Periods. Menses. Bleeding. There are lots of names for that monthly ritual half of the population have to look forward to throughout a large part of our lives. I get many questions on this topic ranging from how to deal with it to what is normal.
First, we are all different with different levels of symptoms that can change at different points in our life. For example, I have twin daughters whose menses in their teens were night and day from one another. One had 7-10 days of very heavy menses every few weeks with lots of associated acne, headaches and nausea. The other one, well, I never knew she had a period! When I would ask she would say, “oh, it’s like 3 days, I don’t feel it”. She always had a crystal clear complexion and never complained of any knowledge of her period.
My periods changed drastically from puberty to pre and post-baby to menopause. There were times when the pain would double me over for days on end. Then other years my period was a “normal” 5 days a month light to moderate flow with no real symptoms.
Click here for our article on how to deal with period symptoms and when to be concerned.
What causes changes in my period?
Many things affect our period. Genetics and your current life situation, such as stress and health, are major factors at play in your menses. Stress can increase or decrease your fertility and/or your periods. Your weight and activity can also have a huge impact on your menses. Fat cells produce estrogen and an excess of estrogen may affect your menses and/or fertility. Decreased fat stores, anorexia and increased exercise may also affect your fertility and hence menses as well.
What is a period?
A period, or menses, is your body discarding the unused endometrium when you do not get pregnant every month. The endometrium is the lining of your uterus, or womb, that supports a fetus to implant into your womb/uterus and a placenta that provides nutritional support to the fetus.
Some people wonder if it is “real blood”. Yes, the endometrium is made up of a mix of blood, mucous and endometrial tissue. We have 2 ovaries that take turns each month producing an egg. That is right, only one is at work at a time…. in most situations! There are times when they will both ovulate which may lead to nonidentical twins. They may also over ovulate in polycystic ovarian syndrome (PCOS)—more on that here.
That ovulation is the pushing of an egg from the ovary into the fallopian tube where the sperm meets the egg. The egg will wait about 24 hours for this to happen. If it is fertilized by a sperm it spends 3-4 days traveling down the fallopian tube to the uterus and its associated endometrial lining. The fertilized egg then implants in the endometrium. If it hasn’t been fertilized then it doesn’t implant, your hormone levels fall and your body pushes out the endometrium which is sometimes felt by cramping in your abdomen and back. This is your period.
Now, what is a “normal” period?
Studies have shown that only 13% of women have a menses/period every 28 days. 28 days is simply the average. A “normal” period can come anywhere from every 21 to 40 days. That is quite a range! And this range can change month to month depending on factors such as your environment or health.
The period itself may last from 2-7 days. Some menses may be outside of that range. Studies have shown that women with a lower BMI have higher variability in cycle length. The amount of flow can vary from light to heavy. This is a very subjective matter per person. I have had difficulty finding a study that quantifies it well enough to be able to relate to a patient what would be “normal”. We bleed, on average, 4 tablespoons ( 60 milliliters or 2 shot glasses) of blood each cycle. This amount will take about 4 hours to fill up a regular tampon during a normal menstrual cycle.
You may also wonder if you can become anemic or lose iron from your period. Yes, you can! This can happen when you bleed 80 milliliters or more, or more than 5 tablespoons, during your menses. If anything is outside of what may be a normal range, or you have any concerns you should talk to your doctor about this.
Your associated symptoms with your menses may start prior to the first day of your period and can go until after the last day. Typically you will notice signs 1-2 days prior. These may be mental health changes, breast tenderness, bloating, back or abdominal cramps, fatigue, nausea, headaches or a myriad of other symptoms. As with the other aspects of your menses, this may change month to month or decade to decade. Remember, your period may come about monthly for 30-50 years! The oldest patient I knew that was still menstruating was 59 years old! Then other patients stop having their menses and go through menopause in their 40s.
Is there an odor during my period?
Yes, remember, it has blood in it, which has a metallic type odor. I have had many patients repeatedly getting antibiotics for a monthly vaginal infection on their menses that was simply the smell of their period. Your period does not create infections and you do not need antibiotics for this normal bloody odor.
Due to hormonal changes during your period your sense of smell may be heightened, which means others around you cannot smell your menses. Have you been to the store and smelled another person menstruating? I will assume the answer to that is, no. So don’t worry, they can’t smell yours either!
When will my period start?
Usually, your period begins about two years after you start puberty. Puberty is when your body starts going through the stages of sexual maturity, that is, becoming a young woman or man. Your breasts may begin to form and pubic hair may develop on your genital region.
The average age for the menses to start, or menarche, is 12 years old. This means you could get breast buds at 10 years old. The typical range for menarche is 10-16 years old. Though there have been 8-year-olds that started their menses and it was normal for them. Anything prior to 10 years of age should be evaluated, though, as there may be a medical issue causing the early onset of puberty. Please discuss this with your doctor if this happens.
Along the same lines, if you haven’t had your menses by 16 years old, this needs to be discussed with your doctor as well. But understand we are all different and it may be normal for you to start at 17. Some studies showed that 20% of the human population varied outside of what is book perfect in the composition of their body and disease presentation.
As long as you are regularly following up with your doctor and keeping your physicals up to date they can keep an eye on your progression to adulthood. This is a very exciting time for a young person, but it can become confusing and sometimes scary. Don’t be afraid to talk to your health care professional or someone you trust. It is hard not to be embarrassed, but don’t be! They have most likely been through what you are as well!
So how do we deal with this endometrium coming out of our vagina for days every month?
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Unlike what our female ancestors had to deal with in the not-so-distant past we now have many options available:
1: Pads
They come in a variety of sizes and styles and can be found in most department stores or pharmacies. These need to be discarded in a trash bin and can only be used once.
Pros:
- They are easily accessible and available.
- There are many styles and sizes to choose from.
Cons:
- They may cause an allergic reaction and/or be irritating to your skin.
- They can overflow onto your underwear or not stay in place.
- They can be uncomfortable.
- You may detect more odor during your menses with them.
2: Tampons
Tampons are also single-use and come in a variety of sizes. The sizes are typically listed in ratings of flow; light, medium, super and so on. They also come in varieties with and without an applicator.
Pros:
- They are easily accessible and available.
- There are many sizes to choose from.
- They may allow for less odor during menses.
- Contrary to popular belief you CAN insert these if you are a virgin, or have not had sexual relations. And contrary to some myths, you are still a virgin afterward.
Cons:
- They can cause discomfort but usually you don’t feel them when they are properly in place.
- Your comfort level to insert one.
- Toxic Shock Syndrome—this is a rare, but possibly fatal disease, that comes from the toxins of a bacteria that grows in your vagina the longer a tampon is inside of your body.
3: Menstrual Cups
There are numerous different ones available on the market today. Their popularity is growing.
I have personally used Diva Cup and loved it! The one I used came in 2 sizes specific to whether you have given birth or not. They are discreet, reusable and easy to clean and insert. You just need one. You will probably spend as much on one menstrual cup as you would on 1-2 months of pads or tampons.
Pros:
- They are reusable.
- They are easy to insert.
- They are easy to clean.
- They are discreet.
- They are environmentally friendly, with no waste.
- They can last all day without needing to be emptied. Often you will empty it every 12 hours.
- You may notice less odor as nothing collects on the outside.
Cons:
- You need to get it inserted correctly/around the cervix to work properly.
- There is always the possibility of an allergy to their material.
- They can be messy to insert and remove. You may get a small amount of menses on your hands during this process.
4. Menstrual underwear
This is becoming more and more popular. Many different brands are popping up with multiple styles and colors of underwear. Some also come in different absorbency levels. You simply wash and reuse them.
Pros:
- They are environmentally kind and reusable.
- They are affordable in the over all scheme of reuse and only one per day!
- They are comfortable!
Cons:
- You will need enough menstrual panties for your period cycle.
- They need to be washed.
5. Diapers
There are a variety of adult diapers on the market. They are typically marketed toward persons with issues dealing with urinary or fecal leakage.
Pros:
- They may be less irritating to your skin and easier to move around in.
- They stay in place well and there is decreased risk of overflowing.
- They are comfortable and not noticeable to others.
Cons:
- They may be more expensive than pads or tampons.
- They create more waste for the environment.
6. Free bleeding
This is becoming more of a movement. I have personally tried this during lighter times of my period. The concept is to become more in tune with your body. You will learn when you need to go to the bathroom to flow just as you do to urinate.
Pros:
- There is no need to buy anything.
- You may feel more in tune with your body.
Cons:
- You may bleed on yourself or your surroundings.
I have to admit this one took me by surprise when I first read about it on yahoo during the tampon shortage in the US. But after researching free bleeding, I realized I have done this many times in my life when I simply did not want to use another product. Pads were sometimes itchy and caused rashes. Tampons can be annoying for a myriad of reasons. They can become dry and painful to remove on lighter days. As I reached menopause my menstrual cup sometimes didn’t fit the same and would leak.
So out of my stubborn activism against societal standards, I chose to free bleed at certain times and it worked for the most part. I have had a few small slip-ups but nothing more (and maybe actually less) than leaking through all of my other products that I have a love-hate relationship with! You can also use puppy pads, which are basically flat diapers, to sit or lay on. Free bleeding isn’t my go-to. My current go-to is period underwear, or when very heavy, diapers, but I definitely practice free bleeding and now I know the name for it!
At the end of the day, whatever works for you and makes you the most comfortable is what you should do. There is no right or wrong answer. It is your body for which to choose your period product. And that choice may change month to month or decade to decade. Just go with the “flow”!
Heavy Periods: Overview 4 May 2017, 2020, National Library of Medicine website, National Institute of Health US government, accessed July 2022
Abnormal Uterine Bleeding 14 July 2022, Uptodate website, accessed July 2022