One of the earliest things women learn about feminine health are menstrual cycles. As we (hopefully) all learned in health class when we were all absolutely mature enough, “Aunt Flow” shows up once per month, and according to our health teachers is “perfectly normal”.
As a practicing OB/GYN and a woman, what is clearly missing from our sex education is that our periods, AKA, “our time of the month”, “code red” or “mother nature’s gift” might slightly differ from our friends and family. We also don’t learn much about ovulation, and that a period is actually just a small part of an entire monthly cycle.
Since most adults outside of the medical field don’t study feminine health or menstrual cycles outside of adolescent health class, let’s revisit the basics, and get a better sense of what a normal menstrual cycle should look like, and why we even have it in the first place. If you don’t fall into this category, don’t freak out. In a later part of the series, I’ll highlight various medical conditions or dysfunctions that can impact your cycle.
If you’re anything like me, while we’ve all accepted that a monthly period is just a necessary evil and pain in the ass, you might be wondering, if the actual flow is only a small part of the whole ovulatory menstrual cycle, what’s the point of it all?
According to The American College of Obstetricians and Gynecologists, most ovulatory menstrual cycles last 21 to 35 days. The duration of actual blood flow generally lasts 5 days, with the heavier flow hitting in the first 3 days. This can vary by a few days and become longer or shorter – especially as women approach menopause.
Before jumping into the inconvenient, and even sometimes painful part of the menstrual cycle, it’s important to highlight that ovulation, or the release of eggs from your ovaries, generally occurs in the middle of your menstrual cycle and about 14 days before your period starts. You can think of the start of your menstrual blood flow as a “reset,” as it signifies the first day of your next menstrual cycle.
To get lightly scientific, menstruation occurs in the body through a complex interaction between a number of glands in your reproductive systems. When things are running smoothly, your menstrual cycle should be cyclic, resulting in predictable and relatively consistent blood loss while your uterine lining changes, sheds and repairs itself.
Speaking of shedding, repairing and bleeding – this part of the menstrual cycle is specifically related to that symptom we all know and love – cramps. Menstrual cramps are a result of your uterus contracting to expel the uterine lining. During this, prostaglandins or hormone-like substances involved in pain trigger these contractions. Higher levels of these prostaglandins can be associated with more-severe menstrual cramps. If you fall into the category of severe menstrual cramps, there are a number of conditions that could cause this, including fibroids, endometriosis, and pelvic inflammatory disease.
Given that the ovulatory menstrual cycle is a complex biological interaction, dysfunction at any point in the process of ovulation is common, and it can prevent normal development and that sequential shedding of the uterine lining, AKA your “period.” I always tell my patients, the more steps involved in a biological process, the more likely it will be for a screw up! A complete menstrual cycle is important for embryo implantation and pregnancy.
If the above sounds like you, awesome! Make sure that you keep track of your period on a calendar or app. Pay attention to any changes in cycle length, days of bleeding, pain or flow. If it doesn’t sound relatable, and you want to learn more about periods that might be heavy, long-lasting, spotty or nonexistent, I’ll be linking to more articles soon, related to the specific things that could disrupt your menstrual cycle and lead to varying symptoms.
If you have specific questions, feel free to comment below or shoot me an email here!