Menstruation
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Menstruation (also known as a period, among other
The first period, a point in time known as
Up to 80% of women do not experience problems sufficient to disrupt daily functioning either during menstruation or in the days leading up to menstruation. Symptoms in advance of menstruation that do interfere with normal life are called
Characteristics
Length and duration
The first menstrual period occurs after the onset of pubertal growth, and is called
Menstruation is the most visible phase of the menstrual cycle and its beginning is used as the marker between cycles. The first day of menstrual bleeding is the date used for the last menstrual period (LMP). The typical length of time between the first day of one period and the first day of the next is 21 to 45 days in young women, and 21 to 31 days in adults.[2][3] The average length is 28 days; one study estimated it at 29.3 days.[9] The variability of menstrual cycle lengths is highest for women under 25 years of age and is lowest, that is, most regular, for ages 25 to 39 years.[10] The variability increases slightly for women aged 40 to 44 years.[10]
Bleeding
The average volume of menstrual fluid during a monthly menstrual period is 35 millilitres (2.4 US tbsp) with 10–80 millilitres (0.68–5.41 US tbsp) considered typical. Menstrual fluid is the correct name for the flow, although many people prefer to refer to it as menstrual blood. Menstrual fluid is reddish-brown, a slightly darker color than venous blood.[11]: 381
About half of menstrual fluid is blood. This blood contains sodium, calcium, phosphate, iron, and chloride, the extent of which depends on the woman. As well as blood, the fluid consists of cervical mucus, vaginal secretions, and endometrial tissue. Vaginal fluids in menses mainly contribute water, common electrolytes, organ moieties, and at least 14 proteins, including glycoproteins.[14]
Many women and girls notice blood clots during menstruation. These appear as clumps of blood that may look like tissue. If there was a
The amount of iron lost in menstrual fluid is relatively small for most women.[
Hormonal changes
The
Side effects
Menstrual health overview
Although a normal and natural process,
Moods and premenstrual syndrome (PMS)
Diagnosis requires a consistent pattern of emotional and physical symptoms occurring after ovulation and before menstruation to a degree that interferes with normal life.[37] Emotional symptoms must not be present during the initial part of the menstrual cycle.[37] A daily list of symptoms over a few months may help in diagnosis.[35] Other disorders that cause similar symptoms need to be excluded before a diagnosis is made.[35]
The cause of PMS is unknown, but the underlying mechanism is believed to involve changes in hormone levels during the course of the whole menstrual cycle.
Over 90% of women report having some premenstrual symptoms, such as bloating, headaches, and moodiness.[33] Premenstrual symptoms generally do not cause substantial disruption, and qualify as PMS in approximately 20% of pre-menopausal women.[31] Antidepressants of the selective serotonin reuptake inhibitors class may be used to treat the emotional symptoms of PMS.[31]
Premenstrual dysphoric disorder (PMDD) is a more severe condition that has greater psychological symptoms.[35][36] PMDD affects about 3% of women of child-bearing age.[31]Cramps
In most women, various physical changes are brought about by fluctuations in hormone levels during the menstrual cycle. This includes muscle contractions of the uterus (menstrual cramping) that can precede or accompany menstruation. Many women experience painful cramps, also known as dysmenorrhea, during menstruation.[38] Among adult women, that pain is severe enough to affect daily activity in only 2%–28%.[38] Severe symptoms that disrupt daily activities and functioning may be diagnosed as premenstrual dysphoric disorder.[39] These symptoms can be severe enough to affect a person's performance at work, school, and in everyday activities in a small percentage of women.[5]
When severe pelvic pain and bleeding suddenly occur or worsen during a cycle, this could be due to ectopic pregnancy and spontaneous abortion. This is checked by using a pregnancy test, ideally as soon as unusual pain begins, because ectopic pregnancies can be life‑threatening.[40]
The most common treatment for
One review found tentative evidence that acupuncture may be useful, at least in the short term.[43] Another review found insufficient evidence to determine an effect.[44]
Interactions with other conditions
Known interactions between the menstrual cycle and certain health conditions include:
- Some women with migraines,[medical citation needed] [45]especially when the woman who has migraines is also taking the birth control pill.
- Many women with epilepsy have more seizures in a pattern linked to the menstrual cycle; this is called "catamenial epilepsy".[46] Different patterns seem to exist (such as seizures coinciding with the time of menstruation, or coinciding with the time of ovulation), and the frequency with which they occur has not been firmly established.
- Research indicates that women have a significantly higher likelihood of anterior cruciate ligament injuries in the pre-ovulatory stage, than post-ovulatory stage.[47]
Sexual activity
Sexual feelings and behaviors change during the menstrual cycle. Before and during ovulation, high levels of estrogen and androgens result in women having a relatively increased interest in sexual activity, and relatively lower interest directly prior to and during menstruation.[48] Unlike other mammals, women may show interest in sexual activity across all days of the menstrual cycle, regardless of fertility.[49]
There is no reliable scientific evidence that would advise against sexual intercourse during menstruation based on medical grounds.[medical citation needed]
Fertility aspects
Peak
Menstrual disorders
Infrequent or irregular ovulation is called oligoovulation.
Very little flow (less than 10 ml) is called
There is a wide spectrum of differences in how women experience menstruation. There are several ways that someone's menstrual cycle can differ from the norm:
Term | Meaning |
---|---|
Oligomenorrhea | Infrequent periods |
Hypomenorrhea | Short or light periods |
Polymenorrhea | Frequent periods (more frequently than every 21 days) |
Hypermenorrhea
|
Heavy or long periods (soaking a sanitary napkin or tampon every hour, menstruating longer than 7 days)
|
Dysmenorrhea | Painful periods |
Intermenstrual bleeding | Breakthrough bleeding (also called spotting) |
Amenorrhea | Absent periods |
Extreme psychological stress can also result in periods stopping.[57] More severe symptoms of anxiety or depression may be signs of premenstrual dysphoric disorder (PMDD) with is a depressive disorder.[58]
Women who had undergone female genital mutilation (particularly type III- infibulation) a practice common in parts of Africa, may experience menstrual problems, such as slow and painful menstruation, that is caused by the near-complete sealing off of the vagina.[59]
Dysmenorrhea
Dysmenorrhea, also known as period pain, painful periods or menstrual cramps, is pain during menstruation.[60][61][62] Its usual onset occurs around the time that menstruation begins.[63] Symptoms typically last less than three days.[63] The pain is usually in the pelvis or lower abdomen.[63] Other symptoms may include back pain, diarrhea or nausea.[63]
Dysmenorrhea can occur without an underlying problem.
Dysmenorrhea occurs less often in those who exercise regularly and those who have children early in life.
Estimates of the percentage of femaleMenstrual hygiene management
Menstrual products (also called "feminine hygiene" products) are made to absorb or catch menstrual blood. A number of different products are available – some are disposable, some are reusable. Where women can afford it, items used to absorb or catch menses are usually commercially manufactured products. Menstruating women manage menstruation primarily by wearing menstrual products such as tampons, napkins or menstrual cups to catch the menstrual blood.
The main disposable products (commercially manufactured) include:
- wood pulp or gelproducts, usually with a plastic lining and bleached.
- Tampons – Disposable cylinders of treated rayon/cotton blends or all-cotton fleece, usually bleached, that are inserted into the vagina to absorb menstrual flow.
The main reusable products include:
- Menstrual cups – A firm, flexible bell-shaped device worn inside the vagina to collect menstrual flow.
- Reusable cloth pads – Pads that are made of cotton (often organic), terrycloth, or flannel, and may be handsewn (from material or reused old clothes and towels) or storebought.
- underwearwith extra absorbent layers sewn in to absorb flow.
Due to poverty, some women cannot afford commercial feminine hygiene products.[66][67] Instead, they use materials found in the environment or other improvised materials.[68][69] "Period poverty" is a global issue affecting women and girls who do not have access to safe, hygienic sanitary products.[70] In addition, solid waste disposal systems in developing countries are often lacking, which means women have no proper place to dispose used products, such as pads.[71] Inappropriate disposal of used materials also creates pressures on sanitation systems as menstrual hygiene products can create blockages of toilets, pipes and sewers.[66] In the UK research has shown that for women allotment growers, access to sanitation for menstrual hygiene management is limited.[72]
Menstrual suppression
Due to hormonal contraception
Menstruation can be delayed by the use of
Hormonal contraception affects the frequency, duration, severity, volume, and regularity of menstruation and menstrual symptoms. The most common form of hormonal contraception is the combined birth control pill, which contains both estrogen and progestogen. Although the primary function of the pill is to prevent pregnancy, it may be used to improve some menstrual symptoms and syndromes which affect menstruation, such as polycystic ovary syndrome (PCOS), endometriosis, adenomyosis, amenorrhea, menstrual cramps, menstrual migraines, menorrhagia (excessive menstrual bleeding), menstruation-related or fibroid-related anemia and dysmenorrhea (painful menstruation) by creating regularity in menstrual cycles and reducing overall menstrual flow.[74][75]
Using the
Due to breastfeeding
Breastfeeding causes negative feedback to occur on pulse secretion of gonadotropin-releasing hormone (GnRH) and luteinizing hormone (LH).[79] Depending on the strength of the negative feedback, breastfeeding women may experience complete suppression of follicular development, follicular development but no ovulation, or normal menstrual cycles may resume.[80] Suppression of ovulation is more likely when suckling occurs more frequently.[81] The production of prolactin in response to suckling is important to maintaining lactational amenorrhea.[82] On average, women who are fully breastfeeding whose infants suckle frequently experience a return of menstruation at fourteen and a half months postpartum. There is a wide range of response among individual breastfeeding women, however, with some experiencing return of menstruation at two months and others remaining amenorrheic for up to 42 months postpartum.[83]
Society and culture
Etymology and terminology
The word menstruation is etymologically related to moon. The terms menstruation and menses are derived from the Latin mensis 'month', which in turn relates to the ancient Greek mene 'moon' and to the roots of the English words month and moon.[84]
Some organizations have begun to use the term "menstruator" instead of "menstruating women", a term that has been in use since at least 2010.
Traditions, taboos and education
Many religions have menstruation-related traditions, for example: Islam prohibits sexual contact with women during menstruation in the
Menstruation education is frequently taught in combination with sex education at school in Western countries, although girls may prefer their mothers to be the primary source of information about menstruation and puberty.[92] Information about menstruation is often shared among friends and peers, which may promote a more positive outlook on puberty.[93] The quality of menstrual education in a society determines the accuracy of people's understanding of the process.[94] In many Western countries where menstruation is a taboo subject, girls tend to conceal the fact that they may be menstruating and struggle to ensure that they give no sign of menstruation.[94] Effective educational programs are essential to providing children and adolescents with clear and accurate information about menstruation. Schools can be an appropriate place for menstrual education to take place.[95] Programs led by peers or third-party agencies are another option.[95] Low-income girls are less likely to receive proper sex education on puberty, leading to a decreased understanding of why menstruation occurs and the associated physiological changes that take place. This has been shown to cause the development of a negative attitude towards menstruation.[96]
Seclusion during menstruation
In some cultures, women were isolated during menstruation due to menstrual
Beliefs around synchrony
Effects of the moon
Even though the average length of the human
Cohabitation
Beginning in 1971, some research suggested that menstrual cycles of cohabiting women became synchronized (menstrual synchrony).[110] Subsequent research has called this hypothesis into question.[111] A 2013 review concluded that menstrual synchrony likely does not exist.[112]
Work
Some countries, mainly in Asia, have menstrual leave to provide women with either paid or unpaid leave of absence from their employment while they are menstruating.[113] Countries with policies include Japan, Taiwan, Indonesia, and South Korea.[114][115] The practice is controversial due to concerns that it bolsters the perception of women as weak, inefficient workers,[113] as well as concerns that it is unfair to men,[116][117] and that it furthers gender stereotypes and the medicalization of menstruation.[114]
Other mammals
Most
See also
- Niddah (Jewish laws of menstruation)
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Book sources
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External links
- Quotations related to Menstruation at Wikiquote
- Media related to Menstruation at Wikimedia Commons