THE MENSTRUAL CYCLE
WHAT IS MENSTRUATION?
A woman’s monthly bleeding, also called a ‘period’. Every month your uterus lining thickens to prepare in case of pregnancy. When you don’t become pregnant, the body needs to get rid of this lining, so it sheds the menstrual flow through the vagina. The average period lasts 5 days, but is considered normal is it lasts anywhere from 2 to 7 days.
WHAT IS MENSTRUAL FLOW?
A combination of blood, the unfertilised egg and other tissues that make up the lining of the uterus. The body naturally builds up this lining and sheds it every month (when not pregnant).
WHAT IS THE MENSTRUAL CYCLE?
The monthly hormonal cycle a female’s body goes through to prepare in case of pregnancy. The cycle is counted from day one of your period (bleeding) to the first day of the next period.
HOW LONG IS A TYPICAL MENSTRUAL CYCLE?
A typical cycle is 28 days, but each woman is different. Some women’s periods are so regular they know the exact day the next one will start. Other women have less regular periods. Your periods are ‘regular’ if they come every 24-38 days (the time from the first day of one period to the first day of the next is 24-38 days). Sometimes your cycle length can change from month to month.
WHAT ARE HORMONES?
Hormones are chemicals your body naturally produces to regulate different processes and activities, for example telling your body to release an egg (ovulate). During your menstrual cycle, the two main hormones involved are estrogen and progesterone. As levels of these change, they tell your body to go through the different phases of your cycle - shedding uterus lining (period), releasing an egg, building up the uterus lining again.
WHAT IS DISCHARGE?
This is a fluid produced naturally by your body to keep your vagina healthy. You will probably notice a small amount of clear or white fluid in your underwear. Throughout your menstrual cycle, the amount, thickness and colour of discharge changes naturally. However, you may have an infection and should go to a doctor if you notice any of the following:
Grey, yellow, brown or green colour
Strong unpleasant smell
Very different thickness, amount or colour to what you’re used to
HOW DOES MY MENSTRUAL CYCLE CHANGE AS I GET OLDER?
When you first start to menstruate, it usually takes time for your body to settle into a regular pattern. Menstrual cycles longer than 38 days are common, but usually your cycle becomes more regular within 3 years. If longer or irregular cycles persist beyond that, see a doctor or nurse to rule out other health problems, such as PCOS (polycystic ovary syndrome). A regular menstrual cycle lasts 24-38 days.
Often, periods (bleeding) are heavier when you’re in your teens and get lighter in your 20s and 30s. In your 40s or early 50s a woman’s body starts to transition to menopause and her cycles may become irregular. Periods may stop for a few months then come back. They may be shorter or longer and the flow may be heavier or lighter than usual.
WHAT IS MENOPAUSE?
Menopause a natural change to your body that occurs for every woman. It is the time when a woman goes from having periods (and therefore being fertile) to no longer having periods. Menopause is defined as when you haven’t had a period for 12 months. For most women, this is between the ages of 45-55. Once your body is in menopause, it no longer releases eggs, meaning you can no longer get pregnant.
WHAT IS PMS (PREMENSTRUAL SYNDROME)?
PMS is a collection of symptoms that some women experience in the week or two weeks leading up to the start of their period. Symptoms vary between women, and some women have no symptoms at all. Symptoms can include:
Feeling anxious, irritable or upset
Tiredness or trouble sleeping
Changes to appetite
Changes to sex drive
In general, PMS does not affect your day-to-day life. If your symptoms are so strong that your daily activities are affected, you should see your doctor or nurse.
WHY SHOULD I TRACK MY MENSTRUAL CYCLE?
If you have regular periods, tracking your cycle will help you know when your next period will begin. If you’re trying to get pregnant, tracking your cycle will help you know when you’re ovulating and thus most fertile.
Tracking your cycle also helps you notice any changes so that you can share any problems with your nurse or doctor. If you have pain or bleeding that is causing you to miss school or work, tracking your cycle and symptoms will help your nurse or doctor diagnose the problem and give you treatment. Severe pain or bleeding that is causing you to regularly miss activities is not normal and can be treated.
HOW CAN I TRACK MY MENSTRUAL CYCLE?
You can track your cycle by marking the first day of your periods on a calendar. After a few months, you can begin to see if you have regular periods (ie. a pattern showing there’s the same number of days between each period to the next), or if your cycle changes each month. There are also some free period tracking apps you can use on your phone (eg. Clue, Period Tracker Lite, Monthly Cycles). Some include features to track PMS symptoms, energy levels, activity levels, and more.
WHAT CAN I TRACK?
There are a number of things you can track to get to know your cycle:
PMS symptoms – cramping, headaches, moodiness, forgetfulness, bloating or breast tenderness
When your period begin (was it on the day you expected? Was it earlier or later than normal?)
How many days your period lasted
How heavy the bleeding is – was it heavier or lighter than usual for you? How many pads/tampons did you have to use? Did you bleed so heavily that you had to miss school or work?
Symptoms – did you have any unusual symptoms in a cycle (eg. more bleeding or pain than usual)?
HOW CAN THE MENSTRUAL CYCLE AFFECT OTHER HEALTH PROBLEMS?
The naturally changing levels of hormones throughout your cycle can cause other health problems such as:
Depression and anxiety disorders. These conditions often overlap with PMS. Symptoms may get worse before or during your period.
Asthma. If you have asthma, it may get worse during some parts of your cycle.
IBS (irritable bowel syndrome). IBS causes cramping, bloating and gas. Symptoms may get worse right before your period begins.
Bladder pain syndrome. Women who have bladder pain syndrome are more likely to have painful cramps during PMS.
If you’re worried about a health issue and you think it’s linked to your periods, or you notice it always gets worse at the same point in your cycle, you should speak to a doctor or nurse for advice.
WHAT IS OVULATION?
Ovulation is when the body releases an egg. If you have sexual intercourse, the egg might be fertilised by sperm from the male, creating a baby.
WHEN DO I OVULATE?
If your menstrual cycle is regular, ovulation occurs about halfway through the cycle, but each woman is different.
You don’t ovulate if:
You’re pregnant already
You’re on certain types of birth control (always check with your doctor how your birth control works)
You might not ovulate if:
HOW DO I KNOW IF I'M OVULATING?
A few days before you ovulate, your vaginal mucus/discharge becomes thinner, clearer and more slippery. Some women feel cramps on one side of their pelvic area, breast tenderness, bloating or a combination of these around the time of ovulation. Some women do not notice any symptoms.
HOW DOES OVULATION RELATE TO GETTING PREGNANT?
In order to have a chance of becoming pregnant, a woman has to ovulate (release an egg) and sperm from a male sexual partner has to enter the female reproductive system through sex.
Sperm can survive in the female reproductive system for up to 5 days. This means that if a woman ovulates up to 5 days after having sex, she still has a chance of becoming pregnant.
A woman has the highest chance of falling pregnant if she has sex with no birth control in the 3 days before and including the day she ovulates.
MANAGING YOUR PERIOD
WHAT PRODUCTS CAN I USE WHEN I HAVE MY PERIOD?
There are a range of products you can use to manage your period:
Pads (single-use and reusable)
HOW DO I USE A PAD?
You attach the pad to your underwear, and as you menstruate it absorb the menstrual flow. Pads are either single-use (you throw them away after using) or reusable (you can wash and reuse them). You need to change them at least every 6-8 hours.
Reusable pads are a good option if you can’t afford single-use pads, as they can be reused for multiple months. Check the packaging to see how many months you can reuse yours for.
You can also make your own reusable pads by tracing the shape of a pad onto a few layers of clean fabric and sewing around the edge. You don’t need expensive materials – you can even use old clothing as long as it is clean.
HOW DO I USE A TAMPON?
A tampon is a small plug of cotton. You insert it inside your vagina to absorb the blood. Your vaginal muscles are very strong, so they hold the tampon in place until you remove it – it won’t fall out of your body. Tampons have a small string the hangs down – you pull on this to help you remove the tampon when it’s time to change it.
You change a tampon at least every 6-8 hours, and more often if you have a heavy flow.
Some tampons come with applicator (a plastic or cardboard tube containing the tampon). These help you properly insert the tampon fully inside the vagina, but are more expensive and not essential.
HOW DO I USE A MENSTRUAL CUP?
Like a tampon, a menstrual cup is also inserted into the vagina. The rim (top) of the cup sits just below your cervix and creates a seal with your vaginal walls, stopping any leaks. The menstrual flow collects in the cup until you empty it.
You can wear a cup for up to 12 hours. It’s very important to wash it with plain soap and water every time you change it, and always have clean hands when you’re inserting or removing it. When your period is finished, you need to boil your cup for 5-7 minutes in water to disinfect it fully so it is ready for your next period.
Menstrual cups are reusable for many cycles. The packaging will tell you how many years you can reuse the cup for (usually 2-3). Most brands have different sized cups for women who have given birth vaginally. Make sure you buy the right size for you, as this will ensure the cup doesn’t leak.
HOW DO I USE PERIOD PANTIES?
Period panties look like regular underwear, but they have a washable pad sewn inside them. The menstrual flow is absorbed by the underwear and can be washed out, so you can clean and use the panties again. You don’t need to wear another product with them. They can be washed and reused for multiple cycles – check the packaging to see how long the period panties can be used for before they stop being effective.
WHICH PRODUCT IS THE BEST?
Every woman’s needs during her period are different. What works for one woman may not work for another. You can try different products out and see which is most comfortable and easy to use for you. It’s also important to choose the right product for your flow – some products, like pads, have different size and absorbencies depending on how heavy the menstrual flow is.
Your flow will change during your period. Generally speaking, your flow is much lighter towards the end of your period. This means you may use different products for different days, depending on how heavy your flow is (eg. Some women wear different pad with different absorbencies on the beginning/heavy days and end/light days).
WHAT HAPPENS WHEN I SLEEP?
You still menstruate in your sleep, so you need to wear a menstrual product when you go to bed. You may find that if you move around a lot in your sleep and you’re using a pad or tampon, you might leak. You can solve this by wearing a thicker pad or tampon.
WHEN DOES A GIRL USUALLY GET HER FIRST PERIOD?
The average age for menarche (a girl’s first period) in Uganda is 13. However, not all girls start menstruating at the same age. A girl can get her first period anytime between the ages of 8 and 15. Your first period usually comes about two years after breast begin to develop and pubic hair begins to grow.
The age at which a girl’s mother started to menstruate can also help a girl know when she is likely to begin menstruating.
A girl should see her doctor if:
She has her first period before age 8
She has not had her first period by age 15
She has not had her first period within 3 years of breasts starting to develop
HOW LONG DOES A WOMAN USUALLY HAVE PERIODS FOR?
On average, women menstruate for about 40 years of their life. Most women’s (but not all) periods are regular until perimenopause (the transition into menopause), when their body undergoes changes that affect period length, regularity and frequency.
You do not get periods during pregnancy, and sometimes they don’t come back right away if you’re breastfeeding.
If you don’t have a period for 90 days (3 months), and you’re not pregnant or breastfeeding, you should talk to your nurse or doctor. They can check for pregnancy or a health problem that is stopping you from menstruating regularly.
WHAT IS A 'NORMAL' AMOUNT OF BLOOD?
Every woman’s periods are different. Some women have light flows and some much heavier. Some women bleed for 2-3 days and some up to 7-8. The average amount of blood lost is 2-3 tablespoons across the whole period, but what is normal for your body may not be the same for someone else.
Your periods also change as you get older. They’re usually heavier in your teens than in your 20s-30s. Some women also experience heavier bleeding during perimenopause.
Symptoms of heavy menstrual bleeding include:
Bleeding through one or more pads or tampons every 1-2 hours
Passing large blood clots (larger than a small coin)
Bleeding that lasts longer than 8 days
HOW OFTEN SHOULD I CHANGE MY PAD, TAMPON, MENSTRUAL CUP OR PERIOD PANTIES?
Your menstrual product will come with instructions that say how long you can use it for. Generally speaking, you can use pads and tampons for up to 6-8 hours, a menstrual cup for up to 12 hours, and period panties for a whole day, before you need to change them. However, it will depend on how heavy your flow is. You may need to change them a lot sooner than the maximum recommended time.
It’s best to try to change your product before it becomes full or soaked through. This helps avoid leaking. Also, it can feel uncomfortable to keep wearing a full product. Many women change their pads or tampons every few hours.
If you haven’t bled much, it can be tempting to keep using the same product so as to not ‘waste’ it. However, you should never use a product for longer than the instructions state because this can cause bacteria to build up and put you at risk of infection. You should especially never wear a tampon for more than 8 hours as this puts you at risk of TSS (Toxic Shock Syndrome).
WHAT IS TSS?
TSS stands for Toxic Shock Syndrome. It is a rare but sometimes fatal condition caused by a build-up of bacteria that make toxins or poisons. Nowadays, most cases of TSS are not caused by menstrual products. However, using tampons still puts you at risk of TSS if:
you use a more absorbent tampon than you need
you wear the tampon for longer than 8 hours
Any product inserted into the vagina (menstrual cup, sponge or birth control methods such as the cervical cap or diaphragm) may also increase your risk of TSS if you leave them in place for too long without changing or cleaning them. Check the packaging of the product for how long it is safe to use them for before you must change or clean them.
HOW DO I KNOW IF I HAVE TSS?
Symptoms of TSS include:
sudden high fever
kidney or other organ failure
If you have any symptoms of TSS and you’ve been using a tampon, menstrual cup, sponge or diaphragm, you should immediately remove the tampon/cup/sponge/diaphragm and go to the hospital.