‘The time of the month’, ‘coming on’, ‘Lady days’ – we might talk euphemistically about periods and the subject might not exactly be dinner party conversation but it can help to talk more openly about the subject. Not least because there are an estimated 15 million women of menstrual age in the UK1 and on average a woman menstruates for around 6.5 – 7 years (that is, approximately 500 times) during their lifetime.2 The average woman will typically have periods from the age of around 12 up until 50 or 51 (the median age of the menopause, when periods stop, is 51 in the UK3) meaning it is something that can potentially continue on a monthly basis for 37-38 years of your life. Of course, everything from the length of your cycle, your personal history, illness, stress, whether you get pregnant, breastfeed or use hormonal contraception can all influence the number of periods you have and how you experience them but one thing is pretty certain: periods impact all women at some point and understanding why they happen and how they can manifest themselves is pretty crucial when it comes to your hormonal health and well-being.
What exactly is menstruation?
Menstruation is quite simply the technical term for when you get your period or monthly bleed. This involves blood being released from the uterus through the cervix and out through the vagina which occurs when the lining of your uterus (womb) is shed. For most women this happens around every 28 days but it can be anywhere between 24 and 38 days. Throughout this monthly menstrual cycle your body makes different amounts of hormones and the uterus lining builds up which prepare the body for pregnancy. If you don’t get pregnant, levels of the hormones oestrogen and progesterone begin to fall and signal to your body to start the process of menstruation. Menstrual cycles often change as a woman gets older, until they stop completely at menopause. All women will have a unique menstrual cycle and experience but understanding your own cycle and identifying patterns and changes can be an important part of knowing your body and staying on top of your hormonal health.
The 4 stages of the menstrual cycle explained
Your menstrual cycle is counted from the first day of your period to the first day of your next one. Your hormones, notably oestrogen and progesterone, fluctuate throughout your cycle and typically follow specific phases: the follicular phase, ovulation, the luteal phase and menstruation:
1. Follicular phase
This is the longest phase of your cycle which begins on the first day of your period and lasts around two to three weeks until ovulation takes place. During this time the pituitary gland in the brain releases a follicle-stimulating hormone (FSH) which helps eggs grow in little sacs (known as follicles) on the ovaries. The FSH causes the follicles to grow and release oestrogen. This increased oestrogen thickens the lining of the uterus in preparation for possible pregnancy.
How can it affect you? Oestrogen levels are lower at the beginning of the follicular phase and if you are prone to hormonal migraines this is when you are more likely to get them. Oestrogen can also stimulate your sex drive so you might notice an upswing in your libido at this point.
2. Ovulation
Ovulation is when the ovary releases one mature egg which can potentially be fertilised by sperm. Ovulation usually occurs around the middle of the menstrual cycle (between days 14 and 16 in a typical 28 day one) and lasts between 12 and 24 hours. A woman is most likely to become pregnant if she has sex (without contraception) in the three to five days before and up until ovulation. At various points in a woman’s life, ovulation may not happen or be experienced differently. For instance, pregnant woman don’t ovulate, a breast-feeding woman may or may not ovulate and during perimenopause you might not ovulate on a monthly basis. Then after menopause you stop ovulating altogether.
How can it affect you? A few days before ovulation your vaginal mucous or discharge changes and becomes clear and more ‘slippery’ in texture (some people compare it to the consistency of egg white). This type of mucous helps sperm to move into your uterus and fallopian tubes where it can fertilise an egg. Some women may experience a mild cramping on one side of their abdominal/pelvic area during ovulation. Others find they have tender or sore breasts.
3. Luteal phase
This phase begins when the egg has been released during ovulation, so roughly around 14 days before your period starts. What happens at this point is that the egg leaves behind its ‘shell’ known as the corpus luteum which begins to produce progesterone to help the lining of the uterus mature. At around day 21 progesterone production decreases and progesterone and oestrogen become so low the uterus lining starts to break down resulting in a menstrual bleed.
How can it affect you? If you tend to experience premenstrual symptoms (and around 90-97% of women do, with an estimated 30% reporting them as moderate to severe4) this is the time you are likely to experience them. Typical pre-menstrual symptoms include abdominal cramping, headaches, bloating, breast tenderness, stomach upsets, food cravings, tiredness and mood swings. Levels of progesterone (dubbed the ‘relaxing hormone’ because it has a mild sedative effect) are low at this point so you might feel more irritable, short-tempered, tearful and generally low in mood. Your skin can also become oilier and more prone to break-outs and hormonal acne can also be exacerbated due to low progesterone. Progesterone is also known to promote sleep and relaxation so low levels of it can result in insomnia or disrupted sleep.5
4. Menstruation
This is when blood and tissue are released through the vagina on day 1 of your period. It usually happens every 28 to 30 days and typically lasts between 3 and 7 days. As a rule, women lose around 1-5 tablespoons of blood during each period (even if it might feel like more).6
How can it affect you? When your period starts, or within a few days of it starting, pre-menstrual symptoms are generally alleviated and/or stop completely although you may experience painful period cramps initially and are likely to feel wiped out, especially if you are bleeding heavily. These symptoms are usually managed with painkillers and extra rest.
How your menstrual cycles change as you age Often periods can be heavier when they first start – from around 12 onwards and in your teens – and then tend to become lighter and more regular in your 20s and 30s. In your 40s and the run up to the menopause – the perimenopause phase – some women may experience more irregular periods which become heavier or lighter, or change in terms of frequency. However this isn’t always the case 60% of women in their 40s experience regular periods right up to their final menstrual period!
Period problems and when to get help
Periods may be a completely natural and normal part of a woman’s life but that doesn’t mean there aren’t potential problems linked to them. These can include severe pain, irregularity, heavy bleeding and a range of other conditions including:
PMS (Pre-Menstrual Syndrome)
A collection of physical and psychological symptoms which happen prior to your period starting. These commonly include abdominal cramps, breast tenderness, bloating, headaches, food cravings, tearfulness, irritability, low n mood and tiredness.7 Almost all women will experience some symptoms at some point in their lives, for others they can regularly be severe and life-affecting.
Premenstrual Dysphoric Disorder (PMDD)
Around 5-8% of women suffer with PMDD, a severe and debilitating form of PMS which can impact hugely on a woman’s quality of life, affecting some for around two weeks of every month. It is not known precisely what causes PMDD but it is suggested that certain women are more sensitive to hormonal changes (particularly progesterone) that take place during their menstrual cycle.8 PMDD can cause physical symptoms but it tends to be the psychological ones which are more of an issue. These can be so severe that PMDD is regarded as a mental health problem.9 Both PMS and PMDD tend to be resolved as you reach menopause and your periods stop.
Dysmenorrhea
The technical term for painful cramps during menstruation.
Menorrhagia
The umbrella term for heavy bleeding including periods which last longer than average or excessive bleeding during an average length period.
Amenorrhea
The absence of periods.
Polycystic ovary syndrome (PCOS)
PCOS is a common hormonal condition (affecting around 10% of women) which affects the ovaries and can lead to few, unusual or very long periods. It is common for women with PCOS to have an increase of certain hormones including insulin and androgens (male hormones). Other symptoms linked to PCOS include oily skin and acne, excess hair growth on the face or body, thinning hair on the head, depression and reduced fertility, although not everyone with PCOS will present with all of these symptoms.10
Endometriosis
Endometriosis is a condition where tissue similar to the lining of the womb grows in other locations such as the ovaries or fallopian tubes. It can cause severe period pain, very heavy periods and can impact on your fertility. Endometriosis is a long term condition and can start at your very first period and last until menopause.11
Fibroids
These are non-cancerous growths which grow in the wall of the uterus (womb). Some women can have fibroids unknowingly and not have any symptoms, for others symptoms commonly include heavy and/or painful periods, abdominal pain, lower back pain and pain during sex. Fibroids can lead to problems with your ability to get pregnant.12
You should always seek medical help for any of the above symptoms and/or conditions and similarly if you are bleeding between periods, the consistency of your menstrual blood changes (say, with large blood clots), if you bleed after sex or after you have gone through the menopause.13
FAQs
Q. What causes period pain?
A. Period pain (dysmenorrhea) is very common – affecting around 97% of women according to one UK survey.14 It is caused when a chemical known as prostaglandin makes your uterus contract and tighten quite forcefully. This can cause dull, achy cramps or intense (and often frequent) pain. Exercise can help to relieve it as can taking over the counter pain killers. Having a warm bath and/or holding a hot water bottle over your abdomen should also help soothe the pain.
Q. Is it true that your menstrual cycle start to synchronise with that of close female friends or family?
A. Anecdotally many women say they have noticed that their period tends to happen at around the same time as other women of menstruating age they live or work in close proximity to – say, with work colleagues or when sharing a house together. But does it? The idea of menstruation synchronisation stems from a study published in the 1970s suggesting that pheromones could influence when a woman’s periods start when they live together.15 However subsequent studies have shown that menstrual cycles don’t align like this16 with researchers pointing out that in modern society washing and showering frequently will wash away pheromones so they are unlikely to have any real effect. Others point out it is largely coincidental and simply a matter of timing – so, for instance, if one woman in a shared house or office has a five week cycle and another a three week one at some point in time they will see their periods ‘overlap’ or happen at the same time.
Q. It is normal for your period to be late?
A. In short, yes. The most obvious reason is that you might be pregnant but if you have ruled that out it could be the result of severe stress, low body weight, over-exercising, obesity, going on or coming off hormonal contraception, a change in routine, the effects of the perimenopause, illness, certain medications or a side effect of some medical conditions including polycystic ovary syndrome (PCOS), fibroids, diabetes and thyroid problems.
Q. Can you still become pregnant if you have sex during your period?
A. It might be statistically less likely but it is possible. This is because a woman’s menstrual cycle doesn’t necessarily adhere to hard and fast rules and you can have a short or long cycle meaning that ovulation can potentially happen during your period or soon after it. Sperm is also known to live in the reproductive system for up to five days. This means if you have unprotected sex during your period and ovulate shortly afterwards, the sperm can still fertilise the egg and you can get pregnant.
The benefits of tracking your periods
If you want to understand more about your own personal menstrual cycle tracking your periods can be invaluable. Using an app like the free Health & Her app more expansive picture of your personal cycle, notice if anything seems out of the ordinary, help identify any particular symptoms (such as headaches, bloating and mood swings) and triggers that may exacerbate them. It can also help you to be more in tune with your body and monthly hormonal cycle generally – to help pinpoint, for example, that at certain times of the month you might experience a higher or lower sex drive; have cravings for particular foods and at what point you are likely to feel teary and increasingly irritable. A study from the University of Granada suggests period tracking apps can be an empowering tool which help women to greater awareness and understanding not only of their menstrual cycle but also of their health generally.17 A tracking app can also help you to identify when you are likely to get your next period which gives you some semblance of control over when to expect it so you are better prepared. The information stored in the app can also be helpful to share with a GP or health professional should you be having problems with your periods and/or you are trying to conceive.
References
- https://www.ahpma.co.uk/menstruation_facts_and_figures/
- https://www.unicef.org/press-releases/fast-facts-nine-things-you-didnt-know-about-menstruation
- https://thebms.org.uk/wp-content/uploads/2023/08/17-BMS-TfC-What-is-the-menopause-AUGUST2023-A.pdf
- https://www.pms.org.uk/about-pms-2/what-is-pms/#:~:text=It%20is%20estimated%20that%20as,around%20800%2C000%20in%20the%20UK.
- https://navacenter.com/what-are-the-signs-of-low-progesterone/#:~:text=Yes%20%E2%80%93%20when%20levels%20drop%2C%20it,appear%20less%20firm%20and%20elastic.
- https://www.nhs.uk/conditions/periods/
- https://www.nhs.uk/conditions/pre-menstrual-syndrome/
- https://iapmd.org/hormones-and-pmdd
- https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/what-is-pmdd/
- https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/symptoms/
- https://www.nhs.uk/conditions/endometriosis/
- https://www.nhs.uk/conditions/fibroids/
- https://www.medicalnewstoday.com/articles/12-period-symptoms-not-to-ignore#symtoms
- https://www.wellbeingofwomen.org.uk/what-we-do/campaigns/just-a-period/just-a-period-survey-results/#:~:text=Pain&text=Almost%20all%20(97%25*)%20experience,aged%2012%20said%20the%20same.
- http://radicalanthropologygroup.org/wp-content/uploads/class_text_028.pdf
- https://pubmed.ncbi.nlm.nih.gov/26181612/
- https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7549-8#:~:text=Our%20study%20finds%20that%20period,and%20to%20gain%20new%20knowledge.
