What Is Menstruation? What Are Periods?

Editor's Choice
Main Category: Women's Health / Gynecology
Also Included In: Endocrinology
Article Date: 20 Jun 2009 - 0:00 PDT

email to a friend   printer friendly   view / write opinions   rate article

A period, or menstruation, is the shedding of the endometrium - the uterine lining. Menstruation is also known as menses. All female humans, as well as some other female mammals, have regular periods during their reproductive age. Menstruation which includes bleeding from the vagina is found mainly among humans and similar animals, such as primates. In many mammals, the endometrium is reabsorbed by the animal. As far as humans are concerned a period is a bleed from the womb (uterus) that is released through the vagina. Women have a period every 28 days approximately. However, some women may have a 24-day cycle while other may have a 35-day one. A period is part of the woman's menstrual cycle.

The word "menses" comes from the Latin menses meaning "months". The word "menstruation" comes from Old French menstrual, which comes from Latin menstrualis, meaning "monthly," especially "of or having monthly courses."

Medilexicon's medical dictionary describes menstruation as the "cyclic endometrial shedding and discharge of a bloody fluid from the uterus during the menstrual cycle of humans and primates".

Paula Hillard, M.D., professor of obstetrics & gynecology and pediatrics at the University of Cincinnati College of Medicine, said "The menstrual cycle is a window into the general health and well-being of women, and not just a reproductive event."

When does a girl start having periods?

Menarchemenarche - the start of periods - will occur when all the parts that make up a girl's reproductive system are mature and working together.

A girl's periods can begin from 8 to 16 years of age. Generally, they start when a girl is about 12. Researchers from the USA and Europe identified two genes that are involved in determining when girls begin menstruation. Menstruation is a major stage in a girl's puberty. It is one of several physical signs that a girl is becoming a woman. Approximately 6 months before getting her first period a girl may detect more clear vaginal discharge. Unless the discharge has a strong odor, or causes itchiness, this is normal and nothing to worry about. The periods will occur regularly until the woman reaches her menopause. The menopause arrives generally when the woman is aged about 45 to 55.

US scientists showed that being overweight as a toddler increases the chance that a girl will reach puberty early.

Onset of menstruation can be welcomed with joy and impatience by some girls, while others may feel scared or uneasy. Fear and anxiety tends to be higher among girls who do not understand the reproductive system, and what happens during the menstrual cycle very well.

A study indicated that the earlier a girl starts menstruating the higher the chances are that her future children will be obese.

What is the menstrual cycle?

Hormones are released by the pituitary gland in the brain to stimulate the ovaries during the reproductive cycle. These hormones cause some of the woman's eggs, which are stored in the follicles of her ovaries, to start to grow and mature. The follicles start producing estrogen - a hormone. During this moment increased estrogen levels can be detected in a woman's blood. The increased estrogen causes the womb lining to become thicker in preparation for receiving a fertilized egg.

If a woman has had sex within several days of the egg being released and sperm is present in her fallopian tube, the egg may become fertilized (she becomes pregnant). However, if the egg is not fertilized her estrogen and progesterone levels will drop and the lining of the uterus (endometrium) will start breaking down - marking the start of her period.

The period consists of a small amount of blood and the endometrium. The bleeding is caused by the breaking of fine blood vessels within the womb as the lining detaches itself.

A period generally lasts about five days. Bleeding is more profuse during the first two days.

What are the symptoms of a period?

During a woman's period her blood flow may appear heavy. However, in the majority of cases the amount of blood lost amounts to between 5 to 12 teaspoons. Some women experience heavier than normal periods - menorrhagia. Menorrhagia can be treated with medication.

Premenstrual syndrome (PMS) or Premenstrual Tension (PMT)

PMT or PMS is a collection of emotional, psychological and physical symptoms which are linked to a woman's menstrual cycle. Experts say that about four-firths of all women of child-bearing age have some PMS symptoms. Health experts tend to refer to PMS only when they are sufficiently severe to interfere with some aspects of a woman's life.

The following symptoms may be felt by some women on the days leading up to her period - symptoms of premenstrual syndrome:

• Abdominal cramps
• Headache (include migraine)
• Bloating
• Irritability
• Pains, especially backache
• Depression
• Feeling generally emotional or troubled
• Insomnia
• Lack of concentration
• Breast tenderness or swelling
• Slight weight gain
• Binge eating

As soon as the period begins (the woman starts shedding blood) the symptoms generally improve. In the majority of cases symptoms will be completely gone by the time the period has ended.

The following factors may increase the chances of PMS:

• High caffeine consumption
• Stress
• Increasing age
• A history of depression
• Smoking
• A family history of PMS
• Allergies, especially to nuts, grass, and trees
• Low levels of some vitamins and minerals, especially magnesium, calcium, manganese, and vitamin E. A diet rich in calcium and vitamin D may lower the risk of developing premenstrual sindrome, a study found.

A leading Australian expert believes that pressures of being 'superwoman' are more likely to be the cause of PMS, rather than a hormone imbalance.

One identical twin is twice as likely to experience PMS if the other twin has it. Hence, experts say that family history is a good predictor.

A clinical trial using a popular low-dose contraceptive uncovered a potentially more effective treatment for the 5 to 10 percent of women who suffer from premenstrual dysphoric disorder (PMDD).

How is Premenstrual syndrome diagnosed?

Currently, no laboratory test or unique physical findings exist to determine whether a woman has PMS. Many doctors will ask the patient to keep a prospective record of her symptoms for at least two menstrual cycles, with the aid of a calendar. The record will help the doctor and the patient find out whether the symptoms really are premenstrual and recurring in the predictable way.

The doctor will also have to exclude other factors which may exacerbate during menstruation. Some medical symptoms stand out more during menstruation, this is called menstrual magnification. Menstrual magnification occurs during the second phase of the menstrual cycle, when ovulation occurs - it is also called the luteal phase. If menstrual symptoms are exacerbated during this phase of the menstrual cycle the woman may think she has PMS, when in fact she may be suffering from some other underlying condition. Women who suffer from migraine headaches, seizure disorders, irritable bowel syndrome, chronic fatigue syndrome, asthma or allergies during their menstrual cycle often experience menstrual magnification during the days leading up to the shedding of blood.

Two definitions are commonly used to determine what qualifies as PMS:

• NIMH (National Institute of Mental Health) - this compares the intensity of symptoms from menstrual cycle days 5 to 10 to the 6th day interval before menses (shedding of blood) starts. The woman is deemed to have PMS if symptoms intensify by at least 30% during this 6-day period before menstruation. This pattern must have been recorded for at least two consecutive menstrual cycles.


• University of California at San Diego - Symptoms must include both emotional (affective) and physical (somatic) symptoms during a 5-day period before menstruation for each of 3 consecutive menstrual cycles. These symptoms must not be present during the period before ovulation (days 4 to 13 of the menstrual cycle). Emotional symptoms include depression, angry outbursts, irritability, anxiety, confusion and social withdrawal. Physical symptoms include breast tenderness/swelling, abdominal bloating, headache, swelling of hands and feet.

The National Association for Premenstrual Syndrome explains that diet and lifestyle can significantly benefit health and may make managing PMS symptoms easier.

What are irregular periods?

If a woman/girl has irregular periods there may be variations in the interval length between periods. The amount of blood lost, as well as the duration of bleeding may also vary. Irregular periods can have several different causes, and treatment will depend on the cause. Some doctors arrange for relaxation classes, counseling, or changing the contraceptive pill. Although the majority of doctors say that long-term usage of the contraceptive pill to suppress menstruation is safe, many women do not know this, a study found.

The majority of irregular periods are benign (harmless). In many cases, missed periods, periods that occur too frequently, spotting, or bouts of heavy clotting and bleeding are caused by a hormonal imbalance - this can be easily treated by a doctor. Shifts in period regularity are more common in the perimenopause (the interval in which a woman's body begins its transition into menopause).

Most women have missed a period at some time. This could be for no apparent reason, or in anticipation of a pregnancy, or perhaps because of anxiety or tension.

The majority of doctors are not concerned if a woman has missed an occasional period (once or twice in a given year). Depending on the woman's age, more frequent missed periods or variations in the length of the menstrual cycle may be an indication of the perimenopause or a disturbance of the hormones that control menstruation. Irregular periods may be caused by the following factors:

• Breastfeeding
• Caffeine consumption
• Chemotherapy
• Childbirth
• Considerable changes in body weight - includes gaining or losing lots of weight
• Consumption of some legal medications
• Eating disorders
• Exercising too much
• Hormone imbalance
• Illegal drug consumption
• Miscarriage
• Nutritional factors - sometimes a diet that is too high in carbohydrates
• Polycystic ovarian syndrome (PCOS)
• Smoking
• Too much stress
• Uterine fibroids, cysts, polyps, and endometriosis

What is polycystic ovarian syndrome (PCOS)?

PCOS includes multiple cysts in the ovaries. Women with PCOS may have fertility problems (getting pregnant), acne, weight gain, undesirable hair growth, and irregular or light periods. Treatment can include losing weight, hormone drugs, hormone treatments, the administration of a drug called metformin, and anti-male hormone drugs. 1 in 15 women worldwide are affected by PCOS, a report revealed.

What is amenorrhea (absent periods)

Amenorrhea is when a woman stops having periods altogether. There can be many reasons for this, including excessive exercise, stress, some medications and PCOS (polycystic ovarian syndrome). Doctors may prescribe HRT (hormone replacement therapy) as a treatment for amenorrhea. Researchers from Harvard University found a way to predict which teenage female athletes will stop menstruating. Young female professional dancers face the same health risks as young female athletes when they don't eat enough to offset the energy they spend, and stop menstruating as a consequence, another study found.

Period pains (Dysmenorrhea)

This is a medical condition which includes severe uterine pain during menstruation. The majority of women experience minor pain during menstruation. When the pain is so severe that it undermines normal activity it is called dysmenorrhea and requires medication.

Some women experience pain during the days preceding the period, while others have dysmenorrhea during the period. As menstruation tapers off the pain generally does so as well. Some women experience both dysmenorrhea and menorrhagia (excessive blood loss). There are two types of dysmenorrhea:

• Primary Dysmenorrhea: When period pains are not associated with any underlying disease, disorder or structural abnormality either inside or outside the womb (uterus).


• Secondary Dysmenorrhea: When period pains are linked to an underlying disease, disorder or structural abnormality either inside or outside the uterus.

The following symptoms may be experienced by women with dysmenorrhea:

• Cramping in the lower abdomen
• Diarrhea
• Fainting
• Headaches
• Low back pain
• Nausea
• Pain in the lower abdomen
• Pain which radiates down the legs
• Tiredness (fatigue)
• Vomiting
• Weakness

Other conditions and diseases also have these symptoms. It is important to see your doctor to get an accurate diagnosis.

In many cases we do not know why period pains occur. Women who have higher levels of prostaglandin - a hormone - or those who are more sensitive to it, tend to have more painful periods. Some scientists believe there is a link between dysmenorrhea and a disturbed balance between anti-inflammatory, and vasodilator eicosanoids.

Omega-3 fatty acids, magnesium, vitamin E, and vitamin B₁ (thiamine) supplements have been indicated as effective in treating dysmenorrhea. A study revealed that Pycnogenol, pine bark extract from the French maritime pine tree is effective in alleviating period pains.

The following women are at higher risk of experiencing dysmenorrhea:

• Smokers
• Those who consume alcohol during their periods (alcohol may prolong menstruation)
• Overweight women
• Those whose periods started before they were 11 years old

Diagnosing dysmenorrhea

A gynecologist will evaluate the woman's/girl's medical history and carry out a physical examination - this will include a pelvic examination. The doctor will only be able to diagnose properly when certain other medical conditions or medications which can cause dysmenorrhea are ruled out. The following diagnostic procedures may be performed:

• Sonography (ultrasound) - This is a diagnostic imaging technique that uses high-frequency sound waves. A computer creates images of the organs, blood vessels and tissues. With an ultrasound a doctor can more accurately assess how blood is flowing.


• MRI (magnetic resonance imaging) - MRI uses nuclear magnetic resonance of protons to produce proton density images.


• Laparoscopy - The doctor uses a thin tube with a lens and a light which is inserted into an incision in the abdominal wall. The doctor can then see inside the pelvis and abdominal area and detect abnormal growths if there are any present.


• Hysteroscopy - This is a type of endoscopy. The doctor uses a hysteroscope - a thin telescope that is inserted into the vagina, through the cervix, and into the uterus. Modern ones are so thin that the cervix needs no dilation, or perhaps minimal dilation.

What are the treatments for period problems?

• Painkillers - for period pains and discomfort many women find painkillers are very effective. This could include paracetamol (Tylenol), ibuprofen and aspirin. These painkillers are good at blocking prostaglandin. In the UK aspirin is not recommended for girls under the age of 16.


• Contraception - the contraceptive pill often eases period pains. Contraceptive pills cause thinning of the lining of the uterus, resulting in lower amounts of prostaglandin being released in the body. IUS (intra-uterine system) may also relieve period symptoms.


• TENS (Transcutaneous electrical nerve stimulation) machine - these may help women who do not wish to take medication. They give out a small electrical current that hampers the nerve's pain signals.


• Exercise - exercise has been found to help reduce the level of discomfort and pain experienced by women with period problems.


• Relaxation techniques - these can include breathing exercises, massage and medication. Some women practice yoga for easing pain and stress.


• Hot water bottle - holding one against the abdomen may help in reducing discomfort.


• Warm bath - apart from helping the person relax, a warm bath may also provide some pain/discomfort relief.

Menstrual Products

Menstrual products, used to absorb or catch the menses, come in either disposable or reusable forms.

Disposable menstrual products:

• Sanitary towels (sanitary napkins) - these are towels, pads, napkins which are placed in the underwear and absorb the menstrual flow. Many of them have wings which can fold round the underwear, and have adhesive to make sure they do not slide. They are usually made of either wood pulp or some gel product. Older napkins have a sort of belt instead of adhesive or wings to keep them in place.


• Tampons - these are cylinders (long and tube like) made of treated rayon/cotton blends, or 100% cotton fleece. They are generally bleached. The woman/girl inserts it into her vagina. The menstrual flow is absorbed internally.


• Padettes - these are placed within the inner labia. They are disposable wads of treated rayon/cotton blend fleece.


• Menstrual cups - this is a firm, flexible cup-shaped device that the woman wears inside the vagina to catch the menstrual flow. The disposable ones are made of soft plastic.

Reusable menstrual products

• Cloth pads - these are generally made of cotton, terrycloth or flannel. They are placed externally.


• Menstrual caps - these are similar to the disposable ones, but they can be reused.


• Sea sponges - these are used in the same way as a tampon. They are placed inside, through the vagina, and absorb the menses. After cleaning, they can be used again.


• Reusable underwear - often called 'padded panties'. These are usually made of cotton with absorbent layers sewn on. They can be washed and reused.


• Blanket - also known as a towel or a draw sheet. They are large pieces of cloth which are more commonly used during sleep. They are placed between the legs. They can be washed and used again.

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today