Menstruation: Living with Your Menstrual Cycle

What is menstruation?

Menstruation is a woman's monthly bleeding. It is also called menses, menstrual period, or period. When you have a period, you are menstruating. The menstrual blood is actually partly blood and partly tissue. It comes from the inside of the uterus (womb). It flows from the uterus through the small opening at the lower part of the uterus called the cervix. The blood passes out of the body through the vagina. Sanitary pads or tampons, which are made of cotton or another absorbent material, are worn to absorb the blood flow. Most menstrual periods last from 3 to 5 days.

What is the menstrual cycle?

Menstruation is part of the menstrual cycle, which helps your body prepare for the possibility of pregnancy each month. A cycle starts on the first day of a period. The average menstrual cycle is 28 days long. However, a normal cycle can be shorter or longer than this. It may be anywhere from 21 days to 35 days.

The rise and fall of body chemicals called hormones make the menstrual cycle happen. The ovaries make 2 important female hormones: estrogen and progesterone. Other hormones involved in the menstrual cycle include follicle-stimulating hormone (FSH) and luteinizing hormone (LH), made by the pituitary gland in the brain.

In the first half of the menstrual cycle, levels of estrogen rise and make the lining of the uterus grow and thicken. In response to follicle-stimulating hormone, an egg (ovum) in one of the ovaries starts to mature. At about day 14 of a typical 28-day cycle, in response to a surge of luteinizing hormone, the egg leaves the ovary. This is called ovulation.

After ovulation, the egg begins to travel through the fallopian tube to the uterus. Progesterone levels rise and help prepare the uterine lining for pregnancy. If the egg becomes fertilized by a sperm cell and attaches itself to the uterine wall, you become pregnant. If the egg is not fertilized, it either dissolves or is absorbed into the body. Estrogen and progesterone levels drop, and the thickened lining of the uterus is shed during the menstrual period at the end of the cycle.

What is a typical menstrual period like?

Your period may not be the same every month, and it may not be the same as other women's periods. Periods can be light, moderate, or heavy. The length of the period can also vary. Most menstrual periods last from 3 to 5 days, but anywhere from 2 to 7 days is considered normal. The amount of blood lost is usually only about 2 to 5 tablespoons over the entire period.

Most women can tell their period is coming because they experience some breast tenderness and pelvic discomfort. These symptoms can occur before, during, or after your period. Sudden mood changes are not unusual. Bloating, tiredness, and headaches may occur.

For the first few years after a girl starts getting periods, periods may be very irregular. They may happen anywhere from once a month to 3 times a year. They may also become irregular in women approaching menopause during middle age.

How long does a woman have periods?

Except when they are pregnant, women usually keep having periods until menopause. Average age of menopause is 51. Menopause means that you are no longer ovulating (releasing eggs) and therefore can no longer become pregnant. Like menstruation, menopause can vary from woman to woman and may take several years to occur. Some women have early menopause (before 35 years of age) because of surgery or other treatment, illness, or other reasons.

What kinds of problems do women have with their periods?

Women can have various kinds of problems with their periods, including pain, heavy bleeding, and skipped periods.

• Dysmenorrhea is the medical term for painful periods, including severe menstrual cramps. A hormone called prostaglandin is responsible for the symptoms. Some nonprescription pain medicines, such as ibuprofen, can help with these symptoms. Sometimes a disease or condition, such as uterine fibroids or endometriosis, causes the pain. The treatment depends on what is causing the problem and how bad it is.
• Abnormal menstrual bleeding includes very heavy bleeding or unusually long periods (called menorrhagia), bleeding between periods (metrorrhagia), and periods that are too close together. In adolescents and women approaching menopause, hormone problems often cause abnormal menstrual bleeding. Sometimes this is called abnormal uterine bleeding (AUB). Other causes of abnormal bleeding include uterine fibroids and polyps. Treatment for abnormal bleeding depends on the cause.
• Amenorrhea is the term used to describe the absence of a period in young women who haven't started menstruating by age 16, or the absence of a period in women who used to have regular periods. Causes of amenorrhea include pregnancy, breast-feeding, and extreme weight loss caused by serious illness, eating disorders, vigorous exercise, or stress. Hormonal problems (involving the pituitary, thyroid, or adrenal glands or the ovaries) or problems with the reproductive organs can cause amenorrhea.

How often should I change my pad or tampon?

Sanitary napkins (pads) should be changed as often as necessary, before the pad is soaked with menstrual flow. Each woman decides for herself what is comfortable.

Tampons should be changed often (at least every 4 to 8 hours). Make sure that you use the lowest absorbency of tampon needed for your flow. For example, do not use super absorbency on the lightest day of your period. This can put you at risk for toxic shock syndrome (TSS). TSS is a rare but potentially deadly disease. Using any kind of tampon puts a woman at greater risk for TSS than using menstrual pads. The risk of TSS can be lessened or avoided by not using tampons, or by switching between tampons and pads during your period.

When should I call my healthcare provider about my period?

Call your healthcare provider if:

• You have not started menstruating by the age of 16.
• You are bleeding for more days than usual.
• You have very heavy bleeding.
• You start having blood clots that are the size of a nickel or larger.
• You suddenly feel sick after using tampons.
• You bleed between periods (more than just a few drops).
• You have severe pain during your period.
• You have suddenly stopped having periods.

To learn more about menstruation, contact:

The National Women's Health Information Center (NWHIC) Phone: 800-994-9662 Web site: http://www.4woman.gov.

Developed by RelayHealth, and adapted from material written by the Office on Women's Health in the US Department of Health and Human Services.
Published by RelayHealth.
© 2009 RelayHealth and/or its affiliates. All Rights Reserved.