A Woman’s Period
A period is the part of a woman’s monthly menstrual cycle when a woman bleeds from her vagina for a few days. In most women this occurs every 28 days or so, some women have a cycle slightly shorter or longer than this and can vary between 24 to 35 days.
Most girls have their first period during shortly following puberty. The average age for puberty has been falling across the Western world, but for most girls the average puberty begins between the ages of 8 and 14, with 11 years of age now the average. The first period is called the menarche.
A woman's period continues through to menopause, typically this occurs when a woman reaches her late 40s to mid-50s with the average age being 51.
The menstrual cycle
Each menstrual cycle starts on the first day of your period (day one) and lasts until the day before your next period commences.
The reproductive organs inside a woman's body consist of:
- two ovaries – where eggs are stored, developed and released.
- the womb (uterus) – where a fertilised egg implants and a pregnancy develops.
- fallopian tubes – the two narrow tubes that connect the ovaries to the womb
- the cervix – the lower part of the womb that connects to the vagina
- the vagina – a muscular tube leading from the cervix to outside the body
During each menstrual cycle, levels of the hormone oestrogen rise as an egg develops and is released by the ovary, called ovulation. A woman’s womb lining thickens in preparation for a possible pregnancy. The egg when released travels down the fallopian tube and if it meets a sperm, is fertilized and a pregnancy can occur at this time.
The egg lives for approximately 24 hours and if sperm doesn’t fertilize it, it will be absorbed into your body. The lining of your womb will come away and leave your body through the vagina mixed with blood - tis is a period or the menstrual flow or menses.
Pinpointing when a woman is most fertile is difficult, though it’s around the time of ovulation, which is approximately12 to 14 days before the start of the next period in most women. A woman cannot become pregnant if ovulation does not occur. It is also worth knowing that sperm can survive inside a woman's body for days before ovulation occurs.
There are various forms of hormonal contraception that all rely on preventing ovulation including the pill, patch and injections.
A woman’s body produces different amounts of hormones at different times during the menstrual cycle. These changes in hormones can cause body changes as well as effect emotions.
For example, vaginal secretions change throughout the menstrual cycle and around the time of ovulation they become thinner and stretchy, a bit like raw egg white, this is to allow sperm to swim up to the womb.
During this time you may also experience mood swings in the days leading into your period and your breasts may become swollen and painful.
Premenstrual syndrome (PMS) describes the physical, psychological and behavioural symptoms that can occur in the two weeks before your monthly period, this can also be known as premenstrual tension (PMT).
Symptoms associated with periods
During your period a woman will bleed from their vagina for anywhere between 3 and 8 days with the average being approximately 5 days, with bleeding heaviest in the first two days.
Blood loss during a period depends on how heavy it is. It is usually about 30 to 72 milliliters (or about 5 to 12 teaspoons), although some women can bleed more heavily than this. When a period is at its heaviest, the blood tends to be red, while on lighter days, it may be pink, brown or black.
To deal with bleeding you can use a sanitary towel or tampon and for heavier bleeding use one with a higher absorbency. There are also a number of medications to help reduce bleeding. For example, the levonorgestrel-releasing intrauterine system (LNG-IUS) is a small plastic device that's inserted into your womb and releases a hormone called progestogen. It prevents the womb lining growing so quickly. Alternatively, tranexamic acid tablets work by helping the blood in your womb clot. To learn more or understand if any of these solutions are right for you please discuss this with your doctor.
Before your period
Changing levels of hormones in your body before your period can cause physical and emotional changes as previously mentioned. You may also experience pain or discomfort in your lower abdomen or back, which may last for some or all of your period.
If you are experiencing pain or discomfort, there are a number of self-help techniques such as using paracetamol, gentle exercise, massaging your lower abdomen, applying a heat pad or wheat bag or hot water bottle to your tummy.
If paracetamol or non-steroidal anti-inflammatory drugs do not provide sufficient pain relief, then your doctor may be able to prescribe stronger painkillers such as codeine or your local chemist may be able to recommend something also.
Premenstrual syndrome (PMS)
Premenstrual syndrome (PMS), also goes by the name of premenstrual tension (PMT). It covers the physical, psychological and emotional symptoms that can occur in the days leading into a woman's period.
However, it doesn't affect every woman who has a period. Women can be impacted differently and to varying degrees.
There are many possible symptoms of PMS with some of the most common being:
- fluid retention and feeling bloated
- tummy pain and discomfort
- changes to your skin and hair
- muscle and joint pain
- breast tenderness
- problems sleeping
- weight gain.
Common psychological symptoms of PMS can include:
- mood swings
- feeling upset or emotional
- feeling irritable or angry
- depressed mood
- crying and tearfulness
- difficulty concentrating
- confusion and forgetfulness
- decreased self-esteem
Symptoms such as fluid retention, feeling bloated, mood swings and irritability usually improve when your period starts and typically disappear completely once your period has ended.
Many women also experience period pain or dysmenorrhoea. It's usually experienced as muscle cramps in your lower tummy, which can sometimes spread to your back and thighs.
The pain may be experienced as intense spasms or it may be dull but more constant. It usually starts when the bleeding begins and lasts between 12 and 24 hours.
Changes in your periods
Periods can change some may last longer than others or get lighter. This doesn't mean there's a problem, but it does need to be looked into with the help of your doctor if it is occurring frequently or repetitively.
If you are experiencing bleeding between periods, bleeding after having sex or bleeding after having menopause you need to see your doctor for an immediate check up. It may be caused by and infection, abnormalities in the cervix, or in rare cases, it could be cancer. What it happens to be we highly recommend you make the time to see your doctor as soon as possible.
Finally, if you’ve miss a period and you've recently had sex, you could be pregnant, but if you haven’t had sex and you’ve missed 2 or 3 periods, we recommend seeing your doctor as soon as possible.
Sanitary towels, tampons and menstrual cups
Sanitary towels and tampons absorb blood released during your period.
Tampons need to be changed regularly. Doing so reduces the risk of toxic shock syndrome, a rare but very serious infection.
Menstrual cups are an alternative to tampons and sanitary towels. They're made of medical grade silicone and are worn inside the vagina. Menstrual cups collect menstrual fluid rather than absorbing it. Unlike sanitary towels and tampons, which are thrown away after use, menstrual cups can be re-used.
It is very common for women to experience some form of pain during their period which is also called dysmenorrhoea. There are two types of period pain, primary and secondary.
This is a common type of period pain experienced by teenagers and young women. There is no underlying condition. It is thought that natural chemicals are produced by the body called prostaglandins collect in the uterus lining. These chemicals help the uterus to shed the lining during a period by making the walls of the uterus contract. Women who experience period pain may have higher levels of prostaglandins, making the contractions feel painful.
Cramps are the most common symptom; with some women experiencing them in the days leading up to the commencement of their period.
This type of pain is caused by an underlying condition affecting the uterus and is typically experienced by woman over the age of 30. You may not be aware of any problems, but if you have noticed a change to your period pain (such as it feels more painful, or lasts longer than normal), you may have secondary dysmenorrhoea. Other signs may include bleeding between periods, pain during sex, irregular periods, or period like pain between periods. If you are experiencing any of these symptoms we highly recommend you see your local doctor as soon as possible.
Period pains are caused by menstruation, and most commonly cause a pain in the lower abdominal area. Sometimes this pain spreads towards the back and thigh areas. Pain may feel like sharp twinges or a constant dull pain, though different for all women, there are a number of symptoms that can be experienced:
- feeling faint
How long does it last?
Period pain varies although it is most common to experience period pain at the beginning, rather than during the middle or toward the end of your period. Others may be in pain for the duration of their period and possibly before it starts and a few days after, while many others do not experience little, if any pain at all. Most women find that their pains is worst when their bleeding is at its heaviest. While period pain can often ease with age, and a lot of women find period pains get better after they have given birth.
Heavy periods or menorrhagia is usually recognised through large or ‘heavy’ blood loss. If heavy blood loss persists we recommend you should see your doctor as they will want to investigate the possible causes, ruling out any condition which may negatively impact your well being.
Heavy blood loss month after month can lead to a loss of iron resulting in a condition called iron deficiency anarmia. The most common symptoms of anaemia can be:
- shortness of breath
- palpitations or an irregular heartbeat
Some may also experience:
- altered sense of taste
- ringing in their ears
- sore tongue.
Looking after yourself
- Make sure you change your tampon or sanitary towel at regular intervals. The recommended time frame is every four to eight hours for a tampon, and every four to five hours for a sanitary towel.
- Never leave a tampon in for longer than eight hours. You could try using a higher absorbency tampon and consider using sanitary towels as well.
- You may need to use more tampons or towels on the heavier days of your period. However, if you are changing your towel every one to two hours due to heavy blood loss we recommend seeing your doctor for advice.
You can sleep with a tampon or sanitary towel in place; but it should be changed immediately before bedtime and first thing in the morning. Keeping a tampon in place for longer than the recommended time frame increases your risk of toxic shock syndrome.
Drink plenty of water unless you have an existing medical condition which means this is not possible.
Your menstrual cycle begins on the first day of menstruation and continues up to but not including the first day of your next period. Cycles can range between 21 and 40 days, with the average at 28 days. A cycle can change in length from month to month with periods usually lasting between 3 and 8 days.
The absence of periods or amenorrhoea usually occurs because an egg is not produced in the ovaries. The most common causes of absent periods are:
- puberty hasn’t commenced
There are several other factors that may cause periods to stop or to become lighter or less frequent, such as:
- excessive exercise
- excessive weight or excessive dieting
- feeling upset or stressed
- severe long term illness
- a hormonal imbalance
- a thyroid disorder
- stopping or starting the contraceptive pill or other hormonal contraception
- some medication
- womb or ovaries disorder
Experiencing changes in the frequency or duration of periods is common in most women at some point in their lives and woman near menopause their period becomes more infrequent.
Absent periods in and of themselves aren't a cause for concern. However, sometimes an underlying medical condition can be responsible that will need to be investigated and if required, treated.
Some women will not have periods during pregnancy or while breastfeeding, and of course after menopause. Some types of contraception can also cause periods to temporarily stop from occurring.
However, not having a period (amenorrhoea) can be signal of some sort of medical condition that will require investigation by your doctor.
- Polycystic ovary syndrome (PCOS) – a condition where the ovaries don't regularly release an egg (ovulation).
- Hypothalamic amernorrhoea – where the part of the brain that regulates the menstrual cycle stops working properly; this is thought to be triggered by excessive exercise, excessive weight loss, or stress.
- Hyperprolactinaemia - where a person has abnormally high levels of a hormone called prolactin in their blood.
- Premature ovarian failure – where the ovaries stop working properly in women who haven't yet reached the age of natural menopause.
Treatment will vary based on the underlying issue and in some cases unfortunately, periods cannot be restored as is the case with premature ovarian failure.
In other instances, like polycystic ovary syndrome can often be controlled using hormonal treatments, while women with hypothalamic amenorrhoea will often start to have regular periods if they balance exercise with a healthy weight.
Often, a "wait and see" approach is sometimes taken just in case your period returns. This approach is most often used for girls who have yet to commence their periods and in most cases their periods start naturally by 18 years of age.
When to seek medical advice
See your doctor if you’re worried or if there is something not quite right with your periods. Always better to be safe than sorry.
It's not uncommon to stop having periods for a time, this is known as secondary amenorrhoea and it's estimated to affect around 1 in 25 women.
It's more common in teenage girls and younger women, particularly in certain groups such as professional athletes, dancers and gymnasts. Some girls don’t start their periods by the expected age (primary amenorrhoea), though this is much less common and is estimated to affect only 1 in every 300 girls.
Treating absent periods
Some treatments for absent periods are set out below.
Polycystic Ovary Syndrome
Polycystic ovary syndrome (PCOS) can be treated in a number of different ways, but hormone therapy is often recommended to restore a normal menstrual cycle. This will usually involve either taking the contraceptive pill or tablets containing a hormone called progesterone.
Hypothalamic amenorrhoea is the absence of periods caused by things such as extreme weight loss, excessive exercise, stress or a long-term health condition and is best treated by addressing the underlying cause. For example, symptoms caused by excessive weight loss may be best address by consulting with a dietitian who can advise you about safe ways to regain a healthy weight.
If the weight loss is the result of an eating disorder a psychologist or psychiatrist who has experience iwith patients who have eating disorders may be the best person to assist.
Alternatively, if symptoms are caused by excessive exercise, you'll be advised to reduce the levels of physical activity, many with professional athletes benefiting from seeing sports medicine specialists.
If symptoms are caused by stress, again a psychologist or psychiatrist may be able to assist by working with patients help you manage and change how they think and act.
If your symptoms are caused by a long-term health condition, treating the condition may help restore your period. For example, diabetes can sometimes interfere with monthly periods, so it’s best to make sure blood glucose levels are under control before and during your period.
Hyperprolactinaemia is where a person has abnormally high levels of a hormone called prolactin; treatment will depend on the underlying cause. For example, if hyperprolactinaemia is the result of a brain tumour, surgery, radiotherapy or chemotherapy may be required to remove or shrink the tumour.
Premature Ovarian Failure
Premature ovarian failure is where their ovaries stop producing eggs, even though they should still be young enough to ovulate and typically requires hormone medication. This may involve taking the contraceptive pill or having a hormone replacement therapy. These treatments can help reduce the risk of complications associated with premature ovarian failure, such as osteoporosis but may not necessarily restore periods.
Over and Underactive Thyroids
Treatment for an overactive thyroid may include thionamide medication, which assists in reducing thyroid activity, and a type of radiotherapy called radioiodine treatment, which can be used to reduce the size of the thyroid gland. While treatment for an underactive thyroid may include medication called levothyroxine that can help stimulate thyroid activity.
This is a where the cells lining the womb (endometrium) appear in other areas of the body, usually in the abdominal area, including the pelvis, ovaries and fallopian tubes. Period hormones cause the ovaries to release an egg and the womb lining to thicken. If the egg isn’t fertilised, the womb lining breaks down and bleeds, and leaves the body as a period. Endometriosis cells elsewhere in the body also break down and bleed, which causes inflammation, pain and scar tissue. Some women with endometriosis also have difficulty getting pregnant. Not all women have symptoms, but common symptoms can be
- painful, heavy or irregular periods
- pain during or after sex
- problems going to the bathroom
The only way to make a definite diagnosis is for a surgeon to look into your abdomen with a small camera. But there are a number iof treatment options including:
- hormone treatments such as progestogen
- hormonal contraceptive methods such as the contraceptive pill
- or drugs that can cause a temporary and reversible menopause
- In the most severe cases, surgery can be carried out to remove the endometriosis, the ovaries and womb.
Some women get a one-sided pain in their lower abdomen when they ovulate, this can also be known as mittelschmerz or "middle pain", meaning "pain in the middle of the month" and happens around 14 days before your period on the side of the ovary that’s releasing an egg. The pain can be a dull cramp or a sharp and sudden twinge. It can last just a few minutes or continue for a day or two. Some women notice a little vaginal bleeding when it occurs. However, if the discomfort persist please see your doctor. Birth control methods that stop ovulation, such as the contraceptive pill, implant or intrauterine system can completely eliminate ovulation pain.
Breastfeeding and periods
There are many things that can determine when your period returns when you are breastfeeding. These may include
- how often you bottle feed your baby
- the way your body responds to hormone changes
- how frequently your baby is having a breast feed.
If your only using bottles to feed your baby you may find your periods return shortly after birth. And of periods are irregular or even absent you may still be able to become pregnant. Once periods do return they may still be irregular, especially if you are still lactating. The duration of your period can also change and it is not unusual to skip a period, or go several months without one.
When you start reducing the amount of time you spend breastfeeding, your periods should start to return to your usual routine, however you may notice some light spotting at first.
Your period coming back should have little effect on your breast milk so you can continue to breastfeed if desired. Some women find a temporary drop in the amount of milk they produce just before their period starts or for a few days into it, but it will increase again when your hormones return to their normal levels.
Premenstrual syndrome (PMS)
Premenstrual syndrome (PMS) describes the symptoms that occur around the time of having your period, in the days prior to bleeding and finishing your period. Symptoms can include:
- tender breasts
- abdominal pain or swelling
- bloated stomach
- weight gain
- swollen ankles
Psychological and emotional symptoms can include:
- mood swings
- short temper
- heightened emotions
- feeling aggressive
- poor concentration
- difficulty sleeping
- feeling more tired than usual.
There are several ways to help reduce the symptoms of PMS. One way is by eating and drinking the right things.
- Eating smaller meals throughout the day more often.
- Avoid foods that are high in salt as salt.
- Drink water and avoid alcohol and caffeine.
- Eat plenty of vitamin-rich food, such as fresh fruit, vegetables and whole grains.
- Avoid smoking or breathing in cigarette.
Exercise is a great way to improve your mood if PMS makes you feel tired, angry, depressed or emotional. Exercising will raise the level serotonin which makes us feel happier. Pilates or yoga and other stretching techniques, can also help to reduce feelings of stress and tension, as well as improve circulation and flexibility.
Retained object or tampon
Sometimes an object can become stuck in the vagina or simply forgotten such as tampons or a contraceptive. It is important for these objects to be removed as soon as possible.
A retained tampon is when a tampon has either becomes stuck or ‘lost’. Reasons can include:
- putting in a new one before taking out the last one
- having sex with a tampon in
- simply forgetting about it at the end of a period.
The vagina is quite elastic so it is possible to have sex or insert another tampon whilst another is still inside, it can turn sideways and lodge at the top of the vagina next to the cervix. In these cases, the tampon can turn sideways, the string gets drawn in, and it becomes difficult to remove.
A tampon cannot get lost in the abdomen. The cervix is at the end of the vagina and only has a tiny opening to allow blood or semen through. Damage cannot be caused to the vagina or cervix by using a tampon.
The main concern with a retained tampon is an infection called toxic shock syndrome and this is why the tampon of the objet needs to be removed quickly.
You may not know or may have forgotten about an object or tampon being in your vagina. Signs that you may have a retained object in your vagina include:
- discharge from your vagina (it may be yellow, green, pink, grey or brown in colour)
- discharge that may smell very bad
- a very bad smell from your vaginal area but no discharge
- a high temperature of 40C or above
- vaginal itching
- pain or discomfort when passing urine
- pain around the pelvis or abdomen (below the belly button and above the genital area)
- redness of the skin around your genital area
- swelling of the vaginal area
- a rash around the vaginal area.
If you have any of these symptoms, do not attempt to remove the object or tampon immediately attend your nearest hospital’s emergency room for medical help. Never try to remove an object with another object. You could damage yourself or develop an infection. Seek medical assistance immediately.
Method for removing a foreign body or tampon
If you do attempt to remove the object yourself please follow this advice:
Make sure your hands are thoroughly washed before you try to remove anything as it will stop any outside bacteria from entering the vagina. If you have any scratches or cuts on your hands, make sure these are covered.
Sit on a toilet with your feet resting on something that is about 30 centimetres high and push as if you are having a bowel movement or pushing out a baby. This might help push the object down.
After this, insert one finger inside your vagina and reach as far as possible making circular and back and forward movements. Try to feel the area at the top of your vagina as this is where items like tampons often get stuck. If you feel the object, remove your finger and then place two fingers into the same area, trapping the object between them, and try pulling it out.
When to get help
You should visit your doctor or practice nurse if you cannot easily remove it yourself or if you have worries about whether or not you have put an object in and forgotten.
Toxic shock syndrome
Toxic shock syndrome (TSS) occurs when a bacteria called staphylococcus aureus releases poisonous toxins into the body's bloodstream. This will cause symptoms of shock. The toxins also damage organs and body tissue, which can cause death if left untreated.
TSS is usually linked to tampon use or childbirth, although men and children can also develop the condition if the bacteria gets into the bloodstream.
It is not fully understood how tampons cause TSS, although some research suggests it could be linked to the amount of time a higher absorbency tampon is left in the vagina. It is thought that bacterial toxins develop on the tampon and are then absorbed into the bloodstream.
It is important to remember that TSS is very rare and you shouldn’t stop using tampons, but you should follow the recommendations for changing them.
There are several ways you can help lower your chance of developing TSS, these include:
- washing your hands before and after inserting a tampon
- using low absorbency tampons if possible
- alternating tampons with sanitary towels every so often during your period
- changing the tampons as often as advised on the pack
- never inserting more than one tampon
- making sure you remove the last tampon at the end of your period
- inserting a fresh tampon when going to bed and removing it when waking.
TSS can cause a number of the following symptoms including:
- a high temperature
- aching muscles
- a red rash found on the hands and feet that peels.
TSS is treated in a hospital using antibiotics and providing support to the other functions of the body that have been affected. Treatment is normally successful if detected early.