Menstruation is a very complicated process involving many different hormones, the woman’s sex organs and the brain.

A woman’s internal sex organs consist of two ovaries, the Fallopian tubes, the uterus (womb) and the vagina. The ovaries contain the eggs with which the woman is born and, during each period, a single egg will usually ripen and mature due to the action of hormones circulating in the bloodstream.

When the egg is mature it bursts from the ovary and drifts through the Fallopian tube down into the uterus. The lining of the uterus – the endometrium – has been thickened by the action of hormones and made ready to receive the fertilised egg.

If the egg is fertilized and the woman becomes pregnant, it will fasten itself onto the endometrium. If the egg is not fertilized, however, resultant hormonal changes cause the endometrium to slip away and menstruation begins.

Menstrual discharge is composed of the endometrium itself, together with a little fresh blood caused by the breaking of very fine blood vessels within the endometrium as it detaches itself from the inside of the uterus.

The amount of blood lost due to the normal monthly period is usually less than 80ml.

When does menstruation begin?

These days, girls begin to menstruate when they are about 10 to 14 years-old. The average age is approximately 12. Women will continue to menstruate until the age of 45 to 55, when menopause begins. A woman will have approximately 500 periods in her lifetime.

Can you feel ovulation?

Ovulation usually takes place roughly 14 days after the first day of the start of a period; however, the exact timing can vary greatly from woman to woman. Some women know when they are ovulating because they can feel a slight pain in their lower abdomen. Other women may bleed slightly in the middle of their cycle.

Vaginal discharge also changes at ovulation. It increases in amount and becomes more watery due to hormonal changes. This is one of the ways that women who wish to practice natural family planning (NFP) using the mucus test can find out whether it is safe to have sex or not.

Women who do not experience such symptoms during ovulation can find out when they are ovulating by taking their temperature. This will rise by 0.5 degrees Celsius when ovulation occurs. To measure temperature effectively, it must be taken at the same time every morning before getting out of bed.

Temperature readings taken from different parts of the body such as the mouth, under the arm, in the ear or in the rectum will all give a slightly different measurement. For this reason, it is important to choose one location and stick to it. When checking for temperature, rises can occur for a variety of reasons and, therefore, should not be used as the only method of detecting ovulation.

What influences menstruation?

As described above, menstruation is a very complex process involving many different hormones, the sexual organs and the nervous system.

First and foremost, hormones influence menstruation. If they are not in balance, the cycle will similarly be affected. If a woman’s periods are very irregular, she can ask her doctor to measure the hormones in her blood to find out if her hormones are out of balance. This will give a rough indication as to whether there is a serious hormonal problem. However, since what is ‘normal’ varies greatly with regard to women’s hormones, blood tests are not a particularly good measure of what can be considered much more subtle imbalances in a woman’s cycle.

Weight also influences hormonal balance and menstruation. If a woman is underweight, her hormones will stop working properly and her periods might stop altogether. Recent research has also shown that obesity can throw hormones out of balance and make it harder for women to conceive. Stress also affects the hormones. Many women find that if they are worried about something, it can influence menstruation. In some cases, a woman’s period might actually stop if she is very worried about whether she is pregnant.

Regular exercise and keeping fit and healthy can help regulate the menstrual cycle. On the other hand, exercising too much and overstressing the body can have a negative effect on the hormones to the extent that menstruation may cease.

What are the symptoms of painful periods?

The degree of discomfort experienced during menstruation varies from woman to woman. Some are never bothered by their periods, while others can be badly affected by unpleasant symptoms. These may include:

• pains in the abdomen
• pain in the vagina
• feeling nauseous and generally unwell
• diarrhoea
• sweating
• fatigue.

What can women do to relieve their symptoms?

There are several things that will help relieve discomfort:

• while menstruating, refrain from drinking caffeinated drinks such as coffee, tea, cola or cocoa.
• avoid stress. Relaxation and massage can work wonders.
• exercise and staying fit can help prevent painful periods.
• keep your abdomen warm.
• finally, use pain-relieving medicines if necessary.

Remember that it is always best to consult your doctor about your specific concerns.

What causes painful periods?

There is no single proven theory, but there are several possible reasons:

contractions of the uterus similar to those felt in childbirth due to the hormone prostaglandin.

the pain can be caused by the cervix dilating when the blood and the tissue are passed out of the womb.

the pain can be due to earlier infections or inflammations of the uterus, or benign tumours in the uterus.

in some cases, painful periods are hereditary. If a woman has painful periods, her daughters may later be affected in the same way.

Why do some women’s periods stop altogether (amenorrhoea)?

Periods can stop for a number of reasons. The most common are:

• pregnancy.
• premature menopause (this can affect women in their early twenties).
• weight loss.
• weight gain.
• some forms of medication including the contraceptive pill or injections.
• drug abuse.
• stress.
• hormonal imbalances such as an underactive thyroid gland or the overproduction of a hormone called prolactin.
• a condition called polycystic ovaries (see below) is a very common cause of irregular or absent periods.

The treatment suggested will depend upon the diagnosis. If you are uncertain as to why your periods have stopped, seek advice from your doctor. Investigation usually involves a blood test to measure the levels of various hormones in your body.

Irregular, infrequent periods (oligomenorrhoea)

Periods are often light or infrequent both when a young woman starts having periods, and also when a woman is nearing menopause. This is normal because they are not producing an egg every month.

Many women experience one or two irregular periods every six months. This is not usually caused by any serious condition; however, many women do seek an explanation and reassurance from their GP or gynaecologist.

The most common cause of infrequent periods is a condition called polycystic ovaries. This is a common condition affecting as many as 10 per cent of women, in which a large number of very small (less than 1cm) cysts on the ovaries appear in association with a hormone imbalance.

This condition results in irregular ovulation and thus periods are usually infrequent. The diagnosis of polycystic ovaries is made on the basis of one or more blood tests to measure hormones; a pelvic ultrasound scan of the ovaries is often taken as an additional test.

Treatment is only necessary if there is concern about the irregularity of periods or if a woman is having difficulty becoming pregnant.

Visit Menstrual Cycle for more information.

Eumenorrhea denotes normal, regular menstruation that lasts for a few days (usually 3 to 5 days, but anywhere from 2 to 7 days is considered normal). The average blood loss during menstruation is 35 milliliters with 10–80 ml considered normal. (Because of this blood loss, women are more susceptible to iron deficiency than men are.)[14] An enzyme called plasmin inhibits clotting in the menstrual fluid.

Painful cramping in the abdomen, back, or upper thighs is common during the first few days of menstruation (most women experience some pain during menstruation). Severe uterine pain during menstruation is known as dysmenorrhea, and it is most common among adolescents and younger women (affecting about 67.2% of adolescent females). When menstruation begins, symptoms of premenstrual syndrome (PMS) such as breast tenderness and irritability generally decrease.  Many sanitary products are marketed to women for use during their menstruation.

The menstrual cycle, under the control of the endocrine system, is necessary for reproduction. It is commonly divided into three phases: the follicular phase, ovulation, and the luteal phase; although some sources use a different set of phases: menstruation, proliferative phase, and secretory phase. Menstrual cycles are counted from the first day of menstrual bleeding. Hormonal contraception interferes with the normal hormonal changes with the aim of preventing reproduction.

Stimulated by gradually increasing amounts of estrogen in the follicular phase, discharges of blood (menses) slow then stop, and the lining of the uterus thickens. Follicles in the ovary begin developing under the influence of a complex interplay of hormones, and after several days one or occasionally two become dominant (non-dominant follicles atrophy and die). Approximately mid-cycle, 24–36 hours after the Luteinizing Hormone (LH) surges, the dominant follicle releases an ovum, or egg in an event called ovulation. After ovulation, the egg only lives for 24 hours or less without fertilization while the remains of the dominant follicle in the ovary become a corpus luteum; this body has a primary function of producing large amounts of progesterone. Under the influence of progesterone, the endometrium (uterine lining) changes to prepare for potential implantation of an embryo to establish a pregnancy. If implantation does not occur within approximately two weeks, the corpus luteum will involute, causing sharp drops in levels of both progesterone and estrogen. These hormone drops cause the uterus to shed its lining and egg in a process termed menstruation.

In the menstrual cycle, changes occur in the female reproductive system as well as other systems (which lead to breast tenderness or mood changes, for example). A woman’s first menstruation is termed menarche, and occurs typically around age 12. The end of a woman’s reproductive phase is called the menopause, which commonly occurs somewhere between the ages of 45 and 55.

Source: Menstrual Cycle

Our skin helps to protect us from germs. Although we need to clean our bodies of dirt and germs, the skin needs its natural oils to work well. Gentle washing with mild soaps and warm, not too hot, water is all that is needed. Buffing or other rough treatment should be used only on tough skin like our feet. Daily moisturizing with a cream containing a sunscreen will help protect our skin from the sun’s harmful effects, like skin cancers and wrinkles. Apply sunscreen daily to all body areas not covered by clothes.

What is the best way to keep the genital area clean? 

The skin of a woman’s genital area also works to protect her from germs. There are natural oils and discharge that keep this area healthy. The skin and the lining of the vagina are very sensitive. Any chemical or perfume can break down the natural protection of this area and even start infections. Gentle daily cleaning on the outside skin with mild soap and water is all that is needed.

What about vaginal discharge and odor? 
The body produces a milky discharge that naturally cleanses the vagina. When women douche or use tampons or pads, they are removing the natural protection of the body against infections and odor. Regular use of such things as minipads can even make the body form more discharge in an attempt to protect itself. Limit using these pads to the times when you may spot with your period. Do not douche unless it is recommended by your healthcare provider.

Everyone’s private area has a normal odor that cannot be removed or covered no matter how much we try. Deodorants and perfumes added to pads and tampons may cause allergy problems with this sensitive skin. If the odor is strong or the discharge yellow, this may indicate that something is wrong. An exam by your provider may be needed to find the cause.

How can I help vaginal dryness caused by menopause? 
Women in menopause may notice that the natural moisture of the vagina decreases. Sexual activities can become uncomfortable because of this dryness. The skin cannot protect itself and may need more wetness. There are several ways to take care of this. Hormones that are taken regularly can help with this problem. Nonprescription gels and inserts have also been made to help women with this type of dryness. Be sure to use unscented products.

What else can I do? 

Other important feminine hygiene tips include:

• changing underwear daily
• wearing underwear with a cotton crotch to help pull moisture away from the body
• wiping from front to back after going to the bathroom
• changing tampons and pads every 4 to 6 hours when on your period, and
• sleeping without underwear or in loose-fitting pajama bottoms.

Practice good feminine hygiene:

• Bathe daily with mild soap and warm water.
• Wear all-cotton underwear or underwear with cotton crotches.
• Change underwear and pantyhose every day.
• Avoid wearing pantyhose or tights for too many hours, especially in hot, humid weather.
• Use deodorant-free white toilet paper to avoid perfume and dye that might irritate.
• Avoid using feminine hygiene products (such as sprays and powders) and bath additives (such as bubble baths and oils).
• Avoid douching more than once a month. Douching is not necessary.
• Use deodorant-free sanitary pads or tampons.
• Avoid spermicidal foams, gels, and creams.
• If you tend to get yeast infections when you take antibiotics, use an antiyeast cream while you are taking antibiotic medicine.
• Have just 1 sexual partner who is not sexually active with anyone else, and practice safe sex.

The main symptom of vaginitis is a lot of whitish, gray, or yellowish discharge from the vagina. Some milky vaginal discharge is normal for females of all ages, but infections cause an abnormal amount of discharge. The discharge may have a bad odor.

You may also have:

• an unpleasant odor from the vagina
• itching
• a swollen, red vulva, which may be painful or itchy
• painful intercourse
• bleeding in the vaginal area.
• symptoms of a urinary tract infection, such as pain when you urinate.

If you have pain in your lower abdomen or irregular bleeding with these symptoms, see your health care provider right away. If you are at risk for a sexually transmitted disease and have the above symptoms, you should also see your provider right away.

Vaginitis is the medical name for swelling, burning, itching, or an infection of the vagina. When the vulva is also affected, it is called vulvovaginitis. (The vulva is the fold of skin around the opening of the vagina.) Vaginitis is a very common problem that can occur in females of any age.

How does it occur? 

Vaginitis can be caused by organisms that infect the vagina, such as bacteria, viruses, protozoa, or yeast. It can also be caused by irritants such as soap, powders, or lubricants.

Sexually transmitted diseases (STDs) that cause vaginal infections are:

• trichomoniasis
• chlamydial infections
• gonorrhea
• syphilis
• genital herpes
• human papillomavirus.

Yeast infections of the vagina are caused by overgrowth of a fungus called Candida. Vaginitis can also be caused by an overgrowth of bacteria normally found in the vagina. This is a condition called bacterial vaginosis or nonspecific vaginitis.

Irritants that can cause vaginitis include:

• birth control products such as condoms, diaphragms, and spermicides
• feminine hygiene products such as perfumed sprays, powders, or douches
• perfumed soaps, detergents, or fabric softeners
• nonabsorbent, heat-retaining clothing such as nylon pantyhose and tights
• antibiotics
• tampons
• sexual devices
• injury.

Vaginitis can also be caused by psychological stress, poor hygiene, or a decrease in estrogen hormone.

Sometimes the cause of vaginitis is not known.

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Our skin protects us from the world. Although we need to clean our bodies of dirt and germs, the skin needs its natural oils to work well. Gentle washing with mild soaps and warm, not too hot, water is all that is needed. Buffing or other rough treatment should be used only on tough skin like our feet. Daily moisturizing with a cream containing a sunscreen will protect our skin from the sun’s harmful effects, like skin cancers and wrinkles. Apply this to all areas not covered by clothes.

The skin of a woman’s private area also works to protect her from germs. There are natural oils and discharge that keep this area healthy. The skin and the lining of the vagina is very sensitive. Any chemical or perfume can break down the natural protection of this area and even help start infections. Gentle daily cleaning on the outside skin is all that is needed.

The vagina produces a natural cleaning liquid, that works its way out of the vagina daily. When women remove or absorb this with douches, tampons, or pads, they are removing the best protection against infections and odor. Regular use of such things as minipads can even make our body form more discharge trying to protect itself. Limit these pads to the times when you may spot with your period.

Everyone’s private area has a normal odor that cannot be removed or covered no matter how much we try. Deodorants and perfumes added to pads and tampons may cause allergy problems on this sensitive skin. If the odor is strong or the discharge yellow, this may indicate that something is wrong. An exam by your healthcare provider may be needed to find the cause.

Women in menopause may notice that the natural moisture of the vagina is gone. Sex, and even walking, can become uncomfortable because of this dryness. The skin cannot protect itself and may need more wetness. There are several ways to take care of this. Hormones, taken regularly, can help with this problem. Over-the-counter gels and inserts have also been made to help women with this type of dryness. Be sure to use only those that are unscented.

If these agents do not improve the problem, see your healthcare provider.

More information about Feminine Hygiene.

 DO

• Open lips and clean between folds.
• Change underwear daily.
• Wear underwear with a cotton crotch because cotton wicks moisture away from the body.
• Wipe from front to back to prevent spread of bacteria.
• Urinate after intercourse to prevent urinary tract infections.
• Change tampons and pads every 4-6 hours while awake.
• Use a blow dryer or air dry before dressing.
• Wear loose comfortable clothing when possible.
• Sleep without underwear or in loose cotton boxer shorts to promote natural drying of the genital area.

 DON’T

• Neglect the hidden areas.
• Wear jeans without underwear.
• Wear mini-pads on a regular basis: they hold in moisture and can promote vaginal infections like yeast.
• Douche: douching washes away “good” bacteria and can promote vaginal infections.
• Postpone going to the bathroom when the urge is felt or after sex.
• Leave tampons and pads in place for prolonged periods: moisture promotes bacterial growth.
• Stay in wet clothes or bathing suits; moisture promotes bacterial and fungal growth.
• Wear tight jeans or spandex clothing for prolonged periods because they promote moisture.
• Use powder in the genital area or under breasts; powders hold in moisture and promote fungal infections.