Menstruation, what is commonly referred to as a ‘period’ is the discharge of blood and tissue from the inner lining of the uterus (called the endometrium) which breaks down if pregnancy does not take place. This discharge of blood lasts on average of 3-5 days and is commonly a painful process. At puberty, young girls usually experience their first period (known as menarche) around the ages of 12 to 15 years, although menarche can begin as early as 8 years of age in some cases. From this point onwards, women will experience a monthly period until they reach menopause between the age of 45 to 55 years of age. The only time when a period naturally stops during the reproductive years is during pregnancy, usually while breastfeeding and after menopause. Other common reasons for not having periods include after having a hysterectomy or when it’s purposefully supressed with hormones, and some contraceptives. Interestingly, under severe stress, the menstrual cycle may be supressed and the monthly period can stop temporarily. The absence of a period under any other circumstances than those mentioned may be a sign of a medical condition and needs to be checked by a medical professional.
The menstrual cycle is measured from the first day of the period until the next period starts. This time varies from person to person, but on average the cycle repeats itself every 28 days, although changes in cycle length of up to 4 days is quite common. Cycle length variability is common in younger women (less than 25 years) but especially common just after menarche and when women draw closer to menopause (40-44 years).
The simplest way to understand what takes place each month in a women’s reproductive cycle is to refer to those two important organs we already mentioned, i.e. the ovaries and the uterus. We will try to explain the process using two different cycles which take place in these organs simultaneously each month.
The ovarian cycle
The ovarian cycle describes the changes which take place in the follicles (eggs) and the ovary during the menstrual cycle and consists of three phases:
- Follicular phase (days 1-13) During the follicular phase, a rise in a messenger hormone from the brain called FSH (follicle stimulating hormone) early in the new menstrual cycle stimulates the ripening of one of the follicles in the ovary. As the follicle containing an egg matures, high levels of oestrogen is produced which helps the egg to mature further and, at the same time, preparing the uterus lining for possible pregnancy.<\li>
- Ovulation phase (day 14) The process of ovulation takes place in the middle of the menstrual cycle when another hormone from the brain called LH (luteinising hormone) suddenly rises around day 12 of the cycle. This surge in LH triggers the ovulation process 24-36 hours later on day 14. Ovulation is when the mature, ripe follicle ruptures and releases an egg (oocyte) into the woman’s pelvis, and is then taken up by one of the fallopian tubes. The remaining parts of the follicle are not discarded but go on to form what is known as the corpus luteum (think of the corpus luteum as the egg shell). Occasionally woman can feel a type of pain when they ovulate, this is called ‘mittelschmerz’ (German for ‘middle pain’). Women are most fertile around 5 days before ovulation and for 1-2 days after ovulation takes place. There are various methods to calculate fertility. Simple calculation when ovulation is likely (the calendar method) is useful, however fertility test kits typically measure the LH surge which takes place 24-36 hours before ovulation and are useful to determine when to try and conceive. The released egg remains viable for around 24 hours if not fertilised. This is a critical window period at which contact with the male sperm is imperative for fertilisation to take place. If not fertilised, the egg disintegrates in the fallopian tube. If a viable egg encounters the male sperm cell (spermatozoon), fertilisation takes place. This usually occurs in the fallopian tube and an embryo is formed. The embryo then travels down the tube and reaches the uterus after roughly 3 days, where implantation into the uterus takes a further three days to occur.
- Luteal phase (days 15 – 28) After ovulation, in this final phase the remaining parts of the follicle transforms into the corpus luteum which itself produces progesterone. Around 10 days later , FSH and LH levels drop and, in response to the corpus luteum, degenerates resulting in a sudden drop in progesterone. This sudden drop in progesterone causes the next period to take place, resulting in the end of the cycle.
If an egg is fertilized, however, it releases a hormone called hCG which preserves the corpus luteum throughout the pregnancy which continues producing progesterone. Interestingly, this hCG hormone is what pregnancy tests look for when confirming the presence of pregnancy.
The common condition known as PMS/PMT (premenstrual syndrome/tension) typically occurs during this phase of the ovarian cycle and affects around 80% of women.
The uterine cycle
The uterine cycle describes the changes which take place in the uterus during the menstrual cycle and it runs in parallel with the ovarian cycle. There are also three phases to this:
- Proliferative (growing) phase (+- day 5 – day 14) Because of all the oestrogen produced by the maturing follicle in the ovary, the inner lining of the uterus (called endometrium) starts to grow, thicken and get ready in case a pregnancy takes place by increasing its blood supply and making it nutrient rich. Interestingly, it is the maturing follicle itself which produces this oestrogen influencing the respective changes in the uterus, essentially preparing a suitable home for itself ahead of time if it becomes fertilized. The oestrogen also stimulates cervical mucus which promotes conception.
- Secretory phase (day 14-28) At this stage progesterone levels are high. Produced by the corpus luteum, progesterone plays a major role in preparing the endometrium for possible pregnancy. It further increases blood flow to the endometrium, promotes uterine secretions and prevents the uterine muscle from contracting (you don’t want that to happen now!).
- Menstruation (day 1-5) The return and flow of the period (menses) usually signifies that a woman is not pregnant, i.e. the egg wasn’t fertilised, and progesterone levels have dropped. At this stage the thick, nutrient dense endometrial layer of the uterus, since it’s not needed, breaks away and is discharged via the vagina. The onset of menstruation is considered Day 1 of the menstrual cycle, and bleeding typically lasts 3-5 days with the average amount of blood lost being 35ml (10ml – 80ml max). Excessive bleeding is called menorrhagia, and if this takes place regularly, the woman may be at risk of anaemia. Pain during menstruation is common, especially on Day 1 and 2. This is typically described as cramping in the abdomen, with back pain and even pain in the upper thighs. Excessive pain is known as dysmenorrhoea and is common in young women.
Common conditions affecting menstruation and the menstrual cycle
Given how complex the menstrual cycle is and how many different factors are involved with regulating it, there are a number of ways in which things can go wrong. We will summarise some common conditions and medical terminology here:
|Common medical terminology relating to abdominal menstruation
|Vaginal bleeding which takes place between expected periods.
|Infrequent periods i.e. cycle lengths greater than 35 days from one to the next.
|Frequent periods i.e. cycle lengths less than 21 days from one to the other.
|Absence of menstrual periods in a woman still in her reproductive years.
|Irregular cycle length when ovulation does not occur, there is no luteal phase and no progesterone production by the corpus luteum.
|Very heavy periods (during normal cycle) – a form of ‘abdominal uterine bleeding’.
|Abdominal painful periods.
These are all conditions which should be ideally assessed by a medical practitioner or gynaecologist. In the absence of any major pathology, there are a variety of gently regulating remedies one can use which help the body to re-establish balance:
A.Vogel Menstruation Formula is a homeopathic medicine which assists with the treatment of painful, irregular or heavy periods, abnormal menstrual flow, premenstrual tension and menstrual cycle irregularities.
It can be used in two ways:
- For symptomatic relief during the premenstrual (luteal phase) phase for PMS and during the menstrual period itself for pain, discomfort, and abnormal flow – 10 drops 4 times daily.
- To assist in regulating the menstrual cycle (irregular cycles) – 10 drops twice daily for 3 menstrual cycles or 90 days. In women who are perimenopausal and experiencing menstrual irregularity associated with change of life, consider adding: A.Vogel Menstruation Formula.