Menstruation is a natural process, often referred to as a period. It is an essential aspect of reproductive health experienced by individuals assigned female at birth. But it is a process that often is mysterious even to those who go through it. This basic guide will give anyone (even those who do not or will not get a period) a basic understanding of what is happening during the cycle. It also will highlight some irregularities, which can be normal or might signal something more serious is wrong. So let’s get started at the beginning.

What is a Period?

A period, or menstruation, refers to the monthly discharge of blood and tissue from the uterus through the vagina. It is a regular part of the menstrual cycle and is indicative of a healthy reproductive system. When an egg released during ovulation is not fertilized by sperm, the lining of the uterus, which had thickened in preparation for pregnancy, is shed through menstruation. 

Understanding the Menstrual Cycle

First, it is important to understand that, like all processes in the human body, there is no one-way things happen. We are all different; we are not machines. These are basic guidelines and averages, and it is important to note that what you experience may be perfectly normal even if it is not “average.” Understanding what the process entails can go a long way to making someone feel confident about what’s happening and having the ability to recognize when things might not be right.

The menstrual cycle encompasses a series of hormonal and physiological changes that occur in the body over approximately 28 days, although variations are common. It is crucial to comprehend the different phases of the menstrual cycle to comprehend the complexities of menstruation better.

Menstruation Phase (Days 1-7)

During this phase, the uterus sheds its lining, resulting in menstrual bleeding. It typically lasts between three to seven days. It is essential to note that menstrual blood consists of a combination of blood, tissue, and mucus.

Follicular Phase (Days 1-14)

The follicular phase begins on the first day of menstruation. Hormones are released, signaling the ovaries to develop follicles. Each follicle contains an egg, and as they mature, one follicle becomes dominant.

Ovulation (Around Day 14)

Approximately midway through the menstrual cycle, the dominant follicle releases an egg into the fallopian tube. This phase is considered the most fertile, offering the highest chances of pregnancy if sexual intercourse occurs.

Luteal Phase (Days 15-28)

After ovulation, the ruptured follicle transforms into the corpus luteum, which produces progesterone. The purpose of progesterone is to prepare the uterus for potential pregnancy. If fertilization does not occur, the corpus luteum breaks down, initiating the next menstrual phase. And the cycle begins again.

Common Menstrual Complications and What to Do

Irregular Periods

Irregular periods refer to variations in cycle length, duration, or the amount of bleeding. It might be “normal” for you to consistently have longer periods or for the length of your cycle to be longer or shorter than the average. But irregularities in whatever patterns you see are worth noting and could be a sign you should see a healthcare professional. The cause could be a wide range of issues that could include hormonal imbalances, stress, underlying medical conditions, or lifestyle factors. Period tracking (see below) is an important exercise and can help you (and your healthcare provider) assess any issues or patterns.

Painful Periods (Dysmenorrhea)

Many individuals experience mild cramps or discomfort during their periods, but severe pain can indicate a condition called dysmenorrhea. Primary dysmenorrhea describes the cramps that occur from contractions in the uterus and are usually more severe during heavy bleeding. Pain occurs in the lower abdomen but can spread to the lower back and thighs. Secondary dysmenorrhea is pain caused by another menstrual condition, such as fibroids or endometriosis. (See sources below for more information)

Over-the-counter pain relievers, applying heat to the abdomen, gentle exercise, and relaxation techniques like deep breathing or yoga may provide relief. Mild, tolerable pain is a normal part of having a period, but if the pain significantly interferes with daily activities, it is important to consult a healthcare professional for evaluation and treatment options.

Heavy or Prolonged Bleeding (Menorrhagia)

Excessive or prolonged bleeding during periods, known as menorrhagia, can be a cause for concern. If you frequently soak through sanitary products, experience severe pain, or have periods lasting longer than seven days, it is important to seek medical attention. The underlying causes may include hormonal imbalances, uterine fibroids, polyps, or other medical conditions, and there are a range of treatment options that might be helpful.

How to Track Your Period

Keeping track of your menstrual cycle can provide valuable insights into your reproductive health. The bleeding days are the ones we focus on the most, but understanding the entire menstrual cycle (even the times of the month when there is no blood) can offer a lot of insight and help create a much clearer picture of overall health and wellness. 

Period trackers have become very popular apps. If you go the electronic route, just be sure you know who is seeing/using your personal medical data. It’s best to find an app where you store data locally (on your device) rather than giving it to an app to store. 

You can also go old school, using a calendar, journal, or printable. Simply record the start and end dates of each period on a calendar to get a sense of the pattern, or fill in moods, overall health, eating, and any other indicators that give you insight into how your body functions.

How Much Blood is Lost During a Period?

On average, individuals lose about 30-40 milliliters of blood during a menstrual cycle, but it can range from 20 to 60 milliliters. This is equivalent to approximately 2 to 4 tablespoons. (We like to say it’s about three nail polish bottles of blood and tissue.) However, it is important to note that everyone’s body is different, and the amount of blood lost can vary. If you have concerns about heavy bleeding, again, you should consult a healthcare professional for further evaluation.

Understanding the basics of menstruation is empowering and critical to a person being able to recognize patterns or events that might signal trouble. Reproductive health education is important not just for those who get periods but for all people. Being aware of and sensitive to the process and the complications creates empathy and can help ease the stigma surrounding periods.

Other sources for information:

Mount Sinai

Cleveland Clinic

Penn Medicine

American College of Obstetrics and Gynecology