To start with, let's use the following comparison: the phases of the menstrual cycle are like the phases of the moon. New moon, first quarter, full moon, and last quarter would correspond to the menstrual phase, follicular phase, ovulation, and luteal phase, respectively. We can observe the moon and deduce which phase it is in, and it is similar with observing our own biological rhythm. There are some exceptions to the circular motion of planetary successions, such as lunar eclipses, two new moons in a month, or two full moons next to each other, but the general order is unwavering here. On the other hand, our menstrual cycles, although the name itself should suggest something, are often disturbed or disrupted - follicular phases lengthen or shorten, ovulation does not occur, and heavy bleeding does not stop. We, on the other hand, run for another pregnancy test or another pack of sanitary products, worried we call our friends or seek advice from the not always trustworthy Uncle Google.
Knowledge of the processes and a number of changes occurring in our body and the ability to distinguish between instability and disorders make us calmer and less helpless. Today we will review this topic. What are the causes of menstrual disorders? When is our body more susceptible to them? And our favorite question and most common dilemma - what is normal and what is out of it? I hasten to answer everything, but first let's recall how, at least in definition, the menstrual cycle proceeds.
Menstrual cycle phases
Textbook menstrual cycles last 28 days. Given that this is a more individual matter, a seven-day variation is assumed. So the cycle length ranges from 21 days to 35 days.
The first day of menstruation is the first day of the menstrual cycle and at the same time the beginning of the follicular phase, which lasts about 14 days. Bleeding usually lasts from 3 to 7 days, and the typical volume of menstruation is 100 ml. At first, the uterine lining is very thin, but stimulated by estrogens, it gradually thickens, thanks to which any possible implantation of the egg will take place in the well-supplied endometrium. At that time, several competing Graafian follicles mature in the body. One or two of them assume the dominant function and burst, releasing the egg, capable of fertilization for 24 hours. This moment is called ovulation, which is the last stage of the follicular phase and the beginning of the next phase, the luteal phase, lasting from 10 to 16 days. During this time, the level of progesterone increases, and the lining of the uterus prepares to receive the embryo. If fertilization does not occur, this lining is shed, leading to another menstruation. And in this way, like the moon in the sky, we come full circle in a renewable way.
Not all cycles are the same
We already know the menstrual cycle in its typical, proper course. Now let's approach the subject even more realistically and talk about the not-so-rare menstrual disorders. They can concern the length of the menstrual cycle, the abundance and duration of bleeding, and the pain of periods. And above all, they are related to ovulation, which is an indicator of our fertility. A few days ago, I talked about all this with my friend, sexual health educator Kristen Fernandes, and I liked a certain statement she made. As she said: bleeding is the result of ovulation, so there is no such thing as a delayed period - there is only delayed ovulation or its absence. However, bleeding that occurs in an anovulatory cycle is not really a period . Logical, but I have not found a similar explanation online, and it sheds bright light on the crux of the problem, placing ovulation, not menstruation, at the center of menstrual cycle instability.
We also encourage you to read the article about withdrawal bleeding .
Ovulation like a full moon
It is said thatovulation occurs in the middle of the cycle, but it is worth knowing that it is often mobile, which causes irregular periods. This is related to the mobility of the aforementioned follicular phase, which can shift by several days. The luteal phase, on the other hand, is constant, so if it lasts less than 10 or more than 16 days during the cycle, there was probably no ovulation.
The most common causes of delayed or absent ovulation include travel and climate change, significant weight loss, increased physical exertion, stress, and various illnesses. What we eat in a given month and how much we sleep also affect our biological rhythm. If a period appears 4 days earlier than in the previous cycle, or 4 days later, there is no reason to worry. If, for example, one cycle lasts 30 days, the next 20 days, and the next 45 days, then we can say that we have irregular periods. Periods that occur too rarely may be the result of polycystic ovary syndrome , thyroid disease, hyperprolactinemia, or ovarian cancer. If we do not know the causes of cycle disorders, we should see a gynecologist. Situations such as repeated anovulatory cycles or a long break in bleeding, lasting at least 6 months and which may indicate secondary amenorrhea , also require medical diagnostics.
Too short, too long, too sparse, too bloody
An irregular period often manifests itself in the fact that it lasts less than 3 or more than 7 days. It is even more often associated with an abundant period. The amount of menstrual fluid can be affected by all the previously mentioned circumstances of our lives. The length of the menstrual cycle and the presence or absence of ovulation also determine the volume of menstruation. Normally, it is about 100 ml. I wrote more about menstrual blood here , I encourage you to explore the topic :). On our blog, you will also find articles about scanty period and heavy period . In the case of the former, we lose less than 30 ml of menstrual fluid, in the case of the latter, heavy bleeding forces us to change our pad on average every hour. Sometimes, spotting appears on our panties between periods. If it occurs before the period, the cause may be a low level of progesterone, a hormone produced by the corpus luteum. Thanks to it, it is possible to implant a fertilized egg and maintain pregnancy until the placenta is formed. Spotting before your period can also be a sign of ovarian cysts, which are caused by hormonal imbalances. On the other hand, marks on your panties that you notice around mid-cycle are probably ovulation spotting, related to the drop in estrogen levels, which causes the lining of the uterus to gently flake off.
Too painful
As you can see, there have been quite a few deviations from the textbook menstruation. But there are still two unpleasant, but unfortunately common, ailments ahead of us: menstrual pain and PMS (premenstrual syndrome), which are clear emotional fluctuations preceding a period. To some extent, menstrual pain is a normal phenomenon, but sometimes it is so strong that it disrupts our daily functioning. When it comes to feeling bad a few days before menstruation, as many as 85% of women struggle with it. Some of us suffer from a more severe form of PMS, which is premenstrual dysphoric disorder (PMDD) , which manifests itself in a depressive mood and self-destructive behavior.
In addition to ovulation bleeding, in all the recurrent situations mentioned so far, you should contact a gynecologist and start an individual treatment. I used the term 'recurrent' for a reason. Let's remember that one cycle that differs from the others is not yet a reason to worry or a reason to see a doctor. The basis for taking action are 2, or preferably 3, observed cycles.
Also read the articles: the impact of COVID on menstruation and the impact of vaccinations on menstruation .
Special time for menstruation part 1 - puberty
I hope you've reached this point, because it's time for a small correction. There are three stages of our lives in which some of the disorders listed here are a natural reaction of the body. The first is... puberty. Dr. Hab. Grażyna Jarząbek-Bielecka is the author of the work Menstrual disorders in girls in gynecological practice , which is really helpful in understanding what menstrual disorders in adolescence are. As we can read, they are most often caused by irregularities at various levels of the hypothalamic-pituitary-ovarian system, which at this time is sensitive to pathogenic stimuli, such as stress. In addition, the young body is only just getting used to the new rhythm of ovarian function and to a dose of hormones it has never had before. For these reasons, for several years after menarche (first period), our cycles are often irregular - they last longer than 34 days and are usually anovulatory. If they are not accompanied by prolonged or very heavy bleeding, they do not require treatment at this stage of life. Similarly, frequent menstruation, which sometimes occurs in 11-12 year old girls, does not require treatment. Their cycles are shorter than 22 days and are anovulatory, which is associated with corpus luteum insufficiency or a shortened follicular phase.
Hormonal disorders occurring before puberty include another, particularly interesting issue - functional uterine bleeding. As Jarząbek-Bielecka explains, these are acyclic, heavy bleedings that can last from 10 days to even 3 months, which usually occur shortly after the first period. As a result of the lack of ovulation, caused by a deficiency of progesterone, there is irregular exfoliation of the loosened uterine lining, and therefore heavier bleeding. It may also happen that the uterine lining does not exfoliate sufficiently. Then, it slowly grows for up to 3 months, and then its functional layer slowly exfoliates, which can last up to a month.
Bleeding in adolescents is often the cause of anemia or anaemia, and may also be related to blood clotting disorders or von Willebrand's disease (here I refer you once again to our post on von Willebrand's disease , where you can learn more about this condition). It is important to diagnose the problem early so that serious complications do not occur. If, as a pubescent girl, you have observed any of the above symptoms, do not delay a visit to a gynecologist.
An irregular period is like an unexpected guest, and especially an uninvited one, during our trips. Since some of us prepare a place for such a guest at the Christmas Eve table, let's behave similarly in this situation. Just in case, let's be prepared and always have a few pads with us :).
We also encourage you to read the article: menstrual synchrony - does it really exist?
Special time for menstruation part 2 - pregnancy
When we do not systematically observe our bodies, irregular periods can make it difficult for us to get pregnant. Anovulatory cycles simply rule it out, but in a situation where ovulation is only shifting, keeping a temperature chart and observing the mucus and position of the cervix are very helpful when trying to conceive a child.
And what about our menstrual cycle after giving birth? The pituitary gland of new mothers produces prolactin, a hormone responsible for breast growth and lactation, or the process of secreting milk. Prolactin inhibits ovulation, which is why most breastfeeding women (the concentration of prolactin increases through stimulation of the nipples by the infant) experience a period of infertility that can last for several or even a dozen months. In non-breastfeeding women, ovulation (and menstrual bleeding itself) can occur much sooner (after 6 weeks after giving birth). However, let's not treat prolactin as a natural and guaranteed contraception. Let's remember that the time at which menstruation and ovulation return after giving birth is really an individual matter for each woman.
If I bring up pregnancy in the context of irregular periods, I should say a few words aboutcontraception . Many doctors prescribe contraceptives to regulate irregular periods. This is a very common solution to the problem, although opinions on its validity are divided. In reality, pills do not regulate cycles, because by inhibiting ovulation, they restore regular bleeding, which is not menstrual bleeding. These are so-called withdrawal bleedings (caused by a seven-day break in taking pills or four days of taking "empty" pills without a hormonal substance), acting like a placebo, thanks to which we do not feel strange due to the complete lack of a period. You can learn more about the effect of pills on the menstrual cycle in the article: Contraceptive pills and period - facts and myths . And if you want to read more about contraception, we recommend the articles: Hormonal contraception and The morning-after pill .
Special time for menstruation part 3 - menopause
Yes, menopause is a special time for menstruation, because it means saying goodbye to it forever. However, even before the menstrual cycle stops permanently (usually around the age of fifty), we enter a several-year phase of premenopause. Then our cycles usually start to shorten or lengthen, which causes irregular periods. This is the process of ovarian function ceasing, which produce less and less estrogen, so important for the menstrual cycle in its first phase. Additionally, menopause is accompanied by changes in well-being and often mood swings, which is the result of hormonal swings.
You can read about the menopause diet in the articlehere .
Menstruation is an indicator of the health of menstruating people. You have just finished reading an article that is a huge dose of knowledge, I hope it is helpful and interesting. But remember one thing - our bodies and lifestyles are very different. Seek knowledge, talk to each other, observe your cycles, but do not self-diagnose - as they say, a doctor doesn't bite :).
Created at: 06/08/2022
Updated at: 15/08/2022
