Menstruation is an inseparable element of femininity. The arrival of the first menstruation is a very important event in the life of every young woman and will continue until menopause, or menopause. However, there are many myths around the topic of menstruation.

The menstrual cycle, as the name suggests, is a repetitive process of changes in a woman’s body, the main goal of which is to prepare it monthly for potential fertilization. The menstrual cycle is regulated by hormones, the concentration of which changes in different phases of the cycle.

The mechanism of the menstrual cycleis very complicated. It strictly depends on precise hormonal regulation. The mainhormones regulating the menstrual cycleare: estrogens, progesterone, follitropin (FSH) and lutropin (LH). Each of them is responsible for specific changes, while their mutual cooperation is an indispensable element of the proper course of the cycle. To facilitate the description and understanding of the complicated courseof the monthly cycle, it is usually divided into three components:

• ovarian cycle
• endometrial cycle (describing changes in the endometrium),
• and the cervical cycle.

A woman’s menstrual cyclebegins on the first day of her period and ends on the first day of the next bleeding. Typically, in healthy women, the cycle length is 28 days. However, it varies individually and depends on many different factors. The length of the cycle is influenced by: stress, diet, sleep hygiene, climate change and medications taken. Also after giving birth, women can often observe a change in the length of the cycle compared to the state before pregnancy. However, the most important element influencing the correct length and course of the menstrual cycle are hormones.

Menstruation – the first stage of the cycle

Menstruation is the first stage in the menstrual cycle. The averageduration of menstruationis 4-5 days. During menstruation, the excess of the uterine mucosa (endometrium) that was not used for implantation in the previous cycle is shed. In this phase of the cycle, the ovaries contain a lot of so-called primary follicles, i.e. follicles that are not yet stimulated for further growth. The cervix is ​​not producing mucus yet. The levels of hormones such as estrogen and progesterone are very low at this time of the menstrual cycle.

During menstruation, women may experience pain in the lower abdomen or feel worse. However, very severe pain, especially the one that causes disruption of daily activity or even prevents it, should always arouse anxiety and be a reason for consulting a doctor.

Pre-ovulatory phase of the menstrual cycle

The pre-ovulatory phaseis also referred to as the follicular phase or the growth phase. In thisphase of themenstrual cycle, thedominant hormones are FSH and estradiol. FSH is secreted in a pulsatile manner by the pituitary gland. Thanks to this hormone, several primary follicles of the ovary are selected, and finally one – the so-called dominant follicle. It is he who in this cycle will release the egg ready for fertilization. Before this happens, FSH stimulates the follicles to secrete large amounts of estrogen.

These hormones, in the follicular phase of the monthly cycle, are responsible not only for the further development of the follicle, so that it becomes ready for ovulation. They are also designed to stimulate the reconstruction of the exfoliated uterine mucosa during menstruation. Only a properly formed endometrium will allow the embryo to implant in the uterine cavity. Estrogens also cause increased secretion of cervical mucus. Its amount increases, reaching its peak during ovulation. Estrogen-dependent mucus is transparent, sparse, and pulling. These features are extremely important as they enable the sperm to move and survive.Pre-ovulation phase is variable in length. If a woman is subjected to factors influencing the course of the cycle (stress, poor diet, stimulants, climate change, medications), it is during this period that the entiremonthly cycle is shortened or lengthened. In this phase of the cycle, a woman should not feel any discomfort.

Ovulation – the release of the egg

Ovulationis a key moment inthe menstrual cycle. During ovulation, the egg is released from the dominant follicle. It is possible due to the so-called FSH and LH peak – that is, the peak concentrations of these pituitary hormones. These concentrations are achieved about 24 hours before ovulation. The mechanism of peak formation is very complex and works by positive feedback between estrogens and FSH and LH.Egg releasemay have clinical symptoms in the form of lower abdominal pain, nausea, headache, flatulence. Some women experience ovulatory spotting. The uterine mucosa, under the influence of very high concentrations of estrogens, reaches a considerable thickness. Cervical mucus is the most profuse, extensible and completely transparent. It enables the sperm to reach the egg quickly.

Postovulatory phase (luteal, secretory)

The name of this phase of the monthly cycle comes from the Latin name of thecorpus luteum. The cells of the dominant follicle, which surrounded the egg before ovulation, transform into the corpus luteum after ovulation. Its main role is to produce large amounts of progesterone. It isprogesterone that is the main hormone in the postovulatory phase of the menstrual cycle. If fertilization occurs, the corpus luteum, until the placenta is produced, will nourish the embryo and be responsible for the proper maintenance of pregnancy. Considerable amounts of progesterone and low levels of FSH and LH during this part of themenstrual cyclethey also protect against the possibility of another ovulation in this cycle. This is very important for the safety and proper development of a potential embryo. Progesterone is also responsible for significant changes in the endometrium. It is he who causes the endometrial glands to enter the secretory phase. They become thick, wavy, and store significant amounts of glycogen, fat and protein. These changes are to prepare the mucosa even better for the implantation of the embryo.

Progesterone in this phase of the menstrual cycle is also responsible for changes in the cervical mucus. It becomes dense, sticky and opaque, which means that sperm will not be able to pass through it into the uterine cavity. Some women do not see any mucus after ovulation. All these mechanisms prevent the possibility of subsequent fertilization. The post-ovulatory phase of the menstrual cycle in a healthy woman is constant and lasts about 13-14 days. If it is too shortened, the risk of obstetric failures increases.

Atthe end of the menstrualcycle , if fertilization is not achieved, the hormone levels drop quite sharply. During this time, some women experience irritability, fatigue, general breakdown, malaise, depressed mood, headaches, and breast pain. There may also be problems with the complexion or pale pale skin. These symptoms are calledpremenstrual syndromeand usually disappear after the start of bleeding.

When can you expect your first period?

Very often, the moment of the firstmenstruationis genetically determined. However, it depends on manyfactors, such as body weight, the use of slimming diets or intense exercise. Then the time of getting the firstperiodmay shift.

Usuallymenarche(i.e. the firstperiod) occurs in girls between 11 and 15 years of age. However, if it does not appear before the age of 16, it should be consulted with a gynecologist, as the absence ofmenstruationmay be due to a disease. On the other hand, the appearance of the firstmenstruationbefore the age of 9 can also mean problems – usually related to premature puberty. This condition also requires consultation with a gynecologist.

How long does normal menstruation last?

The correct cycle should be within 25-35 days, of which 3-7 days is monthly bleeding. Deviations from these norms may indicate disease states and hormonal problems.

A woman loses about 50-200 ml of blood duringmenstruation .Remember, however, that exfoliated uterine epithelium and mucus are excreted along with blood. Heavymenstruationmay be a sign of disease –ovarian cysts,uterine fibroids, neoplasms of the genital tract and should not be underestimated.

Hygiene items used during menstruation should be adapted to your needs. An interesting alternative to disposable tampons and pads are pads and reusable pads. They are ideal for skin prone to irritation and allergies. They come in a variety of sizes and colors.

Menopause

The menopauseis the moment when six months have passed since the lastmenstrual period .It falls between the ages of 45 and 55. The ovarian secretory function decreases,periodsbecome irregular and eventually cease completely.