Learn about the different phases, duration, and signs of a normal menstrual cycle. Stay informed and track your menstrual health with Meri Sehat.

Normal Menstrual Cycle

A. JABBAR DENTAL CLINIC

Sadia Khan

Overview

The menstrual cycle is defined as the interval between a woman&#39;s first day of menstruation and the day before the next period. 
The menstrual cycle lasts an average of 25-30 days. However, it can vary from person to person, lasting as little as 21 days or as long as 35. The cycle&#39;s length may change from month to month as well. 
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During puberty, a woman&rsquo;s body goes through several internal and external changes. The change in hormones brings about the process of menstruation in girls. Menstruation is defined as the shedding of the lining of the uterus (endometrium). This discharge of blood and tissue characterizes a girl&rsquo;s first period and occurs at the beginning of the menstrual cycle.&nbsp;

A period can last around 2-7 days.&nbsp;The average person may lose anywhere from 1-5 tablespoons of menstrual blood each period. It can be pink, dark red, brown, thin, or clumpy.

Most girls begin their first period at around the age of 12 years[3]. However, every girl is different and menstruation can begin as early as 9 to as late as 16 years of age in some<a href="#accordion">[4]</a>.

An estimated 1.8 billion people worldwide menstruate every month<a href="#accordion">[9]</a>. However, millions of people lack access to basic menstrual products and hygiene facilities like toilets and access to water. Moreover, the topic of menstruation is weighted by various cultural taboos. This further leads to a lack of awareness and contributes to unhealthy and unhygienic menstrual practices.&nbsp; 
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The female reproductive system consists of the uterus, two fallopian tubes, two ovaries, the cervix, and the vagina. Ovulation is defined as the release of an egg from the ovary. It typically occurs on day 14 of the menstrual cycle.

During the menstrual cycle, a surge in levels of luteinizing hormone (LH) causes the release of an egg from one of the ovaries. This egg then travels down the fallopian tube to the uterus for fertilization with sperm. If the egg is fertilized, pregnancy occurs and the fertilized egg attaches to the thickened endometrium. The placenta then develops, allowing oxygen and nutrients to pass from the mother to the fetus.

However, the lack of fertilization will lead to the uterus lining breaking down and bleeding. Thus, resulting in the start of periods, or the menstrual cycle.

Some women have little lower abdominal pain, spotting, or bleeding during this period, while others show no symptoms at all. If a woman engages in sexual activity just before and during ovulation, she is often more likely to get pregnant as she is most fertile during this period. 
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<h5>When Does Menstruation Begin?</h5>

Menstruation typically begins at the age of 12 years. However, the age varies from person to person, with some girls menstruating as early as 8 years and others as late as 16<a href="#accordion">[7]</a>. &nbsp;The onset of a girl&#39;s menstruation can be influenced by stress, intense activity, and diet<a href="#accordion">[8]</a>.

It typically occurs 2 to 3 years after the breasts first begin to develop. This is also when the pubic and underarm hair starts to grow.

The American College of Obstetricians and Gynecologists advises young women to speak with their doctor if they haven&#39;t begun menstruating by the age of 15, or if they haven&#39;t started to grow pubic or underarm hair by the age of 13<a href="#accordion">[8]</a>.

Menstruation ends at menopause. 
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The menstrual cycle is influenced by the rise and fall of various hormones. These hormones affect the reproductive hormones, resulting in the various phases of the menstrual cycle. The menstrual cycle comprises four main phases. These include: 
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<h5>1.&nbsp;The Menstrual Phase</h5>

Menstruation is generally referred to as periods. The uterus&#39;s lining sheds and bleeds out of the vagina during menstruation. Blood, mucus, and some uterine lining cells are all present in the period.

Menstruation can last three to seven days (day 1 to day 7). People typically use sanitary pads, tampons, menstrual cups, period clothing, or sanitary pads to absorb the period. Menstrual cups should be replaced every eight to twelve hours, while pads and tampons should be changed often (ideally every three to four hours).

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<h5>2.&nbsp; The Follicular Phase</h5>

The follicular phase, which lasts for 13 to 14 days and culminates in ovulation, begins on the first day of the period. A rise in estrogen levels causes the endometrium to grow and thicken. Additionally, the pituitary gland in the brain produces follicle-stimulating hormone (FSH) which causes follicles in the ovaries to grow. Approximately 5 to 20 little follicles containing immature eggs are produced by the ovaries. Eventually, only one follicle will develop into an egg. 
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<h5>3.&nbsp; Ovulation Phase</h5>

During ovulation, a mature egg is produced from an ovary and travels down the fallopian tube to the uterus. Normally, this occurs once each month, two weeks before the next period. A woman can ovulate for 16 to 32 hours. A rapid rise in another hormone called luteinizing hormone (LH) is responsible for the release of the egg.

Although it is possible to conceive on the day of ovulation and in the five days prior, the likelihood increases in the three days before ovulation. The egg has a maximum survival time of 24 hours. People can become pregnant during this period if sperm gets to the egg. 
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<h5>4.&nbsp; The Luteal Phase</h5>

The corpus luteum, which is a group of ovarian cells, releases progesterone and a small amount of estrogen after ovulation. As a result, the uterine lining thickens in preparation for pregnancy. If a fertilized egg attaches to the endometrium, the corpus luteum continues producing progesterone. This helps maintain the thickened endometrium.&nbsp;

However, in the absence of pregnancy, the corpus luteum dies, progesterone levels fall, the uterine lining sheds and a new menstrual cycle begins. 
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Signs and Symptoms

Some people have menstrual symptoms, whereas others don&#39;t. The severity of these symptoms might also vary. Some people may experience tender breasts while some may feel bloating around their abdomens. However, cramps are the main symptom. These cramps typically appear in the pelvic region and result from the uterus contracting to discharge its lining. Other normal menstruation signs include: 
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<ul>
	<li>
	<a href="https://merisehat.pk/disease/acne">Acne</a>
	</li>
	<li>
	Mood swings
	</li>
	<li>
	Trouble sleeping
	</li>
	<li>
	<a href="https://merisehat.pk/disease/cluster-headaches">Headache</a>
	</li>
	<li>
	Backache
	</li>
	<li>
	Food cravings
	</li>
</ul>

Note: If your period lasts more than 7 days, is heavier than usual, requires a change of pad/tampon every hour, or does not occur for more than 3 months, contact a healthcare professional immediately. 
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A warm heating pad on the abdomen usually aids to combat menstrual cramps. However, taking over-the-counter (OTC) drugs, such as ibuprofen, naproxen, and acetaminophen, may help reduce cramps or headaches. 
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<h5>What Is PMS (<a href="https://merisehat.pk/disease/premenstrual-syndrome-pms">Premenstrual Syndrome</a>)?</h5>

Approximately 85% of women who menstruate experience premenstrual syndrome (PMS)2. This typically occurs days or weeks before the periods and affects the person&rsquo;s daily functioning. Symptoms of having PMS are usually similar to that of periods. Following are the signs of having premenstrual syndrome<a href="#accordion">[3]</a>:

<ul>
	<li>Mood swings</li>
	<li>Sadness</li>
	<li><a href="https://merisehat.pk/disease/anxiety">Anxiety</a></li>
	<li>Fatigue</li>
	<li>Bloating</li>
	<li>Acne 
	&nbsp;</li>
</ul>

<h5>How To Track Periods?</h5>

While the menstrual cycle can vary from person to person, irregular periods can point to an underlying medical disorder. Therefore, keeping a record of periods can help doctors identify any menstrual issues, plan pregnancies, and help the person prepare for the bleeding in advance.

Keeping a track of the following can help identify any irregularities and track the period.

<ul>
	<li>Date when the periods begin</li>
	<li>Date when the periods end</li>
	<li>Flow of the period (heavy flow, light flow, intermediate flow, clumpy flow, etc.)</li>
	<li>Note if the bleeding is abnormal, for example, whether it occurs outside the expected dates of menstruation</li>
	<li>Pain (if it&rsquo;s worse than usual)</li>
	<li>Any other behavioral or mood changes</li>
</ul>

 
Note: Currently, there are many AI (artificial intelligence) powered women platforms that encompass accurate cycle predictions as well as ovulation predictions for those who want to track their periods and also for those who are trying to conceive. 
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Certain factors can contribute to irregular menstrual cycles, including but not limited to:

<ul>
	<li>Pregnancy or breastfeeding</li>
	<li>Extreme weight loss</li>
	<li>Eating disorders such as <a href="https://merisehat.pk/disease/anorexia-nervosa">anorexia nervosa</a></li>
	<li>Excessive workout</li>
	<li>Premature ovarian failure</li>
	<li><a href="https://merisehat.pk/disease/polycystic-ovary-syndrome-pcos">Polycystic ovary syndrome (PCOS)</a></li>
	<li><a href="https://merisehat.pk/disease/pelvic-inflammatory-disease">Pelvic inflammatory disease (PID)</a></li>
	<li>Uterine fibroids 
	&nbsp;</li>
</ul>

Treatment

Menstrual periods can be regulated for some women by taking birth control tablets. Treatment for any underlying issues, including an eating disorder, may also be beneficial. Hence, it is best to consult a healthcare professional for all advice regarding menstrual irregularities. 
&nbsp;

<h5>When To See A Doctor?</h5>

Though stress and other lifestyle variables are frequently linked to transient alterations, persistent irregularity may be an indication of a more serious health issue. The following require a medical consultation:

<ul>
	<li>
	No menarche by the age of 16.
	</li>
	<li>
	Lack of periods for &nbsp;90 days or more, in the absence of pregnancy
	</li>
	<li>
	The bleeding lasts longer than seven days.
	</li>
	<li>
	The flow is much more or less than normal.
	</li>
	<li>
	Heavy bleeding leading to the use of one or more menstruation products per hour.
	</li>
	<li>
	Bleeding between periods. 
	&nbsp;
	</li>
</ul>

Conclusion

The menstrual cycle is unique to each woman. What is typical for one may not be typical for another person. It&#39;s critical to become familiar with the cycle, including the timing and duration of the periods. Moreover, it is important to keep an eye out for any changes and let the doctor know about them.

The menstrual cycle gives the doctor important information about a woman&rsquo;s reproductive health. In a healthy woman, a menstrual cycle can last around 21 to 35 days. During each cycle, bleeding occurs for three to seven days. 
&nbsp;

Key Points

<ul>
	<li>Menstruation is defined as the shedding of the lining of the uterus (endometrium). This discharge of blood and tissue characterizes a girl&rsquo;s first period and occurs at the beginning of the menstrual cycle.</li>
	<li>A period can last around 2-7 days. The average person might lose anything from 1-6 tablespoons of menstrual fluid each time. It might be pink, dark red, or brown, and it can be thin or clumpy.&nbsp;</li>
	<li>The menstrual cycle is defined as the interval between a woman&#39;s first day of menstruation and the day before the next period. It lasts an average of 25 to 30 days. However, it can vary from person to person and last as little as 21 days or as long as 35.</li>
	<li>The phases of the menstrual cycle are triggered by the rise and drop of hormone levels. These hormones influence the reproductive organs.</li>
	<li>The menstrual cycle comprises four main phases - menstruation, the follicular phase, ovulation, and the luteal phase.</li>
	<li>Some people have menstrual symptoms, whereas others don&#39;t. The severity of these symptoms might also vary. Some people may experience tender breasts while some may feel bloating around their abdomens. However, cramps are the main symptom.</li>
	<li>A warm heating pad on your belly usually aids to combat menstrual cramps. However, taking over-the-counter (OTC) drugs may also help reduce period cramps or headaches.</li>
	<li>Tracking the periods can help identify any menstrual irregularities.</li>
	<li>Menstrual periods can be regulated for some women by taking birth control tablets. Treatment for any underlying issues, including an eating disorder, may also be beneficial. However, certain menstrual anomalies cannot be prevented. 
	&nbsp;</li>
</ul>

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