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technology 25 Nov 2019

Menstrual cycle: What’s normal, what’s not?

By Dr.Walter Odongo, Pharmacist

Member, Pharmaceutical Society of Kenya (MPSK)

Your menstrual cycle can say a lot about your health. Understand how to start tracking your menstrual cycle and what to do about irregularities.

Tracking your menstrual cycles can help you understand what’s normal for you, time ovulation and identify important changes — such as a missed period or unpredictable menstrual bleeding. While menstrual cycle irregularities usually aren’t serious, sometimes they can signal health problems.

 What’s the menstrual cycle?

“The menstrual cycle is the time from the first day of a woman’s period to the day before her next period.”

It is the monthly series of changes a woman’s body goes through in preparation for the possibility of pregnancy. Each month, one of the ovaries releases an egg — a process called ovulation. At the same time, hormonal changes prepare the uterus for pregnancy. If ovulation takes place and the egg isn’t fertilized, the lining of the uterus sheds through the vagina. This is a menstrual period.

 What happens during the menstrual cycle?

The menstrual cycle is controlled by hormones. In each cycle, rising levels of the hormone oestrogen cause the ovary to develop and release an egg (ovulation). The womb lining also starts to thicken.

In the second half of the cycle, the hormone progesterone helps the womb to prepare for implantation of a developing embryo.

The egg travels down the fallopian tubes. If pregnancy doesn’t occur, the egg is reabsorbed into the body. Levels of oestrogen and progesterone fall, and the womb lining comes away and leaves the body as a period (the menstrual flow).

The time from the release of an egg to the start of a period is around 10 to 16 days.

What are periods?

A period is made up of blood and the womb lining. The first day of a woman’s period is day 1 of the menstrual cycle.

“Periods last around 2 to 7 days, and women lose about 3 to 5 tablespoons of blood in a period.”

Some women bleed more heavily than this, but help is available if heavy periods are a problem.

What’s normal?

The menstrual cycle, which is counted from the first day of one period to the first day of the next, isn’t the same for every woman. Menstrual flow might occur every 21 to 35 days and last two to seven days. For the first few years after menstruation begins, long cycles are common. However, menstrual cycles tend to shorten and become more regular as you age.

Your menstrual cycle might be regular — about the same length every month — or somewhat irregular, and your period might be light or heavy, painful or pain-free, long or short, and still be considered normal. Within a broad range, “normal” is what’s normal for you.

Keep in mind that use of certain types of contraception, such as extended-cycle birth control pills and intrauterine devices (IUDs), will alter your menstrual cycle. Talk to your health care provider about what to expect.

When you get close to menopause, your cycle might become irregular again. However, because the risk of uterine cancer increases as you age, discuss any irregular bleeding around menopause with your health care provider.

How can I track my menstrual cycle?

To find out what’s normal for you, start keeping a record of your menstrual cycle on a calendar. Begin by tracking your start date every month for several months in a row to identify the regularity of your periods.

If you’re concerned about your periods, then also make note of the following every month:

(a) End date. How long does your period typically last? Is it longer or shorter than usual?

(b) Flow. Record the heaviness of your flow. Does it seem lighter or heavier than usual? How often do you need to change your sanitary protection? Have you passed any blood clots?

(c) Abnormal bleeding. Are you bleeding in between periods?

Pain. Describe any pain associated with your period. Does the pain feel worse than usual?

(d) Other changes. Have you experienced any changes in mood or behavior? Did anything new happen around the time of change in your periods?

What causes menstrual cycle irregularities?

Menstrual cycle irregularities can have many different causes, including:

(a) Pregnancy or breast-feeding. A missed period can be an early sign of pregnancy. Breast-feeding typically delays the return of menstruation after pregnancy.

(b) Eating disorders, extreme weight loss or excessive exercising. Eating disorders — such as anorexia nervosa — extreme weight loss and increased physical activity can disrupt menstruation.

(c) Polycystic ovary syndrome (PCOS). Women with this common endocrine system disorder may have irregular periods as well as enlarged ovaries that contain small collections of fluid — called follicles — located in each ovary as seen during an ultrasound exam.

(d) Premature ovarian failure. Premature ovarian failure refers to the loss of normal ovarian function before age 40. Women who have premature ovarian failure — also known as primary ovarian insufficiency — might have irregular or occasional periods for years.

(e) Pelvic inflammatory disease (PID). This infection of the reproductive organs can cause irregular menstrual bleeding.

(f) Uterine fibroids. Uterine fibroids are noncancerous growths of the uterus. They can cause heavy menstrual periods and prolonged menstrual periods.

What can I do to prevent menstrual irregularities?

For some women, use of birth control pills can help regulate menstrual cycles. Treatment for any underlying problems, such as an eating disorder, also might help. However, some menstrual irregularities can’t be prevented.

In addition, consult your health care provider if:

>Your periods suddenly stop for more than 90 days — and you’re not pregnant

>Your periods become erratic after having been regular

>You bleed for more than seven days

>You bleed more heavily than usual or soak through more than one pad or tampon every hour or two

>Your periods are less than 21 days or more than 35 days apart

>You bleed between periods

>You develop severe pain during your period

>You suddenly get a fever and feel sick after using tampons

If you have questions or concerns about your menstrual cycle, talk to your health care provider.

 What happens during ovulation?

Ovulation is the release of an egg from the ovaries. A woman is born with all her eggs.

Once she starts her periods, 1 egg develops and is released during each menstrual cycle. After ovulation, the egg lives for 24 hours.

Pregnancy happens if a man’s sperm meet and fertilise the egg. Sperm can survive in the fallopian tubes for up to 7 days after sex.

Occasionally, more than 1 egg is released during ovulation. If more than 1 egg is fertilised it can lead to a multiple pregnancy, such as twins.

A woman can’t get pregnant if ovulation doesn’t occur. Some methods of hormonal contraception – such as the combined pill, the contraceptive patch and the contraceptive injection – work by stopping ovulation.

 When are you most fertile?

“Theoretically, there’s only a short time when women can get pregnant, and that is the time around ovulation.”

It’s difficult to pinpoint exactly when ovulation happens but in most women, it happens around 10 to 16 days before the next period.

“It’s not accurate to say that all women are fertile on day 14 of the menstrual cycle.”

This might be true for women who have a regular, 28-day cycle, but it won’t apply to women whose cycles are shorter or longer.