Menstruation Symptoms, Pain Relief & Remedies

Menstruation, also known as menses, the menstrual period, period, is the regular discharge of blood and mucosal tissue (known as menses) from the inner lining of the uterus through the vagina. The first period usually begins between twelve and fifteen years of age, a point in time known as menarche. Bleeding usually lasts around 2 to 7 days. Menstruation stops occurring after menopause, which usually occurs between 45 and 55 years of age. Periods also stop during pregnancy and typically do not resume during the initial months of breastfeeding. Having considered health effects, Siddha Spirituality of Swami Hardas Life System appeals to our valuable readers to read this article for well-being.

What is the meaning of Menstruation?

Menstruation, or period, is normal vaginal bleeding that occurs as part of a woman’s monthly cycle. Every month, your body prepares for pregnancy. If no pregnancy occurs, the uterus, or womb, sheds its lining. The menstrual blood is partly blood and partly tissue from inside the uterus. It passes out of the body through the vagina.

What are the Symptoms of Menstruation?

The primary sign of menstruation is bleeding from the vagina. Additional symptoms include:

• Abdominal or pelvic cramping
• Lower back pain
• Bloating and sore breasts
• Food cravings
• Mood swings and irritability
• Headache
• Fatigue

Why do women bleed during Menstruation?

The actual purpose of getting periods is to prepare the womb for conception. If this does not take place, then it could be a sign of pregnancy. Bleeding is good and it is a vital function of a women’s biological life.

Did you know?

This Interesting fact about Menstruation

We’ve evolved as a species for a cause that none can define and every bodily function has a purpose. Why do women bleed? What is its purpose? Well, here are some interesting facts about menstrual cramps and their very purpose:

• Did you know that periods can come through the eyes (bleeding in the eye)? Yes, a rare condition called vicarious menstruation makes you bleed from your eye
• Sleeping with night light regulates your menstrual cycle
• Menstruation can worsen asthma conditions
• The sound of your voice changes during your menstruation
• Female astronauts use tampons in space during menstruation
• Disney made an animated movie on the process of menstruation in the 1940s titled “The Story of Menstruation”.

Onset and frequency of Menstruation

The first menstrual period occurs after the onset of pubertal growth and is called menarche. The average age of menarche is 12 to 15. However, it may start as early as eight. The average age of the first period is generally later in the developing world, and earlier in the developed world. The average age of menarche has changed little in the United States since the 1950s.

Menstruation is the most visible phase of the menstrual cycle and its beginning is used as the marker between cycles. The first day of menstrual bleeding is the date used for the last menstrual period (LMP). The typical length of time between the first day of one period and the first day of the next is 21 to 45 days in young women and 21 to 31 days in adults. The average length is 28 days; one study estimated it at 29.3 days.

Perimenopause is when a woman’s fertility declines, and menstruation occurs less regularly in the years leading up to the final menstrual period when a woman stops menstruating completely and is no longer fertile. The medical definition of menopause is one year without a period and typically occurs between 45 and 55 in Western countries.

During pregnancy and for some time after childbirth, menstruation does not occur. The average length of postpartum amenorrhoea is longer when breastfeeding; this is termed lactational amenorrhoea.

What are the health effects of Menstruation?

In most women, various physical changes are brought about by fluctuations in hormone levels during the menstrual cycle. This includes muscle contractions of the uterus that can precede or accompany menstruation. Some may notice bloating, changes in sex drive, fatigue, breast tenderness, headaches, or irritability before the onset of their period.

It is unclear if the breast discomfort and bloating are related to electrolyte changes or water retention. Some women have mild or no symptoms before the onset of their periods. A healthy diet reduced consumption of salt, caffeine, and alcohol, and regular exercise may be effective for women in controlling water retention. Severe symptoms that disrupt daily activities and functioning may be diagnosed as a premenstrual dysphoric disorder.

Cramps

Many women experience painful cramps, also known as dysmenorrhea, during menstruation.

Painful menstrual cramps that result from an excess of prostaglandin release are referred to as primary dysmenorrhea. Primary dysmenorrhea usually begins within a year or two of menarche, typically with the onset of ovulatory cycles. Treatments that target the mechanism of pain include non-steroidal anti-inflammatory drugs (NSAIDs) and hormonal contraceptives. NSAIDs inhibit prostaglandin production.

With long-term treatment, hormonal birth control reduces the amount of uterine fluid/tissue expelled from the uterus. Thus resulting in shorter, less painful menstruation. These drugs are typically more effective than treatments that do not target the source of the pain e.g. acetaminophen. Risk factors for primary dysmenorrhea include:

• Early age at menarche
• Long or heavy menstrual periods
• Smoking
• Family history of dysmenorrhea.

Regular physical activity may limit the severity of uterine cramps.

Primary dysmenorrhea

For many women, primary dysmenorrhea gradually subsides in the late second generation. Pregnancy has also been demonstrated to lessen the severity of dysmenorrhea when menstruation resumes. However, dysmenorrhea can continue until menopause. 5–15% of women with dysmenorrhea experience symptoms severe enough to interfere with daily activities.

Secondary dysmenorrhea is the diagnosis given when menstruation pain is a secondary cause of another disorder. Conditions causing secondary dysmenorrhea include:

• Endometriosis
• Uterine fibroids
• Uterine adenomyosis
• Congenital malformations
• Intrauterine devices
• Certain cancers
• Pelvic infections

Pain between menstrual periods

If the pain occurs between menstrual periods, lasts longer than the first few days of the period, or is not adequately relieved by the use of non-steroidal anti-inflammatory drugs (NSAIDs) or hormonal contraceptives, women should be evaluated for secondary causes of dysmenorrhea.

When severe pelvic pain and bleeding suddenly occur or worsen during a cycle, the woman or girl should be evaluated for ectopic pregnancy and spontaneous abortion. This evaluation begins with a pregnancy test and should be done as soon as unusual pain begins because ectopic pregnancies can be life-threatening.

Physical, emotional, or psychological sensations

In some cases, stronger physical and emotional, or psychological sensations may interfere with normal activities and include menstrual pain (dysmenorrhea), migraine headaches, and depression. Dysmenorrhea, or severe uterine pain, is particularly common for girls and young women.

Mood and behavior

Some women experience emotional disturbances starting one or two weeks before their period and stopping within a few days of the period starting. Symptoms may also include:

• Mental tension
• Irritability
• Mood swings
• Crying spells
• Problems with concentration and memory
• Depression or anxiety.

These symptoms can be severe enough to impact a person’s performance at work, school, and in everyday activities. Greater loss in workplace productivity, quality of life, and greater healthcare costs occur in those with moderate to severe symptoms in comparison to those without these symptoms.

This is part of premenstrual syndrome (PMS) and is estimated to occur in 20 to 30% of women. In 3 to 8% it is severe.

More severe symptoms of anxiety or depression may be signs of premenstrual dysphoric disorder (PMDD). This disorder is listed in the DSM-5 as a depressive disorder. Rarely, in individuals who are susceptible, menstruation may be a trigger for menstrual psychosis.

Extreme psychological STRESS can also result in periods of stopping.

Bleeding

The average volume of menstrual fluid during a monthly menstrual period is 35 milliliters with 10–80 milliliters considered typical. Menstrual fluid is the correct name for the flow, although many people prefer to refer to it as menstrual blood. Menstrual fluid is reddish-brown, a slightly darker color than venous blood.

About half of menstrual fluid is blood. This blood contains sodium, calcium, phosphate, iron, and chloride, the extent of which depends on the woman. As well as blood, the fluid consists of cervical mucus, vaginal secretions, and endometrial tissue. Vaginal fluids in menses mainly contribute water, common electrolytes, organ moieties, and at least 14 proteins, including glycoproteins.

Blood clots

Many women and girls notice blood clots during menstruation. These appear as clumps of blood that may look like tissue. If there was a miscarriage or stillbirth, examination under a microscope can confirm if it was endometrial tissue or pregnancy tissue that was shed. Sometimes menstrual clots or shed endometrial tissue is incorrectly thought to indicate an early-term miscarriage of an embryo. An enzyme called plasmin – contained in the endometrium – tends to inhibit the blood from clotting.

The amount of iron lost in a menstrual fluid is relatively small for most women. In one study, premenopausal women who exhibited symptoms of iron deficiency were given endoscopies. 86% of them actually had the gastrointestinal disease and were at risk of being misdiagnosed simply because they were menstruating. Heavy menstrual bleeding, occurring monthly, can result in anemia.

Menstrual disorders

There is a wide spectrum of differences in how women experience menstruation. There are several ways that someone’s menstrual cycle can differ from the norm, any of which should be discussed with a doctor to identify the underlying cause:

Term	Meaning
Oligomenorrhea	Infrequent periods
Hypomenorrhea	Short or light periods
Polymenorrhea	Frequent periods (more frequently than every 21 days)
Hypermenorrhea	Heavy or long periods (soaking a sanitary napkin or tampon every hour, menstruating longer than 7 days)
Dysmenorrhea	Painful periods
Intermenstrual bleeding	Breakthrough bleeding (also called spotting)
Amenorrhea	Absent periods

There is a movement among gynecologists to discard the terms noted above, which although they are widely used, do not have precise definitions. Many now argue to describe menstruation in simple terminology, including:

• Cycle regularity (irregular, regular, or absent)
• Frequency of menstruation (frequent, normal, or infrequent)
• Duration of menstrual flow (prolonged, normal, or shortened)
• The volume of menstrual flow (heavy, normal, or light)

Dysfunctional uterine bleeding

It is hormonally caused by a bleeding abnormality. Dysfunctional uterine bleeding typically occurs in premenopausal women who do not ovulate normally i.e. are anovulatory. All these bleeding abnormalities need medical attention; they may indicate hormone imbalances, uterine fibroids, or other problems. As pregnant women may bleed, a pregnancy test forms part of the evaluation of abnormal bleeding.

Women who had undergone female genital mutilation a practice common in parts of Africa may experience menstrual problems, such as slow and painful menstruation, that is caused by the near-complete sealing off of the vagina.

Premature or delayed menarche should be investigated if menarche begins before 9 years if menarche has not begun by age 15, if there is no breast development by age 13, or if there is no period by 3 years after the onset of breast development.

Sexual activity

Sexual intercourse during menstruation does not cause damage in and of itself, but the woman’s body is more vulnerable during this time. Vaginal pH is higher and thus less acidic than normal, the cervix is lower in its position, the cervical opening is more dilated, and the uterine endometrial lining is absent, thus allowing organisms direct access to the bloodstream through the numerous blood vessels that nourish the uterus.

All these conditions increase the chance of infection during menstruation.

Ovulation suppression

Birth control

Hormonal contraception affects the frequency, duration, severity, volume, and regularity of menstruation and menstrual symptoms.

The most common form of hormonal contraception is the combined birth control pill, which contains both estrogen and progestogen. It is typically taken in 28-day cycles, 21 hormonal pills with either a 7-day break from pills or 7 placebo pills during which the woman menstruates. Although the primary function of the pill is to prevent pregnancy, it may be used to improve some menstrual symptoms and syndromes which affect menstruation, such as:

• Polycystic ovary syndrome (PCOS)
• Endometriosis
• Adenomyosis
• Amenorrhea
• Menstrual cramps
• Menstrual migraines
• Menorrhagia
• Menstruation-related or fibroid-related anemia
• Dysmenorrhea by creating regularity in menstrual cycles and reducing overall menstrual flow.

Combined birth control pill

Using the combined birth control pill, it is also possible for a woman to delay or completely eliminate menstrual periods, a practice called menstrual suppression. Some women do this simply for convenience in the short-term, while others prefer to eliminate periods altogether when possible. This can be done either by skipping the placebo pills or using an extended cycle combined oral contraceptive pill, which was first marketed in the U.S. in the early 2000s. This continuous administration of active pills without the placebo can lead to the achievement of amenorrhea in 80% of users within 1 year of use.

Depo-Provera

Injections such as Depo-Provera (DMPA) became available in the 1960s and later became used to also achieve amenorrhea. A majority of patients will achieve amenorrhea within 1 year of initiating DMPA therapy. DMPA therapy is typically successful in achieving amenorrhea but also has side effects of decreased bone mineral density that must be considered before beginning therapy.

Devices

Levonorgestrel intrauterine devices have also been used been shown to induce amenorrhea. The lower dose device has a lower rate of achieving amenorrhea compared to the higher dose device where 50% of users have been found to achieve amenorrhea within 1 year of use. A concern for the usage of these devices is the invasive administration and initial breakthrough bleeding while utilizing these devices however they have the advantage of the most infrequent dosing schedule of every 5 years. The use of intrauterine devices has also shown to reduce menorrhagia and dysmenorrhea.

Contraceptive pills

When using the subdermal progestin-only implants, unpredictable bleeding continues and amenorrhea is not commonly achieved amongst patients. Progestogen-only contraceptive pills are taken continuously without a 7-day span of using placebo pills, and therefore menstrual periods are less likely to occur than with the combined pill with placebo pills. However, disturbance of the menstrual cycle is common with the mini-pill; 1/3-1/2 of women taking it will experience prolonged periods and up to 70% experience break-through bleeding. Irregular and prolonged bleeding is the most common reason that women discontinue using the mini pill.

Breastfeeding

Breastfeeding causes negative feedback to occur on pulse secretion of gonadotropin-releasing hormone (GnRH) and luteinizing hormone (LH). Depending on the strength of the negative feedback, breastfeeding women may experience complete suppression of follicular development, follicular development but no ovulation, or normal menstrual cycles may resume. Suppression of ovulation is more likely when suckling occurs more frequently.

The production of prolactin in response to suckling is important to maintaining lactational amenorrhea. On average, women who are fully breastfeeding whose infants suckle frequently experience a return of menstruation at fourteen and a half months postpartum. There is a wide range of responses among individual breastfeeding women, however, with some experiencing return of menstruation at two months and others remaining amenorrheic for up to 42 months postpartum.

How to manage Menstruation?

Menstruating women manage menstruation primarily by wearing menstrual products such as tampons, napkins, or menstrual cups. These products catch the menstrual blood to prevent it from staining and damaging clothing and inconveniencing the wearer. 

Due to poverty, some cannot afford commercial feminine hygiene products. Instead, they use materials found in the environment or other improvised materials:

• Sand
• Ash
• A small hole in the earth
• Cloth
• Whole leaf
• Leaf fiber (such as water hyacinth, banana, papyrus, cotton fiber)
• Paper (toilet paper, re-used newspaper, brown paper bags, pulped and dried paper)
• Animal pelt (such as goatskin), double layer of underwear, socks, skirt, or sari.

Menstrual products –

A number of different products are available – some are disposable, some are reusable:

Disposable products