Periods (Menstruation)

Menstruation, or periods as they are colloquially called, are the first few days of the menstrual cycle, when the body sheds the unfertilised egg along with uterine blood and tissue. This period can last between two and seven days in different women.

Read more: Period myths and facts

The menstrual cycle is a monthly cycle in which the female body gets ready for pregnancy and then goes back to normal. This preparation comprises a series of hormonal changes in the body. The hormones involved in the menstrual cycle are:

• Gonadotropin-releasing hormone: Released by the hypothalamus in the brain, gonadotropin-releasing hormone triggers the release of follicle stimulating hormone (FSH) and luteinizing hormone (LH). (Read more: Female hormones and their role in women's health)
• Follicle-stimulating hormone and luteinizing hormone: The pituitary gland in the brain releases FSH and LH. Follicles are cells in the ovaries that contain unfertilized eggs (oocytes). Research shows that on average, our ovaries contain four lakh eggs at the onset of puberty—we lose about 15 of these each month, as we get our period.
  Now, FSH and LH stimulate the follicles and encourage them to grow. The follicles send out their own signal in the form of the next major hormone in this cycle: estrogen.
• Estrogen: Released by the follicles, estrogen does several important things. Among them:
  • It tells the brain to stop producing gonadotropin-releasing hormone and FSH. 
  • And two, it causes the mucus in the cervix (the tiny passage connecting the uterus and vagina) to become thin so that sperm can swim through it.
• Luteinizing hormone: Next, there is a momentary dip in the amount of estrogen in the body, when the LH causes the ovary with the mature follicle to release the egg into the fallopian tubes (ovulation). (An excess of luteinizing hormone is linked to health problems like polycystic ovary syndrome and infertility.) 
• Progesterone: The mature but now broken follicle (which released the egg into the fallopian tubes during ovulation), now forms what is known as corpus luteum and releases progesterone—this causes the uterus to form a thicker lining, in preparation for implantation (read more: what is implantation bleeding). Progesterone also causes the mucus in the cervix to become thick again.
• The drop in hormone levels: After ovulation, there’s a 24-hour window for fertilization. If the egg is not fertilized in this time, the corpus luteum disintegrates and the levels of progesterone and estrogen drop drastically, precipitating a period.
• FSH, again: As the levels of estrogen drop, the brain can again produce FSH and start the cycle all over again.

Read more: Swimming during periods

The menstrual cycle is divided into two clear phases:

• Follicular phase: This is the first phase of the cycle. It starts on the day you get your period and lasts until ovulation (release of the mature egg into the fallopian tubes). This phase can last anywhere from 10 days to 16 days.
• Luteal phase: Named after the corpus luteum—the shell of the burst follicle after the egg is released—this is the second phase of the menstrual cycle. It lasts for 14 days.

There’s no hard and fast rule for how periods should feel or be: each woman has her own experience with them. For example, while some women find period pain debilitating, for others it’s practically non-existent.

Depending on her stage of life—young age, old age, breastfeeding or not—the same woman can also experience each period slightly differently.

That said, there are some common symptoms of periods that every girl and woman of reproductive age should know about:

• Menstrual cramps: These occur because of tiny uterus contractions, to push the menstrual blood out of the body. They can vary in intensity from mild to severe. Drinking water throughout the day and eating a balanced diet with adequate amounts of magnesium and potassium can help prevent cramps. For mild to moderate cramps, applying a hot water bottle to your stomach or taking an antispasmodic tablet can help. If you have unbearable cramps, though, visit your gynaecologist for a thorough checkup.
• Bloating: Bloating during periods is just one of the gastrointestinal symptoms that can accompany menstruation. This occurs because of the hormonal changes in the body: the female sex hormones, estrogen and progesterone, also affect the water and electrolyte balance in the body. This is why most women experience water and salt retention in the body during periods, which causes bloating and diarrhoea or constipation.
• Headaches: Also linked to the rise and fall of estrogen and progesterone hormones in the body, period headaches can range from mild to moderate “hormonal headaches” to severe “menstrual migraine” headaches.
• Breast pain: Research is still on to find out why this happens. Some medical researchers have suggested that breast pain during periods (cyclical breast pain) could be because of an imbalance in the amount of estrogen and progesterone in the body (more estrogen), while others have implicated the hormone prolactin (a hormone responsible for breast development and for producing breast milk). Women often describe more pain in one breast. The pain can also start in the underarms. At least one study suggested that taking five drops of camomile extracts three times a day during your periods may soothe the symptoms.
• Back pain: Prostaglandins—a hormone that is also responsible for contractions, and back pain, during labour—is thought to be the main culprit behind this. The pain tends to radiate from the front of the body to the back. If taking pain medication and applying a hot water bottle doesn’t help and if the back pain is unbearable, visit a doctor to rule out endometriosis (a condition in which some tissue from the uterus starts growing in another part of the body).
• Blood clots: Small blood clots during periods are perfectly normal. If, however, you start to pass many big clots (bigger than a Rs 2 coin), then you may be experiencing heavy bleeding during periods. It is a good idea to see your doctor, if you feel like you are bleeding a lot more than usual.

As mentioned before, each woman experiences periods differently—if you are someone who needs to put up her feet and rest for a day or two, you should be able to do that without judgement from anyone. That said, there are some things to make periods easier on yourself:

• Take a painkiller: Over-the-counter antispasmodic drugs like cyclopam or a painkiller like ibuprofen can help deal with the pain on heavy flow days.
• Exercise: Exercises during periods can reduce menstrual cramps and lower back pain. This includes having sex during periods, which can be more enjoyable for some women despite being messy.
• Eat healthily: Eating a healthy diet and staying hydrated can reduce symptoms like bloating and cramps.
• Take a warm bath: Taking a warm shower or applying a hot water bottle directly to the stomach can help reduce pain, too.
• Avoid coffee and alcohol: It is a good idea to avoid too much coffee and alcohol during periods, as they can dehydrate the body.
• Use contraceptive pills: Birth control pills can help women with period problems like PCOS. They can also reduce period symptoms like heavy bleeding and pain. Talk to your doctor about picking the contraceptive for you.

The menstrual cycle is a symphony of many hormones, chemicals and body parts working together. A change in any one of the components can lead to some problems. Here’s a quick list of the most common period problems—these are not signs of normal periods, but rather departures from the norm:

• Irregular periods: The irregularity could be in terms of the time between periods, the duration of the period itself or in the amount you bleed in each period.
• Stopped periods or missing periods: While stress and eating disorders can cause you to skip a period, missing periods (amenorrhea) can also signal an underlying health problem like PCOS or thyroid problems. Of course, stopped periods can also signal pregnancy.
• Polymenorrhea: If you have periods at a gap of less than 21 days each month, this condition is known as polymenorrhea (literally, multiple periods).
• Oligomenorrhea: Women whose regular cycle is more than 35 days long are considered oligomenorrheic.
• Dysmenorrhea: Painful periods
• Heavy periods: Heavy bleeding during periods or menorrhagia can lead to further complications like anaemia and severe pain. Some of the more serious causes of this include uterine fibroids, pelvic inflammatory disease, adenomyosis and liver disease, among other causes.
• Metrorrhagia: Vaginal bleeding in-between periods.
• Post-menopausal bleeding: Having a period six months or more after hitting menopause.

Metrorrhagia and post-menopausal bleeding are types of abnormal uterine bleeding.

A big part of having a safe period is taking extra care of hygiene. This is because women can be more susceptible to some infections like urinary tract infections and vaginal yeast infection during or just before their period. Thankfully, there are some hygiene products and practices that can help:

• Sanitary napkins: These come in different sizes and materials, from banana fibre to super-absorbent polymer. You can also choose a reusable cloth one, which is more eco-friendly. Whichever sanitary pad or napkin you choose, make sure you change the napkin every four to six hours, use an unscented one (to avoid contact dermatitis) and change in a hygienic setting after washing your hands properly.
• Tampons: Like menstrual cups, tampons are menstrual hygiene products that are inserted into the vagina to soak up menstrual blood. It is a good idea to change a tampon every four to eight hours and choose a lower absorbent strength than you think you need. 
• Menstrual cup: Menstrual cups have gained popularity in the 21st century as an eco-friendly and cost-effective solution. Wearing one and removing it to drain the blood can take some getting used to, though. Usually made of silicone, these cups are safe and hygienic. However, it is important to wash them and store them in a clean place between uses.

Having a safe period also means taking good care of your diet, doing light exercises and getting adequate sleep.

Read more: Period diet: what to eat, what not to eat during periods

Periods are a natural part of your reproductive years. And while women can do anything they like during periods, they also have the choice to delay or stop periods when they want. Here are some commonly available therapies to achieve this:

• Birth control pills: Birth control pills regulate the sex hormones in the body. Depending on which type of contraceptive you use, you could get a period once every month, once every three months or once in a year. Make sure you talk to your doctor before going on the pill, as he or she will be able to prescribe one that is best suited to your body and your requirements.
• Hormone shot: You could talk to your doctor about hormone injections to delay your periods for up to 22 months.

In addition to these, there are ways to reduce period symptoms and bleeding without stopping periods altogether. These include:

• Hormonal intrauterine devices
• Arm implant

Both are long-acting contraceptive solutions that slowly release synthetic hormones into the body, to regulate the cycle and reduce period symptoms.

Read more: How to get your period early

Though each woman’s body is different and each one can have slightly different experiences of menstruation, there are some facts we can count on:

• The menstrual cycle typically lasts 25-35 days.
• The menstrual cycle occurs in two stages: the follicular phase that lasts 10-16 days and the luteal phase which is 14 days long. Ovulation occurs at the end of the follicular phase.
• The normal duration for periods is two to seven days. Women who regularly have periods for more than seven days may have menorrhagia or long periods.
• Most women tend to experience heavier bleeding at the beginning of the period.
• Women typically lose about 30 millilitres of blood in each cycle. Loss of more than 80 millilitres is considered abnormal; it requires medical intervention.
• Women who are just starting their period (menarche) or are nearing the end of their reproductive years (menopause) are more likely to have irregular periods.