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Menstrual Health

Understanding Your Cycle & Common Conditions

Your Period, Your Health

Menstruation is a vital sign of your reproductive health. Understanding your cycle helps you recognize what's normal and when to seek help.

Understanding Your Menstrual Cycle

The Four Phases

Days 1-5
1. Menstruation (Period)

The uterine lining sheds, causing bleeding. This is Day 1 of your cycle. Typical duration: 3-7 days.

Days 6-14
2. Follicular Phase

Ovaries prepare an egg for release. Estrogen rises, making you feel more energetic. Uterine lining rebuilds.

Around Day 14
3. Ovulation

An egg is released from the ovary. This is your most fertile time. Some women feel mild pain (mittelschmerz).

Days 15-28
4. Luteal Phase

Body prepares for possible pregnancy. Progesterone rises. PMS symptoms may occur. If no pregnancy, cycle restarts.

Cycle Length Varies

A "normal" cycle ranges from 21-35 days. The 28-day cycle is just an average. Track your own pattern to know what's normal for you.

What's Normal?

Normal Period Characteristics
  • Cycle length: 21-35 days
  • Period duration: 3-7 days
  • Blood loss: 30-80ml per cycle
  • Colour: Bright red to dark brown
  • Small clots (smaller than a ₹10 coin)
  • Mild cramps
Normal Variations
  • Heavier flow on days 1-2
  • Lighter flow towards the end
  • Slight cycle variation (few days)
  • Mild mood changes
  • Breast tenderness before period
  • Clear/white discharge between periods

Irregular Periods

Irregularity can mean different things:

Types of Irregularities

  • Amenorrhea: Absence of periods (no period for 3+ months)
  • Oligomenorrhea: Infrequent periods (cycle longer than 35 days)
  • Polymenorrhea: Frequent periods (cycle shorter than 21 days)
  • Menorrhagia: Heavy bleeding (soaking a pad/tampon hourly)
  • Metrorrhagia: Bleeding between periods

Common Causes

  • Hormonal imbalances (PCOS, thyroid disorders)
  • Stress and lifestyle factors
  • Significant weight changes
  • Excessive exercise
  • Perimenopause
  • Uterine fibroids or polyps
  • Certain medications
When to See a Doctor
  • No period for 3 months (if not pregnant)
  • Periods suddenly become irregular
  • Bleeding lasts more than 7 days
  • Soaking through a pad/tampon every hour
  • Severe pain affecting daily life
  • Bleeding between periods or after intercourse

PCOS (Polycystic Ovary Syndrome)

PCOS affects 1 in 10 Indian women and is one of the most common hormonal disorders.

What is PCOS?

A condition where the ovaries produce excess androgens (male hormones), leading to irregular ovulation and small cysts on the ovaries.

Symptoms

Menstrual Symptoms
  • Irregular or missed periods
  • Heavy bleeding when periods occur
  • Difficulty getting pregnant
Other Symptoms
  • Weight gain, especially around the belly
  • Excess facial/body hair (hirsutism)
  • Acne, oily skin
  • Hair thinning on scalp
  • Dark patches on skin (acanthosis nigricans)

Diagnosis

  • Medical history and symptom review
  • Physical examination
  • Blood tests (hormone levels, glucose, lipids)
  • Ultrasound to check ovaries

Management

  • Lifestyle changes: Weight management, regular exercise, balanced diet (crucial for Indian women with PCOS)
  • Medications: Birth control pills to regulate cycles, metformin for insulin resistance
  • For fertility: Ovulation induction medications when trying to conceive
  • Symptom management: Treatments for acne, excess hair
PCOS Diet Tips for Indian Women
  • Reduce refined carbs (maida, white rice, sweets)
  • Choose whole grains (brown rice, millets, whole wheat)
  • Include protein in every meal (dal, paneer, eggs)
  • Eat plenty of vegetables
  • Limit sugary drinks and packaged foods
  • Don't skip meals - it worsens insulin resistance

Painful Periods (Dysmenorrhea)

Primary Dysmenorrhea

Common menstrual cramps caused by uterine contractions. Usually starts 1-2 years after first period.

  • Lower abdominal cramping
  • Pain may spread to back and thighs
  • Usually worst on days 1-2
  • Improves with age and after childbirth

Secondary Dysmenorrhea

Pain caused by an underlying condition. Usually starts later in life and may worsen over time.

Possible causes:

  • Endometriosis: Uterine tissue grows outside the uterus
  • Fibroids: Non-cancerous growths in the uterus
  • Adenomyosis: Uterine tissue grows into the muscular wall
  • PID: Pelvic inflammatory disease

Managing Period Pain

Home Remedies
  • Hot water bottle on lower belly
  • Warm bath or shower
  • Gentle exercise (walking, yoga)
  • Ginger or chamomile tea
  • Adequate rest
  • Massage with warm oil
Medical Options
  • NSAIDs (ibuprofen, mefenamic acid)
  • Paracetamol
  • Hormonal birth control
  • Prescription medications
  • Treatment of underlying cause

Endometriosis

A condition where tissue similar to the uterine lining grows outside the uterus. Affects about 10% of women.

Symptoms

  • Severe menstrual cramps that don't improve with regular pain relief
  • Pain during or after intercourse
  • Pain during bowel movements or urination (especially during periods)
  • Heavy periods
  • Infertility
  • Chronic pelvic pain
  • Fatigue

Diagnosis

Can be difficult to diagnose. May include:

  • Detailed symptom history
  • Pelvic examination
  • Ultrasound
  • MRI in some cases
  • Laparoscopy (keyhole surgery) for definitive diagnosis

Treatment Options

  • Pain management: NSAIDs, heat therapy
  • Hormonal treatments: Birth control pills, progestins, GnRH agonists
  • Surgery: Laparoscopic removal of endometrial tissue
  • Fertility treatment: If trying to conceive
Early Diagnosis Matters

On average, it takes 7-10 years to diagnose endometriosis. If you have severe period pain that affects your daily life, don't assume it's "normal" - get evaluated.

Uterine Fibroids

Non-cancerous growths in the uterus. Very common - up to 70% of women develop them by age 50.

Symptoms

Many women have no symptoms. When present:

  • Heavy menstrual bleeding
  • Prolonged periods (more than 7 days)
  • Pelvic pressure or pain
  • Frequent urination
  • Difficulty emptying bladder
  • Constipation
  • Backache or leg pain

Treatment

Treatment depends on size, location, symptoms, and whether you want children:

  • Watchful waiting: If small and not causing symptoms
  • Medications: To manage symptoms or shrink fibroids
  • Non-surgical: Uterine artery embolization
  • Surgery: Myomectomy (removes fibroids, preserves uterus) or hysterectomy

Period Products: A Complete Guide

Sanitary Pads

  • Pros: Easy to use, widely available, non-invasive
  • Cons: Can feel bulky, environmental impact
  • Tips: Change every 4-6 hours, use overnight pads for sleeping

Tampons

  • Pros: Discreet, good for swimming/sports
  • Cons: Learning curve, rare risk of TSS
  • Tips: Change every 4-8 hours, use lowest absorbency needed

Menstrual Cups

  • Pros: Reusable (5-10 years), eco-friendly, cost-effective, can wear up to 12 hours
  • Cons: Initial learning curve, requires cleaning
  • Tips: Sterilize between cycles, fold to insert

Period Underwear

  • Pros: Comfortable, reusable, good for light days or backup
  • Cons: Higher upfront cost, needs washing

Cloth Pads

  • Pros: Eco-friendly, reusable, soft on skin
  • Cons: Requires washing and drying

Tracking Your Cycle

Keeping track helps you understand your body and notice changes.

What to Track

  • Start and end dates of period
  • Flow heaviness
  • Pain levels
  • PMS symptoms
  • Mood changes
  • Discharge changes
  • Any spotting between periods

Methods

  • Apps: Clue, Flo, Period Calendar (many available in India)
  • Calendar: Simple marking on a regular calendar
  • Journal: Detailed written notes
Bring Your Records

When visiting a gynecologist, bring your tracking data. It helps us understand your pattern and identify any issues more quickly.

Concerned About Your Periods?

Whether it's irregular cycles, heavy bleeding, or painful periods, schedule a consultation for proper evaluation.

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