Menstrual cycle

What is the menstrual cycle?

The menstrual cycle is the process of your ovaries releasing an egg every month. ``

These cycles represent the monthly changes that a woman’s body goes through to prepare for a possible pregnancy.

What happens during a menstrual cycle?

Before understanding the menstrual cycle,you must know about a woman’s reproductive organs. These are:

• 2 ovaries- this is where are the eggs are:
  • Stored
  • Developed
  • Released
• Uterus (the womb) – this is where a baby grows after a fertilized egg implants.
• The fallopian tubes – these are the tubes that connect the ovaries to the uterus. These are two in number.
• Cervix- this is the entrance to the womb from the vagina.
• Vagina

Hormones control the menstrual cycle

In each cycle:

• The levels of the hormone estrogen rise
• The rise in the hormone levels induces the ovary to develop an egg and then release it –called ovulation.
• The lining inside the womb also thickens.

Second half of the cycle:

• In this cycle, the embryo is implanted and developed.
• Hormone progesterone helps the uterus in this process.
• Hormonal changes are essential for preparing the uterus for pregnancy.
• The egg travels through the fallopian tubes.
• In case ovulation happens but the egg is not fertilized (pregnancy doesn’t occur), the egg is reabsorbed back into the body, and;
• Hormone levels (both estrogen and progesterone) fall back to normal levels
• The uterus lining sheds through the vagina- this is called a period or the menstrual flow.

The time gap between the release of an egg and the start of the period is about 10 to 16 days.

What are the periods?

A period consists of blood and the lining in the womb (uterus). The first day of your period marks the first day of your menstrual cycle.

Even though variations are possible, generally:

• the average duration of menstrual flow is four to six days
• the average normal amount of menstrual blood is 30 mL (“about 3 to 5 tablespoon”) and an amount greater than 80 mL is considered abnormal

What happens during ovulation?

When an egg is released from the ovaries, it is called ovulation.

• While being born, a woman has all her eggs.
• After the periods start, 1 egg is released per menstrual cycle. After ovulation, an egg lives for 24 hours.
• Pregnancy happens when a man’s sperm meets and fertilizes the egg.
• The life of sperm in fallopian tubes is for 7 days after sex.

Exception: In some cases, more than one egg is released during ovulation. Multiple pregnancies happen when more than one 1 egg is fertilized.

If ovulation doesn’t occur, a woman can’t get pregnant. Hormonal contraception works by stopping ovulation; these include:

• Combined pill
• Contraceptive patch
• Contraceptive injection

When are you most fertile?

The exact time of ovulation is difficult to mark. However, in most women, ovulation happens about 10 to 16 days before the next period.

However, in cases of women who have experienced irregular lengths of cycles, an exact time frame is difficult to pinpoint.

Normal vaginal secretions

There are changes in vaginal secretions during the menstrual cycle. During ovulation, these secretions, also referred to as vaginal discharge becomes thinner and stretchy, with a raw egg white like appearance.

What’s normal?

• Duration of the menstrual cycle:
  • Counted from the first of one period to the first day of the next.
  • It may vary from woman to woman.
  • Long cycles are typical for the first few years after menstruation begins.
  • Cycles tend to shorten and may become more regular with age.
• Duration of Menstrual flow: Occurs every 21 to 35 days. It lasts for two to 7 days.
• Your menstrual cycle may be of the same length each month or they may be irregular.
• Your periods can be normal even if they are:
  • Light or heavy
  • Painful or pain-free
  • Long or short

Generally, when it comes to the menstrual cycle, normalcy is what’s normal for you and your body.

What could alter a regular menstrual cycle?

• Contraception: certain types of contraception can bring changes to your menstrual cycle. Such contraception includes:
  • Extended cycle birth control pills
  • Intrauterine devices (IUDs)

Discuss with your doctor about the possible effects of different types of contraception on your menstrual cycle

• Menopause: When a woman approaches her menopause, her cycle may become irregular again.

How can I track my menstrual cycle?

You need to discover what is normal for your body. To do this, start by keeping track of your menstrual cycle on a calendar. The first step would be to track your start date every month for a few months in a row – this will help in knowing about the regularity of your periods.

If you notice something concerning while keeping a track, try answering and making a note of the following things every month:

• End date:
  • What is the length of your period- the duration?
  • Is it longer or shorter than usual?
• Flow:
  • Is the flow heavier or lighter than usual?
  • How regularly do you need to change your sanitary protection
  • Have there been any blood clots?
• Abnormal bleeding:
  • Have you noticed bleeding between periods?
• Pain:
  • Do you experience any pain during your period?
  • Is the pain worse than usual?
• Other changes

What are the causes of irregularities in the menstrual cycle?

Some of the factors that lead to irregularities in the menstrual cycle include:

• Pregnancy or breastfeeding:
  • Missing a period is an early sign of pregnancy.
  • Typically, breastfeeding can delay the return of menstruation after pregnancy.
• Polycystic Ovary Syndrome (PCOS):
  • This disorder is commonly observed in the endocrine system.
  • PCOS may cause:
    • Irregular periods
    • Enlarged ovaries
  • Eating disorder such as anorexia nervosa
  • Extreme weight lossor being underweight
  • Intense physical activity: a problematic factor, especially among athletes, dancers and gymnasts.
  • Pelvic inflammatory disease (PID): An infection of the reproductive organs and can lead to irregular menstrual bleeding
  • Premature ovarian failure:
    • In this condition, women lose normal ovarian function before the age of 40.
    • Also known as primary ovarian insufficiency, it might lead to irregular or occasional periods for years.
  • Uterine fibroids: These are non-cancerous growths of the uterus. They can lead to
    • heavy menstrual periods
    • Prolonged menstrual periods.
  • Hormonal imbalance
  • Extreme stress
  • Any problem with ovaries, womb or vagina

How can I prevent irregularities in my menstrual cycle?

While there is “no one solution works for all” when it comes to preventing irregularities, for some women the following may work:

• Use of birth control pills
• Treatment of any underlying problems like eating disorder

However, some menstrual irregularities cannot be avoided.

Delayed periods

Generally, periods start between the ages of 10 to 16. A majority of girls get their first period when they are around 12 years of age.

However, everyone’s development rates are different. Hence there is no right or wrong age to have the first period.

You will get your first period when your body is ready – this is generally 2 years after the early signs of puberty.

Note: First signs of puberty among girls:

• Development of breasts
• Pubic hair starts to grow

How long after you miss your first period should you worry?

In case you haven’t started your periods by the age of 16 you should see your doctor. Your healthcare provider will assess if you are going through the normal stages of puberty.

In some of the cases, your doctors do advise to wait for some time. This is because the periods might naturally start by the time a person is 18. However, in some other cases, you may be referred to a specialist who will try to analyze the cause and suggest possible treatments.

What are the treatments for periods that have not started?

The possible treatment depends on the underlying problem. Some of the issues that lead to delayed periods and the corresponding procedures that could solve the problem are:

How to handle period problems?

If problems associated with your periods are affecting your life, you don’t have to worry as there are solutions and help available. However, before you see your doctor, it is better to track and note down your symptoms during your menstrual cycle. This will make it easier for your healthcare to pinpoint the problem and the concomitant solution:

• Painful periods: Pain is commonly associated with periods. However, you should see your doctor if the pain is so severe that it affects your daily life.
  • Cause: Contraction in the uterus (womb) to push out the blood
  • Solution:
    • Exercise
    • Over-the-counter painkillers like ibuprofen and aspirin.

Note:Paracetamol could be taken to reduce pain. However, studies have shown it is not as effective as ibuprofen and aspirin

• Hormonal contraception, like the contraceptive pill, intrauterine system (IUS), contraceptive patch, contraceptive injection

• Avoid: ibuprofen or aspirin if you have asthma, kidney, stomach or liver problems. Anyone under the age of 16  should avoid aspirin

• Heavy periods: Some women naturally experience heavy periods; however, if your periods are so heavy that it is affecting your normal life, you should consult your doctor. Based on information such as how much you are bleeding and how often you need to replace your sanitary protection, your doctor may try to find the cause of heavy bleeding. Your healthcare provider may also conduct a few blood tests or scans.
  • Treatments(depending on the cause):
    • Hormonal contraception like intrauterine system (IUS) or the contraceptive pill
    • Tranexamic acid tablets
    • Progestogen tablets
    • Anti-inflammatory painkillers like ibuprofen or mefenamic acid
    • Surgery
  • Irregular periods: Generally, periods last for about 2 to 7 days, with the average period being 5 days. The length of the menstrual cycle may vary in different people; however, the average length is 28 days. A cycle of length anywhere between 21 to 40 days is considered normal.

If you notice a wide variation in the following you may be experiencing irregular periods:

• The Time between your periods (arriving too early or too late)
• Amount of blood lost (Heavy or light periods)
• Number of days the period lasts

Irregular periods are frequent during puberty and just before menopause. A change in your method of contraception may also disturb your menstrual cycle.

• Stopped or missed periods: Some of the common factors because of which you may have missed your periods include
  • Pregnancy
  • Stress
  • Reaching menopause
  • Sudden weight loss
  • Being overweight
  • Intense exercise

If your periods have stopped, you should see your doctor.

• Premenstrual syndrome (PMS): this is believed to be caused by a change in hormonal levels throughout the menstrual cycle. Only some women get PMS and in them, the range and severity of symptoms vary. Some of these symptoms might include:
  • Mood swings
  • Bloating
  • Depression or irritability
  • Headaches
  • Fatigue
  • Breast tenderness

Typically, symptoms start 2 weeks before the period and disappear after the period begins.

• Endometriosis: this is a condition in which the tissue like the one that lines the uterus (endometrium) grows outside the womb.

Symptoms do not always accompany endometriosis, however, it can cause:

• Pelvic pain
• Fatigue
• Bleeding
• Pain while going to the toilet
• Pain during or after sex
• Irregular periods

• Ovulation pain: During ovulation, some women experience one-sided pain in the lower abdomen.
  • Nature and severity of the pain: vary from being a dull cramp to sharp and sudden pain.
  • Duration:just a few minutes or may last for 1 or 2 days
  • Treatment: you can get relief by simple remedies, like:
    • soaking in a hot bath
    • over the counter painkillers like paracetamol

You may also notice a little vaginal bleeding during ovulation pain.

Reference:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5098399/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2913133/
3. https://www.nhs.uk/conditions/periods/fertility-in-the-menstrual-cycle/
4. https://www.tommys.org/pregnancy-information/planning-pregnancy/how-get-pregnant/ovulation-and-fertility#:~:text=It%20doesn't%20matter%20how,you%20find%20your%20fertility%20window.
5. https://www.thewomens.org.au/health-information/fertility-information/getting-pregnant/ovulation-and-conception
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132001/
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3285482/

By -
Dr. Ruchika Singh

14-April-2023