There are many ‘taboo’ health topics out there, and I think menstruation is right up at the top of that list. Although a very natural part of being a woman, it’s a stage in our development as females that many feel embarrassed to talk about, both in Ireland and abroad. Why is that? Several reasons I’m sure, but a big factor in my opinion is, similar to the stigma around sexual health, that it feels for many like an ‘unclean’ thing to talk about. As one of my favourite authors Elizabeth Day says, ‘we live in an age of curated perfection’ – scrolling through social media can make it seem like everyone has their shizz fully together, in perfect physical and mental health, when in fact, we are all perfectly imperfect! The main issue with the stigmatisation of health topics (whether its menstruation and reproductive health, mental health or sexual health – the three areas with the most taboo I think) is that it often leads to people suffering unnecessarily and cruelly in silence, and also distorts what society views as ‘normal’, leading to people feeling that anything they experience which is out of the ordinary is therefore abnormal and to be hidden away. That is why discussing these topics, through my writing and Podcasting, is central to my content – to start these conversations and help people remember that we are all unique individuals with unique life experiences.
Periods (i.e. ‘menstruation’) affect women for most of their teenage and adult lives, and in the typical scenario, they disrupt our lives once per month – that’s a pretty regular occurrence I think you’d agree! So why do so many of us hide such a frequent experience away? In this post, I aim to break down the basics of menstruation to help you understand the process of what goes on in your body, and hopefully help you realise what a healthy menstrual cycle looks like, and when help from your doctor might be needed. Us ladies are pretty darn lucky to have our period as a vital sign of our reproductive and overall health, and just like we’re aware of our heartbeat, we should be aware of the ins and outs of our period too. I’ve kept this article to the absolute basics, because it’s a vast topic and I want to leave you with key take home points. Hopefully it will be a topic that I can expand on in the blog and Podcast further in the future. Please note, I haven’t gone into specifics about contraceptive methods and how they affect the menstrual cycle – it’s a whole other blog post so leave that with me for now!
There is a fantastic menstruation app called FitrWoman, which not only helps you track your period through the four phases (which I will discuss below), it also provides insights into how your period interacts (i.e. affects, and is affected by) with your training, food intake and nutrition. I use it, and love it – it’s so informative, teaches you a LOT about your cycle, and also provides recipe ideas for each phase too, based on the science of hormone fluctuations during menstruation. I’m really excited to be joining the FitrWoman team of Brand Champions soon, and can’t wait to help spread the message of healthy menstruation to you guys!
SO. What is a period?!
First of all I want to start by saying in females the reproductive system consists of: the ovaries, the Fallopian tubes (which connect the ovaries to the uterus (i.e. the womb)), the uterus, the vagina and the vulva. Between the onset of puberty and menopause, in the scenario of a healthy female, the body prepares for a possible pregnancy through a hormone-driven process that results in a number of internal changes – this is the menstrual cycle. A period occurs each month as part of the menstrual cycle, and is the loss of blood from the vagina – this blood is the lining of the uterus, which is shed when fertilisation of an egg in the uterus does not occur. The menstrual cycle, on average, lasts anywhere from 21 to 35 days depending on the person, although the most commonly cited approximate length is 28 days.
There’s 4 phases to the menstrual cycle that we should be aware of, and simply put, it runs from the onset of bleeding (i.e. menstruation) all the way through to when bleeding begins again. You may have seen these 4 phases named differently, but I liked the categorisation in an article on the FitrWoman blog which focused on female physiology (check it out in full here – here).
- Phase 1: This is menstruation; shedding the lining of your uterus i.e. when you are having your period.
- Phase 2: This starts after menstruation and ends when ovulation (i.e. the release of an egg) occurs.
- Phase 3: This phase includes ovulation (i.e. when the ovary releases a mature egg) and the time until phase 4 (the pre-menstrual phase).
- Phase 4: During this phase, the released egg becomes something called the corpus luteum, a structure which releases hormones (mostly progesterone and some oestrogen), the function of which is to keep the lining of the womb thick, ready for the possibility that the egg will be fertilised and implant there. This is the phase in which women may experience premenstrual symptoms. Following this, we’re back to phase 1 (i.e. menstruation) if fertilisation does not occur as we’ve said above.
You may have seen the menstrual cycle more simply categorised into two phases – follicular, and luteal. Essentially, as you’ll see in the diagram below, the follicular phase includes phases 1 and 2 above, and the luteal phases includes phases 3 and 4.
As I mentioned earlier, the menstrual cycle is a hormone-driven process. Which hormones, I hear you ask?
Good question. In your brain, you have a region called the hypothalamus, which produces something called GnRH (gonadotropin-releasing hormone), which acts on your pituitary gland in your brain – this has an anterior (front) and a posterior (back) part. During the follicular phase of the menstrual cycle, with the action of GnRH, the anterior part of the pituitary produces a hormone called FSH (follicle-stimulating hormone), which stimulates the ovary to release several follicles, all of which contain an immature egg, one of which usually matures, and causes a big rise in oestrogen which stimulates thickening of the lining of the uterus. The rising oestrogen level also stimulates the pituitary to release a hormone called LH (luteinising hormone), which peaks mid-cycle and triggers the release of the mature egg from its follicle, which then moves down the Fallopian tube to the uterus (located so that it may be fertilised by sperm from a male during sexual intercourse). This phase usually lasts about 24 hours, and is the time when a woman is most likely to become pregnant. In the final part of the luteal phase, the corpus luteum maintains a level of oestrogen and higher levels of progesterone as mentioned above, the function of which is to thicken the lining of the womb. Finally, if a women doesn’t get pregnant. the corpus luteum shrinks away, and the thickened lining of the uterus is shed as the period.
Below you’ll see a great graphic representation of how your hormones fluctuate throughout the menstrual cycle. Photo/graph credit is to the FitrWoman website:
As you can see, oestrogen rises during phase 2 when it reaches a peak just before ovulation – it’s main role in the cycle is to initiate this process. Then, it drops post-ovulation, and rises again afterwards before falling again in Phase 4. Post-ovulation, it is acting to stimulate the growth of an egg in the womb, and maintain the lining of the womb.
Progesterone, on the other hand, remains low until after ovulation, rises to a peak in Phase 3, and falling again in Phase 4. It’s main action in the menstrual cycle is to maintain the lining of the womb, preparing it for a possible pregnancy. When it falls in Phase 4, if pregnancy hasn’t occurred, this loss of progesterone triggers menstruation via the shedding of the thickened womb lining.
So. What are some signs to look out for of an abnormal menstrual cycle?
This is a very important question to finish with, as although a normal menstrual cycle looks slightly different for every women, there are abnormal red flags that every women should be aware of for their menstrual cycle. I’ve listed these in bullet points below, and please note, they are all flags that every woman should note as being signs of a need to get checked out – with your general practitioner or family doctor. Many different aspects of our health and lifestyle can affect the menstrual cycle, and it’s important not to ignore the signs that our menstrual cycle can tell us! Let’s look at this list:
- Irregularity of periods (i.e. not occurring at roughly the same time each month)
- Infrequent or excessively frequent periods (i.e. occurring less often than every 21 days or more often than every 35 days)
- ABSENT periods – this one is especially important. Primary amenorrhoea means periods never started at all, while secondary amenorrhoea means they did start, but then disappeared. For primary amenorrhoea, generally periods may start between the age of 8 and 16 years, and continue until menopause (age 45-55 usually) (Health Service Executive, 2019). So for a young woman, it’s 100% advised to take a trip to the GP if periods have not begun by the age of 16. For secondary amenorrhoea, if periods disappear, this definitely needs to be checked out too. It is not normal to not have a period.
- Excessively or disruptively heavy periods – Heavy or prolonged, termed menorrhagia, can be very tricky to manage. The amount of blood lost during menstruation varies from woman to woman, but if you find your periods are heavy enough to disrupt your day to day activities (e.g. leaking through clothes or double sanitary protection, soaking through one or more sanitary pads or tampons every hour for several consecutive hours, bleeding for longer than a week or passing large blood clots) it is worth popping to see your GP.
- Painful periods (dysmenorrhoea) – Although pain and discomfort can be part of pre-menstrual syndrome (PMS – see below), that which significantly affects a woman’s ability to function day to day should be checked out.
- Bleeding between periods (intermenstrual bleeding) – While this can be a normal occurrence (e.g. in the early stages of starting a new contraceptive), it can be a sign of something more serious, but the differential here is wide-ranging and it’s not helpful for me to list off minor and serious possibilities! Instead, suffice it to say that if you are experiencing bleeding between periods and you are concerned, it’s important to make a trip to your GP to get it checked out. The UK NHS has a great webpage on intermenstrual bleeding here.
Finally, a note on PMS – pre-menstrual syndrome. The Health Service Executive in Ireland define PMS in an nicely put manner – ‘the physical, psychological and behavioural symptoms that can occur in the two weeks before a woman’s monthly period.’ PMS symptoms typically include fluid retention, breast tenderness, mood swings, feeling irritable, and loss of interest in sex, although this is not an exhaustive list. The symptoms usually improve when the period starts, and disappear a little while after. These symptoms can, for some women, be particularly tough to manage and severe – this is known as premenstrual dysphoric disorder (PMDD) (HSE, 2019). Both PMDD and PMS significantly adversely affecting a woman’s day to day life are cause to seek help and advice from a doctor, so don’t be shy about doing so!
And that’s a wrap gang! This post was all about the basics, and I hope it has been both helpful and informative for you ladies – and guys too! As always, you know where to find me – @theirishbalance on Instagram/Twitter/Facebook! If you would like to see follow up articles on this topic let me know – I’m looking forward to collaborating with FitrWoman in the future to bring you more insights on menstruation.
Ciara 🙂 x