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Menstrual cycle
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Menstrual cycle 

Overview of Menstrual cycle

The process by which a woman’s body gets ready for the chance of a pregnancy every month is known as menstrual cycle. Every month the body prepares itself for a potential pregnancy. However, if this pregnancy fails to occur, the inner lining of the uterus shreds down. This shedding down of the inner lining is known as menstruation. The menstrual blood comprises partly of blood and partly the tissue from inside the uterus. The menstrual blood passes out of the body through the vagina.

The fertile period in a woman starts at the menarche (first menstrual period), which usually occurs around the age of 12 and ends with the menopause, which occurs around the age of 51. The fertile period is divided in cycles of 28 to 35 days in length. These cycles are separated by menstruation and are known as menstrual cycle.


What Happens During the Menstrual Cycle?

During the first half of the menstrual cycle, the level of female hormone or estrogen increases. The increased level of estrogen makes the inner lining of the uterus thicker and stronger. Through this process the body readies the uterus to bear the embryo if pregnancy occurs. During this period, the egg or ovum starts to mature. Around the 14th day of the average 28 day cycle, ovulation occurs and the egg leaves the ovary. A woman has more chances of getting pregnant during the three days before as well as on the day of ovulation.

After leaving the ovary, the egg travels through the fallopian tube to the uterus. The woman becomes pregnant if this egg is fertilized by a man’s sperm cell. Under such circumstances, the fertilized egg attaches to the uterine wall. In case, if the egg is not fertilized it breaks down. Thereafter, the hormone level drop and the thickened lining of the uterus sheds down resulting in menstruation flow.  

The menstrual cycle can be divided into two parts, namely, the ovarian cycle and the uterine cycle.

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Ovarian Cycle

The period during which the changes in the ovaries occur is known as ovarian cycle. This cycle is again divided into two parts, namely, Phase 1 and Phase 2. 
 
Phase 1 starts from the first day of the menstruation and last till ovulation which marks the release of a matured egg from the ovary. This phase is also known as the follicular phase as the egg matures within the follicle. Ovulation occurs roughly on the 14th day of the menstruation cycle due to the surge of luteinizing hormone (LH). The first stage usually lasts for 14 days but may vary from person to person lasting anywhere from seven days to 40 days.

Phase 2 starts with the release of the egg till the first day of the next menstruation cycle. This phase is also known as luteal phase and it last for 12 to 16 days. 

 
Uterine Cycle

The uterine cycle occurs simultaneously with the ovarian cycle. It signifies the changes that involve the uterus. This phase is again divided into two phases:
 
The proliferative phase is the time after menstruation and before the next ovulation. During this time the inner lining of the uterus thickens rapidly and the uterine glands multiply and grow.

The secretory phase is the time after ovulation. In case if the egg is not fertilized the levels of estrogen and progesterone (hormone) drop significantly. Thereafter, the thickened uterine lining is shed. This shedding of the uterine lining is known as menses or period.

 

Irregular menstrual cycle

At times women may not get periods, get periods too often, have unpredictable menstrual bleeding, or have painful periods. Such problems in the menstrual cycle are referred to as menstrual irregularities or menstrual problems.

When pregnancy is not the cause of such irregularities, it indicates the presence of a larger condition or problem.   

The several types of menstrual cycle problems are listed below:

Amenorrhea
Amenorrhea is a condition during which a woman does not get her period by the age of 16, or she stops getting her period for at least three months and is not pregnant.

Amenorrhea itself is not a disease but a symptom of another condition. The different causes of amenorrhea are moderate or excessive exercising, eating disorders like anorexia nervosa, physical or psychological stress, tumors, and hormonal problems. Amenorrhea also occurs in women with polycystic ovary syndrome (PCOS). The treatment of amenorrhea depends on the underlying cause. Sometimes lifestyle changes can help in treating amenorrhea caused by weight, stress, or extreme physical activity. Sometimes, medications as well as oral contraceptives are used for the treatment of amenorrhea.

Oligomenorrhea
Oligomenorrhea is a condition during which a woman gets infrequent and irregular menstrual periods. Oligomenorrhea itself is not a disease, but a symptom of a larger condition. Sometimes polycystic ovary syndrome (PCOS) causes oligomenorrhea.

Premature Ovarian Failure (POF)
POF is a condition during which the normal functioning of the ovaries stops in a woman younger than the age of 40. Women suffering from POF may not have periods or may get them irregularly. However, there is no guaranteed treatment for this condition. At times, estrogen replacement therapy (ERT) or administration of other hormones can help women have regular periods and lower their risk for osteoporosis.

Uterine Fibroids
Uterine fibroids are the most common, non-cancerous tumours in women. It occurs mainly during the child bearing age. The presence of fibroids does not affect fertility and most women with uterine fibroids may get pregnant when desired. However, in some cases, the presence of uterine fibroids may prevent a woman from becoming pregnant naturally. 

This situation seldom manifests any symptoms and seldom requires any treatment. However, some women with fibroids have heavy menstrual periods. They may even bleed in between periods.    Medications are usually used to provide relief from many of the symptoms of fibroids like pain. At times the medications are also effective at slowing or stopping the growth of the fibroids. Moreover, there are several types of surgery that can be used to remove the fibroids.

Endometriosis 
The condition of unusual growth of tissues outside a woman's uterus is known as Endometriosis. These tissues are supposed to grow inside the uterus. Endometriosis may cause pain before and during the first few days of the menstrual period. Almost 30 – 50 % women suffering from endometriosis are infertile. It is one of the top three causes of infertility in a woman. These women usually encounter very heavy and painful periods. The pain can be treated through pain medication, hormone therapy and surgery. Infertility associated with endometriosis is treated through in vitro fertilization. The other lines of treatment are hormone therapy and surgery.

Dysmenorrhea
Dysmenorrhea is the condition during which a woman suffers from very painful periods with severe menstrual cramps. This condition at times is caused by infection, endometriosis, or ovarian cysts.

Relief from Dysmenorrhea can be obtained by using heating pads or taking a warm bath. Over-the-counter pain relievers can also be helpful.

 

When to consult a health care provider

  • If menstruation does not start by the age of 15.
  • If menstruation does not start within 3 years of breast development or if breast development does not start by the age of 13.
  • If period suddenly stops for more than 90 days.
  • If periods become very irregular after having had regular, monthly cycles.
  • If period occurs more often than every 21 days or less often than every 35 days.
  • If it bleeds for more than 7 days.
  • If bleeding is very heavy.
  • If bleeding occurs between periods.
  • Occurrence of severe pain during periods.
  • Onset of fever after using tampons.
 

Personal Care during menstruation

During periods, a lot many products like pads, panty liners, or tampons can be used to soak up the menstrual flow. Some use tampons for heavy flow and pads/panty liners for lighter flows.

Pads 
Pads are worn inside the underwear to absorb the menstrual flow. Pads are available in different sizes, styles, and thicknesses. Some pads have special features like "wings" that fold the underwear to provide better protection. Some pads are extra-thick to absorb heavy flows while others contain deodorant.

Pads should be chosen on the basis of body size, the amount of flow, and comfort level. 

Panty Liners 
Panty liners are thinner and shorter than pads. Panty liners are used on days when the flow is light. It is specially used during the last days of the period. Some use panty liners with tampons for extra protection.

Tampons 
Tampons are worn inside the vagina to absorb the menstrual flow as it leaves the body. Tampons usually come with plastic or cardboard applicators that are used to slide the tampon into the vagina. The tampon comes with a short string attached at the end of it. This string hangs out of the vagina and is later used remove it.

Tampons are also available in different sizes with different absorbing capacities. It should be changed after every 4 to 6 hours. At the beginning of the period, the tampon should be changed more often as the flow is heavy during those days.

 

Menstrual cycle chart

The basic biological timing is based on an average 29 day cycle. The first day of bleeding is referred to as Day 1 of the menstrual cycle. The length of the cycle is measured from Day 1 of one cycle to Day 1 of the next cycle.

When the egg is released, ovulation occurs. Usually, ovulation occurs 14 days before the onset of the next bleed. As a result, for different cycle lengths, ovulation occurs at different times. Moreover, at times sickness or stress may delay the onset of ovulation. The window of fertility starts a few days before ovulation. During this time the cervical mucus starts to turn wetter and more profuse.

The graphical representation of this cycle is known as menstrual cycle chart. It is used for the rough calculation of the date of ovulation and the window of fertility.

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Written by: Healthplus24 team
Date last updated: September 10, 2012

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