By Joy Jensen, MN, RN

Evidence-based research indicates that most women do not understand how their bodies, hormones, and menstrual cycles work.  Many women lack health literacy, or awareness of the behaviors that affect their general and reproductive health over the course of their lives, such as nutrition, weight, sleep, stress, and exercise. Finally, women frequently experience shame and stigma surrounding menstruation, which further leads to poor health outcomes. Education is essential for women to feel empowered, make informed health care and family decisions, and take charge of their individual health needs. With the growing need and demand for women’s health education, many programs are becoming more available.

FEMM, or Fertility Education & Medical Management, is a comprehensive women’s health program found at https://femmhealth.org.  The goal of FEMM is to empower women in the achievement of their health and reproductive goals by helping them gain a better understanding of their biology and monthly cycles. Menstrual Matters, at https://www.menstrual-matters.com is a non-profit online information hub where you can 1) find out if your health may be affected by the menstrual cycle, or hormonal medications, 2) find evidenced-based ways to improve your health and wellbeing through simple lifestyle changes, and 3) and learn about how menstrual myths and taboos help to perpetuate gender inequalities. The Society for Menstrual Cycle Research (SMCR), at http://www.menstruationresearch.org is a non-profit including scientific researchers, health care providers, policy makers, health activists, and students from a wide range of fields with interests in the role of menstrual and ovulatory health across the life span.

FEMALE REPRODUCTIVE ANATOMY

The female reproductive system is responsible for menstruation, and therefore an integral to part to understanding why women menstruate and have vaginal bleeding. The female reproductive anatomy includes ovaries, fallopian tubes, a uterus, cervix, and vagina. These structures, along with key hormones, regulate the menstrual cycle which spans from the onset of menstruation to the next month onset of menstruation.

The ovaries are two small organs, one located on each side of the uterus. During puberty, these “wake up” and start making estrogen and progesterone, which cause many body changes. Once a month, the ovaries release a single egg (ovum) during ovulation. (Release of more than one egg may lead to a multiple pregnancy, such as twins.) The fallopian tubes connect the ovaries to the uterus. The released egg moves along a fallopian tube, and if sperm are present they may fertilize the egg, which immediately starts cell division and continues to the uterus. The uterus has a lining (endometrium) that becomes thick with tissue, blood and fluid in preparation for implantation of the already developing pregnancy. If the egg is not fertilized, it will die and shed along with the lining of the uterus. The cervix (lower uterus) has a narrow canal with a lining that responds to hormonal changes to create a dry, moist or highly mucus environment. The blood and fluid leave the uterus through the cervix into the vagina. The vagina serves as the exit and entrance to the body, for the shedding uterine lining (menstruation) to leave and a male penis and sperm to enter.

WHAT IS MENSTRUATION

Menstruation involves vaginal bleeding and is both an expected and a normal part of female reproductive health.  Girls start menstruating between the ages of 12 and 14 (sometimes earlier or later), as their bodies begin to make specific hormones. At first, the frequency, duration, and flow amount of menstruation may be irregular. But eventually, it becomes regular and each young woman develops her own menstrual pattern. According to Girls Health at https://www.girlshealth.gov, the frequency of menstruation occurs over about one month (around 21 to 34 days), with the average occurring every 28 days. The duration usually lasts between 3 and 7 days each cycle, and the flow varies between light bleeding, to medium, to heavy bleeding.

THE MENSTRUAL CYCLE EXPLAINED

A menstrual cycle begins with the first day of bleeding, involves the rise and fall of specific hormones, causing specific body changes, resulting in key days of fertility and ovulation, and ends with the onset of next menstruation. This cycle is what makes it possible for a woman to have a baby. Once women understand their bodies, they may identify normal or abnormal patterns of reproductive function, and seek medical support in a timely manner as informed participants of their own health care. Over time, a woman can identify her unique fertility window, which may be useful in family planning to either achieve or avoid pregnancy.

Generally, for a healthy adult female the menstrual cycle occurs as follows: Follicle Stimulating Hormone (FSH) is produced near the brain and signals the ovaries to develop small sacs known as follicles, each of which has an egg within it. Only one follicle each month will generally become dominant and quickly mature. As this follicle grows, it produces increasing amounts of the hormone estrogen. Rising estrogen levels stimulate the cervix to secrete mucus, which becomes very stretchy, clear, and slippery. This “fertile” mucus helps to propel sperm up the cervix, into the uterus and fallopian tube. A surge in estrogen signals the brain to release luteinizing hormone (LH), which is responsible for triggering the egg (ovum) to be released from the ovary (ovulation) and swept into the fallopian tube. The follicle sac that was holding the egg then becomes a corpus luteum, which slowly disintegrates and produces the hormone progesterone. If pregnancy occurs, high levels of progesterone cause the lining of the uterus to stabilize and the cervix to produce a dense, dry, protective mucus barrier. The progesterone made by the corpus luteum for the first 10-12 weeks of pregnancy is then taken over by the placenta of the developing fetus. However, if pregnancy does not occur, the egg will die in 24-36 hours, both progesterone and estrogen will decline, and the uterine lining (and egg) will shed causing menstruation.

Some women have shorter cycles, while other women may have longer cycles. What is important to note, is that some women may have a fertility window (ovulation and possibility of pregnancy) that overlaps with their menstruation. Other women may not ovulate at all, as in cases such as pre-puberty, breastfeeding, or menopause.

Knowledge is power, so take charge now. Menstruation is not a shameful or stigmatizing event or topic. As a woman, you have the right to be informed about your body, reproductive system, hormonal function, and individual menstrual cycle. With this knowledge you can then make informed and empowering health care and family planning decisions. If you would like more information, or a free FEMM consultation, please contact us at 206-588-0311.