Menstruation
Menstruation is also known as having a period. It’s when there is bleeding from the vagina about once a month. The average age when menstruation begins (also known as menarche) is 12-13 years. However, it can also occur as early as nine and as late as 16. Menstruation ends with menopause (when a woman has her final period). This is usually anywhere between 45 and 55 years of age.
The time between periods is known as the menstrual cycle. On average, menstruation usually happens every 28 days. However, a menstrual cycle can be as short as 21 days or as long as 35 days. Bleeding can last between two and seven days.
Periods can be light or heavy, and this can vary between cycles. Blood may be bright red to dark brown and there may also be some small clots.
What is the menstrual cycle?
The menstrual cycle is a natural and recurring cycle that prepares a woman’s body for pregnancy. It involves a complex relationship between hormones from the brain and the ovaries. There are three main phases of a menstrual cycle:
Follicular — This phase starts on the first day of your period and lasts for 13-14 days. It ends with ovulation. During this phase, the pituitary gland in the brain releases a hormone that stimulates the surface of the ovary to produce follicles. One of these will mature into an egg. During the follicular phase, the lining of the uterus thickens.
Ovulation — When one of the ovaries releases a mature egg it’s called ovulation. This usually happens once a month in the middle of your cycle (about two weeks before your period is due). If sperm reaches the egg during this time, you may become pregnant.
Luteal phase — After ovulation, cells in the ovary (called the corpus luteum) release the hormones progesterone and oestrogen. This causes the lining of the uterus to thicken even more to prepare for pregnancy. If a fertilised egg implants in this lining, the corpus luteum keeps producing progesterone, which maintains the thick lining of the uterus so pregnancy can continue. If pregnancy doesn’t happen, the corpus luteum dies and progesterone levels drop. As a result, the uterus sheds its lining, which is known as menstruation. Then the cycle begins again.
Period symptoms
Everyone experiences periods differently, and periods can vary from one cycle to another. Symptoms that occur in the lead up to a period are called premenstrual syndrome (PMS). Up to 30% of women experience PMS, which may include emotional and physical symptoms.
Emotional symptoms may include:
irritability or mood swings
anxiety or nervous tension
difficulty concentrating or coping
depression or sadness
aggression.
Physical symptoms may include:
fluid retention or bloating
weight increase
swollen breasts
acne
tiredness or insomnia
changes in bowel habits such as constipation or diarrhoea
food cravings
headaches or migraine
general aches and pains.
Some women may experience these symptoms leading up to, and during menstruation.
How to manage a period
There are several ways you can absorb blood from your period. These include:
sanitary pads
tampons
period underwear
menstrual cups
It’s important to use a product you feel comfortable with and that suits your lifestyle. You may also wish to use a combination of the above.
Pads and tampons need to be changed regularly (preferably every three to four hours). Menstrual cups should be changed every eight to 12 hours.
How to manage PMS
There are many ways you can manage and reduce your period symptoms. These include lifestyle changes, complementary and home remedies, and medication and hormonal treatments.
Lifestyle changes
Lifestyle changes you can make that may reduce symptoms include:
being physically active on most, if not all days
reducing stress
eating regular, healthy meals that include protein, fruits, vegetables and whole grains
limiting caffeine and salty foods
drinking plenty of water
quitting smoking.
Complementary and home remedies
Scientific evidence is not strong but there is some evidence that some supplements can help manage PMS. These include:
vitamin B6
magnesium
calcium
evening primrose
Talk to your doctor or pharmacist before taking any supplement as they may have side effects or interact with other medications.
Other therapies that may help manage PMS include acupuncture, naturopathy and relaxation techniques. Home remedies can involve taking over-the-counter (OTC) pain relief. There are different types of pain-relieving medications which include:
anti-inflammatories such as ibuprofen, naproxen or diclofenac – these work by preventing your body from producing prostaglandins. They are best taken as soon as pain starts or 48 hours before you expect to get your period
paracetamol — can be helpful for mild cramps.
Your pharmacist can provide advice on the right pain relief for you.
Medication or hormone treatment
Sometimes the above measures may not be enough and other medication or hormonal treatments may be required. Speak to your doctor if you have trouble managing your symptoms.
Common menstrual problems
It’s not unusual to experience problems with menstruation. Some of the more common issues include8:
amenorrhoea — the absence of menstruation that is not due to pregnancy, lactation or menopause
premenstrual dysphoric disorder (PMDD) — a severe form of PMS that causes psychological distress and interferes with your daily life
dysmenorrhoea — painful periods
menorrhagia — heavy periods.
These conditions can all be treated and managed so if you are worried, speak to your doctor.
Using a period tracking app or a period diary can also help you notice patterns or any unusual changes.
When should you see your doctor?
While menstruation is a normal part of life, sometimes periods aren’t normal. If you’re worried about your period, you should speak to your doctor. You should also visit your doctor if:
the pattern of your periods change
your periods are very heavy and you need to change your pad or tampon more often than every two hours
bleeding lasts more than eight days
your menstrual cycle is less than 21 days
periods are sporadic (more than two or three months apart)
painful periods affect your daily life
you bleed between periods or after sex
you bleed after menopause.
You should also visit your doctor if you are 16 years or older and haven’t begun to menstruate.
Your local MediADVICE pharmacist is available to help you manage your health. We can provide advice on the right period protection products for you and your family. We can also recommend other products and medications that may help relieve premenstrual symptoms, and refer you to a doctor if necessary.
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General advice only – this information should not replace the information provided to you by your health care professional. If symptoms are severe or persist, please speak to your health care professional. Information current as of date of publishing.