Menstruation: facts and fallacies

Thursday, February 16, 2006
Menstruation begins when a girl reaches puberty, although this varies with each individual. When a girl starts menstruating she will notice bleeding from the vagina.

I'm a girl - I have not yet menstruated - what happens when I menstruate?
You won't menstruate until you reach puberty. Puberty is when you mature, or become able to produce children and that can be any time between the ages of 9 and 18, but is usually around 12 or 13. The age at which menstruation starts can vary as much as the periods themselves and the way they affect different women. When you start menstruating you will notice bleeding from the vagina. It might seem a bit scary, but you shouldn't be alarmed. This is normal and natural. You're showing the first signs of a cycle that makes you capable of conceiving. In other words, you have an egg (or ovum) which can be fertilised by a sperm to become a baby.

What exactly happens during the menstrual cycle?
Every girl is born with the basis of thousands of tiny eggs. They're called follicles. They're groups of cells that might eventually encase mature eggs, called ova. Most follicles never mature. Those that do stay in your ovaries until they are released, travelling down one of your two fallopian tubes to your uterus, or womb. The opening into the uterus is called the cervix. It is at the end of your vagina. The menstrual cycle is the process by which the eggs are released, ready to be fertilised. It is a cycle, usually of around 28 days, but this varies. The bleeding is only part of it, but let's use it as the starting point of the cycle. Once you start bleeding, some of the eggs start to ripen, though usually only one matures ready for fertilisation. You start to produce the hormone oestrogen.

Approximately 14 days from the start of the bleeding, one egg matures and is released from the follicle on the surface of the ovary and then into a fallopian tube. If it has not been fertilised with a sperm it will break up. After about 14 more days the production of oestrogen and progesterone stop and the lining of your uterus starts to come away. This starts the bleeding that you notice from your vagina. It's actually a combination of blood, tissue and mucus. The most likely time to conceive - in other words, become pregnant - is when the egg pops out of the ovary, and that's usually about midway between the start of one period and the next. When the egg breaks away from the ovary you might feel cramping or pain and notice a spot or two of blood or mucus. This is normal.

It's unlikely that you can become pregnant if you have sex during a period, but it can happen. Sperm can remain alive inside you for up to five days. The most risky time for pregnancy is the time immediately after the period until 24 hours after the egg is released. If an egg becomes fertilised it will normally move down a fallopian tube to the uterus and develop into a fetus.

Do I use sanitary pads or tampons? Which is better?
It's simply a matter of preference. These days there are many different kinds of tampons that you insert into your vagina to soak up the menstrual bleeding. For some girls, it might be difficult to push a tampon in, even with a lubricated applicator. There are many different brands of sanitary pads which attach to your panties. It's all a matter of personal choice whether to use pads or tampons.

Tampons should be changed every 4 to 8 hours. It is important not to forget to remove the last tampon at the end of your period. If you have trouble removing it, ask your mother or an experienced sister or friend to help - or your doctor. You must also change sanitary pads frequently.

I'm an adult woman: I have painful periods - What can I do?
You're not alone. Period pain can affect your back, your legs, give you headaches, cramps, sore breasts and make you want to throw up. In extremes, these symptoms may be difficult to cope with. You should get medical advice on how to relieve or manage the pain and discomfort. What else can you do about it? Exercise, a nice warm bath and then a hot-water bottle help give relief to cramps and aches. Aspirin has also been used successfully to alleviate period pain. There are specific tablets which in most women relieve period pain effectively, so ask your chemist. Some women find masturbation is a good way to get rid of period pain.

I get the miseries. Periods are so depressing.
If your periods really get you down, you may be suffering from Premenstrual Syndrome (PMS) or Premenstrual Tension (PMT) as it is sometimes called. If it really gets you down, don't try to be too brave. Consult a doctor - there are various ways of dealing with it.

I'm an older woman: what's menopause?
This is another stage in life, the so-called change of life. Just as you reached puberty and started menstruating, ready to conceive and have children, at a certain stage in life your body decides the time for you to have children has passed. Like menstruation, menopause can happen at different times and affect women in different ways. Menopause is the name given to the last period and generally occurs in your mid to late 40s. This can vary widely. Sometimes menopause happens suddenly, but more often than not it's a stop/start process that reduces your body's reproductive capability gradually. Your periods happen irregularly and less and less frequently until they stop completely. As your body produces less of the hormone oestrogen there can be many accompanying changes and effects. Hot flushes are common. There may also be mood changes, some memory loss, and a reduced interest in sex. The reduction in oestrogen can also lead to osteoporosis, a condition in which your bones lose some calcium and can become very fragile. Oestrogen replacement, using impregnated patches or in tablet form, is being used successfully to offset the risk of osteoporosis and frequently to minimize many of the other symptoms of menopause. Your doctor should be able to advise you.

What is Toxic Shock Syndrome?
Toxic Shock Syndrome is a rare condition that has been associated with tampon use. The symptoms include a high fever, vomiting, diarrhea, dizziness, a rash and fainting. If you have these symptoms while using a tampon contact your doctor immediately. Toxic Shock Syndrome can be fatal. It is believed to be caused by toxin producing strains of a bacterium, Staphylococcus aureus. About half of the cases of Toxic Shock Syndrome are in women using tampons, the rest occur in men, women and children.

ThinkstockMammograms could cause more harm than good in older women: experts Four surprising skin sins ThinkstockMental health issues missed by doctors in most suicides ThinkstockWoman suffered five-day clitoris erection after taking antidepressants