All About Periods Pt 1

I might have gotten an overview of periods in health class, but as I’ve gotten older I realized how little I actually know about my own menstrual health. Here is a general rundown of the most common topics, some less talked about conditions, and a list of resources at the end of the post to learn more. Stay tuned for part 2 next week where my fellow Tulhoma writers and I discuss our personal experiences + tips. 

Menstrual Phases: A total cycle is an average of 28 days, although this varies depending on individual health. 

1. Menstruation 

The release of tissue and blood (AKA period). Your period is the result of the egg not being fertilized. Hormone levels drop and the thickened uterine lining is shed. Typically lasts 3-8 days. On average women lose around 30-80 mL (about 1.1-2.7 oz or 2-5 ½ TBSP) of blood during one menstruation. 

2. Follicular Phase

Starts on the first day of menstruation and ends when ovulation begins. The hypothalamus prompts the pituitary gland to secrete follicle-stimulating hormone (FSH). FSH stimulates follicles, fluid-filled sacs that contain oocytes (immature eggs), to prepare for ovulation. The follicles go through a process to determine dominance. One follicle becomes victorious and matures while the rest degenerate. Estrogen rises, ovum (mature egg) prepares for release. As part of the proliferative phase that happens simultaneously with the follicular phase, the endometrium (lining of the uterus) becomes thicker to prepare for fertilization. 

3. Ovulation (midway through the cycle) 

Estrogen rises causing an increase in luteinizing hormone (LH), which then causes the mature egg (ovum) to break free from the follicle, travel through the fallopian tubes, and wait to be fertlized by sperm. 

4. Luteal Phase (late in the cycle)

Usually lasts 14 days for most women. The follicle that once held the egg transforms into the corpus luteum. This transformation causes a rise in progesterone and estrogen. The secretory phase that happens along with the luteal phase allows the hormones released by the corpus luteum to either start preparing for pregnancy or help the endometrium break down. If the egg is fertilized, it is now a zygote (on its way to becoming an embryo). If the egg is not fertilized progesterone and estrogen decline and the cycle begins again. This is also the phase you experience PMS (see below). 

*In the case of identical twins, the zygote (fertilized egg) splits into two.

*You are most fertile in the few days leading up to ovulation; the mature egg only lives 24 hours before the endometrium begins to shed. Although much less likely to get pregnant after ovulation and before your next period, changing cycles and other menstrual irregularities can make it hard to know for sure. It is always best to talk to your gynecologist and discuss the best options to prevent or up your chances of pregnancy and be taught how to properly track your cycle.

Periods and bowel movements

Ever heard the charming term “period poops”? Well, if you have ever experienced changes in bowel movements throughout your menstrual cycle, you are definitely not alone. A combination of hormones (namely progesterone) and uterine contractions (prostaglandins: lipids that are part of the body’s inflammatory response process) are big culprits of constipation or loose stool. If this is something that significantly disrupts your life, you can talk to your doctor about simple dietary changes, OTC supplements, and other lifestyle changes you can make to manage these symptoms.

Premenstrual Syndrome (PMS)

Various symptoms that happen monthly, before the start of menstruation. The cause of PMS is not known, but it is suspected that metabolic and hormonal fluctuations play a big part. There is an extensive list of symptoms but some of the most common are abdominal cramping, sore breasts, headaches, irritability, mood swings, bowel changes, and fatigue. Symptoms can last for a few days up to a couple of weeks, beginning around ovulation. PMS can be relatively unnoticeable to some women, while others experience more moderate to severe symptoms. 

Premenstrual Dysphoric Disorder (PMDD)

A severe form of PMS. Symptoms vary but include feelings of hopelessness, anxiety, sadness, depression, etc. PMDD can be comorbid (co-exist) or exacerbate (worsen) other mental and physical health conditions which can complicate diagnosis. In fact, most women with PMDD go misdiagnosed or undiagnosed completely. These severe symptoms seem to dissipate when menstruation starts but can be negatively impactful on quality of life and interfere with personal, social, and work life. There aren’t a lot of known treatments for PMS or PMDD, but suggestions range from prescription medication (birth control, hormonal therapies, SSRIs, and NSAIDs) to more natural methods like diet changes, vitamin intake, stress control, and cognitive behavioral therapy.

Although there is not a lot of evidence to support what the best treatment is for PMDD, speaking with your doctor, therapist, or a trusted functional medicine professional is a great first step in learning how to best manage and improve symptoms.

Amenorrhea 

The complete absence of menstruation (primary amenorrhea) or loss of menstruation for more than 3 consecutive cycles after having a regular or otherwise irregular period (secondary amenorrhea). 

It is well known that during pregnancy or at the onset of menopause your period stops, however, the loss or absence of your period at any other time is called amenorrhea. Amenorrhea is considered a symptom or sign of another underlying health problem, rather than an actual solitary condition. Primary amenorrhea can be caused by genetic or anatomic issues. Some common driving factors of secondary amenorrhea, particularly hypothalamic amenorrhea (HA) are undereating, malnutrition, excessive exercise, and stress. Although it is often seen in athletes or women that struggle with eating disorders, secondary amenorrhea can happen to anyone regardless of weight. Treatment varies depending on the root cause. For HA, eating habits, reduced exercise, and stress management can help regain period and reduce symptoms.

If you are interested in learning more about HA, I highly recommend checking out Nicola Rinaldi, Ph.D. She has dedicated her time, education, and personal experience to learn and write about this topic. 

Poly-Cystic Ovarian Syndrome (PCOS)

A hormonal imbalance; high levels of androgens (male hormones) that negatively affect ovarian function. The root cause is unknown, but it is thought that genetics can play a part (i.e., someone diagnosed with PCOS is likely to have a female relative that also has it).

Getting this diagnosis can be a long and difficult process since symptoms can be quite broad; PCOS is determined through a process of elimination (blood tests, ultrasound, symptom checks that rule out other causes). A common driving factor of PCOS is metabolic issues, particularly insulin resistance which, if left untreated, can lead to type 2 diabetes (high blood sugar). Some more common symptoms are irregular periods, hirsutism (excessive hair growth on the face and body), and acne. Treatments include diet and lifestyle changes, as well as certain medications to help with symptom management if necessary. There is a lot of discussion among conventional and functional medicine communities on the best treatment for PCOS, and the use of medication to “manage” or “mask” symptoms, particularly in the case of hormonal therapy being used when insulin resistance is present and (often) not addressed.

Although cyst is in the name, not all women with PCOS actually develop cystic ovaries, so it is not always considered a criterion of diagnosis. It is common for women with PCOS to struggle with weight gain, although it can occur in women at any weight. 

Insulin Resistance (IR) 

IR is often described as a “lock and key” problem.

– you eat food (particularly carbs)

-insulin is made and opens the lock of the cells to deliver glucose 

-cells use glucose for energy

In IR, the cells become somewhat unresponsive to insulin (or the key no longer fits the lock of the cell), which then stops glucose getting to the cells. In order to open the lock, the body produces more insulin, thus starting a cycle of IR. Overtime this resistance leads to high glucose levels, which can turn into pre-diabetes or type 2 diabetes (high blood sugar). Some functional medicine doctors suggest ditching high this, low that diets for a more holistic approach; eat a balanced diet with good sources of protein, fat, and yes.. carbs. Other medical professionals suggest high fat, low carb diets. It is always best to talk with a trusted doctor or a functional medical professional to figure out what diet and lifestyle changes you can make to improve IR (and sustain these improvements in the long-term).

Endometriosis 

A condition in which tissue, similar to the endometrium (lining of the uterus), grows outside of the uterus. 

Endometriosis is typically seen forming on other reproductive organs (outer uterus, fallopian tubes, ovaries), but in some cases, this growth does occur in other parts of the body. This can be a very painful condition for many women and is a cause of infertility, digestive issues, and irregularity of the menstrual cycle. 

Menopause

Perimenopause is the transition that happens before menopause; hormones fluctuate and periods become irregular. Menopause is when the period has been absent for 12 or more months. Can begin mid-to-late 40’s. 

Some of the most prominent symptoms of menopause are irregular periods, hot flashes, mood swings, sleep troubles, and vaginal dryness. Unfortunately, due to low hormone levels, women that are post menopausal are at higher risk for osteoporosis and cardiovascular disease. The most common treatment for menopause is hormonal replacement therapy, however, there are a number of integrative approaches as well.

Collection Methods 

–  Tampons

A cotton plug inserted into the vaginal opening to absorb blood flow. Tampons come in different sizes and absorbency options that can be changed according to flow. You can also swim with a tampon in, so it’s a good option for more physically active days. You should always change your tampon every 4-8 hours, and tampons should never be worn for more than 8 hours. Leaving a tampon in for too long or not changing throughout the day can increase the risk of toxic shock syndrome.

– Pads

A blend of absorbent fabrics (some liners, some with wings) with strips of adhesive that stick on underwear. Pads come in different shapes, sizes, and absorbencies so you can adjust throughout your period. Some common complaints with pads are that they can be bulky, feel uncomfortable, or allow leaking if you have a heavier flow. Also not as convenient as tampons ( can’t wear when swimming, harder to be active in, etc). 

*There are washable/reusable options as well.

– Period Underwear 

A blend of absorbent fabrics built into normal-looking underwear that is meant to be comfortable to wear and used as a washable/reusable replacement for pads and tampons. The potential negatives are leaking and being a generally messy option if you have a heavy flow, but period underwear can be used in combination with a tampon or pad to provide extra protection.

– Menstrual Cup 

A small silicone cup shaped item that is inserted into the vaginal canal and catches the blood (unlike tampons which absorb). You take them out to empty, rinse, and wash before re-inserting; you can technically leave them in, but it is recommended to check them more often if you have a heavier flow. It is less of a concern to get TSS from menstrual cups than from tampons, however, it is still important to keep things as sterile as possible when cleaning and inserting the cups to avoid other bacterial and yeast infections. This is also a more sustainable option if you want to ditch disposables.

Pap Smear Reminder (Papanicolaou test)

A cervical examination wherein the doctor uses a tool to collect a sample of cells from your cervix, then sends them to a lab to be checked for abnormal or precancerous cells.  

While we’re on the subject of women’s health, I want to give a quick mention to the pap test. I know with a global pandemic happening the last thing you probably want to think about is a doctor’s appointment, but some things shouldn’t wait, and for good reason. A lot of things in this world might be on pause right now, but your body isn’t, so please consider keeping your pap smears scheduled. 

Period Tracker App

If you are unfamiliar with your cycle or feel you’ve been experiencing irregularities, it is a good idea to start tracking in some way to observe patterns and various symptoms throughout the month. This is an extremely useful tool to be able to bring the data you collect to your doctor so they can see a more in-depth view of what’s going on versus trying to memorize every little change that happens over the month(s). 

Clue: I have tried a few period tracker apps over the years and Clue is by far my favorite. It’s easy to use, you can add tons of different symptom trackers (you can even customize and add your own). You can also use it to track other things like sleep, when you’re not feeling well, what days you take medicine/vitamins, doctor appointments, etc.

I hope you’ve been able to gain some insight from this post and learn a little more about your own health! What are some physical or mental health topics you wish were discussed more openly?  

RESOURCES 

• Menstrual Cycle

1. https://helloclue.com/articles/cycle-a-z/the-menstrual-cycle-more-than-just-the-period

2. Reed BG, Carr BR. The Normal Menstrual Cycle and the Control of Ovulation. [Updated 2018 Aug 5]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279054/

3. Cunningham, Joanne et al. “Update on research and treatment of premenstrual dysphoric disorder.” Harvard review of psychiatry vol. 17,2 (2009): 120-37. doi:10.1080/10673220902891836

4. https://www.verywellfamily.com/myths-about-getting-pregnant-and-ovulation-4160934

5. https://www.healthline.com/health/prostaglandins#takeaway

• HA

1. https://www.sciencedirect.com/topics/medicine-and-dentistry/hypothalamic-amenorrhea

2. https://www.noperiodnowwhat.com/hypothalamic-amenorrhea-info/hypothalamic-amenorrhea-resources

• PCOS

1.https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos

2.https://www.endocrineweb.com/conditions/polycystic-ovary-syndrome-pcos/what-causes-pcos-how-will-it-affect-body

3.https://www.endocrineweb.com/conditions/polycystic-ovary-syndrome-pcos/polycystic-ovary-syndrome-pcos-how-it-diagnosed

• Insulin Resistance

1.(Dr. Jason Fung) https://m.youtube.com/watch?v=vMymMf3-LSc

2. https://m.youtube.com/watch?v=TaouRuqqEfY

3. (Abbey Sharp) https://m.youtube.com/watch?v=VrFaw0J7p_E

4. https://healthcareinamerica.us/what-exactly-is-insulin-resistance-2b0c62f343b0

5. https://www.cdc.gov/diabetes/basics/insulin-resistance.html

• Endometriosis 

1. https://www.womenshealth.gov/a-z-topics/endometriosis

2. https://www.acog.org/patient-resources/faqs/gynecologic-problems/endometriosis

• Menopause 

1. https://www.nia.nih.gov/health/what-menopause

2. (Hot and Flashy Q & A) https://m.youtube.com/watch?v=vsQJoyn2vxo

other:

Pap smear info

https://store.lunette.com/blogs/news/how-often-do-i-need-to-empty-my-menstrual-cup

DISCLAIMER: This post is for educational and entertainment purposes only. This information is not intended to be a replacement for professional medical advice and/or treatment.