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Everything you need to know about periods

October 16 2019

We all have questions around periods whether you’ve not yet started having periods, just started having them, been having periods for years, your periods ended a while ago or will never experience having periods but are curious about what happens and why.

What is a period?

A period is the part of the menstrual cycle when a woman bleeds from her vagina for a few days.

The menstrual cycle is the time from day one of a woman’s period to the day before her next. Controlled by hormones, a new menstrual cycle will begin every 28 days though some women’s cycles can last anywhere between 21 and 40 days, and for the first couple of years of a young woman starting her period, they may not come regularly (which is normal).

A period occurs after ovulation. Ovulation happens when levels of the hormone oestrogen begin to rise and signal for an egg to be released from the ovaries (did you know, a woman is born with all her eggs?). The rising levels of oestrogen, and progesterone, also signal for the womb (uterus) lining to thicken in preparation for receiving a fertilised egg. The egg then travels down from the ovaries through the fallopian tubes to the uterus.

If the egg doesn’t become fertilised by sperm after roughly 24 hours, then the egg is reabsorbed by the body, levels of oestrogen and progesterone fall and the womb lining comes away leaving the body via the vagina as a period.

Women tend to lose anywhere between three and five tablespoons of blood during their period, though some may bleed heavier than this and some less.

Periods tend to be heavier in the first couple of days. During these heavier days the blood will be red. As it lightens the blood may become pink, brown or black.

How long do periods last?

Periods can last between two and eight days.

When do periods start?

A young woman will usually start having periods around age 11, but some may start earlier and some later than this.

However, some women will not have periods for many complex and diverse reasons. Just a few examples may be because of medical issues, some may undergo early menopause (when a woman stops having periods and becomes unable to get pregnant naturally), some may have had a hysterectomy (when the uterus is removed for medical reasons), some may be transgender, or some through complications because of eating disorders.

What sanitary products are available?

Pads: Strips of absorbent material that soak up the blood. These have a sticky underside so they can line underwear and be held in place. Pads come in varying sizes to accommodate how heavy or light a flow currently is. Pads with wings indicate extra material sections that wrap around the crotch part of the underwear for a more secure underwear hold.

Pantyliners: A smaller and thinner type of pad for very light period flow days.

Tampons: A small tubular plug inserted into the vagina to soak up blood before it leaves the body. These have a string at one end which is pulled to remove it. It’s important to follow the instructions that come with tampons to avoid discomfort while using them (if the tampon can be felt or hurts, it may not have been inserted far enough inside the vagina). The vagina holds the tampon in place which expands as it absorbs the blood. Many women find wearing tampons more convenient for exercising, playing sports or swimming. Tampons must be removed and changed every few hours to avoid toxic shock syndrome.

Menstrual cups: A medical-grade silicone cup is inserted into the vagina to catch the blood before it leaves the body. Just like tampons, menstrual cups need to be removed every few hours, however, they need to be washed before being reinserted but can used time and time again. Many have guarantees of up to ten years and can cost between five and seven percent of that spent on pads or tampons over a ten-year time frame.

With a little experimentation, every woman will find her own preference for the types of sanitary products she uses.

What is premenstrual syndrome?

Premenstrual syndrome (PMS) or premenstrual tension (PMT) is the way in which a woman may be affected emotionally and physically due to the hormonal changes before her period. Typical symptoms include bloating, breast tenderness, mood swings, irritability, anxiety, acne, and changes in appetite and sex drive.

Symptoms usually occur in the week before a period and begin to ease after a couple of days of the period starting. PMS does not affect all women.

What problems may affect periods?

Painful periods (dysmenorrhea): Pain during periods is usually caused by the womb contracting to push out the blood. Exercise may help relieve the pain, as well as taking over-the-counter painkillers, such as ibuprofen or paracetamol. However, pain affecting daily life should be spoken about with a GP.

Heavy periods: Some women naturally have heavier periods than others, but for periods so heavy they impact daily life, a GP should be consulted to investigate further into the overly heavy bleeding.

Irregular periods: Irregular periods can be common during puberty or before the menopause and can consist of a variation between the time of periods (arriving late or early), the amount of blood lost (heavy or light), and the number of days a period lasts. Most of the time they are nothing to worry about, but it’s best to get irregular periods checked by a GP.

Endometriosis: It can be a painful condition that occurs when tissue similar to the lining of the womb starts to grow in other places, such as the ovaries and fallopian tubes. Not all women with endometriosis have symptoms but it can impact heavily on other women’s lives by causing painful periods, pelvic pain, pain when going to the toilet, nausea, depression and more. Though there is currently no cure, there are treatments available to manage the symptoms.

Polycystic ovary syndrome (PCOS): PCOS is a common condition that affects how a woman’s ovaries work. The three main symptoms of PCOS are irregular periods, excess facial or body hair due to high levels of ‘male hormones’, and polycystic ovaries where the ovaries become enlarged and contain many fluid-filled sacs (follicles). There is no cure for PCOS but symptoms can be treated.

Stopped or missed periods: Some common reasons for why a woman may miss her monthly period include: pregnancy, stress, sudden weight loss or gain, extreme over exercising, an eating disorder, hormonal problems, pregnancy, breastfeeding and reaching the menopause, though there may be many more reasons also. Speak to a GP about stopped or missed periods.

What changes in periods might happen?

Changes such as periods lasting longer or getting lighter, bleeding between periods, bleeding after having sex, or bleeding after the menopause need to be checked by a doctor. There might not be anything wrong, however, it should be investigated to rule out an infection, abnormality or in rare cases, cancer.

What about pregnancy?

Conception (pregnancy) happens when a man's sperm fertilises a woman's egg. For some women this happens quickly, but for others it can take longer. Pregnancy can only happen when ovulation occurs.

Those looking to get pregnant may find it difficult to work out when their fertility is at its highest. It's around the time of ovulation, which is about 12 to 14 days before the start of a period.

However, sperm can survive inside a woman's body for days before ovulation occurs. This means fertility extends back earlier in the cycle. An online period calendar can help to calculate when periods will likely start and peak ovulation times for getting pregnant.

What about contraception?

Some hormonal methods of contraception such as the combined pill, the contraceptive patch and injection work by preventing ovulation. Other contraceptive methods such as male and female condoms, caps and diaphragms work by blocking semen to prevent the 

sperm from meeting an egg in the womb. There are more contraceptive measures that work in other ways too, speak to a GP or sexual health clinic for more information, or see this contraception guide from the NHS.

When do periods stop?

Periods continue until the menopause is reached. The menopause is when a woman stops having periods and becomes unable to get pregnant naturally.

In the UK the average age of menopause is 51, however, some women can reach the menopause earlier or later than this. Periods may become less frequent over a few months or years, or may stop suddenly. 1 in 100 women experience premature menopause and will reach the menopause before 40 years of age.

Not all women experience the menopause in the same way but many common symptoms include hot flushes, night sweats, vaginal dryness, difficulty sleeping, low mood and anxiety, reduced sex drive and problems with memory and concentration.

A GP can offer treatment and suggest lifestyle changes for severe menopausal symptoms that affect day-to-day life.

Want to know more?

Periods are natural, healthy and a part of the female experience, for most women; and though no two women’s periods are the same, a period shouldn’t get in the way of exercising, having fun, and enjoying life. For more information about periods, speak to a GP or visit a sexual health clinic.