Patient education: Menstruation (The Basics)

What is menstruation? — 

This is the medical term for having your period. Doctors also use the terms "menstrual cycle" or "menses." During your period, you bleed from your vagina.

People with a uterus start getting their period when they go through puberty. They continue getting periods until they reach "menopause." This is when periods naturally stop.

Why does menstruation happen? — 

Menstruation happens because of hormone changes that affect the uterus. Once a person starts menstruating, it is possible for them to get pregnant.

Different hormone levels rise and fall at different times during the menstrual cycle. This causes changes in the body. During each cycle:

●The lining of the uterus starts to thicken (figure 1).

●1 of the ovaries releases an egg. This is called "ovulation."

●If the egg is "fertilized" by sperm, the person becomes pregnant. The thickened lining of the uterus is ready to hold the pregnancy.

●If the person does not get pregnant, the body "sheds" the uterus lining. It comes out of the vagina as blood and small bits of tissue. This is the menstrual period.

●This cycle repeats about once a month.

How often should I get a period? — 

When a person first starts getting their period, they might not get one every month. Early on, it is normal for a period to skip a month, or come more frequently.

Over time, periods should become more regular:

●Most people get a period about once a month. But a normal cycle can range from 24 days to 38 days. Cycle length is counted from the first day of your last period to the first day of your next period.

●Each period, meaning the time you are bleeding, lasts from a few days to about a week.

It's a good idea to keep track of how often you get your period and how long it lasts. This way, you will know if something changes.

Does menstruation cause other symptoms? — 

It can. Along with bleeding, some people have other symptoms. These symptoms are related to hormone changes and can happen even before your period starts. They can include:

●Acne

●Bloating (a feeling of fullness in the belly)

●Breast soreness or swelling

●Cramps

●Diarrhea

●Eating more than usual, or craving certain foods

●Feeling very tired

●Headache

●Mood changes, like feeling angry, worried, or sad

●Nausea

●Sleeping too much, or having trouble sleeping

●Trouble concentrating

Some people get "premenstrual syndrome" ("PMS"). This is when these symptoms happen often and have a negative effect on your life. When these symptoms are severe, it is called "premenstrual dysphoric disorder" ("PMDD"). This usually needs treatment with prescription medicines.

Some people have symptoms during ovulation, which is when the ovary releases an egg. The most common symptom is pain on 1 side of the lower belly. Ovulation usually happens about 14 days before the start of your period.

What things can affect my period? — 

It's normal for your cycle to sometimes be a few days shorter or longer than usual.

Many different things can make your period come less often or not at all. They include:

●Pregnancy

●Breastfeeding

●Heavy exercise, feeling very stressed, or big changes in weight

●Certain health problems, for example, "polycystic ovary syndrome" or "celiac disease"

●Certain medicines, including some types of birth control

●Menopause

If your periods stop completely for no obvious reason, or seem very irregular, tell your doctor or nurse. They might want to do tests to try to figure out the cause.

What are the different types of menstrual products? — 

There are many different products you can use during your period. They include:

●Pads – These stick to your underwear to absorb blood. They come in different sizes and thicknesses. Most are disposable, meaning you throw them away after you use them. Some you can wash and reuse.

●Tampons – These are made of cotton or another absorbent material. They go inside the vagina to absorb moisture and blood. They are compressed so they are easy to insert. Once inside the body, the tampon expands.

Tampons are available in different sizes depending on how heavy your period is. For example, many come in light, regular, and super absorbency. Some come with disposable plastic or cardboard "applicators" to make them easier to put in. Tampons have a string that hangs outside of the body to help you remove the tampon.

Change a tampon at least every 4 to 8 hours. Leaving a tampon in for too long increases the risk of a serious problem called "toxic shock syndrome."

●Menstrual cups and discs – These are small, flexible cups or discs made of rubber or a similar material. They go inside the vagina to catch blood before it leaves the body. They come in different brands and sizes. They can be worn for up to 12 hours, then washed and reused.

●Period underwear and swimwear – These are special underwear and swimwear that absorb blood. They can be washed and reused.

You might need to try different products to find what works for you. Some people change which product they use depending on how heavy their period is at a certain time. This also depends on your preferences and lifestyle. For example, some athletes (including swimmers) might prefer tampons or a menstrual cup instead of pads.

You might also want to consider cost. Some people prefer reusable products instead of ones you throw away.

How can I take care of myself during my period? — 

You can do all your normal activities while you have your period.

If you have symptoms related to your period, it can help to:

●Avoid salty foods and large meals – This might help if you feel bloated.

●Take an "NSAID" medicine for cramps – NSAIDs are a group of medicines that includes ibuprofen (sample brand names: Advil, Motrin) and naproxen (sample brand name: Aleve).

●Put a heating pad (on the low setting) or hot water bottle on your lower belly – This might also relieve cramps. Do not use heat for longer than 20 minutes at a time. Also, do not use anything too hot that could burn your skin.

It might help to get regular physical activity and find ways to lower stress. These things can improve your overall health and mood.

When should I call the doctor? — 

Call your doctor or nurse for advice if:

●You are older than 15, and still have not had your first period.

●You used to get periods, but have not had one for more than 3 months.

●Your periods used to be regular, but have started coming more or less often.

●You soak through a pad or tampon every 1 or 2 hours.

●You pass large lumps or "clots" of blood.

●You have very bad cramps even after taking pain medicine.

●You think you might be pregnant.

●You have other symptoms that bother you.

More on this topic

Patient education: Absent or irregular periods (The Basics)
Patient education: Heavy periods (The Basics)
Patient education: Painful periods (The Basics)
Patient education: Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) (The Basics)
Patient education: Normal puberty (The Basics)

Patient education: Absent or irregular periods (Beyond the Basics)
Patient education: Heavy periods (Beyond the Basics)
Patient education: Painful menstrual periods (dysmenorrhea) (Beyond the Basics)
Patient education: Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) (Beyond the Basics)