This Vulvapedia entry covers the topic of menstruation (periods), something that comes up quite frequently in our VP on LJ conversations.
Menstruation is the part of a woman's menstrual cycle during which the lining of the uterus, also known as the endometrium, along with blood produced by the blood vessels within the uterus, is shed via the cervix and vagina. Women use a variety of menstrual products during this time to absorb or contain menstrual fluid.
Menstruation can be divided into two phases.
The first part of the cycle, from the first day of menstruation to ovulation, may vary from 13 to 20 days in length. The length of the first part is not only different from one woman to another, but also differs in some women from month to month. It is during this critical first part of the cycle that fertilization can occur. Such common circumstances as sickness, worry, physical exertion, and even sudden changes in climate may occasionally upset a regular pattern by shortening it or extending it.
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Menstruation can last anywhere between two and eight days; the average length is four to six days. Menstruation may not last for the same number of days with every cycle, and some variation is normal.
In a larger sense of the question, menstruation lasts from menarche (pronounced men-ar-kee), or the onset of menstruation, through menopause, or the cessation of it.
According to Our Bodies, Ourselves, the average age of menarche is twelve and a half, with the normal range being between nine and eighteen; the average age of menopause is fifty, with any age from forty to fifty-five being considered normal.
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According to the Mayo Clinic, "[n]ormal menstrual flow occurs about every 28 days, lasts four to five days and produces a total blood loss of 60 to 250 milliliters (4 tablespoons to about 1 cup)."
Of course, it can be very hard to measure blood loss during menstruation. Users of menstrual cups may find it easier to measure the total amount of blood lost during menstruation, as they can keep track of how much menstrual fluid is in the cup each time it is emptied. For those who use pads or tampons, the Mansfield-Voda-Jorgensen Menstrual Bleeding Scale may be helpful in determining how heavy their bleeding is.
Mansfield-Voda-Jorgensen Menstrual Bleeding Scale
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Heavy bleeding, i.e. a six on the Mansfield-Voda-Jorgensen scale, is known as menorrhagia. There are many possible causes. Some listed by Our Bodies, Ourselves are:
Menorrhagia is something that you should mention to your healthcare provider. Other symptoms of menorrhagia (according to the Mayo Clinic) include:
Our Bodies, Ourselves says:
Some possible signs of anemia include:
Mild anemia may have no recognizable symptoms. Your healthcare provider can do a simple blood test (called a hematocrit) to determine whether or not you have anemia, and can help you devise a treatment plan.
There are two different types of anemia.
This type of anemia occurs when your body does not have enough iron. This can be caused by heavy menstrual periods, pregnancy, miscarriage, abortion, childbirth, ulcers, colon polyps, colon cancer or fibroid surgery.
Ways to prevent/treat this type of anemia:
This type of anemia results from a lack of folic acid and/or vitamin B12. This can happen to women who are pregnant, have had many children, are taking oral contraceptives, or are malnourished.
Ways to prevent/treat this type of anemia:
Some women suffer from a condition called pernicious anemia. Their bodies lack a protein called the intrinsic factor which allows the body to properly absorb B12. Women with this condition may need to get monthly B12 injections or take additional B12 supplements.
There are some forms of anemia that are inherited, such as sickle-cell anemia and thalassemia.
Aplastic anemia can also be the result of such illnesses or treatments for illnesses such as kidney disease, thyroid disease, arthritis, cancer, lupus or diseases/infections of the bone marrow, and by exposure to toxic chemicals.
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From Our Bodies, Ourselves:
If you miss more than three periods in a row, or are experiencing symptoms consistent with amenorrhea, you should consult your healthcare provider.
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The absence of menstruation is called amenorrhea. Amenorrhea can also be characterized by extremely light, short periods.
There are two types of amenorrhea.
Primary amenorrhea occurs when a woman does not begin menstruating by the latest "normal" age. Generally speaking, if you are over the age of sixteen and have not yet begun menstruating, you should see your heathcare provider, as some of the causes of primary amenorrhea (such as hormone imbalance or ovarian problems) require medical treatment.
Secondary amenorrhea refers to the cessation of menstruation after menarche. Many women experience amenorrhea at some point during their lifetime.
Some of the possible causes are:
For women of childbearing age who are sexually active, this can be a pressing concern when amenorrhea occurs.
As you can see from the previous section, there are many causes of amenorrhea besides pregnancy. However, as the the Mayo Clinic says, "[t]he proof is really in the pregnancy test." If you are concerned that you may be pregnant, you may find that the best course of action is to purchase an at-home pregnancy test (which can be found at virtually any drugstore/pharmacy or grocery store, and at most retail outlets that sell condoms and other forms of birth control) or to visit your heathcare provider and ask them to administer a test. If you are pregnant, it is best to know as early as possible in the pregnancy.
The following are some possible early signs and symptoms of pregnancy, according to the Mayo Clinic:
However, it's important to note that, again according to the Mayo Clinic, "these signs and symptoms aren't unique to pregnancy. Some can indicate that you're getting sick or that your period is about to start. And, conversely, you can be pregnant without ever experiencing these symptoms."
While it's natural and understandable to worry about prengnacy, it's important to keep in mind the odds of pregnancy occurring. If you are correctly using some form of birth control (either hormonal methods such as the pill or non-hormonal methods such as condoms), your odds of being pregnant are greatly reduced. Even women having completely unprotected sexual intercourse will not always become pregnant, and many people who are trying to conceive have to try for some time before becoming pregnant.
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Many women keep track of their menstrual cycles. Some do so as part of the Fertility Awareness Method, which is a way of predicting one's fertile and non-fertile days. Other women like to keep track of their cycles simply to increase their knowledge, and to become more familiar with how their bodies work.
You can use pen and paper (in the form of a calender) to track your cycle. This is a good method to use if you don't have regular internet access, or if you prefer to have a hard copy of your results. Below is a simple way to track your cycle with a regular calendar, as explained by Tracee Cornforth at About.com.
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Or you can use one of the many free online cycle tracking programs. Like an internet email account, you can log into these sites from any computer, and keep your information private. Some to try are:
The short answer is "Yes! Absolutely!"
Period sex can be messy sometimes.
But don't let that stop you! Try putting down a towel to avoid staining sheets or furniture, or engaging in sex/sexual play in the shower, where a mess is easily washed away. Some women find they are able to wear Insteads (a type of menstrual cup) during penetrative vaginal sex, because they sit far enough up in the vagina that they are usually not felt during sex. Others find that they can enjoy other sexual activities (oral sex, mutual masturbation) while wearing a tampon or regular, non-disposable menstrual cup.
If you do end up with a few bloodstains, check out what VP members recommend for getting them out.
There is a broad range of feelings about period sex -- some people are totally comfortable with it, but others are not.
Many people find that menstruation does not hamper their enjoyment of sex in the slightest, and are comfortable engaging in all manner of sexual activity during menstruation. (Some people, in fact, report enjoying period sex more than sex at any other time, and some women report that orgasm helps alleviate their menstrual cramps.) Others prefer to limit their sexual activities to those they are comfortable with (for instance, some people prefer not to perform oral sex on a woman who is menstruating; others may prefer to avoid penetrative sex during menstruation), and some prefer to avoid sexual activity during menstruation altogether. These are all valid choices, and it is important to discuss them with your partner(s), to be respectful of their feelings and for them to be respectful of yours.
See what other VP members have to say about period sex!
Menstruation can increase the risk of spreading HIV during sex.
It is important to note that because of the presence of blood (which contains a higher concentration of the virus than vaginal fluid), sex during menstruation can make it easier for HIV to pass from an HIV-positive woman who is menstruating to her partner. HIV can also be spread from an HIV-positive woman to a partner when she is not menstruating, so it is important to know your partner(s)' HIV status and to be safe at all times. See our entry on Safer Sex for more information on how to be safe.
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No, it is not. While women are not typically fertile while menstruating, it is possible for sperm that enters the body to remain potent for several days -- if a woman has unprotected sex while menstruating, she could ovulate later and the egg could be fertilized by sperm that remains in her body. To prevent pregnancy it is important to use birth control at all times, even during menstruation.
Note: If you are using a method of hormonal birth control correctly, you are still protected from pregnancy during your hormone-free (or placebo) week.
Cramps, or dysmenorrhea, are a very common side effect of menstruation. Many women experience menstrual cramps at some time during their life. For some women, they are merely uncomfortable; however, for others they can be extremely painful and when the occur can interfere with their usual activities.
If cramping interferes with your life for several days per month, or if you have been menstruating for more than a few years and have suddenly begun experiencing severe cramps, you should see your doctor.
Symptoms of dysmenorrhea can include:
According to the Mayo Clinic, there are two types of dysmenorrhea.
Primary dysmenorrhea is not caused by any other problem (fibroids, for example, or endometriosis. Often you can treat the cramps with simple at-home measures.
Primary dysmenorrhea is believed to be caused by prostaglandins, hormone-like substances involved in pain and inflammation. Prostaglandins are thought to cause the uterine muscle contractions that cause menstrual cramps.
Some treatments for primary dysmenorrhea include:
If you'd like to see an expanded list you can check out this post on VP on LJ.
Secondary dysmenorrhea is dysmenorrhea that is caused by another condition. Treatment of this type of dysmenorrhea usually involves treating that underlying condition.
Some of the conditions that cause secondary dysmenorrhea include:
Treatment for secondary dysmenorrhea depends on the underlying cause.
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Spotting is light bleeding that occurs outside of normal menstruation.
Spotting can occur for many reasons. Spotting a few days before you are due to being menstruating is normal, as is spotting during the first few months of hormonal birth control use.
Spotting can also be a sign that you are pregnant. The Mayo Clinic has the following to say about this type of spotting, commonly called implantation bleeding:
If you are experiencing spotting and are concerned that you might be pregnant, you may want to purchase and take a home pregnancy test, or visit your healthcare provider for a test.
Other causes of spotting listed by the Mayo Clinic include:
Source: The Mayo Clinic -- Vaginal bleeding: What's normal, what's not? |
If you are experiencing spotting that is not caused by pregnancy or hormonal birth control, you may want to schedule an appointment with your healthcare provider to discuss it. In premenopausal women, spotting most often has a benign cause (such as hormonal fluctuation), but since some of the rarer causes are conditions requiring medical treatment, a visit to your healthcare provider may be in order.
If you experience any type of vaginal bleeding or spotting before menarche (the onset of menstruation) or after menopause or total hysterectomy, you should also contact your healthcare provider.
The cause of spotting is not likely to be anything life-threatening. As mentioned above, you should contact your healthcare provider if you cannot pinpoint a likely reason for spotting.
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Premenstrual syndrome, or PMS is the phrase used to describe the negative changes some women notice several days before and sometimes several days after menstrual bleeding begins.
It should also be noted that not all feelings associated with the premenstrual phase of a woman's cycle are negative. Some women find that they feel more creative or more energetic during this time in their cycle. If you are tracking your menstrual cycle, you may want to note both positive and negative premenstrual feelings so as to keep things in perspective.
According to the Mayo Clinic, the following symptoms are often associated with PMS:
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Most women do not experience every single one of those problems. Those who do may be suffering from a more severe form of PMS, called premenstrual dysphoric disorder (PMDD).
It's believed that more than one factor may be responsible for PMS.
Some potential causes, according to the Mayo Clinic:
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Some treatments you can try yourself at home:
Some treatments commonly prescribed by physicians are:
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According to the Mayo Clinic, "for some women with premenstrual syndrome, symptoms are so severe they're considered disabling. This form of PMS has its own psychiatric designation — premenstrual dysphoric disorder (PMDD). PMDD is a severe form of premenstrual syndrome with symptoms including severe depression, feelings of hopelessness, anger, anxiety, low self-esteem, difficulty concentrating, irritability and tension. A number of women with severe PMS may have an underlying psychiatric disorder."
PMDD is quite rare -- the Mayo Clinic estimates that of all menstruating women, only about eight percent have PMDD.
Doctors are not sure what exactly causes PMDD. Some women with PMDD also have major depression, but this isn't always the case.
According to the Mayo Clinic, some of the symptoms of PMDD include:
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You should talk with your healthcare provider if you think that you may have PMDD.
Because it is often associated with depression, PMDD may be treated with antidepressants, specifically SSRIs (selective serotonin reuptake inhibitors).
Other things that may help relieve PMDD:
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Endometriosis occurs when fragments of the uterine lining, or endometrium, become implanted outside the uterus. Like the rest of the uterine lining, these fragments respond to the hormonal changes of the menstrual cycle, thickening and then sloughing off. There is nowhere for the blood shed by these fragments to go, and so it becomes trapped and can irritate and inflame the surrounding tissue.
This trapped blood can cause cysts to grow, and cysts can lead to scar tissue and adheseions -- all of which can cause pelvic pain during menstruation and at other times of a woman's cycle.
There are a number of ways to treat endometriosis, ranging from pain management to surgery. It can take some time to determine which method of treatment is best for an individual sufferer.
Some of the options available are:
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NOTES AND DISCLAIMERS: This FAQ (and VP) is no substitute for medical care. Much of the information above has been adapted from the indicated sources. Click on the links to see their original text or to get more information. Any non-quoted items come from the VP Team's personal experience, which, again, is no substitute for medical care. As always, there is a limit to the information internet resources can provide; if you require additional assistance, it's best to contact an appropriate professional.