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Menstruation

GENERAL INFORMATION:

What is menstruation?

• Menstruation (men-stroo-A-shun), also called menstrual or monthly period, is a natural process affecting the female reproductive system. The female reproductive system includes the ovaries, fallopian tubes, uterus (womb), endometrium (lining of the womb), and vagina. These structures are located in the lower abdomen (stomach). During the menstrual cycle, hormones (special chemicals) are released from different parts of the body. These hormones include estrogen and progesterone that help prepare and control the body for pregnancy. As the levels of estrogen and progesterone increase, the endometrium becomes thicker. A thickened endometrium is needed to support the growth of the baby when a woman gets pregnant.
  
  
• At the middle of the menstrual cycle, other hormones start to cause ovulation. Ovulation is when the ovaries release an egg each month. Before pregnancy can happen, the egg must get fertilized by a sperm from a recent sexual act, and attach itself to the endometrium. With menstruation, the egg released by the ovaries is not fertilized and pregnancy does not occur. The egg begins to fall apart, and the estrogen and progesterone levels drop. The thickened endometrium, together with blood and mucus, breaks down and sheds (falls off). This bleeding makes up the menstrual flow, also known as a period or menses, that passes through the vagina.

When does menstruation begin and stop?

• The female reproductive system usually begins working between 12 and 16 years of age. Sometimes, it may begin working earlier or later as every woman's menstrual clock is different. Some girls may have their first period at nine years of age while others begin at 16 years of age or older. Most women usually start having a monthly period at about 12 years. The first menstruation is known as menarche. Menarche is a sign that you are starting to become a woman and may be able to have a baby.
  
  
• Breast development, particularly breast budding, is usually the first sign that a girl has entered puberty. This is often followed by the growth of some pubic hair. About a year after breast budding begins, most girls enter into a phase of rapid growth. They may get taller and their bodies develop some curves. The first period arrives about a year after the growth spurt begins and about three years after breast budding starts. Menstruation stops when a woman has her menopause. Menopause, also called change of life, is the time in a woman's life when monthly periods stop. This usually occurs when a woman reaches 50 years of age or older.

How long does a monthly period last and how much blood is lost? Every woman's monthly cycle is different. A menstrual cycle may be as short as 21 days or as long as 45 days. Your own monthly cycle may also sometimes change. Your menstruation may be irregular for 2 to 3 years after your first monthly period begins. Each period may last for 2 to 7 days and can be light, moderate, or heavy. The total amount of blood loss may be 1 to 4 tablespoons (20 to 60 milliliters) for the whole menstrual period. This amount may vary in different women and from period to period in the same woman.

What may cause irregular or absent menstruation? Pregnant women do not have monthly periods. A full-time breast-feeding mother may not have a period until she stops breast-feeding. The following conditions may also cause an absent or irregular menstruation:

• Congenital abnormalities: Some women are born with defects in their vagina which may prevent menstruation. A hymen (thin covering of the vagina) may also not have an opening and block the menstrual flow.
  
  
• Ovulation disorders: Changes in the hormones that affect ovulation may be caused by the following:
  
  
  • Endocrine conditions: These cause problems in the release of hormones into the bloodstream. These conditions may include poorly-controlled diabetes mellitus, Cushing's syndrome, or thyroid disorders.
    
    
  • Polycystic ovarian syndrome: This is also called PCOS. This is a condition where the ovaries produce higher levels of male hormones than female hormones.
  
  
• Tumors: Tumors of the adrenals, pituitary gland, or ovaries may cause problems with your monthly periods and ovulation.
  
  
• Other causes:
  
  
  • Eating disorders and weight problems, such as being overweight or losing too much weight.
    
    
  • Exercising or working out too much.
    
    
  • Previous surgeries done on the abdomen or pelvis, such as surgery to remove the uterus.
    
    
  • Stress or being emotionally upset.

What are the possible signs of a menstrual problem? The following are possible signs of having problems with menstruation:

• Delayed first period: The following may be a sign of delayed menarche when menstrual periods have:
  
  
  • Not started within three years after having breast budding.
    
    
  • Not started by age 13 years and absent breast budding and other physical changes.
    
    
  • Not started by age 14 years and have any of the following:
    
    
    • Abnormal vagina or imperforated hymen.
      
      
    • History of too much exercise or eating disorders.
      
      
    • Excess hair growth on the chin, face, upper lip, sideburns, chest, around the nipples, or lower abdomen.
    
    
  • Not started by 15 or 16 years of age.
  
  
• Irregular periods: Menstruation may be considered irregular when:
  
  
  • Changing sanitary napkins or tampons occurs more than once every 1 to 2 hours.
    
    
  • Episodes used to be regular, occurring every month, then become markedly irregular.
    
    
  • Happens more frequently than every 21 days or less frequently than 45 days.
    
    
  • Lasts for more than seven days.
  
  
• Painful periods: These are also called dysmenorrhea. They are severe (very bad) abdominal cramps during menstruation. These may interfere with daily activities, such as work or going to school.

What other conditions may be related with menstruation? The following are possible conditions which may happen before, during, or after menstruation:

• Premenstrual syndrome: This is more commonly known as PMS. PMS is a group of physical, emotional, and mental changes that some women have before their monthly periods. These include headache, dizziness, bloating (feeling full), and nausea (upset stomach) before your period. Breast swelling or soreness, fatigue (getting tired more easily), or problems sleeping are other PMS symptoms. Some women may have mood changes, such as feeling grumpy, sad, or wanting to cry. These symptoms usually go away when the monthly period starts. Ask your caregiver for more information on PMS and how symptoms can be controlled.
  
  
• Toxic shock syndrome: This rare disease, also called TSS, has been related to using tampons. Tampons are small tubes of cotton that absorb (soak up) blood. These are placed inside the vagina to collect blood during a monthly period. TSS may be caused by leaving a tampon in for a long time. Another cause may be an allergic reaction to the dyes or chlorine in the cotton or rayon tampon fibers.

How can I take care of myself while having menstruation? You may do any of the following while having a period:

• A calendar or diary may be helpful to keep track of your monthly periods and PMS symptoms. This record should include when your periods start and stop. You may also include your PMS symptoms, such as changing moods, behavior, and physical changes.
  
  
• Use tampons or sanitary napkins. Sanitary napkins or pads are worn on the inside of your panties to collect the blood. Read the instructions carefully or ask caregivers on how to use them.
  
  
  • Always wash your hands before putting in a new tampon to prevent infection. Wash your hands after changing the pads or tampons.
    
    
  • Change your pad or tampon about every 3 to 4 hours. Changing often keeps the blood from soaking through your clothes.
    
    
  • Wrap toilet paper around the pad or tampon and throw it in the trash. Do not flush the pad or tampon down the toilet. It can block up sewer lines and cause problems.
  
  
• Rest, exercise, and eating a balanced diet may help. These are some ways to help control symptoms of PMS. Your caregiver may also suggest other treatment options for managing your PMS.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

References and sources