The day count for menstrual cycle begins on the first day of menstruation. The entire duration of a menstrual cycle can be divided into four main phases: Phase 1 – The menstrual phase (from day 1 to day 5); Phase 2 – The follicular phase (from day 1 to day 13); Phase 3 – The ovulatory phase (day 14); Phase 4 – The luteal phase (from day 15 to day 28).
The menstrual phase (bleeding phase)
Menstrual phase begins on the first day of menstruation and lasts until the 5th day of the menstrual cycle. In this period, the uterus sheds the lining (endometrium) built up in the previous menstrual cycle. During this period, you may experience abdominal cramps which are caused by the contraction of the uterine and the abdominal muscles to expel the menstrual fluid.
The follicular phase
This phase starts also on the first day of the menstrual cycle and it lasts 13 days. During the follicular phase of the menstrual cycle, the following events occur:
The two hormones, follicle stimulating hormone (FSH) and luteinizing hormone (LH) produced by the pituitary gland are released from the brain and travel in the blood of the ovaries.
These hormones, in turn, stimulate the growth of several ovarian follicles, each containing one egg. Follicle stimulating hormone and luteinizing stimulating hormone increase also the production of the female hormone called oestrogen.
As oestrogen levels rise, like a switch, it turns off the production of the follicle-stimulating hormone.
As the follicular phase progresses, one follicle in one ovary becomes dominant and continues to mature. This dominant follicle suppresses all the other follicles in the group. As a result, they stop growing and die. The dominant follicle continues to produce oestrogen.
The ovulatory phase
The ovulatory phase, or ovulation, starts about 14 days after the follicular phase started. The ovulatory phase is the midpoint of the menstrual cycle, with the next menstrual period starting about two weeks later. During this phase, the following events occur:
The increased levels of oestrogen from the dominant follicle lead to an increase in the amount of the luteinizing follicle. This causes the dominant follicle to release its egg from the ovary.
Once the egg is released (a process called ovulation), it is captured by projections like the fingers at the end of the fallopian tubes. These protrusions, called fimbriae, sweep the egg into the tube.
At this stage, there is also an increase in the amount and thickness of the mucus produced by the cervix (the lower part of the uterus). If you have unprotected intercourse during this time, this thick mucus captures the man’s sperm, nourishes it, and helps it to move towards the egg for fertilization.
The luteal phase
The luteal phase of the menstrual cycle begins right after ovulation. The following processes are involved in this phase:
Once it releases its egg, the empty follicle develops into a new structure called the corpus luteum.
The corpus luteum secretes the hormone called progesterone, which prepares the uterus for a fertilized egg to implant.
If intercourse has taken place and a man’s sperm has fertilized the egg (a process called conception), the fertilized egg (embryo) will travel through the fallopian tube to implant in the uterus. The woman is now considered pregnant.
If the egg is not fertilized, it passes through the uterus. Because it is no longer needed to support a pregnancy, the lining of the uterus breaks down and sheds, and the next menstrual period begins.
What kinds of problems are met during the menstrual cycle?
The most common problems met during the menstrual cycle are:
Premenstrual syndrome (PMS);
Premenstrual syndrome (PMS) occurs one to two weeks before your period begins. Some women experience a range of physical and emotional symptoms. Others experience few symptoms or even none. PMS can cause:
feelings of stress
mild stomach cramps
You may experience different symptoms every month, and the severity of these symptoms can also vary. PMS is uncomfortable, but it’s generally not worrisome unless it interferes with your normal activities.
Amenorrhea represents the absence of menstrual bleeding and it is a normal feature in prepubertal, pregnant, and postmenopausal females. There are two types of amenorrhea: primary amenorrhea and secondary amenorrhea.
Primary amenorrhea is the absence of menstrual bleeding and secondary sexual characteristics (for example, breast development and pubic hair) in a girl by the age of 14 years or the absence of menstrual bleeding with normal development of secondary sexual characteristics in a girl by the age of 16 years.
Secondary amenorrhea is the absence of menstrual bleeding in a woman who had been menstruating but later stops menstruating for three or more months in the absence of pregnancy, lactation (production of breast milk), cycle suppression with systemic hormonal contraceptive (birth control) pills, or menopause.
Amenorrhea can result because of an abnormality in the hypothalamic-pituitary-ovarian axis, anatomical abnormalities of the genital tract, or functional causes.
Dysmenorrhea refers to the symptoms of painful menstruation and it can be divided into two categories:
Primary dysmenorrhea (occurs in the absence of pelvic pathology);
Secondary dysmenorrhea (results from identifiable organic diseases).
The most effective treatment for dysmenorrhea is the pharmacotherapy with NSAIDs. The most commonly used NSAIDs for the treatment of dysmenorrhoeal are:
Menorrhagia represents the heavy and prolonged menstrual periods. During menstruation, the average blood loss is around 20 to 40 millilitres. In case of menorrhagia, is a loss of over 80 millilitres of blood in one cycle.
Menorrhagia can be caused by the following factors:
Non-hormonal Intrauterine Device;
Pelvic inflammatory disease;
Different types of cancer (uterine, cervical and ovarian cancers)
Medications (anti-inflammatory and anticoagulant drugs can lead to heavy bleeding).
How your periods change with age
It is known that fertility declines with age. The exact age of a woman’s fertility decline is unique for each individual. Some women will struggle to conceive in their early 30s due to age-related egg quality and others will find themselves still fertile at 46 years of age.
With age, menstrual cycle becomes irregular. The following events can cause a healthy cycle to become irregular:
Age (irregular periods are common during adolescence and when approaching menopause);
Extreme emotion (good or bad);
Excessive physical activity;
Your period during your 20s
In your teens, your menstrual cycle is irregular, and it becomes regular with time. During teenage, the menstrual cycle is irregular because girls do not ovulate regularly. Ideally, the menstrual cycle should occur regularly during your twenties to early thirties.
A major menstruation change that tends to happen in your 20s is linked to birth control. In this decade, many women decide to start taking hormonal contraception. The administration of contraceptive pills will trigger changes in their usual flow.
Which are the problems that can occur during your 20s?
Your period during your 30s
After 30, many women decided to stop birth control and their periods become heavier, or they can also have light or missed periods. The periods become irregular and more painful. However, some women report less pain during their period after having a baby.
Although changes in our regular menstrual cycles can occur at any age, it’s more common for any abnormalities to show up during mid-to-late 30s. This might include conditions such as the development of polyps, fibroids, anovulation (lack of ovulation), and endometriosis (growth of endometrial tissue outside the uterus).
The occurrence of bleeding after intercourse or in-between cycles can indicate a problem such as endometritis (infection of the inner lining of the uterus) or pelvic inflammatory disease. It is important to know that not all bleeding irregularities with your cycle mean that you have an abnormal medical condition. Stress and other issues can also cause changes to your cycle from time to time.
Fertility has been shown to start to decline in the late twenties for women and for mid-thirties for men. The decline in fertility does not mean that you necessarily will not be able to conceive, but it may mean it will take you longer to conceive.
At this period, menstrual cramps are very common. You should talk to your doctor if these menstrual cramps are impeding you from daily activities. The diet is very important too because it can have an impact on your hormones, which in turn can impact your period.
Your period during your 40s and 50s
Women begin their perimenopause phase in their early 40s and sometimes mid-30s. This fact causes a variety of symptoms and changes in their menstrual cycle.
During the 40s, the levels of the hormones responsible for controlling the menstrual cycle, progesterone and oestrogen, start to decrease. These decreased levels of the hormones lead to irregular symptoms that can be defined as perimenopause, and then later menopause.
Perimenopause represents the transition period in which the normal menstrual cycle starts to change in duration and frequency. At this time, females’ body will begin to change. Hormone levels will decrease, and the menstrual periods will alter. The chances of getting pregnant will become less and you may experience irregular and sometimes heavy menstrual periods.
Perimenopause occurs as a translational phase which begins between the 30s and 40s and typically last from two to ten years before menopause occurs. The indicators of perimenopause include the following symptoms:
Changes in the period cycle;
Decreased bone density;
Severe premenstrual syndrome;
After 40, you may experience more severe cramps, heavier periods and irregularities in the monthly period cycle. Another common change that women experience in their 40s is the irregular bleeding that occurs before or after the period and it is called intermenstrual bleeding.
In your 40s, fertility declines, but you are still able to get pregnant.
Menopause occurs after the perimenopause stage and it represents the absence of menstrual period for 12 straight months in which the ovaries begin to stop functioning. The average age of menopause is 51, but it can occur early in your 40s and in your 30s. Usually, menopause occurs between the ages of 45 and 55. The symptoms that occur during this period include:
Abnormal vaginal bleeding;
Vaginal and urinary symptoms;
Unexpected mood changes.
Antioxidant protection during the menstrual cycle
During cellular metabolism, free radicals are produced continuously. They are implicated in a wide range of disease processes. Free radicals have been considered as initiators of damage in almost every cellular component. In the female reproductive system, they play various significant roles in the uterine environment, oocyte maturation, ovulation, and corpus luteum function and regression.
Antioxidant defences consist of two main lines: the antioxidant enzymes such as superoxide dismutase, catalase, and glutathione peroxidase (GSH-Px) and smaller antioxidant molecules such as ascorbic acid (AA), urate, tocopherols, carotenoids, vitamin A, several flavonoids, etc. They work synergistically to detoxify the human body from the produced free radicals and to maintain an optimal redox balance.
Ascorbic acid (vitamin C) is present in the body as ascorbate monoanion, which is capable of offering electrons to neutralize other highly reactive radicals before converting itself into a free radical. It is converted, by the detoxification process, to dehydroascorbic acid (DHAA), which in turn is recycled, through non-enzymatic and enzymatic recycling mechanisms, back to ascorbic acid
It is known that, apart from their classic role as steroid hormones, oestrogens also possess significant antioxidant properties which are independent of their hormonal ones.
The antioxidant properties of the oestrogens were assessed by the researchers of Laboratory of Physiology, University of Ioannina, School of Medicine, Ioannina, Greece. The study was undertaken to evaluate the antioxidant potential of the female during the various menstrual phases and to assess the correlation between ascorbic acid, dehydroascorbic acid plasma levels, total antioxidant plasma status, and oestradiol levels.
The study included 13 eumenorrheic women. Ascorbic acid and dehydroascorbic acid plasma levels, total antioxidant plasma status, oestradiol, progesterone, luteinizing hormone, and follicle-stimulating hormone during the time of menstruation, mid-follicular phase, time of ovulation, and mid-luteal phase were determined.
The results have shown a progressive significant rise in ascorbic acid plasma levels, ascorbic- dehydroascorbic acid ratio and total antioxidant plasma status from menstruation to ovulation. Moreover, a significant decrease in dehydroascorbic acid was found in the same phases. Changes of oestradiol levels during the menstrual cycle correlated positively with the changes of ascorbic acid levels and total antioxidant plasma status Furthermore, oestradiol levels correlated positively with ascorbic acid levels, ascorbic-dehydroascorbic acid ratio and total antioxidant plasma status in all menstrual phases.
The study concluded that elevated antioxidant protection during ovulation and the mid-luteal phase appears to be present in eumenorrheic women.
Michos C, Kiortsis D, Evangelou A, Karkabounas S. Antioxidant protection during the menstrual cycle: the effects of estradiol on ascorbic–dehydroascorbic acid plasma levels and total antioxidant plasma status in eumenorrhoeic women during the menstrual cycle. Acta Obstetricia et Gynecologica Scandinavica. 2006;85(8):960-965.
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