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Home , Menstruation, Menstruation (mammal)

F r e q u e n t l y A s k e d Q u e s t i o n s

The rise and fall of levels of during the month control the men- strual cycle.

and the Q: What happens during the men- strual cycle? A: In the first half of the cycle, levels of Menstrual (the “ ”) start to rise. Estrogen plays an important role in keeping you healthy, especially http://www.womenshealth.gov Cycle by helping you to build strong bones 1-800-994-9662 and to help keep them strong as you get TDD: 1-888-220-5446 older. Estrogen also makes the lining of Q: What is menstruation? the (womb) grow and thicken. A: Menstruation (men-STRAY-shuhn) This lining of the womb is a place that is a 's monthly bleeding. When will nourish the if a you menstruate, your body sheds the occurs. At the same time the lining of lining of the uterus (womb). Menstrual the womb is growing, an , or ovum, flows from the uterus through in one of the starts to mature. the small opening in the and At about day 14 of an average 28-day passes out of the body through the cycle, the egg leaves the . This is (see diagram on page 2). Most called . menstrual periods last from 3 to 5 days. After the egg has left the ovary, it trav- els through the fallopian tube to the Q: What is the ? uterus. Hormone levels rise and help prepare the uterine lining for preg- A: When periods () come nancy. A woman is most likely to get regularly, this is called the menstrual pregnant during the 3 days before or cycle. Having regular menstrual cycles on the day of ovulation. Keep in mind, is a sign that important parts of your women with cycles that are shorter or body are working normally. The men- longer than average may ovulate before strual cycle provides important body or after day 14. chemicals, called hormones, to keep you healthy. It also prepares your body A woman becomes pregnant if the egg for pregnancy each month. A cycle is is fertilized by a man’s cell and counted from the first day of 1 period attaches to the uterine wall. If the egg is to the first day of the next period. The not fertilized, it will break apart. Then, average menstrual cycle is 28 days long. hormone levels drop, and the thickened Cycles can range anywhere from 21 to lining of the uterus is shed during the 35 days in and from 21 to 45 days menstrual period. in young teens.

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U.S. Department of Health and Human Services, Office on Women’s Health F r e q u e n t l y A s k e d Q u e s t i o n s

The picture below shows the path the Q: What kinds of problems do egg takes from the ovary, through the women have with their periods? fallopian tube, and to the uterus. A: Women can have a range of problems with their periods, including , heavy bleeding, and skipped periods. • (ay-men-uh-REE- uh) — the lack of a menstrual peri- Fallopian tube od. This term is used to describe the Ovaries absence of a period in: • Young women who haven't start- http://www.womenshealth.gov ed menstruating by age 15 1-800-994-9662 Uterus (womb) • Women and who haven't TDD: 1-888-220-5446 had a period for 90 days, even if Cervix they haven't been menstruating

Vagina for long Causes can include: • Pregnancy • • Extreme Q: What is a typical menstrual • Eating disorders period like? • Excessive exercising A: During your period, you shed the thickened uterine lining and extra • Stress blood through the vagina. Your period • Serious medical conditions in may not be the same every month. It need of treatment may also be different than other wom- As above, when your menstrual cycles en's periods. Periods can be light, mod- come regularly, this means that impor- erate, or heavy in terms of how much tant parts of your body are working blood comes out of the vagina. This is normally. In some cases, not having called menstrual flow. The length of menstrual periods can mean that your the period also varies. Most periods last ovaries have stopped producing normal from 3 to 5 days. But, anywhere from 2 amounts of estrogen. Missing these to 7 days is normal. hormones can have important effects For the first few years after menstrua- on your overall health. Hormonal prob- tion begins, longer cycles are common. lems, such as those caused by polycystic A woman's cycle tends to shorten and ovarian syndrome (PCOS) or serious become more regular with age. Most of problems with the reproductive organs, the time, periods will be in the range of may be involved. It’s important to talk 21 to 35 days apart. to a doctor if you have this problem.

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U.S. Department of Health and Human Services, Office on Women’s Health F r e q u e n t l y A s k e d Q u e s t i o n s

• (dis-men-uh- Abnormal bleeding can have many REE-uh) — painful periods, causes. Your doctor may start by check- including severe . Menstrual ing for problems that are most common cramps in teens are caused by too in your age group. Some of them are not much of a chemical called prosta- serious and are easy to treat. Others can glandin (pros-tuh-GLAN-duhn). be more serious. Treatment for abnor- Most teens with dysmenorrhea do mal bleeding depends on the cause. not have a serious disease, even In both teens and women nearing though the cramps can be severe. In , hormonal changes can cause older women, the pain is sometimes long periods along with irregular cycles. http://www.womenshealth.gov caused by a disease or condition such Even if the cause is hormonal changes, as uterine fibroids or . 1-800-994-9662 you may be able to get treatment. You For some women, using a heating should keep in mind that these changes TDD: 1-888-220-5446 pad or taking a warm bath helps ease can occur with other serious health their cramps. Some over-the-coun- problems, such as uterine fibroids, pol- ter pain medicines can also help with yps, or even cancer. See your doctor if these symptoms. They include: you have any abnormal bleeding. • (eye-byu-PROH- fuhn) (for instance, Advil, Q: When does a usually get her Motrin, ) first period? • Ketoprofen (key-toh-PROH- A: In the United States, the average age for fuhn) (for instance, Orudis KT) a girl to get her first period is 12. This does not mean that all girls start at the • (nuh-PROK-suhn) same age. A girl can start her period (for instance, Aleve) anytime between the ages of 8 and 15. If these medicines don’t relieve your Most of the time, the first period starts pain or the pain interferes with work about 2 years after first start to or school, you should see a doctor. develop. If a girl has not had her first Treatment depends on what’s causing period by age 15, or if it has been more the problem and how severe it is. than 2 to 3 years since growth • Abnormal uterine bleeding started, she should see a doctor. — that’s different For help teaching your daughter about from normal menstrual periods. It her changing body, visit http://www. includes: girlshealth.gov/body/period/index.cfm • Bleeding between periods for information on getting your period. • Bleeding after sex Q: How long does a woman have • Spotting anytime in the menstru- periods? al cycle A: Women usually have periods until • Bleeding heavier or for more days menopause. Menopause occurs than normal between the ages of 45 and 55, usually • Bleeding after menopause around age 50. Menopause means that a woman is no longer ovulating (produc- page 

U.S. Department of Health and Human Services, Office on Women’s Health F r e q u e n t l y A s k e d Q u e s t i o n s

ing ) or having periods and can no • You suddenly get a fever and feel longer get pregnant. Like menstruation, sick after using . menopause can vary from woman to woman and these changes may occur over several years. Q: How often should I change my pad and/or ? The time when your body begins its A: You should change a pad before it move into menopause is called the becomes soaked with blood. Each menopausal transition. This can last woman decides for herself what works anywhere from 2 to 8 years. Some best. You should change a tampon at women have early menopause because least every 4 to 8 hours. Make sure http://www.womenshealth.gov of surgery or other treatment, illness, to use the lowest absorbency tampon or other reasons. If you don’t have a 1-800-994-9662 needed for your flow. For example, use period for 90 days, you should see your junior or regular tampons on the light- TDD: 1-888-220-5446 doctor. He or she will check for preg- est day of your period. Using a super nancy, early menopause, or other health absorbency tampon on your lightest problems that can cause periods to stop days increases your risk for toxic shock or become irregular. syndrome (TSS). TSS is a rare but sometimes deadly disease. TSS is caused Q: When should I see a doctor by bacteria that can produce toxins. If about my period? your body can’t fight the toxins, your A: See your doctor about your period if: immune (body defense) system reacts and causes the symptoms of TSS (see • You have not started menstruating below). by the age of 15. Young women may be more likely • You have not started menstruating to get TSS. Using any kind of tam- within 3 years after breast growth pon puts you at greater risk for TSS began, or if breasts haven't started to than using pads. The Food and Drug grow by age 13. Administration (FDA) recommends • Your period suddenly stops for more the following tips to help avoid tampon than 90 days. problems: • Your periods become very irregular • Follow package directions for inser- after having had regular, monthly tion. cycles. • Choose the lowest absorbency for • Your period occurs more often than your flow. every 21 days or less often than • Change your tampon at least every 4 every 35 days. to 8 hours. • You are bleeding for more than 7 days. • Consider switching between pads • You are bleeding more heavily than and tampons. usual or using more than 1 pad or • Know the warning signs of TSS (see tampon every 1 to 2 hours. below). • You bleed between periods. • Don't use tampons between periods. page  • You have severe pain during your period.

U.S. Department of Health and Human Services, Office on Women’s Health F r e q u e n t l y A s k e d Q u e s t i o n s

If you have any of these symptoms of • Vomiting TSS while using tampons, take the • Dizziness and/or fainting tampon out, and contact your doctor right away: • Sunburn-like rash • Sudden high fever (over 102 degrees) • Sore throat • Muscle aches • Bloodshot eyes n • Diarrhea

http://www.womenshealth.gov 1-800-994-9662 TDD: 1-888-220-5446 For more information For more information about menstruation, contact womenshealth.gov at 1-800-994- 9662 or the following organizations:

Food and Drug Administration Association of Reproductive Health Phone Number(s): (888) 463-6332 Professionals Internet Address: www.fda.gov Phone Number(s): (202) 466-3825 Internet Address: http://www.arhp.org American College of Obstetricians and Gynecologists (ACOG) Resource Center for Young Women's Health Center Phone Number(s): (617) 355-2994 Phone Number(s): (202) 638-5577; (202) Internet Address: http://www.youngwom- 863-2518 (for publications requests only) enshealth.org Internet Address: www.acog.org

All material contained in this FAQ is free of copyright restrictions, and may be copied, reproduced, or duplicated without permission of the Office on Women's Health in the Department of Health and Human Services. Citation of the source is appreciated. This FAQ was reviewed by: Lawrence M. Nelson, M.D. Investigator National Institute of Child Health and Human Development National Institutes of Health

Content last updated October 21, 2009.

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U.S. Department of Health and Human Services, Office on Women’s Health