Gynaecology · Health

Understanding the Menstrual Cycle

Ah the menstrual cycle, otherwise known as your period, Aunt Flo, “having the painters in” or whatever it is that you are comfortable with.  The one thing that makes being a women much less enjoyable.  Something that is full of unnecessary stigma, pain and awkwardness. 

But, having taken the time to learn more about it (because what they teach you at school is not that useful) I have never understood my body and it’s symptoms more. 

Menstrual Cycle: The Basics

It’s a natural change that occurs in the female body with the female reproductive system.  It’s a set of stages of hormone changes that ultimately lead to the chance of pregnancy.  It’s part of puberty, and tends to happen in girls after the age of 12.   It comes with some signs and symptoms such as acne, mood swings, pelvic pain and fatigue, and some people experience these before their period starts.  Of course, it can also come with problems and conditions, but we’ll get to those later.  On average, a typical menstrual cycle lasts for 28 days and should not stop you from carrying out your normal activities. 

Its Cycles and Phases

Ovarian Cycle 

The follicular phase is the first part of the menstrual cycle.  The ovarian follicles – the sacs that contain an immature egg – matures in preparation to release an egg.  The hormone FSH (follice stimulating hormone) rises causing the follicles to be stimuated.

Ovulation is the second phase of the menstrual cycle in which a mature egg is released.  This happens when there is an acute rise in LH (luteinising hormone).  Ovulation typically occurs between cycle days 12-14 and only lasts around 48 hours.  After the egg is released, it is moved down the fallopian tube ready to be fertilised by sperm.  There is no pattern as to which ovary an egg will be released from and in some women, ovulation can cause pain, which is also known as “mittelschmerz”.

The luteal phase is the final phase of the ovarian cycle.  The FSH and LH cause the follicle that’s released an egg to transform into the corpus luteum, a temporary endocrine structure that secretes progesterone.  If the egg is not fertilised then this structure stops secreting progesterone and decays.  But if the egg is fertilised, the corpus luteum thickens and helps maintain pregnancy. 

Uterine Cycle

Menstruation is the first phase of the uterine cycle.  The first day of bleeding is also counted as day 1 of your cycle.  Typically, the sign of menstrual bleeding will confirm that a women is not pregnant, however women can get bleeding for other reasons (see below).  The normal and average length of the menstrual cycle is 3-5 days and the average blood loss can be anywhere between 10 to 80ml.  The usual cramping pain associated with menstruation is due to the uterus contracting to shed it’s lining – it is sometimes thought that the thicker the lining, the more cramping is needed to help it shed.   The drop in oestrogen triggers the bleeding. 

The proliferative phase occurs when oestrogen levels begin to rise again causing the lining of the uterus to grow (or proliferate).  Ovarian follicles once again begin to mature and the hormone oestradiol rises alongside oestrogen, which causes other symptoms such as cervical mucus. 

The final phase of the uterine cycle is the secretory phase, which corresponds to the luteal phase of the ovarian cycle.  This phase is when the corpus luteum secretes progesterone. 

Associated Symptoms

Due to the rise and fall in hormones throughout your cycle, your body can react in different ways;

  • Acne – related to androgen hormones, and it tends to flare up before and during your period
  • Back and leg pain – linked to menstrual cramping and the uterus
  • Fatigue – hormone fluctuations can knock you for six, but the physical act of bleeding can lead to tiredness too, usually due to reduced iron in the blood
  • Mood swings – again those hormones are playing havoc!  Drops in certain hormones can affect how you feel, making you feel sad, snappy or stressed

Common Menstrual Problems and Disorders

The most common problems women go to their GP about regarding their periods are heavy bleeding, irregular bleeding and severe pain, as well as lack of bleeding and spotting.  Most can be rectified either over time or with medication, such as the pill, but should be taken seriously.  For example, heavy and long bleeding can lead to iron deficiency anaemia and irregular bleeding may be hiding fertility problems.  

However, some symptoms will require further investigation due to them being associated with gynaecological diseases;

  • Endometriosis – a condition that causes extremely heavy bleeding and severe disabling pain, as well as other symptoms.  It requires surgery to be effectively managed, but has no cure and is associated with infertility
  • Adenomyosis – often considered the sister-disease of Endometriosis, it is where endometrial cells have implanted the muscle of the womb, causing heavy periods associated with flooding, contraction-type pain and problems with fertility
  • Polycystic Ovaries – technically an endocrine problem, it is a disease that causes irregular or absent periods, delayed or no ovulation and symptoms like hair loss, bad acne or abnormal hair growth
  • Early menopause – a problem in which the production of oestrogen stops prematurely, leading to a woman entering the menopause before the age of 40

There are some signs and symptoms that you should definitely see your doctor about.  These include painful sex, bleeding after sex, persistent bleeding or spotting, disabling period pain or heavy bleeding with flooding.

How Can Periods Be Managed?

The most common method of managing periods and some of the aforementioned symptoms is the use of contraceptives.  Contraceptives work by either suppressing ovary function and putting the body into a state of pregnancy using synthetic hormones.  

The combined contraceptive pill (which contains oesteogen and progesterone) and prevents the ovaries from releasing an egg, thus preventing pregnancy.  It also thickens the lining of the womb to prevent sperm from reaching an egg and implantation from happening.  It is taken for 21 days and then a 7 day break in which the lack of hormones create a bleed.  

The progesterone-only pill contains, as the name suggests, only progesterone, and has to be taken everyday to be effective.  The synthetic progesterone thickens the womb, preventing sperm from reaching an egg.  It may or may not effect the number of periods you have.

The implant is inserted under the skin of you arm and releases a synthetic version of progesterone.  It can be used for 3 years at a time, and doesn’t reply on needing to take it everyday.  With the implant, you may find your periods stop. 

The coil comes in two types – hormonal and copper.  The hormonal coil (also known as the Mirena or IUD – intrauterine device) is inserted into the vagina and sits at the base of the womb.  The hormonal coil, like the implant, secretes progesterone, thickening cervical mucus making it harder for sperm to reach an egg.  It can be left inside for upto 5 years and again, you may find your periods stop.  The copper coil, on the other hand,  contains no hormones at all – the copper has an affect on the cervical mucus in a similar way to progesterone. 

This is not the definite list of contraceptives – other methods include injections that put the body into a menopausal state, use of female diaphragms and of course condoms.  

There are other ways too for those with troublesome periods, including surgical interventions, such as endometrial ablations- where the uterus lining is burnt away by laser – or radical interventions like hysterectomies. l

The Menopause

Usually around the age of 40, our periods become lighter and may become less frequent, indicating that we might be going through “the change”.  When going through the menopause, we are ultimately no longer fertile as our body does not produce any more eggs.  And much like our monthlys, the menopause comes with it’s own side effects of hot sweats, bone thinning and hair loss. 

Although periods are often perceived as a nuisance or even gross, learning about their ins and outs has actually highlighted that the bleeding is only a small part.  Once you get your head around what is going on inside our reproductive organs,  we can actually understand what our symptoms or problems may mean. 

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