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MENSTRUATION

Hands on Stomach

Your body is an amazing concert of hormones and cellular responses which act together in a precise and coordinated way to bring about your monthly cycle.

 

The knowledge and information about periods can be complex, but it doesn’t need to be, and the details are magnificent.

You don’t have to think about it, your body just works, each and every month, gearing up with its hormones spanning the brain to the ovaries; in fact, your whole body is involved.

Every month, and at any point during it, your brain and ovaries are working together to produce changes that affect your hormones, your ovaries and the eggs they contain, as well as your uterine lining.

 

It’s well known that these changes also affect how we feel as women, and how we experience life. Ever feel more sensitive just before your period?  I used to realise I was getting my period when I would cry at ads on TV or articles on the evening news! 

 

If the hypothalamus sets the rhythm, and the anterior pituitary gland is the conductor, oestrogen and progesterone are the two female hormones that orchestrate the symphony that is the menstrual cycle (see diagram).

Graafian follicle kmu.edu.tw.gif

Science alert! 

The human egg (oocyte), shown to the left in the picture that shows a mature ovarian follicle just prior to ovulation, is surrounded by a translucent zone (the corona radiata, literally “radiant” or “shining crown”), and borne by an "egg bearing little cloud" (cumulus oophrous). The antrum ("cave") is full of fluid (the lightest speckled pink space in the picture). Granulosa cells surround the antrum, and are in turn surrounded by theca cells. Together, these cells make up the ovaries. 

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The ovaries produce sex hormones (androgens, oestrogen and progesterone) that travel in the bloodstream to the brain, which constantly monitors the levels of these hormones, and signals when it’s time for more (or less) to be produced. Hormones produced within the brain prompt the release of yet more hormones, which are carried throughout the body in the bloodstream, eventually reaching the ovaries and uterus.

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Oestrogen works to enrich the blood supply to the uterus, grows the little follicles in your ovaries which each contain ovum (or eggs), and when one egg is released (ovulation), it is collected by the fimbrae ("fingers") of the Fallopian (or uterine) tube, and conducted down into the uterus. The cells left behind in the ovary then kick in to produce progesterone.

 

Progesterone can be thought of as the ‘pregnancy hormone’, in that it acts to thicken the lining of the uterus and encourages a rich blood supply, ready for a fertilized egg that might be looking to implant and grow. It also suppresses maturation of other ovarian follicles and inhibits ovulation.

 

But what happens if you are not pregnant? 

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Most often when having a period, your body sheds and clears out the endometrium (uterine lining), ready for the beginning of a new monthly cycle. The blood you can see (usually only about 80mL over the entire days of bleeding) is that endometrial lining.  The egg will also be in there, but is microscopic, so you won't see it. Once the uterine lining is shed, hormone levels from the ovaries are low, which prompts the whole cycle to start again. 

Background image of mature Graafian follicle. 

 

Wagner, R.C. & Hossler, F.E. (undated) Graffian [sic] follicle.  University of Delaware Department of Biological Sciences, retrieved 18/6/2021 from http://class.kmu.edu.tw/~wags/Biology/Wags/histopage/colorpage/cfr/cfrgf.GIF

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Definitions from https://www.etymonline.com/ and Jones, R.E., & Lopez, K.H. (2014).  Gamete Transport and Fertilisation in Human Reproductive Biology (4th ed.).  

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Your menstrual cycle... (see diagram below)

Menstrual Cycle 20223202-01.png

Did you know?

When you are fertile, your cervical mucus becomes slippery, which helps sexual intercourse be well lubricated.  Slippery mucus helps to guide sperm to their ultimate destination, the egg, to facilitate a pregnancy.

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Once you have ovulated, and the window for conception has closed, your cervical mucus changes to thick and sticky, preventing sperm from travelling any further than the vagina, making pregnancy much less likely.

Have you ever actually asked your body to do this for you? 

 

If you were aware of these changes, did you know why? 

I could not count the number of women I have spoken with who think their cervical mucus is gross, abnormal, too scant or abundant, and/or indicative of something ‘wrong’ with them.

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It’s wise to have an idea of what to expect, when and the general parameters that are considered normal – in relation to your womanly cycle – but also more broadly.

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And whilst this forms part of the purpose of these pages and workshops, you can always conduct your own research.

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Get to know your body by what IT tells you - it is truly the greatest superpower!

Colorful Books

When I speak with adults about this topic, many share how poorly their transition from girl to woman was handled by everyone. Some women just noticed their period blood appearing and were told to grab some rags (before pads were made), and not talk about it. 

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Nowadays, there's the well-meaning but at-times-AWKWARD sexual education, which can be helpful, but mostly just makes everyone want to get out of there! Not to mention the boy-girl dynamics if this happens at school.

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'Are you there, God, it's me Margaret', by Judy Bloom was the only book in my primary school library that talked about being a girl and becoming a young woman in any kind of light-hearted way. It filled my head with notions of having to do certain things to look a certain way, which wasn't necessarily useful, but we all want to know what is before us!

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Journalling had its place (I wish I'd kept them).

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After high school, I started learning with anatomy and physiology textbooks. 🤓

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But I have learnt the most in and through the School of Life!

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There are now HEAPS of books, podcasts, and other resources out there relating to being a woman and about the menstrual cycle. Period trackers are super-useful. There are literally hundreds of apps available, and you pretty much can't go wrong. The ones with features to connect where you are at in your cycle with how you are feeling and what is going on in your body are priceless. 

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Be careful when reading up online: beware horror stories and misinformation.

 

Many people are given the microphone, keyboard and platform to speak as experts of their experiences, without having dealt with the challenges - they either minimise them (making it not real or relatable) or dramatise them (which is all round harmful). 

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This is where you getting to know your body through experience, and above all, OBSERVING what it is telling you, is the perfect way to wise up through all the hype. 

How do you feel about your period? Why?

As young women, we are told that our period is a curse, that we are dirty when we have it, and it’s certainly not something we are encouraged to talk about.
 

In fact, it sometimes feels that if it were not mentioned at all, that would be great!

 

Culturally, there are lots of practices regarding menstruating women that are misguided (at best) and inhumane (at worst).

Flowers in Pocket

For example, foot binding in China was related to physical and sexual attractiveness, menstruation huts in Nepal continues to relegate bleeding women to outhouses, often co-sharing with animals each month, and the often cited and ubiquitous notion of being unclean, dirty and/or untouchable when a woman has her period.

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However, and although that tide is changing, as they say, knowledge is power, and to understand how your body works with such delicate precision is the beginning of an awe-filled relationship, which blows these kind of constructs out of the water.

Speaking of cycles – how frequently do these periods occur? 

Most textbooks teach a 28-day cycle, but this figure was the average in a huge American study in the 1960s, which analysed over 30 000 period cycles in over 2300 women (Chiazze, Brayer, Macisco, Parker & Duffy, 1968).

 

They found that 95% of women’s cycles had a length between 15 and 45 days. They further determined that 75% of women had cycles between 25 and 31 days. There tended to be greatest variability in cycle length in women aged 15-19 years, and beyond age of 25, variability of cycle length tended to settle down.

 

Your body is as unique as you are, and as you begin to establish a menstrual pattern, your periods can be more or less frequent. That aside, if you are spotting or bleeding more frequently – like once a fortnight – there may be a reason for that. Sometimes women have hormone imbalances, either their own naturally produced hormones or related to taking the pill, or other hormonal contraception.

My general rule of thumb is that if you have concerns about something, it is always worth seeing a doctor who can help to guide you towards treatment if necessary, or reassure you if there is nothing abnormal from the medical perspective.

That, of course, can leave a bit of a gap for women who might have unexplained symptoms, or who don’t want to take hormonal birth control as a form of treatment, etc. It’s often these women (myself included) who turn to other complementary therapies such as naturopathy, seeking support for what medical science might otherwise be limited in treating.

Medical doctors are trained to read bodily symptoms and signs to make a medical diagnosis, and we can certainly trial a wide range of treatments, however what we don’t read are the messages your body is constantly communicating to you about, well, everything (see also section discussing [preciousness]).

Lazy Morning

For example:

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Have you ever had the sense that you really should go to bed, because you’re feeling tired or sleepy but you prefer not to… because you’d rather:

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  • go out to a party?
     

  • continue the conversation?
     

  • speak on the phone to your partner or friend?
     

  • watch the next episode?
     

  • read the next chapter?

 

 

These are just very simple examples, and there are literally millions more.

If we override our body over and over again, often it has to send louder and stronger messages, which then can manifest as those symptoms and signs you seek medical attention for. We can actually act before it reaches the threshold for a diagnosis, but on the whole, we are not taught how to do this.

 

By no means does this encourage avoiding medical attention; on the contrary, it forms part of empowering yourself in relation to your body. YOU are the expert that lives inside YOUR body. Doctors are trained broadly in things that happen physiologically for everyone, but as I always say, no two people with the same condition are the same.

For instance, some women are aware of the moment they ovulate, and this can be a benign or painful sensation – it’s called mittelschmerz, German for ‘middle pain’. Others say they have a sense for which side they are ovulating from, but that it’s not painful. Others still have no awareness of their ovulation.

 

Mood changes are common throughout the cycle, with women feeling particularly sensitive just prior to their period. Of course this is going to be unique for you and your situation in life. Sometimes people feel very down in the lead up to their period:  that could indicate a treatable condition, termed ‘premenstrual dysphoria’.

Some women aren’t aware that their flow would be objectively considered to be heavy.

 

If you soak through a pad or a tampon within an hour or two, this is considered heavy menstrual flow.

 

Untreated, it can lead to complications such as anaemia, fatigue, light-headedness, dizziness and/or passing out.

 

In such a case, it’s worth seeing a doctor – even as an emergency – as there are treatments we can trial to ensure you don’t lose too much blood, and to facilitate you being able to get on with all you need to do in your day.

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You can always ask your doctor for referral to a gynaecologist.

Likewise, although discomfort is also common, it is not normal to be in excruciating pain with your period.

 

Many of these examples are extreme, and form the bulk of reasons why I see women in the hospital and clinic.

Stomach Ache

You may experience a dragging or heavy sensation of period pain, feel a bit homely in the lead up and once the bleeding begins, be ready to get on with life. Or maybe you want to curl up in bed with a hot water bottle and not be seen until your bleeding has stopped.

 

Every woman is different and her relationship with her body unique, so it is well worth tuning in and getting a sense for what your body communicates with you each cycle, month in, month out.

It’s a no-brainer that people don’t enjoy experiences that impact on their ability to live their life. And this is equally true for women in relation to their body and their period.

 

Could moments of ill-symptoms offer an opportunity to listen and learn from what your body says in relation to how you live month to month?

 

Remember, whatever you do in your life involves your body – it goes everywhere you do, and it carries out whatever action precipitates from thought.

Well before I ever tracked my period dates with an app I found that I would always have the urge to clean my house a few days before my period came, back then that was my app notification!

 

Years later I realised how much it made sense because to me my period is a time of clearing and resetting, of starting anew each month.

R.B., 39 yrs

I love my period... for me it’s always been a time to really honour myself, and even though on occasion I ignore the invitation to do this, it is there, nonetheless.

 

I love getting to know my body and how it changes along with my moods and feelings throughout the cycle, and each month, if I pay attention, I see different patterns emerging and learn more about myself.

A.M., 44 yrs

I love getting my period. I love the change in my body, I love the pace that it asks me to walk in, the way it asks me to go gently, to feel the fullness, to connect to my body.

 

I love the connection it brings with how I have lived, the confirmation, the lessons.

 

I love the stages of the period; I love the whole cycle.

L.H., 47 yrs

woman-on jetty with sunset Jill Wellington Pixabay.jpg

There are literally hundreds of thousands, if not millions of biochemical and biological processes happening within your body, each and every moment of each and every day.

 

This to me is the part of magic of the human body – it does so much without our even being aware of it.

 

Yet we can bring our awareness to our body and listen to its constant messages, and in so doing, we can honour ourselves with far greater depth and capacity than the mind alone ever can.

 

Amazing, hey?!

REFERENCES & READING LIST

Chiazze, L., Brayer,, F.T., Macisco, J.J., Parker, M.P. & Duffy, B.J. (1968) The Length and Variability of the Human Menstrual Cycle, Journal of the American Medical Association, https://jamanetwork.com/journals/jama/article-abstract/337826, accessed 23 March 2021.

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Pawlina, W. & Ross. M.H. (2016). Histology: A Text and Atlas with Correlated Cell and Molecular Biology.  Wolters Kluwer, Philadelphia.

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Shelton, T. (2019). 'Menstruation huts' still widespread in Nepal, despite them being outlawed.

https://www.abc.net.au/news/2019-12-10/menstruation-huts-still-common-practice-in-nepal/11772464, accessed 9 May 2021.  

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Wikipedia (2021). Foot binding. https://en.wikipedia.org/wiki/Foot_binding, accessed 9 May 2021.  

 

You may also like to read the experience of female athletes who were forced to tune into their bodies when attempting pregnancy, from the ABC series “In Her Words”:

 

Shalala, A. (2020). Exercising too much could affect fertility in young, healthy women, expert warns.  Accessed 16 May from https://www.abc.net.au/news/2020-08-30/fertility-family-exercise-fitness-pregnancy-babies-health/12553466

 

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See also the use of menstrual cycles as a clue to physical performance in athletes:

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Kleyn, B. (2020). Menstruation cycles mapped by app helps coaches boost team performance.  Accessed 16 May 2021, from https://www.abc.net.au/news/2020-02-19/menstrual-cycle-tracking-female-athletes-performance/11966194

 

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Also on the reading list:

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Briden, L. (2018). Period Repair Manual: Every Woman's Guide To Better Periods. Pan Macmillan Australia.

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Gaskins, M. (2019). In the Name of The Pill. (Google -- it's on Amazon). 

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Henrickson-Jack, L. (2019). The Fifth Vital Sign: Master Your Cycles & Optimize Your Fertility.  Fertility Friday Publishing Inc.

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Weaver, L. (2016). Women’s Wellness Wisdom: What Every Woman Needs To Know. Little Frog Publishing Pty, Ltd.

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