Stages of Life > Menstruation > Menstruation - Overview

The Facts About Menstruation

Understanding the complexities of your cycle is essential to managing your menstrual symptoms.

The midsection of a woman standing in her underwear is shown while she is wearing a cardigan.

The menstrual cycle is a monthly process that most women regularly experience. And while we can typically predict when our periods will occur, many women know very little about how their menstrual cycle impacts their daily lives.

Understanding how and why your cycle affects your body and mind can help you better manage your health and quickly identify warning signs of complications.

Overview of the menstrual cycle

Often, when we think of menstruation, we focus on the period itself. However, there is much more at work in your body. The menstrual cycle is a complex process during which the ovarian cycle and the uterine cycle work in tandem. The ovaries, the uterus and the brain all work together, communicating through hormones, to keep the overall menstrual cycle working as it should.

The phases of the menstrual cycle are as follows:

Menstruation is the period itself, when the uterine lining sheds. In this phase, your levels of estrogen and progesterone are low.

The follicular phase is the time between the first day of the period and ovulation. As the egg prepares to be released, your estrogen levels will slowly rise.

The proliferation phase occurs just after your period ends, and your uterine lining begins building up again.

Ovulation is the midpoint of the cycle. This is when your estrogen peaks and your ovaries release an egg.

The luteal phase is the time between ovulation and the start of menstruation. Progesterone peaks as your body prepares for a possible pregnancy.

The last phase of the menstrual cycle is the secretory phase, in which the uterine lining goes one of two ways: builds up to support a pregnancy or prepares to break down to restart the menstrual cycle.

The menstrual cycle is a monthly process, typically restarting every 28 to 32 days. Cycles running between 21 to 40 days are considered normal. If your cycle falls outside of these ranges, you should schedule an appointment with your gynecologist.

Menstruation typically begins during puberty and will continue each month until menopause. It's not uncommon to experience irregular periods during puberty and menopause. However, after the first year of menstruation, the periods should start to normalize. Understanding and monitoring your regular menstruation symptoms can help to detect early indications of reproductive complications.

How menstruation affects the body and the mind

As your body enters the menstruation phase, it's normal to experience symptoms such as cramps, abdominal discomfort, digestive disturbances, fatigue, muscle cramps, heavy bleeding and headaches or migraines.

The length and severity of these symptoms vary from woman to woman, so monitoring these symptoms can be important until you understand the pattern of your usual menstrual cycle.

Once bleeding stops, the symptoms typically end. During ovulation, it's common to feel pelvic discomfort and localized pain around the ovary, and hormone levels will fluctuate dramatically at times throughout your cycle. These fluctuations will continue as your body prepares for menstruation, which can lead to many side effects.

The most common impact of the menstrual cycle is premenstrual syndrome (PMS). This complication is a real condition that causes symptoms that can severely affect your daily routine. Symptoms can begin as early as two weeks before your period and can continue even after bleeding begins.

The type and severity of symptoms will vary from one woman to another, but mood swings, depression, weight fluctuation, acne, bloating, diarrhea, constipation, pelvic pain, extreme fatigue and forgetfulness are all associated with PMS. While most women experience some form of PMS, it's estimated that 30 to 40 percent of women experience extreme menstrual symptoms that can severely impact their daily activities.

In addition to physical complications, hormonal fluctuations of the menstrual cycle can cause extreme cases of chronic depression, insomnia and extreme mood swings. While PMS can cause temporary mood swings and depressive states, a more serious condition called premenstrual dysphoric disorder (PMDD) can cause daily complications. This condition is particularly difficult to diagnose and treat because it is commonly misdiagnosed as PMS.

The psychological effects of PMDD include forgetfulness, feeling out of control, paranoia, insomnia and restlessness. The most debilitating physical impacts can be gastrointestinal complications, such as sharp cramping, bloating or abdominal heaviness, backache, nausea and vomiting. Many women also report skin and neurological disorders when symptoms are at their worst.

The symptoms can be all-consuming, and many women find that they are unable to function in the weeks leading up to and during their period. When secondary conditions such as inflammatory bowel disease (IBD) or fibromyalgia are present, PMDD can cause flare-ups in their symptoms.

It's thought that PMDD impacts the body's ability to create and regulate serotonin levels, leading to depressive states. For this reason, some women have found relief with selective serotonin reuptake inhibitors (SSRIs).

Other effective treatments for PMDD include a combination of lifestyle and diet changes such as stress reduction and stabilizing sleep patterns. Dietary choices, such as eliminating alcohol, caffeine and other stimulants, can aid in stabilizing mood and hormone levels. Some women report that increasing dietary supplements such as B vitamins, calcium and vitamin D can help to reduce their PMDD symptoms, which can also address PMS symptoms.

It's better to be overly cautious than to miss a potentially serious diagnosis.

Finally, medicinal interventions such as oral contraceptives can allow women with PMDD to skip their period, which allows their hormone levels to stabilize and can reduce some of their worst symptoms. However, the dosage of this treatment can vary, depending on your symptoms, and treatments should be closely monitored by your gynecologist. Keeping a journal of your symptoms can help to adjust your treatment plan.

Menstrual irregularities

Some women will also experience menstrual cycle irregularities. While missed, early or late periods can be caused by stress, there are other potential causes, including:

  • Eating disorders or extreme exercise
  • Polycystic ovary syndrome (PCOS)
  • Premature ovarian failure
  • Pelvic inflammatory disease (PID)
  • Uterine fibroids
  • Pregnancy

If you miss a period or find yourself with an irregular cycle, it's important to schedule a gynecologist appointment and get checked for any underlying conditions.

Tracking your symptoms

Regardless of your typical cycle, it's important to track your symptoms. There are many apps (Flo, Clue, Ovia) that can help you keep track of any symptoms you experience. Your period can be an indication of your overall wellness, and when a period complication arises, these changes can act as a beacon for your healthcare provider. When you notice a change, tell your doctor and be your own advocate. If you disclose changes in your body and the doctor does not take it seriously, you should insist on completing diagnostic testing. It's better to be overly cautious than to miss a potentially serious diagnosis.