Hesperian Health Guides
About once each month during her reproductive years, a woman has a few days when a bloody fluid leaves her womb and passes through her vagina and out of her body. This is called ‘monthly bleeding’, the ‘monthly period’ or ‘menstruation’. It is a healthy process and is part of the way the body gets ready for pregnancy.
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Most women think of their monthly bleeding as a normal part of their lives. But often they do not know why it happens or why it sometimes changes.
The Monthly Cycle (Menstrual Cycle)
The monthly cycle is different for each woman. It begins on the first day of a woman’s monthly bleeding. Most women bleed every 28 days. But some bleed as often as every 20 days or as little as every 45 days.
The amount of the hormones estrogen and progesterone produced in the ovaries changes throughout the monthly cycle. During the first half of the cycle, the ovaries make mostly estrogen, which causes a thick lining of blood and tissue to grow in the womb. The body makes the lining so a baby would have a soft nest to grow in if the woman became pregnant that month.
About 14 days before the end of the cycle, when the soft lining is ready, an egg is released from one of the ovaries. This is called ovulation. The egg then travels down a tube into the womb. At this time a woman is fertile and she can become pregnant. If the woman has had sex recently, the man’s sperm may join with her egg. This is called fertilization and is the beginning of pregnancy.
A woman may find that the time between each monthly bleeding changes as she grows older, after she gives birth, or because of stress.
During the last 14 days of the cycle—until her next monthly bleeding starts—a woman also produces progesterone. Progesterone causes the lining of the womb to prepare for pregnancy.
Most months, the egg is not fertilized, so the lining inside the womb is not needed. The ovaries stop producing estrogen and progesterone, and the lining begins to break down. When the lining inside the womb leaves the body during the monthly bleeding, the egg comes out too. This is the start of a new monthly cycle. After the monthly bleeding, the ovaries start to make more estrogen again, and another lining begins to grow.
|The monthly cycle|
During monthly bleeding, the lining breaks down.
Just after monthly bleeding
lining of the womb
When the ovary
releases an egg
5 days after
For most women, the whole menstrual cycle takes about 28 days —just like the cycle of the moon.
Problems with Monthly Bleeding
If you have problems with your monthly bleeding, try to talk with your mother, sisters or friends. You may find that they have them too and they may be able to help you.
Changes in bleeding
Sometimes the ovary does not release an egg. When this happens, the body makes less progesterone, which can cause changes in how often and how much a woman bleeds. Girls whose monthly bleeding has just begun—or women who have recently stopped breastfeeding—may only bleed every few months, or have very little bleeding, or too much bleeding. Their cycles usually become more regular with time.
Women who use hormonal family planning methods sometimes have bleeding in the middle of the month. For more information about changes in bleeding caused by hormonal family planning methods, see "Hormonal Methods of Family Planning".
Older women who have not yet gone through menopause may have heavier bleeding or bleed more often than when they were younger. As they get closer to menopause, they may stop having monthly bleeding for a few months and then have it again.
Pain with Monthly Bleeding
During monthly bleeding the womb squeezes in order to push out the lining. The squeezing can cause pain in the lower belly or lower back, sometimes called cramps. The pain may begin before bleeding starts or just after it starts.
What to do:
|Pressing hard on the tender place between your thumb and first finger can ease many kinds of pain. For other places where pressure can ease pain from monthly bleeding see "Acupressure Massage."|
- Rub your lower belly. This helps the tight muscles relax.
- Fill a plastic bottle or some other container with hot water and place it on your lower belly or lower back. Or use a thick cloth you have soaked in hot water.
- Drink tea made from raspberry leaves, ginger, or chamomile. Women in your community may know of other teas or remedies that work for this kind of pain.
- Keep doing your daily work.
- Try to exercise and walk.
- Take a mild pain medicine. Ibuprofen works very well for the pain that comes with monthly bleeding.
- If you also have heavy bleeding and nothing else works, taking a low-dose birth control pill for 6 to 12 months may help.
Pre-menstrual Syndrome (PMS)
Some women and girls feel uncomfortable a few days before their monthly bleeding begins. They may have one or more of a group of signs that are known as pre-menstrual syndrome (PMS). Women who have PMS may notice:
- sore breasts
- a full feeling in the lower belly
- constipation (when you cannot pass stool)
- feeling extra tired
- sore muscles, especially in the lower back or belly
- a change in the wetness of the vagina
- oiliness or spots (pimples) on the face
- feelings that are especially strong or harder to control
Many women have at least one of these signs each month and some women may have all of them. A woman may have different signs from one month to the next. For many women, the days before their monthly bleeding starts are a time of unrest. But some women say they feel more creative and better able to get things done.
What to do:
What helps with PMS is different for each woman. To find out what will help, a woman should try different things and notice what makes her feel better. First, try following the suggestions for pain with monthly bleeding.
These ideas may also help:
- Eat less salt. Salt makes your body keep extra water inside, which makes the full feeling in your lower belly worse.
- Try to avoid caffeine (found in coffee, tea and some soft drinks like cola).
- Try eating whole grains, peanuts, fresh fish, meat and milk, or other foods that are high in protein. When your body uses these foods, it also gets rid of any extra water, so your belly feels less full and tight.
- Try plant medicines. Ask the older women in your community which ones work.