bit “unfit”), feeling weak and fatigued, look pale, or have a rapid heartbeat, get in touch with your healthcare professional. A blood test check your iron, ferritin (stored iron), red cells, level of haemoglobin as well as your B12 and folate levels can help to understand the reason for your symptoms.
Bleeding Between Periods is not normal
Growths in and around your uterus (such as endometriosis, fibroids, or polyps), problems with your hormones or the type of birth control pill you’re using, and infections can be responsible for blood showing between your periods. The causes are endless so please do not IGNORE this symptom.
Rectal pain around your period
Does it hurt when you use the bathroom (to pee or pass a poop), or do you have diarrhoea or constipation, while you’re on your period? These may be things that indicate irritable bowel syndrome or even endometriosis.
How to Track Your Menstrual Cycle
Tracking your cycle helps you recognise patterns, identify fertile windows, and spot irregularities. You can use a simple calendar, a menstrual diary, or a period tracking app. Basic cycle tracking involves recording start and end dates of your period, the flow, and any symptoms like cramping, mood changes, or bloating.
There are three primary methods to monitor your cycle more closely:
Cervical Mucous Testing
Cervical mucous changes throughout your cycle, becoming clear, stretchy, and egg-white-like when you’re most fertile. To check, observe your mucous before and after urination or use a clean finger. Note the consistency and record your observations.Basal Body Temperature (BBT) Tracking
BBT is your lowest body temperature at rest. This increases slightly after ovulation due to hormonal changes. Using a thermometer, record your temperature each morning before any activity, and before getting out of bed. A rise of about 0.5°C indicates ovulation. If your temperature doesn’t change over the course of your cycle, and your periods are irregular, it is possible that you may not be ovulating. You may want to do at DUTCH hormone test to understand what your hormonal rhythm is doing.Ovulation Prediction Kits
These kits measure luteinising hormone (LH) in your urine. LH surges 24-48 hours before ovulation, making these kits a useful way to pinpoint your most fertile days if you wish to become pregnant. This is not a useful method for predicting “best sex avoidance days” if you do not wish to use other methods of contraception.
Missed period
The most common cause of a missed period is pregnancy. However, stress, a hormone imbalance, being underweight, excessive exercising and some medications, birth control can also stop periods.
If you’ve skipped 3 periods in a row – that is, you have had 3 months of no periods, first do a home pregnancy test (from the pharmacy). Whether that test is positive OR negative, you will need to see your health professional.
If you are not pregnant, other symptoms you have can help figure out what’s going on. For example, extra hair growth, acne, and trouble controlling your weight, too, suggest polycystic ovary syndrome (PCOS). Primary Ovarian insufficiency (POI) can occur where your periods stop. Also it’s not unusual for periods to be irregular when you’re perimenopausal, which is when you enter the time of “change” that comes before periods stop altogether.
What Is PeriMenopause and Menopause?
PERIMENOPAUSE is a transition period leading up to menopause when oestrogen production starts to decline. It can last several years and typically begins when a woman is in her 40s, but can start earlier.
During perimenopause, periods may become irregular, and women may experience symptoms like hot flashes, mood swings, sleep problems, and changes in menstrual flow. It ends when a woman has gone 12 months without a period, which marks the start of menopause.
MENOPAUSE is when a woman’s menstrual periods permanently stop, marking the end of her reproductive years. It usually happens between ages 45 and 55.
Once 12 months has passed without a period, she’s considered to have gone through the menopause.
Bleeding After MenopauSe
If you have had 1 year without a period and then get a vaginal bleed – even if it’s small amount or a brown discharge – that is not normal and should not be ignored.
There could be a number of reasons such as a Uterine polyps, cervical ectropion or the endometrial lining thickening. However, a transvaginal +/- abdominal ultrasound should be done to find the underlying cause.
In Summary
The menstrual cycle is a normal part of the life of women. It should not be distressing, painful or associated with other problems. If it is, then working with a caring professional can help map out a plan for examining your hormonal rhythms and/or working with diet, nutritional or herbal supplementation to support you – no matter where in the reproductive cycle you are.
With proper support, you can live life to the fullest!
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References
References:
Menstrual Cycle, by
Physiology, Female Reproduction, by Julie Rosner, Tijana Samardzic, and Manbeer S. Sarao. StatPearls
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