Women experience a monthly bleeding cycle in which the lining of the uterus is shed and released through the vagina. This is referred to as menstruation or a period.
Most often, the first menstrual period is experienced by young girls ranging in age from 8 to 15 and may begin as irregular cycles of bleeding. The average age for onset of menstruation in the United States is 12.
The menstrual cycle is controlled by the body's hormones. Each hormone has a vital role in menstruation and a specific job.
- Luteinizing hormone and follicle stimulating hormone: These two hormones are responsible for the release of eggs and production of estrogen and progesterone.
- Estrogen and progesterone: During the menstrual cycle, these hormones, are responsible for thickening the lining of the uterus. This is essential in providing nutrients to an implanted embryo.
Medical conditions may have a negative impact on some women's menstrual cycle, leading to numerous symptoms.
Additionally, progesterone is responsible for the thickening of cervical mucus and increasing temperature. Both estrogen and progesterone cause breast swelling and tenderness. If no pregnancy has occurred, these hormones decrease and menstrual bleeding occurs.
For most women, their period will recur every 28 days. However, cycles of 21 to 35 days are also normal in adult women. Teenagers can experience more irregular cycles that range from 21-45 days.
Periods typically last from 3-7 days and vary in the amount of blood loss. They also range in severity from mild, moderate, and heavy in quantity.
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Period symptoms and problems
Not every woman will experience the same premenstrual symptoms. Common symptoms include:
- Breast swelling and tenderness
- Acne breakouts
- Leg, back, or stomach cramping
- Premenstrual syndrome
Some women report feeling the symptoms of premenstrual syndrome, also referred to as PMS. This very common condition can include symptoms such as:
- Mood swings and changes
- Social withdrawal
- Difficulty concentrating
- Breast tenderness
PMS may be caused by certain conditions such as changes in hormone or serotonin levels.
Premenstrual dysphoric disorder
Some women experience a severe form of PMS known as premenstrual dysphoric disorder or PMDD. PMDD can lead to the following symptoms:
If concerned about symptoms, it is important to speak to a healthcare provider.
- Mood swings
- Feelings of being overwhelmed
- Concentration difficulties
People should speak with their doctor for evaluation and treatment if they feel they may be experiencing PMDD. Depression may be an underlying cause of PMDD.
Menstrual cycle problems
At times, some women may experience problems with their menstrual cycle. Commonly experienced problems include:
- Amenorrhea: A term to describe the lack of a period in a young girl by the age of 15 or no blood or discharge in a menstruating woman for 90 or more days.Some contributing factors to the lack of a period include pregnancy, breastfeeding, eating disorders, excessive exercising, and stress.
- Dysmenorrhea: This is a condition in which a woman experiences menstrual pain that is severe at times. It may be caused by excessive prostaglandin (a chemical produced by the body), uterine fibroids, or endometriosis.
- Abnormal uterine bleeding: This condition is described as any vaginal bleeding that is not related to a menstrual period. This type of bleeding may include bleeding between periods, bleeding after sex, any vaginal spotting, heavy or prolonged menstrual bleeding, and postmenopausal bleeding.
Some women may confuse the symptoms of menstruation with early pregnancy symptoms, as they can be similar. These include a missed period, breast tenderness or swelling, nausea, a more frequent need to urinate, and tiredness.
In early pregnancy, some women will also experience what is referred to as implantation bleeding, caused by the embryo attaching to the uterine wall. Menstrual bleeding can be expected around 10 to 14 days after conception.
If bleeding occurs 6-12 days after ovulation, implantation bleeding may be the cause. It can be described as light, brown spotting compared with the bright red flow of a menstrual period. In most cases, implantation bleeding is brief and requires no treatment.
If someone thinks they may be pregnant despite a negative pregnancy test, they should speak to a healthcare provider for evaluation. They may benefit from a blood test to evaluate for pregnancy.
When to call a doctor
It is important for people to speak with a healthcare provider if they are concerned about any symptoms. Some indications for speaking with a doctor include:
- Abnormal uterine bleeding
- Lack of a period by age 15, no menstruation within 3 years of breast development, or lack of breast development by age 13
- Lack of bleeding for more than 90 days
- Irregular bleeding
- Menstrual bleeding lasting more than 7 days, occurring more than every 21 days, or less than 35 days
- Heavy vaginal bleeding requiring a change in tampon or pad every 1-2 hours
- Bleeding between periods or severe menstrual pain
- Signs of toxic shock syndrome, a bacterial infection more commonly associated with tampon use
Symptoms of toxic shock include:
- A fever over 102°F
- Muscle aching
- A rash resembling a sunburn
- Sore throat
- Bloodshot eyes.
Toxic shock is a medical emergency and requires medical attention immediately.
Treating premenstrual symptoms
Premenstrual symptoms affect women differently. Treatment of these symptoms will depend on their severity. The Mayo Clinic recommend regular exercise, reducing stress, and diet modifications.
Diet changes include:
- Eating smaller, more frequent meals
- Limiting intake of salt, caffeine, and alcohol
- Eating more fruit, vegetables, whole grains, and calcium-rich foods.
Additionally, the application of warm compresses in the lower belly may provide relief of cramps. Other menstrual symptoms, such as those in PMS, may be treated with a variety of medications such as:
Menstrual symptoms such as PMS can be treated with a variety of medications such as hormonal contraceptives.
- Selective serotonin uptake inhibitors (SSRIs) such as fluoxetine, paroxetine, and sertraline
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen
- Diuretics such as spironolactone
- Hormonal contraceptives
A healthcare provider will provide instructions on medication use.
Alternative therapies that may offer some relief include treatment with acupuncture and the use of certain supplements. Supplements include calcium, magnesium, vitamin E, gingko, ginger, chasteberry, evening primrose oil, and St. John's wort.
It is important to note that there may be interactions with certain supplements and 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.
Anyone with questions about their period or any symptoms they may be experiencing should speak with a healthcare provider.
Written by Lori Smith BSN MSN CRNP