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Home , Menstrual cycle, Menstruation (mammal)

The Patient®

What You Should Know About ANDOUT Your Period H

ow do you feel when Some women experience pain, called mittel- TIENT schmerz, when this happens. your period comes each A In the second half of the cycle, the begins a P month? Is it a nuisance, journey down one of your two fallopian tubes. a reassurance, a relief, or Another female , , thickens Ha disappointment that you aren’t the lining of the , preparing it to receive a fertilized egg. If fertilizes the egg, it contin- pregnant? The average woman ues down the tube, attaches to the uterine lining, will have between 400 and 500 and grows into a fetus. and proges- menstrual periods in her lifetime. terone levels increase to keep the healthy. An unfertilized egg either dissolves or is So no matter how you feel about it, absorbed. Estrogen and progesterone take a moment to admire how levels drop, causing the tissue lining in A your body works and learn about the uterus to pass out of your body through your . is the time from your period. the first day of one Menstrual Cycle Variations: period to the day The Language of Periods What’s Normal, What , menstrual periods, menses, or peri- Might Not Be before the next ods are all terms used to describe women’s month- .—This is when you have one. An average ly bleeding. Most menstrual periods last from about no periods. It is normal and expected menstrual cycle is 3 to 5 days. is the time when a girl gets during pregnancy and -feeding. about 28 days long, her first period. The average age of menarche in the It can also be caused by serious illness, is 12 years old, but anywhere between weight loss, extreme stress, excessive but anywhere age 8 and 16 years is normal. is when exercise, anorexia, and problems with from 23 to 35 women stop having periods. This usually happens the pituitary, , , or other days is normal. naturally around age 51, with any time from the glands. If your periods do mid 40s to mid 50s considered normal. Women not start by age 16, or if may also have surgical menopause—this is when previously regular periods their uterus and/or ovaries are removed by surgery. stop for 2 months or more, A menstrual cycle is the time from the first day of you should see your health one period to the day before the next one. An care provider. average menstrual cycle is about 28 days long, .—Charac- but anywhere from 23 to 35 days is normal. terized by painful periods, this common condition What Happens During may be severe enough to a Menstrual Cycle cause you to miss school, Every month or so, your body prepares to become work, or other activities. pregnant. In the first half of the cycle, follicle- The disorder is usually due stimulating hormone signals an ovum (egg) to de- to a hormone called prosta- velop in your ovaries and the female hormone glandin, which is produced estrogen makes the lining of the uterus (womb) when you get your period. grow. At about midcycle, cues It can also be caused by the egg to burst from the ; this is . , a disease

6/06 The Female Patient grants permission to reproduce this handout for the purposes of patient education. Your Period

that occurs when uterine-lining tissue grows on Bleeding Between Periods.—Some women notice other pelvic organs. Nonprescription medications a few drops of or spotting around like aspirin, ibuprofen, and naproxen lower the time they ovulate. Heavy bleeding or many levels and often relieve the pain. days of spotting between periods may indicate These medications work best when taken as soon infection, noncancerous growths called polyps, or as your period starts, or even the day before. other conditions. If you fall into this category, you Dysmenorrhea that interferes with your life and should get checked by your health care provider. cannot be controlled by medication may be treated in other ways. Treating Period Problems Menorrhagia.—This is when you have very heavy The treatment of problems related to your and long periods. The condition is common period depends on the cause. Your health care for a few years after menarche and provider will most likely give you a pregnancy a few years before menopause. An test and perform a physical exam, which may Even if your periods occasional heavy or prolonged include a pelvic exam, Papanicolaou (Pap) period is not unusual if your smear, blood tests, infection check, and/or per- are “normal” but pattern then returns to form an ultrasound. Don’t be surprised if your you want the normal. For excessive bleed- health care provider suggests using hormonal convenience of fewer, ing (e.g., soaking a pad or methods—oral contraceptives, the lighter, or no periods every hour for 24 patch, vaginal ring, birth control injection, or a hours or more, or bleeding hormone-containing (IUD)— at all, you have the for 10 days or longer) you as treatment, even if you’re not having sex, or option of using should see your health care have a female sexual partner. These methods hormonal birth provider. Fibroids (noncancer- can control heavy bleeding, cramping, and too- control methods. ous growths in the uterus), endo- frequent periods and may be part of the treat- metriosis, or an undetected preg- ment for PCOS and other hormonal problems. nancy are some conditions that can Even if your periods are “normal” but you cause menorrhagia. want the convenience of fewer, lighter, or no Very Frequent Periods.—Routinely having peri- periods at all, you have the option of using ods more often than every 3 weeks—counted hormonal birth control methods. Research has from the first day of one period to the day before shown it is safe to do so. Smokers over age 35 the next one, not from the end of one period to years, or women who have had a stroke, heart the beginning of the next—may not signal a attack, or blood clot cannot use methods con- problem. However, it is a good idea to get taining a combination of the two checked, as you may become anemic (have a estrogen and progesterone, but can usually low blood count) from such frequent bleeding. use the hormone-containing IUD or the birth You may also want to discuss options for control injection since both contain proges- lengthening your cycles. terone only. .—This describes very light or infrequent periods. Stress, travel, or just life may In Conclusion cause an occasional missed period. Regularly Whether welcome or inconvenient, menstruation going for months without a period, or is part of women’s lives. Menstrual cycles vary having periods that don’t even require sanitary from woman to woman, and at different times in protection, may be signs of polycystic ovary each woman’s life. If you have questions about syndrome (PCOS) or other hormonal problems. whether your pattern is normal, you should dis- cuss them with your health care provider. Resources

• The National Women’s Health Information Center This Patient Handout was prepared by Diane E. Judge, http://4women.gov/faq/menstru.htm APN/CNP, using materials from The National Women’s Health 1-800-994-9662 Information Center; and Judge, DE, What You Should Know About Extended Cycle Contraception. The Female Patient. 2006;31(2):49-50.

The Female Patient grants permission to reproduce this handout for the purposes of patient education. 6/06