About Menstrual Periods

Your menstrual period is the 5-7 days during each month that a small amount of bloody fluid flows from your vagina. The flow begins slowly-it doesn't spurt or gush-and is heaviest during the first few days. The flow gradually lessens and then stops. Although it may seem like you are losing a lot of blood, you're really not. The total amount of flow over an entire period is only about 1/4 cup.

Most women have a monthly menstrual period until they are about 50 years old. Then the periods stop. Pregnant women usually do not have any bleeding.

Women who are breast-feeding their babies usually do not have periods during that time. There are times, too, when a woman misses a period. This may happen if she is sick, upset, or very nervous about something; if she hasn't been eating right; or if she has been exercising a lot.

Your Monthly Schedule
Once you start having periods, you may see just a few spots of blood one month and then have a normal period the next month. Also, you may skip a month, or have two periods in one month during the first year. Your body needs a little time to get on a set schedule. If a woman has had sex and misses a period, though, she should see a doctor as soon as she can because she may be pregnant.

You may want to use a calendar to keep track of your periods. Put an "X" on the first day of your period. Count the first "X" as day I, and keep counting the days until you have your next period. If you do this every month, you'll be able to tell how many days there are between your periods. For some girls, it will be every 28 days; for others. it may be anywhere from 23 to 35 days; and for others, it may change from month to month. Even when your periods start to come after the same number of days each month, you may miss a period or be a few days early or late.

About Your Period
A girl's first period-menarche-usually about age 12. Periods may begin anywhere from age 9 to age 16. Menopause-when menstrual periods end occurs at about age 50. One factor that influences when your periods will begin and end is the age at which your mother's or grandmother's periods began.

The length of an average menstrual cycle lasts 3-5 days, counting from the first day of one period to the first day of the next. Normal cycles can vary 23-35 days The number of days a woman menstruates varies. Periods lasting 3-5 days are average, some are as long as 7 days.

Problems of Menstruation

Heavy Bleeding: Bleeding that is heavier than usual for you or goes on for longer than a week may be abnormal. It can have a number of possible causes:

• Hormone imbalance
• Coagulation disorders (problems with blood clotting)
• Infection of the uterus
• Tumors of the uterus
• Miscarriage

The loss of blood may lead to a shortage of iron, which makes a woman anemic. Iron deficiency can be corrected with a good diet and iron supplements. The cause of the deficiency, though, should be looked into. Bleeding or spotting (sometimes along with pelvic pain) may sometimes occur in the middle of a cycle, during ovulation. But if it occurs often, at any time other than midcycle, or as a woman nears menopause, it could be a sign of a serious problem, and the woman should see her doctor.

Exercise and Menstrual Changes
Regular, heavy exercise may cause changes in the menstrual cycle. This may result in fewer menstrual periods. Sometimes menstrual periods stop completely in women who exercise vigorously, such as dancers or long-distance runners. It is not fully known how exercise affects the menstrual cycle. Some factors have been identified, though, such as loss of body fat, stress, and changes in the amount of body hormones.

Irregularities in the menstrual cycle happen more often with running than with any other sport. The amount of running also plays a role. Some women who run more than 20-30 miles per week may find that they stop having periods. More will notice this at 40-60 miles per week. When the mileage is reduced, the normal menstrual cycle usually resumes. A woman should never assume that menstrual changes are related to exercise-you can't tell the cause without a thorough checkup. If your periods stop, you should see your doctor. You can keep exercising unless your doctor advises against it.

Amenorrhea
Some women never start menstruating during their teenage years, while some women who have been having regular periods suddenly stop menstruating. This condition is called amenorrhea, or the absence of menstrual periods. The most common reason for a missed period is pregnancy. A woman who has been having sex and misses a period should consult her doctor. But there are many other possible causes-an abrupt weight change, severe stress, or heavy exercise.

At other times, problems with the pituitary gland (a gland located near the brain that controls growth and other changes in the body), the thyroid gland (a gland in the lower neck that helps regulate metabolism), the adrenal glands (located above the kidneys), or the reproductive organs are the cause of amenorrhea. A girl should see her doctor if she has not started having periods by age 16, or if her breasts have not begun to develop by age 13-14. Although many women sometimes miss a period, any woman who misses periods often should see her doctor.

Premenstrual Syndrome
Premenstrual syndrome (PMS) is the term used to describe a group of physical, mental, or behavioral changes that some women go through before their menstrual periods begin every month. PMS can cause discomfort in different parts of the body. It can also cause disturbing emotional feelings.. Menstruation, or the menstrual period, is the monthly discharge of blood and other secretions from a woman's uterus. Most women have monthly menstrual periods from the time they are about 12 years old until they are about 50.

Each woman's pattern of menstruation is different. Some changes in menstruation are normal and should not cause concern. For instance, pregnant women do not have periods. Women who are breast-feeding their babies may not have periods. There are other times, too, when a woman misses a period. This may happen if she is sick, upset, exercising heavily, or nervous about something. Knowing about menstruation and its role in the reproductive process will help you understand the normal cycle of events that take place in your body before, during, and after your reproductive years.

Good Hygiene
Practicing good hygiene is as important during menstruation as at any other time of the month. During the menstrual period, sanitary napkins or tampons should be changed about every 4 hours, possibly more often during the first days of the period, when the menstrual flow is usually heavier. Douching is usually not needed for good hygiene and may sometimes cause problems. Ask your doctor if you have questions about douching.

Keeping Healthy
Menstruation is a normal, healthy process. It usually does not affect a woman's daily activities. Women athletes exercise vigorously while menstruating. Many women notice that increased exercise during menstruation reduces dysmenorrhea. Some women feel an increased desire for sex while menstruating. It is safe to have a pelvic during the menstrual period. Significant changes in your menstrual cycle and irregular bleeding should be reported to your doctor.

Source: Patient education material from the American College of Obstetrics and Gynecology was used as a source of information to develop the content for this topic.

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