Menstrual Cycle: All You Need to Know

Understanding your menstrual cycle is crucial for managing your reproductive health and overall well-being. Knowing your menstrual dates not only helps in predicting ovulation and managing your cycle but also plays a crucial role in identifying any irregularities or changes that might indicate underlying health issues. In this article, we'll delve into the intricacies of the menstrual cycle, exploring its phases, common symptoms, and the significance of tracking your cycle. Whether you're looking to better manage your health, plan for pregnancy, or simply understand your body better, this comprehensive guide will provide you with all the essential information you need.

What is Menstruation?

Menstruation is the monthly shedding of the uterine lining that occurs when a woman is not pregnant. This process is part of the menstrual cycle, which prepares the body for a potential pregnancy each month. Menstruation typically lasts between 3 to 7 days and involves the flow of blood and tissue from the uterus through the vagina. It usually begins during puberty, around the ages of 11 to 14, and continues until menopause, which typically occurs between ages 45 and 55.

What is a Menstrual Cycle?

The menstrual cycle is the monthly hormonal process a woman's body goes through to prepare for a potential pregnancy. It starts on the first day of your period (menstruation) and ends on the first day of your next period. The cycle is typically about 28 days long, but it can vary from 24 to 38 days. It's normal for the cycle length to vary slightly from month to month, especially in younger women or those approaching menopause.

What are the Four Phases of the Menstrual Cycle?

The four phases of the menstrual cycle are:

• Menstrual Phase: This is the first phase, starting on the first day of your period. During this phase, the uterine lining is shed and exits the body through the vagina. This phase typically lasts 3 to 7 days.
• Follicular Phase: Overlapping with the menstrual phase, the follicular phase begins on the first day of your period and continues until ovulation. In this phase, the pituitary gland releases a hormone called follicle-stimulating hormone (FSH), which stimulates the ovaries to produce several follicles. Each follicle contains an egg, but usually only one follicle will mature into an egg that is released during ovulation. The uterine lining also begins to thicken in preparation for a potential pregnancy.
• Ovulation: Ovulation usually occurs around the midpoint of the cycle, typically around day 14 in a 28-day cycle. During ovulation, the mature egg is released from the ovary and travels down the fallopian tube, where it may be fertilised by sperm.
• Luteal Phase: After ovulation, the luteal phase begins and lasts until the start of the next menstrual period. During this phase, the empty follicle transforms into the corpus luteum, which secretes progesterone to maintain the thickened uterine lining. If the egg is not fertilised, the corpus luteum breaks down, leading to a drop in hormone levels and the start of menstruation. The egg remains alive for 24 hours only.

Each phase plays a crucial role in the menstrual cycle and is essential for reproductive health.

At What Age Does Menstruation Typically Begin?

Menstruation typically begins during puberty, usually between the ages of 11 and 14. However, it can start as early as 8 or as late as 16, depending on individual factors like genetics, overall health, and environmental influences. The onset of menstruation, known as menarche, marks the beginning of a girl's reproductive years.

What are the Symptoms Just Before Getting Your Period?

Symptoms just before getting your period often referred to as premenstrual symptoms (PMS), can vary but commonly include:

• Cramping: Mild to moderate pain in the lower abdomen or lower back as the uterus contracts.
• Bloating: A feeling of fullness or swelling in the abdomen due to hormonal changes.
• Breast Tenderness: Soreness or swelling in the breasts, which can occur due to hormonal fluctuations.
• Mood Swings: Irritability, anxiety, or mood changes caused by hormonal shifts.
• Fatigue: Feeling unusually tired or low on energy in the days leading up to your period.
• Headaches: Hormonal changes can trigger headaches or migraines in some women. This is called menstrual migraine.
• Acne: Breakouts or skin changes may occur as hormone levels fluctuate.
• Food Cravings or Changes in Appetite: A desire for certain foods, especially sweets or salty snacks, or a change in appetite.

These symptoms typically appear a few days before the period starts and may continue into the first few days of menstruation.

What is Considered an Irregular Period?

An irregular period is one that deviates from your usual menstrual cycle pattern. This can include:

• Variations in Cycle Length: If your menstrual cycle varies significantly each month (e.g., one cycle is 28 days, the next is 40 days), it may be considered irregular.
• Missed Periods: Skipping one or more periods without being pregnant or nearing menopause can indicate irregularity.
• Unusually Long or Short Periods: Periods lasting more than seven days or less than two days may be considered irregular.
• Heavy or Light Flow: A sudden change in the heaviness of your menstrual flow, such as very heavy bleeding (requiring frequent pad or tampon changes) or unusually light periods, can be a sign of irregularity. Normal flow is changing less than 5 pads /day. Passage of clots, and waking up in night to change pads also indicate heavy periods
• Spotting Between Periods: Bleeding or spotting between periods, especially if it’s frequent or heavy, is considered irregular.
• Early or Late Periods: If your period starts much earlier or later than expected, it can also be a sign of an irregular cycle.

If you experience any of these irregularities consistently, it’s a good idea to consult with a healthcare professional, as they can sometimes indicate underlying health issues.

How much Bleeding is Normal During Your Period?

During a typical period, the amount of bleeding can vary, but on average, you should expect to lose about 2 to 3 tablespoons (30 to 45 millilitres) of blood over the course of your period. Here are some general guidelines for what is considered normal:

• Flow: Most women experience a flow that starts light, becomes moderate, and then tapers off. The heaviest bleeding usually occurs in the first two to three days of the period.
• Duration: A period usually lasts between 3 to 7 days. If bleeding lasts significantly longer or shorter, it may be worth discussing with a healthcare provider.
• Pads/Tampons: Typically, changing a pad or tampon every 4 to 6 hours is sufficient. Needing to change your pad or tampon more frequently than every 1 to 2 hours might indicate heavier bleeding.
• Colour and Consistency: Menstrual blood can vary in colour from bright red to dark brown and may include clots. This is usually normal, but if you notice unusually large clots or a significant change in colour, it could be a sign to seek medical advice.

Heavy menstrual bleeding, or excessive blood loss, which can lead to fatigue or interfere with daily activities. It can lead to anaemia and a feeling of excessive tiredness. If you’re concerned about the amount or consistency of your menstrual flow, it’s a good idea to consult a healthcare professional.

How do I Track My Period?

Tracking your period can help you understand your menstrual cycle better and identify any irregularities. Here’s how to effectively track your period:

Use a Calendar or App

• Calendar: Mark the first day of your period on a calendar each month. Note the end date as well to track the duration.
• App: Many period-tracking apps are available that allow you to log your period start and end dates, flow intensity, symptoms, and more. Apps like Clue, Flo, and Period Tracker can provide predictions and reminders.

Record Cycle Length

Track the number of days from the first day of one period to the first day of the next period. This helps you determine the length of your menstrual cycle, which typically ranges from 24 to 38 days.

Monitor Flow and Symptoms

Note the heaviness of your flow (light, moderate, heavy) and any symptoms such as cramps, bloating, or mood changes. Record any irregularities like spotting or missed periods.

Track Ovulation

If you want to track ovulation, consider recording the date of your ovulation or using ovulation predictor kits. Some apps also provide predictions based on your cycle data.

Review Patterns

Regularly review your tracking data to identify any patterns or changes in your cycle. This can help you spot irregularities or changes in your menstrual health.

Tracking your period can provide valuable insights into your reproductive health and help you manage your menstrual cycle more effectively.

When to See Your Doctor?

It’s important to consult your doctor if you experience any of the following issues related to your menstrual cycle:

• Irregular Cycles: If your menstrual cycle is consistently shorter than 21 days or longer than 35 days, or if you notice frequent changes in your cycle length.
• Heavy Bleeding: If you need to change your pad or tampon every hour or less, or if you pass large blood clots, which could indicate HMB or heavy menstrual bleeding or another issue.
• Prolonged Bleeding: If your period lasts more than 7 days or if you experience bleeding between periods.
• Severe Pain: If you have severe menstrual cramps that interfere with your daily activities, or if the pain suddenly worsens. In normal periods pain is worse on first day but if pain is persisting throughout menstrual cycle it is abnormal.
• Missing Periods: If you miss more than one period in a row and are not pregnant or approaching menopause, it may be a sign of hormonal imbalance or another condition.
• Spotting or Unusual Discharge: If you notice spotting between periods or any unusual discharge that has a strong odour or is different in colour or consistency.
• Symptoms Affecting Daily Life: If you experience significant changes in mood, fatigue, or other symptoms that impact your quality of life during your cycle.
• Fertility Concerns: If you have trouble conceiving after trying for a year (or six months if you’re over 35) and suspect it might be related to your menstrual cycle.

Consulting a healthcare professional can help address these issues, identify any underlying conditions, and provide appropriate treatment or management strategies.

How is Abnormal Uterine Bleeding Diagnosed?

To diagnose abnormal uterine bleeding, your doctor will review your medical history and suggest potential causes for the irregular bleeding. Diagnostic tests may include:

• Pregnancy-related issues: Urine or blood tests and ultrasound.
• Hormonal abnormalities (e.g., thyroid or prolactin issues): Blood tests.
• Menopause (especially in women in their 40s or 50s): Blood tests to assess oestrogen levels and ultrasound to examine the uterine lining. An endometrial biopsy or hysteroscopy with directed biopsy may be used if needed.
• Uterine or ovarian abnormalities: A transvaginal ultrasound, which uses a small probe inserted into the vagina to measure the endometrial lining and evaluate ovarian conditions.

How is the Abnormal Menstrual Cycle Treated?

Treatment for an abnormal menstrual cycle depends on the underlying cause, the extent of bleeding, and the woman's reproductive goals. If dysfunctional uterine bleeding is linked to another medical condition, addressing that condition can often restore normal cycles. When the cause is not related to another health issue, treatment focuses on the specific cause of the abnormal bleeding. Options include medication or surgery, depending on whether there are structural abnormalities.

For structural issues such as fibroids, polyps, or scar tissue, surgical procedures like hysteroscopy can often correct the problem and restore normal bleeding patterns. If no structural abnormalities are found, medical therapy can help regulate menstrual cycles. It's important for patients to discuss their symptoms and treatment options with their doctors to determine the most suitable approach based on their individual situation and reproductive goals. Advances in treatment today offer effective solutions for managing abnormal uterine bleeding and improving overall menstrual health.

What are Hysteroscopy and D&C, and How do They Help Treat Abnormal Uterine Bleeding?

Hysteroscopy and dilation and curettage (D&C) are procedures used to diagnose and treat abnormal uterine bleeding.

• Hysteroscopy involves inserting a thin, telescope-like instrument through the cervix into the uterus to visually inspect the uterine cavity. This allows the physician to identify and potentially biopsy or remove specific areas of the endometrium that may be causing abnormal bleeding. It is typically performed as a minor daycare procedure, meaning you can often return to work the next day.
• Dilation and Curettage (D&C) may be performed in conjunction with hysteroscopy or as a separate procedure. A D&C involves scraping the lining of the uterus to remove abnormal tissue. It is often recommended to further assess endometrial tissue or to control persistent or heavy bleeding that hasn't responded to other treatments. While hysteroscopy provides a detailed view of the uterine cavity, D&C can effectively address abnormal bleeding, especially when combined with hysteroscopy for a comprehensive approach.

Both procedures can be crucial in diagnosing and treating the causes of abnormal uterine bleeding, helping to restore normal menstrual function and improve quality of life. Hysteroscopy and D&C is more of a diagnostic procedure and give temporary relief and further treatment is decided according to the cause identified.

Wrap Up

Understanding and tracking your menstrual cycle is vital for maintaining reproductive health and identifying any potential issues early. If you notice any irregularities or have concerns about your menstrual health, Max Hospitals is here to help. Our team of skilled gynaecologists offers expert guidance, personalised care, and advanced diagnostic services to address your needs. Don’t hesitate to take control of your health—schedule a consultation with Max Hospitals today and ensure that your menstrual health is managed with the utmost expertise. Your well-being is our priority, and we are dedicated to supporting you every step of the ways.