Periods are not something women can control or stop. It is estimated that a woman experiences around 450 periods in her lifetime. Some start menstruating early and some late. The same applies to attaining the end of menstruation, known as menopause. Periods can also be unpredictable in terms of symptoms, where each woman can have different experiences.

At Ubuntu Medical, we have compiled answers to the 10 most asked questions about the process of menstruation or most commonly known as periods. We hope to assist you in understanding more about this biological process and trust this article will clarify some of your queries.

 

1. What is a period?

Approximately every month, a woman’s reproductive organ prepares itself to receive a fertilised egg from the ovary by thickening its lining. When this does not occur, the thickened layer is broken down and shed. This process is called menstruation or period.

The pituitary gland is located in the brain and has the vital role of producing a hormone called  Follicle Stimulating Hormone (FSH). These hormones stimulate the eggs in the ovary follicles to start growing and maturing. These follicles produce the hormone oestrogen which causes the walls of the uterus, where a foetus develops, to thicken for the purpose of support and nourishment of the foetus. In the absence of a fertilised egg, the thickened walls are deemed unnecessary by a woman’s body, therefore, are broken down and removed from the body. This is released through the cervix and out of the vagina in the form of blood. This process occurs in a cycle that repeats itself in a regularly or irregularly from the start of puberty till the end of menopause.

 

2. Are periods necessary?

 

Although many sources suggest it is not necessary for a healthy woman to have her period, the answer to this burning question is: YES, it is essential to ensure the well-being of a woman’s body and reproductive organs. It is a necessary step of growing up and maturing and is required for a female body to prepare itself to be physically able to get pregnant.

The process of menstruation is truly a blessing in disguise and health benefits do exist for it:

• Body cleansing

The menstrual cycle cleanses the body from contents such as unwanted bacteria and excessive iron.

• Iron loss

Iron has been linked to cardiovascular diseases by specialists. Its removal from the body protects a woman from heart-related problems and have a longer life span.

• Health indicator

A period can act as an indicator of a woman’s health. It can confirm the normal function of the body and of an absence of hormonal imbalance. Periods can also offer warnings about any emerging diseases or abnormalities

• Resistance

Pain due to menstrual cramps can make a woman have higher pain threshold, resistance and tolerance.

• Weight loss

A menstruating woman will have increased hunger and cravings, yet will surely lose weight by the end of the duration.

• Improved mood and appearance

The high levels of oestrogen release endorphins which cause women to be more positive and active. Stress hormones are also suppressed which make women feel more attractive and feminine. Additionally, there will be a glow in the face and the skin will be softer and smoother.

• Increased libido

Women in their periods will have an increased sexual desire at that time.

• Release of frustration

Traditional Chinese Medicine methods state that the liver plays an important role in menstruation. There can be a build-up of energy (Qi) in the liver that influences irritability, chest tightness, and feelings of anger and frustration. Menstruation releases this energy and relieves the body from such stress.

 

3. How long should a normal period last and how often should it occur?

It is known that human variation is a natural occurring, where each person’s body functions differently and uniquely. Therefore the phrase “normal period” is not essentially accurate. Nevertheless, there are known approximate frequencies and duration of the menstrual cycle.

The length of time between each period, or menstrual cycle, and the duration of discharge in a woman’s body can vary between individuals. The cycle can take place every 21 to 31 days, with an average of 28 days, for a healthy adult and can occur every 21 and 45 days for young women. The menstrual blood discharge can last between 2 to 7 days, with a 30 to 50ml of blood loss.

 

4. At what age will periods start and end?

The first menstrual cycle is called the menarche and it normally starts anytime between the ages  of 12 to 14 years, with a growing number of girls attaining menarche between the ages of 8 and 16 years due to different biological timelines. Menstruation is a major stage of a girl reaching puberty. Periods will occur regularly or irregularly, until the woman reaches menopause, where menstruation will end. This is usually between the ages of 45 and 55 years for most women.

 

5. Why does a period occur irregularly or stop?

 

A period is expected to occur regularly from the start of menarche. Although a healthy woman’s menstrual cycle occurs on an average of 28 days, irregularity is common with periods starting early or late and can even sometimes be absent. Almost 1 in 25 women suffer from an irregular, loss or absent period. The temporary or permanent stoppage of the menstrual cycle is known as an amenorrhea. There are several factors that can cause mistimed periods or amenorrhea:

• Pregnancy and breast-feeding

The placenta begins producing the hormone human chorionic gonadotrophin (hCG) when pregnancy starts. This helps nourish the egg after fertilisation and it causes periods to stop temporarily. Additionally, the process of breastfeeding can cause amenorrhea as well. The hormone prolactin is produced to assist in the production of milk and it halts the menstrual cycle.

• Ageing – puberty and menopause

Young women that experience the first few years of their menstrual cycles will be affected during puberty. Their body will take some time to adapt to hormonal changes during puberty and will very commonly cause early periods. Menstrual cycles become lighter with age and tend to stop permanently due to premature or normal menopause. This process of menopause causes hormonal fluctuations in the body with progesterone levels diminishing at a faster rate than oestrogen, causing hormonal imbalance. The ovulation cycle in a woman becomes irregular and will eventually come to a halt.

• Use of contraception

Women that take birth control pills can result in lighter bleeding or even in complete absence of a period. Birth control works by introducing additional hormones into the body, affecting the menstrual cycle.

• Medication

Medication such as tranexamic acid, non-steroidal anti-inflammatory drugs (NSAIDs) and hormone-releasing intrauterine device alter hormone levels and the thickness of the uterus lining. Eventually, this leads to changes in the menstrual cycle.

• Increased stress

Increased stress can have a strong impact on the menstrual cycle of a woman and can lead to absent periods. During times of high stress, the hormone cortisol (stress hormone) is produced in excess. This directly impacts the oestrogen-progesterone level balance and can affect the flow, length and due date of the menstrual cycle. Furthermore, stress also impacts the brain’s hypothalamus in performing its role of hormone control.

• Lifestyle factors

Lifestyle factors such as weight loss, dieting and excessive exercise can also cause amenorrhea. In these cases, many hormonal functions can be interrupted in the body, resulting in the halting  of ovulation.

• Structural problems

Problems with the female reproductive organs can also cause amenorrhea. Examples include uterine scarring, lack of reproductive organs and abnormal structural composition of the vagina.

• Hormone imbalance

Medical conditions such as thyroid malfunction, pituitary tumour, premature menopause and polycystic ovary syndrome (PCOS) can also cause hormonal imbalance, which can contribute to amenorrhea.

 

6. What are key symptoms caused by periods?

Different symptoms exist for menstruation and they can differ from person to person. The most common symptoms are:

• Mood swings;
• Breast tenderness or soreness;
• Acne;
• Abdomen bloating;
• Lower abdomen and back cramps;
• Tiredness;
• Hunger; and
• Uneven sleeping patterns.

 

7. Why are periods painful?

Some women experience minimal or mild discomfort during menstruation while other women can suffer from more severe and painful symptoms that prevents them from carrying out their daily routine.

Period pain, known as menstrual cramps or primary dysmenorrhea, is common among adolescents and young women but can also be experienced by older women. Pain takes place in the lower abdomen and lower back and occurs when an egg is released from the ovaries and travels through the fallopian tube. It starts 1 or 2 days prior to menstruation with symptoms lasting between 2 to 4 days.

Primary dysmenorrhea can be caused by excessive levels of the chemical compounds prostaglandins, which prevent blood loss by promoting blood clot. It is believed that the presence of these chemicals narrows blood vessels in the muscles of the uterus and the intestines causing the parts to contract.

Secondary dysmenorrhea can also be a cause for painful period and it is caused by disorders in the female reproductive organs. Examples include medical problems such as endometriosis, adenomyosis, uterine fibroids or pelvic inflammatory disease. Pain begins earlier in the menstrual cycle and also lasts longer than most period pains and cramps.

If your menstrual pain is unbearable and affects your daily living, please consult one of our GPs to discuss it.

 

8. Why do periods cause tiredness and weakness?

Fatigue is a symptom experienced by many women during their menstrual cycle and is most commonly experienced due to dehydration, fluid loss and blood loss during the menstrual cycle. The best way to counter menstrual weakness and tiredness would be the intake of water and/or electrolyte-containing fluids. Additionally, the consumption of a balanced diet could prevent low energy levels in the body.

Additionally, it is very common for adolescents and young women to develop anaemia, which causes iron deficiency. This arises from the blood lost and could also cause tiredness and weakness. Fortunately, anaemia can easily be diagnosed by a doctor who will take a blood sample for examination and can be treated.

 

9. Why do periods cause headaches and nausea?

Both headaches and nausea are very common symptoms from pre-menstruation and menstruation. Headaches are the result of fluctuations in hormone levels with oestrogen levels dropping and the levels of other hormones such as progesterone increasing. Nausea can also be a common symptom that occurs from the release of prostaglandins due to menstrual cramps which disturb the function of the digestive system. This not only causes a loss of appetite, but also a lack of concentration and tiredness.

 

10. Why do periods cause abdominal pains and diarrhoea?

Menstruation can cause diarrhoea. The exact reasons are still being researched but it has been linked to menstrual cramps. The excessive presence of the the chemical compound prostaglandins can cause the contraction of the lower back and abdomen, in addition to leading intestinal parts to contract and release contents, in the form of loose stool.

There is no danger associated with the excessive levels of prostaglandins except for symptoms such as abdominal pain, nausea and headaches and an overall discomfort. This can be relieved by taking rest, using a heating pad, consumption of a balanced diet, some exercise and perhaps some medication, after consulting with your GP.

 

Management of pre-menstrual and menstrual symptoms

Although there is no cure for these symptoms, they can be managed efficiently with lifestyle changes, a balanced diet, the intake of supplements as well as medication and hormone treatments. You can discuss these with your GP to develop an effective management plan.

• Lifestyle changes

Regular exercise, sufficient sleep, smoking control and stress management, all aid the management of symptoms.

• Dietary changes

Replacing high-fat and high-sugar foods for healthier foods such as fruits, vegetables and low-salt intake can immensely help.

• Supplements

Supplements such as calcium, vitamin D, vitamin B6 and isoflavones have shown to be beneficial.

• Medication and hormone treatments 

Multiple treatments are available to relieve pre-menstrual and menstrual symptoms. Examples include:

• • SSRIs (selective serotonin reuptake inhibitors) fluoxetine, sertraline, paroxetine and escitalopram, which act as mood stabilisers;
  • GnRH and danazol, which suppress ovulation; and
  • Oral contraceptives, which may pause menstruation.

 

For more information and guidance, you can book an appointment with our GPs… call us on (07) 3857 3777 or email [email protected].