Everything to Know About Menstruation

Menstruation is period bleeding, which is casually referred to as “having your period.” This happens monthly (for most females) during your fertile years, except during pregnancy. Menstruation occurs when the lining of the uterus sheds by breaking down and leaving the body as blood. Most periods last around three to seven days. 

This article reviews menstruation and the menstrual cycle, when periods typically begin, what’s normal and what’s not, and how to manage bleeding and period symptoms.

What Is Menstruation?

Menstruation is a natural part of life. Throughout the month, your uterus builds up its lining to support a possible pregnancy. If pregnancy does not occur, the uterine lining sheds and leaves the body as blood.

When Do Periods Start?

Periods typically start between the ages of 8 and 15. The average age in the United States is between 12 and 14. Most females experience menarche (the medical term for the onset of menstruation or a female's first period) one to two years after their first signs of puberty. Signs of puberty include breast development, growth spurts, and pubic hair growth. 

The Menstrual Cycle

A menstrual cycle is a monthly process the female body goes through to prepare for pregnancy. Your brain and hormones (natural chemical messengers) tell your body how to react during each phase. Day one of your menstrual cycle begins with menstruation. Most cycles last between 21 and 35 days.

Menstrual Cycle

Follicular Phase

The follicular phase overlaps with menstruation. It begins with the first day of menstruation and lasts, on average, 17 days. During this time, hormones direct the ovaries to develop an egg.

Ovulation Phase

Ovulation is when the ovaries release an egg. It occurs around the middle of the menstrual cycle. If sperm fertilizes the egg, pregnancy can result. You are most likely to get pregnant if you have unprotected sex in the three days leading up to ovulation and on the day of ovulation.

Luteal Phase

After ovulation, your body enters the luteal phase by preparing the uterine lining to support a possible pregnancy. If pregnancy doesn’t happen, the uterus sheds its lining, and the menstrual cycle begins again with menstruation.

Menstruation Signs and Symptoms

Vaginal bleeding is the most apparent sign of menstruation. It typically lasts three to seven days. Blood varies in color from bright red to a darker red or brown. It is generally brighter in the beginning and darker toward the end as the old blood sheds. 

Other signs and symptoms of menstruation include:

• Abdominal (belly) cramps
• Lower back pain
• Breast tenderness
• Mood swings or irritability
• Fatigue (overtiredness)
• Headaches
• Bloating 
• Acne
• Stomach issues or a change in bowel habits
• Food cravings

Other than menstrual bleeding, many of these symptoms can start the week or so before your period. This is known as premenstrual syndrome (PMS).

Menstrual Cramps

Products to Manage Menstruation

Menstrual products are items you use to manage menstrual flow. They include disposable products like pads or tampons and reusable products like menstrual cups.

Disposable Menstrual Products

Menstrual pads attach to the inside of your underwear. The layers absorb blood while wicking moisture away from the skin and preventing leaks. They come in many forms and absorbency levels, including pantiliners, heavy-flow maxi pads, winged pads, and overnight pads.

Tampons are soft, small cylinders of absorbent material like cotton that you insert into the vagina to absorb menstrual flow. Some people prefer tampons to pads as they allow more freedom of movement and are less visible. They also come in multiple absorbency levels.

It’s best to choose the lowest absorbency tampon possible and not wear it for more than eight hours. These practices reduce the risk of toxic shock syndrome (TSS), a rare but potentially life-threatening complication of certain bacterial infections.

Reusable Menstrual Products

Reusable menstrual products are eco-friendly. You can use them multiple times, reducing waste and environmental impact. Most come in various sizes and absorbencies. Examples include: 

• Menstrual cups: Flexible, bell-shaped devices made of medical-grade silicone, rubber, or latex. They are inserted into the vagina and collect menstrual blood. Removing, emptying, and washing them at least twice daily is best.
• Menstrual underwear: Underwear with an absorbent, moisture-wicking lining that absorbs blood and an outer layer that prevents leaks. Most people wear them all day on lighter days or as a backup with other menstrual products. 
• Reusable menstrual pads: Reusable pads are cloth pads made with breathable materials like cotton, bamboo, or hemp. They fasten inside of your underwear with velcro or clips. 
• Sea sponges: Natural sea sponges are inserted into the vagina. You can rinse and reuse them. Most people rinse them once or twice a day. They are biodegradable and last several cycles.
• Reusable tampon applicators: Some brands offer reusable tampon applicators made from medical-grade silicone or plastic. You can use them with regular tampons, reducing the waste from disposable applicators.

How to Cope With Period Symptoms

The following self-care strategies can help you manage period symptoms: 

• Regular physical activity: Physical activity releases natural pain relievers and mood boosters.
• Stay hydrated: Drinking plenty of water helps reduce bloating.
• Eat nutritious foods: A diet rich in vegetables, fruits, whole grains, lean proteins, and healthy fat provides essential nutrients. Ultra-processed foods high in sugar and salt increase symptoms like cramping, bloating, and fatigue.
• Pain relief: To alleviate cramps and headaches, you can try over-the-counter pain relievers like Motrin and Advil (ibuprofen) or Aleve (naproxen).
• Heat therapy: A heating pad, hot water bottle, or disposable heat patch can help relieve pain in your abdomen or lower back. You can wear a disposable heat patch under your clothing all day. But keep an eye on your skin and remove it if it becomes too hot. 
• A warm bath or shower: A warm bath or shower can help your muscles relax, easing tension and discomfort. Consider aromatherapy for extra relaxation. 
• Topical medications: If you experience lower back pain during your period, consider a topical cream or patch such as Aspercreme (trolamine salicylate). Some people prefer creams that include lidocaine for a numbing effect.
• Vitamins and minerals: Some studies show calcium can help reduce fatigue, cravings, and depression. Vitamin B6 may help with irritability, bloating, forgetfulness, and anxiety.
• Herbal supplements: Research shows that black cohosh, chaste berry, and evening primrose oil may help with PMS symptoms. But other studies show they do not. 

Talk to a healthcare provider before starting vitamins or herbal supplements. While natural, they can still interact with other medications or may not be safe for those with specific allergies or medical conditions.

Changes in Your Period

Period bleeding is typically heavier in your teens and lightens up as you age. But bleeding and cramping should not disrupt your daily life. Talk to a healthcare provider if you experience the following: 

• Heavier or longer-lasting periods
• Period bleeding lasting longer than eight days
• Bleeding through one or more tampons or pads every one to two hours
• Menstrual blood clots larger than a quarter
• Bleeding or flow that's heavy and interferes with daily life
• Cramping or PMS symptoms that interfere with everyday life

Common Menstruation Issues

Menstrual cramps, heaving bleeding, migraines, and irregular periods are common menstruation issues. This can occur due to hormonal fluctuations from puberty or perimenopause, lifestyle factors, birth control, and medical conditions.

Irregular Periods

When you first start your period, it can be unpredictable. But, after a few years, it usually becomes more regular. Irregular periods are variations in the usual timing, length, or flow of your menstrual cycle or period. While it’s normal to have some minor variations, ongoing irregularities could indicate underlying health concerns.

The following are guidelines for when a period is “irregular” for those who previously had a predictable menstrual cycle.

• Variations in menstrual cycle length (more than seven to nine days)
• Cycle length that's less than 21 days or over 35 days
• Not having a period for more than six weeks

When You Stop Having Periods

Once you experience menarche, you will continue to have periods unless you are pregnant, breastfeeding, or postmenopausal. Periods can also stop with some medical conditions or certain medications. 

Pregnancy

Pregnancy is one of the most common reasons for a late or missed period. When pregnancy occurs, the body produces human chorionic gonadotropin (hCG). This hormone prevents further ovulation and helps maintain the uterine lining so the fetus can grow. 

What Is Amenorrhea?

Amenorrhea is when you stop having a period (unrelated to pregnancy) for a significant amount of time. Healthcare providers classify it in two ways, as follows:

• Primary amenorrhea: When a person assigned female at birth does not begin menstruation by age 15 or 16 despite signs of puberty. This can occur due to hormone imbalances, genetic factors, or structural issues within the reproductive system.
• Secondary amenorrhea: When someone who previously had regular periods stops menstruating for three months or more. This can occur due to pregnancy, breastfeeding, lifestyle factors, health conditions, like polycystic ovary syndrome (PCOS), or certain medications.

Menopause

Menopause is the end of a female’s reproductive years. It’s when you stop having your period for 12 consecutive months and can no longer get pregnant. The average age of menopause is 51. 

Perimenopause is the time leading up to menopause. It begins for most females in their 40s and lasts between four and eight years. During this time, you will likely experience changes in your menstrual cycle, such as:

• Skipped periods
• Lighter or heavier menstrual bleeding or cramping
• Shorter or longer time between periods 

Perimenopause and menopause can also cause hot flashes, sleep problems, vaginal dryness, painful sex, mood swings, and decreased libido (sex drive).

How to Track Your Menstrual Cycle

Tracking your menstrual cycle can help you predict ovulation and menstruation. It can also help you identify irregularities, recognize a late or missed period, and monitor your reproductive health. You can use a calendar or digital app to keep track of the following types of details:

• Day one (first day of menstrual bleeding)
• The last day of bleeding (helps you note how long each period lasts)
• Average cycle length (time between each period)
• Bleeding amounts 
• Symptoms

Summary 

Menstruation is period bleeding. Most females experience it monthly, except while pregnant. It typically lasts three to seven days. The menstrual cycle is the body's process that leads to either menstruation or pregnancy. It typically begins between ages 8 and 15 and continues until menopause, which occurs at 51, on average.