What
is menstruation?
Menstruation
is a woman's monthly bleeding, also called a period. When you menstruate, your
body is shedding the lining of the uterus (womb). Menstrual blood flows from the
uterus through the small opening in the cervix, and passes out of the body through
the vagina. Most menstrual periods last from three to five days.
Menstruation
is part of the menstrual cycle, which prepares your body for pregnancy each month.
A cycle is counted from the first day of one period to the first day of the next
period. The average menstrual cycle is 28 days long. Cycles can range anywhere
from 21 to 35 days in adults and from 21 to 45 days in young teens. Body
chemicals called hormones rise and fall during the month to make the menstrual
cycle happen.
In
the first half of the cycle, levels of estrogen (the “female hormone”) start
to rise and make the lining of the uterus (womb) grow and thicken. At the same
time, an egg (ovum) in one of the ovaries starts to mature. At about day 14 of a
typical 28-day cycle, the egg leaves the ovary. This is called ovulation. After
the egg has left the ovary it travels through the fallopian tube to the uterus.
Hormone levels rise and help prepare the uterine lining for pregnancy. A woman is
most likely to get pregnant during the three days before ovulation or on the day
of ovulation. Keep in mind, women with cycles that are shorter or longer than
average may ovulate earlier or later than day 14. If
the egg is fertilized by a man’s sperm cell and attaches to the uterine wall,
the woman becomes pregnant. If the egg is not fertilized, it will break apart. If
pregnancy does not occur, hormone levels drop, and the thickened lining of the
uterus is shed during the menstrual period. In
the picture below, the egg has left the ovary and is on its way through the
fallopian tube to the uterus. 
What
is a typical menstrual period like?
During
your period, the thickened uterine lining and extra blood are shed through the
vaginal canal. Your period may not be the same every month and it may not be the
same as other women's periods. Periods can be light, moderate, or heavy, and the
length of the period also varies. While most periods last from three to five days,
anywhere from two to seven days is normal. For the first few years after
menstruation begins, longer cycles are common. A woman's cycle tends to shorten
and become more regular with age. Most of the time, periods will be in the range
of 21 to 45 days apart.
Women
can have a range of problems with their periods, including pain, heavy bleeding,
and skipped periods.
Causes
can include pregnancy, breastfeeding, and extreme weight loss caused by serious
illness, eating disorders, excessive exercising, or stress. Hormonal problems,
such as those caused by polycystic ovarian syndrome (PCOS) or problems with the
reproductive organs, may be involved. It is important to talk to a doctor.
Dysmenorrhea
– painful periods, including severe cramps. When menstrual cramps
occur in teens, the cause is too much of a chemical called prostaglandin. Most
teens with dysmenorrhea do not have a serious disease even though the cramps
can be severe. In older women, a disease or condition, such as uterine
fibroids or endometriosis or, sometimes causes the pain. For some women, using
a heating pad or taking a warm bath helps ease their cramps. Some pain
medicines available over the counter, such as ibuprofen (for instance, Advil®,
Motrin®, Midol® Cramp), ketoprofen (for instance, Orudis® KT®), or
naproxen (for instance, Aleve®), can help with these symptoms. If pain is not
relieved by these medicines or the pain interferes with work or school, you
should see a doctor. Treatment depends on what is causing the problem and how
severe it is.
Abnormal
uterine bleeding– vaginal bleeding that is different from normal
menstrual periods. It includes very heavy bleeding or unusually long periods,
periods too close together, and bleeding between periods. In both teens and
women nearing menopause, hormonal changes can cause long periods along with
irregular cycles. Even if the cause is hormonal changes, treatment is
available. These changes can also go along with other serious medical problems
such as uterine fibroids, polyps, or even cancer. You should see a doctor if
these changes occur. Treatment for abnormal bleeding depends on the cause.
When
does a girl usually get her first period?
In
the United States, the average age is 12. This does not mean that all girls start
at the same age. A girl can start her period anytime between the ages of eight and
15. Usually, the first period starts about two years after breasts first start to
grow. If a girl has not had her first period by age 15, or if it has been more
than two to three years since breast growth started, she should see a doctor.
Women
usually have periods until menopause. Menopause occurs between the ages of 45 and
55, usually around age 50. Menopause means that a woman is no longer ovulating
(producing eggs) and can no longer get pregnant. Like menstruation, menopause can
vary from woman to woman and these changes may take several years to occur. The
time when your body begins its move into menopause is called the menopausal
transition. This can last anywhere from two to eight years. Some women have early
menopause because of surgery or other treatment, illness, or other reasons. If a
woman doesn’t have a period for 90 days, she should see her doctor to check for
pregnancy, early menopause, or other medical problems that can cause periods to
stop or become irregular.
When
should I see a doctor about my period?
You
should see your doctor if:
you
have not started menstruating by the age of 15, or by three years after breast
growth began, or if breasts haven't started to grow by age 13
your
period suddenly stops for more than 90 days
your
periods become very irregular after having had regular, monthly cycles
your
period occurs more often than every 21 days or less often than every 45 days
you
are bleeding for more than seven days
you
are bleeding more heavily than usual or using more than one pad or tampon
every one to two hours
you
bleed between periods
you
have severe pain during your period
you
suddenly get a fever and feel sick after using tampons
Pads
should be changed as often as needed, before the pad is soaked with blood. Each
woman decides for herself what works best. Tampons should be changed at least
every four to eight hours. Make sure that you use the lowest absorbency tampon
needed for your flow. For example, use junior or regular absorbency on the
lightest day of your period. If you use a super absorbency tampon on your lightest
days, you may have a higher risk for toxic shock syndrome (TSS). TSS is a rare but
sometimes deadly disease. Young women may be more likely to get TSS. Using any
kind of tampon, at any absorbency, puts you at greater risk for TSS than using
pads. The risk of TSS can be lessened or avoided by not using tampons, or by
alternating between tampons and pads during your period. The
Food and Drug Administration (FDA) recommends the following tips to help avoid
tampon problems:
Follow
package directions for insertion.
Choose
the lowest absorbency for your flow.
Change
your tampon at least every four to eight hours.
Consider
alternating pads with tampons.
Know
the warning signs of TSS (see below).
Don't
use tampons between periods.
If
you have any of these symptoms of TSS while using tampons, take the tampon out,
and contact your doctor right away:
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