Menstrual cycle: Youths need to understand

 What is the need?

Menstruation is not just a girl’s matter. Yes, you read that right. It’s a matter of everybody. 

• It is a normal and healthy part of every girl and woman’s life. 
• It is a part of our wellbeing that is often not discussed and, in some cases, stigmatized also. 
• Misinformation or a lack of information leads to misconceptions and discrimination which hinders girls from treating it as the normal part of their childhood as it should be. 
• It also hinders boys from understanding its importance and normalizing it. Hence, youths need to understand this.

What is the Menstrual cycle?

It is the monthly, regular natural change that occurs in the female reproductive system in preparation for the possibility of pregnancy. 

• Every month, one of the ovaries releases an egg in a process called ovulation. 
• At the same time, hormonal changes also occur which prepare the uterus for pregnancy. 
• After ovulation, if the egg doesn’t fertilize, the lining of the uterus sheds through the vagina which is known as menstruation/ periods.

When does it start & end?

• The first period/ menarche usually starts at 11-15 years of age. 
• In countries like India, it may start at the age of 9 years of age also. 
• Menstruation stops after menopause which usually occurs between 45 and 55 years of age.

What is the normal cycle?

The menstrual cycle can vary from woman to woman. 

• For some, it is normal to have a shorter cycle (e.g. 21 days) and for others a longer cycle (e.g. 35 days). 
• The average for all women in the world is 28 days. 
• This means that the time of ovulation varies, but the average is the 14th day. 
• The periods can last from 1 to 8 days, with the average being about 4 to 5 days. 
• Some women have short, light periods, pain-free and others have longer, heavy, painful periods. 
• For the first few years after menstruation starts, long cycles are common. 
• However, it tends to shorten and become more regular as age advances.

What are the phases of the menstrual cycle?

There are four main phases (Approximate duration according to 28 days cycle):

Menstruation: Initial1-5 days: 

• The menstrual flow contains blood, cells from the lining of the uterus (endometrial cells) and mucus. 
• Sanitary pads/ tampons are used to absorb it. 
• Pads should be changed at least in 4 hours. 
• You may experience period symptoms like cramps, tender breasts, bloating, mood swings, irritability, headaches, tiredness & low back pain.

Follicular phase: 1-14 days: 

• The growth of the follicles stimulates the uterine lining to become thicker and enriched in blood and nutrients in preparation for possible pregnancy.

Ovulatory phase: 14^th day:  

(Ovulation occurs usually from day 11 to 17)

• Somewhere around day 14, an egg is released from one of the ovaries & it disintegrates after about 24 hours. 
• If sperm are present in the fallopian tube at this time, fertilization can occur.

Luteal phase: 14-28 days:  

• If the egg does not fertilized or implantation does not occur, hormonal changes signal the uterus to prepare to shed its lining, and the egg breaks down and is shed along with lining.

& again the cycle begins again on Day 1 menstrual bleeding.

What causes the irregularity of the periods?

The cycle varies in a woman from time to time. 

• This can be the result of hormonal fluctuations, emotional stress, illness, travel, sudden weight change or the use of some medicines. 
• Other causes are pregnancy, breastfeeding, PCOD, PID, eating disorders, excessive exercise, premature ovarian failure, and uterine fibroids.

What are the problems related to it?

Many women will experience problems with their menstrual cycle at some time. Some of the more common include:

Premenstrual syndrome (PMS): 

• This occurs due to hormonal events which can trigger a range of side effects in women at risk, including fluid retention, headaches, fatigue, and irritability. 
• Treatment options are exercise and dietary changes.

Dysmenorrhoea/ Painful periods:  

• It is thought that the uterus is prompted by certain hormones to squeeze harder than necessary to dislodge its lining causing pain. 
• Treatment options include pain-relieving medications like NSAIDs, paracetamol (and the oral contraceptive pill-taken only after consultation with your doctor)

Heavy menstrual bleeding/ menorrhagia: 

• If left untreated, this can cause anemia. 
• Treatment options include oral contraceptives and a hormonal intrauterine device (IUD) to regulate the flow & dietary advice for iron-rich foods.

Amenorrhoea/ Absence of menstruations: 

• This is considered abnormal, except during pre-puberty, pregnancy, lactation, and post-menopause. 
• Possible causes include low or high body weight and excessive exercise & severe anemia.

If you have any problems related to your menstrual cycle, discuss them with your physician/gynecologist.

When is pregnancy likely to occur?

• Women are most likely to get pregnant between the 8th and the 18th day, depending on when ovulation is occurring and how long the sperm remain active.  
• It is useful to know when you ovulate—you may feel a pain in the abdomen and notice that vaginal mucus changes from jelly-like to watery. 
• Intercourse at this time and for the next 2 days is most likely to result in pregnancy.

When to consult the doctor?

• When periods suddenly stop for more than 90 days — and you're not pregnant.
• Periods become irregular & erratic after having been regular.
• If bleeding is for more than seven days.
• If bleeding is more heavy than usual or soak through more than one pad or tampon every hour or two.
• If periods are coming within less than 21 days or more than 35 days apart.
• When bleeding occurs in between periods.
• If you develop severe & intolerable pain during the periods.
• When you suddenly get a fever and feel sick after using pads/ tampons.

References:

1. John M. Murtaghs Patient Education. of 6th revised ed edition. North Ryde NSW: McGraw-Hill Australia. 2012
2. https://www.unicef.org/mena/stories/here-why-we-need-stop-stigmatizing-menstruation-period
3. https://www.womenshealth.gov/menstrual-cycle/your-menstrual-cycle
4. https://www.uofmhealth.org/health-library/tn9930
5. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/menstrual-cycle
6. https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/menstrual-cycle/art-20047186
7. https://www.yourperiod.ca/normal-periods/menstrual-cycle-basics/
8. https://step1.medbullets.com/reproductive/116013/menstrual-cycle photo credit
9. https://www.paulcurtispractice.co.uk/menstrual-problems.html photo credit