Women experience a monthly cycle called menstruation or a period. The lining of the uterus breaks down and leaves the body through the vagina. This has a range of effects on the reproductive system and other organs.

Young girls are often between 8 and 15 years old when they experience their first period. The first cycles might be quite irregular. The average age for onset of menstruation in the United States is 12 years.

Most women will see their period recur every 28 days. However, cycles of 21 to 35 days are also normal in adult women.

Girls over 13 years of age can experience more irregular cycles that range from 21 to 45 days. Hormones regulate these cycles.

Periods typically last for between 3 and 7 days, and the amount of blood loss can vary. They can range in severity between mild, moderate, and heavy.

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Menstruation can cause acne breakouts, bloating, and other symptoms.

Not every woman will experience the same premenstrual symptoms. Common symptoms include:

  • breast swelling and tenderness
  • tension
  • bloating
  • acne breakouts
  • leg, back, or stomach cramping
  • premenstrual syndrome

Some women may confuse the symptoms of menstruation with those of early pregnancy, as they can be similar. These include a missed period, breast tenderness or swelling, nausea, frequent urination, and tiredness.

Premenstrual syndrome

Some women report feeling the symptoms of premenstrual syndrome (PMS). This very common condition can include symptoms such as:

  • rapid changes in mood
  • insomnia
  • dizziness
  • bloating
  • social withdrawal
  • difficulty concentrating
  • breast tenderness
  • tiredness

These symptoms can vary in severity. Other symptoms may include joint or muscle pain, headaches, fluid retention, constipation, and diarrhea.

PMS may be caused by changes in hormone or serotonin levels.

Premenstrual dysphoric disorder

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People can experience depression, irritability, and mood swings while menstruating.

Some women experience a severe form of PMS known as premenstrual dysphoric disorder (PMDD). It can lead to the following symptoms:

  • depression
  • mood swings
  • anger
  • anxiety
  • feelings of being overwhelmed
  • concentration difficulties
  • irritability
  • tension

Women should speak with their doctor for evaluation and treatment if they feel they may be experiencing PMDD. Depression may be an underlying cause .

Women may at times experience problems or irregularities in their menstrual cycle. Common problems include:

Amenorrhea: This refers to the absence of a menstrual cycle for at least 90 days. Contributing factors amenorrhea period include pregnancy, breastfeeding, eating disorders, excessive exercising, and stress.

Dysmenorrhea: This is sometimes severe menstrual pain. Possible causes include uterine fibroids, endometriosis, and excessive levels of a hormone called prostaglandin.

Abnormal uterine bleeding: This term includes any vaginal bleeding not considered normal for a menstrual period. This might include bleeding between periods or after sex, any vaginal spotting, unusually heavy or prolonged menstrual bleeding, and postmenopausal bleeding.

In early pregnancy, some women will also experience what is referred to as implantation bleeding, as a result of the embryo attaching to the uterine wall. Implantation bleeding can be expected around 10 to 14 days after conception.

Implantation bleeding occurs as light, brown spotting and not the typical bright, red flow of a menstrual period. Implantation bleeding is short-lived and, for most women, requires no treatment.

When to call a doctor

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Unusual or prolonged bleeding and pain during menstruation may require the attention of a physician.

Some medical conditions can affect the menstrual cycle, including polycystic ovarian disease, uterine fibroids, and endometriosis.

It is important to speak with a healthcare provider if symptoms are causing concern. Indications for speaking with a doctor about a period include:

  • abnormal uterine bleeding
  • any postmenopausal bleeding
  • not having experienced a period by 15 years of age or within 3 years of breast development
  • no menstrual flow for more than 90 days
  • irregular bleeding between periods
  • menstrual bleeding that lasts for more than 7 days
  • periods occurring more often than every 21 days
  • heavy vaginal bleeding that requires a tampon or pad change every 1 to 2 hours
  • severe menstrual pain
  • signs of toxic shock syndrome, a bacterial infection more commonly associated with tampon use

Toxic shock can be extremely dangerous and is in some cases life-threatening. Symptoms of toxic shock include:

  • a fever over 102° Fahrenheit
  • muscle aches
  • diarrhea
  • vomiting
  • dizziness
  • fainting
  • a rash resembling a sunburn
  • a sore throat
  • bloodshot eyes

Toxic shock is a medical emergency and requires immediate attention.

Premenstrual symptoms affect women differently. Treatment of these symptoms will depend on their severity. Regular exercise, reducing stress, and dietary modifications can help reduce symptoms.

Dietary changes include:

  • eating smaller, more frequent meals
  • limiting intake of salt, caffeine, and alcohol
  • eating more fruit, vegetables, whole grains, and calcium-rich foods

The application of warm compresses in the lower belly may also provide relief for cramps. Women can treat other menstrual symptoms, such as the psychological effects of PMS, pain, or swelling, with a variety of medications, including:

  • selective serotonin uptake inhibitors (SSRIs), such as fluoxetine, paroxetine, and sertraline
  • non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen or naproxen
  • diuretics, such as spironolactone
  • hormonal contraceptives

A healthcare provider will provide instructions on how to take these.

Alternative therapies that may offer some relief include treatment with acupuncture and the use of certain supplements. Studies are not overwhelming in showing the efficacy of treatment with nutritional supplements. Supplements which may reduce period symptoms include:

Certain supplements may interact with other medications. St. John's wort will reduce the efficacy of oral contraceptives when taken alongside them. It is vital that people speak with their healthcare provider before starting any herbal or supplement courses.

These products are also not regulated by the U.S. Food and Drug Administration (FDA), so be sure to check that the remedy contains what it claims on the packaging.

Anyone with questions about their period or any associated symptoms should speak with a healthcare provider.