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Menstruation – part of the Journey of Life

Menstruation-cup-dr-Peter-England
Menstruation-cup-dr-Peter-England

Menstruation occurs during a significant portion of a woman’s life.

Menstruation begins during puberty with the onset of your first period (menarche) and ends with the cessation of ovarian function and periods (menopause). It is important to understand what is normal. Equally, let’s discuss some abnormal symptoms that indicate you should see your doctor for a checkup.  

What are the features of a normal menstrual cycle?  

The start of a period is referred to as Day 1 of the cycle. A period represents the breakdown and shedding of the lining of your uterus. This may be accompanied by pelvic pain. Typically, this pain is in the form of cramps and varies in severity from almost none to quite severe in some women. During the next 10 days, hormones are produced by the ovaries to stimulate the production of an egg. The egg matures in a small cyst called a follicle. The follicle pops (ruptures) and the egg floats out around day 14-15. During this time the lining of the uterus has regrown again. The egg is collected by the fallopian tube and transported to the uterus. If no pregnancy occurs, the hormones will fall away into your bloodstream, resulting in your next period. On average, this is 28 days from the start of the previous one and the menstrual cycle goes around again. 

How do I know when I am ovulating?  

Some women can identify the fertile phase of their cycle when egg release occurs by the change in vaginal discharge. Ovulatory mucous is typically clearer, more in amount and very slippery stretchy. It is remarkably similar in consistency to egg white. Sometimes there are 1-2 days of pain to the left or right side of the pelvis due to a small amount of bleeding from the ovary when the egg is released. Of course, many women will not have such symptoms. There are ovulation testing kits available from the chemist to help identify this change, but be warned, they can be tricky to interpret.  

What if my period is not regular?  

In early adolescence, it may take 2-3 years from menarche (first period) for many girls to settle into a regular cycle. Normal menstruation will be from 24-35 days. If your periods are regularly very late: i.e. more than 5 weeks apart, and pregnancy has been excluded, it’s worth seeing your doctor to discuss your period.

What if I bleed between my periods?  

Bleeding between periods is known as intermenstrual bleeding and while it’s quite common, it should be viewed with caution. Some light spotting mid-cycle when ovulation occurs may not cause any issue, but if there is significant bleeding recurrently during your cycle, there may be an underlying gynaecological problem and you should see your doctor for an assessment. 

Is it normal to bleed after having sex?  

The answer is no.  

Post-coital bleeding is not normal and should be checked out and discussed with your doctor. There may be changes in the cells of the cervix, which can be checked by a pap smear. Bleeding after sex may also be an indication of infection.

Will my period change over time?

For most women, the answer is yes, you will notice changes over time, but there is no one pattern. Often there is a time of relative stability in the late teens to early thirties. From late 30s and into the 40s many (but not all) women may start to experience excessively heavy or prolonged bleeding or excessive pain

In summary, if you notice a significant change in your cycle that is bothering you, don’t ignore it but use it as a signal to make an appointment with your GP. If your doctor is concerned they can investigate things further and consider a referral to a gynaecologist.


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