SIGNS AND SYMPTOMS OF MENSTRUATION (similar to early signs of pregnancy) BY SUNITA KHATRI, M.D IN WOMEN’S HEALTH

WHAT ARE PERIODS, REALLY?

Your first period, also called menarche, is most likely to start when you are 12 or 13 years old. Some girls get their periods as early as eight or nine, however, while some don't start menstruating until they are 15 or 16 years old. Though most girls will have been told that they will be experiencing periods — monthly episodeds of bleeding — before menarche, fewer know all about what periods actually are.

So, what are periods, exactly? Before we can answer that question, we have to talk about what the menstrual cycle is. The menstrual cycle is a woman's reproductive cycle, the thing that prepares her for pregnancy each month and cleanses the reproductive system when she does not conceive a baby. 

A cycle is counted from the first day of your period to the day before the next period. The average menstrual cycle is 28 days long, however girls’ cycles can range anywhere from 21 to 35 days and still be considered to fall within the normal range.

The first half of the menstrual cycle is called the follicular phase. During this stage of your cycle, the female hormone estrogen dominates. This hormone is responsible for a number of different processes including contributing to bone health, but it also prepares your body for pregnancy by thickening the lining of your uterus, the endometrium. While that's happening, a number of follicles are also developing in your ovaries. One will start to dominate, and once mature, that egg will be released during ovulation. Young girls who recently started menstruating will not always ovulate during their menstrual cycles, but when ovulation does occur, pregnancy can happen. The so-called "fertile window" starts about five days before ovulation does. Eggs will also be viable for 12 to 24 hours after ovulation.

The luteal phase starts after ovulation finishes. A lot happens during this stage if an egg was fertilized. If it isn't, you're basically just preparing forn menstruation. Menstruation is, simply said, what occurs when pregnancy doesn’t. 

In menstruation, the body gets rid of the material it has been preparing for a potential pregnancy. The blood that comes out comes from the uterus; it is the lining of the uterus (also called endometrium) that was created during the follicular phase of your menstrual cycle, so that the fertilized egg (female egg joined with male spermatozoa) could attach to it and develop further into the fetus and grow into a baby. 

BODY ORGANS INVOLVED IN THE MENSTRUAL CYCLE

The parts of the body involved in the menstrual cycle include the brain, pituitary gland, uterus and cervix, ovaries, fallopian tubes, and vagina.

The reproductive organs involved are:

1. The vagina — the muscular canal extending from the uterus to the exterior of the body, through which menstrual blood flushes out. 

2. The uterus — a pear-shaped organ which, in its non-pregnant state, is collapsed and about the size of your fist. It is located between the bladder and the lower intestines. The lower third of the uterus is called the cervix. The cervix has an opening called the os which opens into the vaginal canal and permits your menstruation to flow out. 

3. The fallopian tubes — extend from each side of the uterus. Eggs move through them to get to the uterus, and sperm travels up there to meet the egg if you are sexually active and not using condoms.

4. The ovaries – placed near the end of each fallopian tube, they are almond-sized organs which produce eggs. 

Hormones Involved In The Menstrual Cycle 

The ovaries make two important female hormones, estrogen and progesterone, while the pituitary gland, situated in the brain, makes follicle-stimulating hormone (FSH) and luteinizing hormone or LH.  

This is how the whole cycle goes: 

During the first half of the menstrual cycle, estrogen levels rise to prepare the uterus for a possible pregnancy by making the lining of the uterus (endometrium) grow and thicken. The follicle-stimulating hormone makes an egg (ovum) from one of the ovaries mature. At about day 14 of a typical 28-day cycle, in response to a surge of luteinizing hormone, this egg leaves the ovary in a process called ovulation.

After leaving the ovary, the egg begins to travel through the fallopian tube to the uterus. There is a rise in progesterone levels, which helps prepare the uterine lining for pregnancy. If the egg becomes fertilized by a sperm cell and attaches itself to the uterine wall, the woman becomes pregnant. If not, the egg either dissolves or is reabsorbed by the body. When doesn't happen, estrogen and progesterone levels drop, and the thickened lining of the uterus (shown as bloody material) is shed during a menstrual period.

HOW LONG DO PERIODS LAST?

Women have an average of 500 periods in their lifetime. Menopause, which marks the end of  a woman's reproductive life, occurs between the ages of 45 and 55, usually around age 50.

Because all girls are different, the length of a period can vary from girl to girl. One girl might have a 3-day period while another girl has a 7-day period. It can take several years for a girl's period to become regular. One month the period might last 4 days, whereas the next month it might be 6 days. Some women experience irregular periods for several years, and others might not ever be "regular."

WHAT ARE THE SIGNS AND SYMPTOMS OF MENSTRUATION?

Bleeding from the vagina is the primary sign of menstruation, but that doesn't mean that you won't experience a whole host of signs before your menstrual flow begins and during your period. These symptoms can include:

Cramping, bloating, and sore breasts

Water retention

Pelvic pressure

Backache

Food cravings

Difficulty concentrating

Mood swings and irritability

Headache and fatigue

Around 85 percent of women report some emotional or physical changes around the time their period occurs. If these physical and emotional symptoms are severe, it might be a sign of premenstrual syndrome (PMS). PMS usually begins one or two weeks before menstruation and is brought on by rising and falling hormonal levels just before the period begins. 

Some women may also experience positive sensations such as relief, release, euphoria, feelings of a new beginning, invigoration, connection with nature, creative energy, exhilaration, increased sex drive and more intense orgasms. 

IS THERE A WAY TO RELIEVE MENSTRUAL SYMPTOMS?

Uterine cramping is the most common and the most annoying uncomfortable sensation women experience during menstruation. There are two kinds of cramping. 

Spasmodic cramping – believed to be caused by prostaglandins, chemicals that affect muscle tension. Some prostaglandins cause relaxation while some cause constriction. Foods such as vegetables and fish, high in linoleic and liblenic acids, increases the prostaglandins for aiding muscle relaxation. 

Congestive cramping — makes the body retain fluids and salt. To counter congestive cramping, avoid wheat and dairy products, alcohol, caffeine, and refined sugar.

To alleviate cramping, don’t turn to pharmaceutical companies that target and create a market to treat this normal part of a woman's cycle as a disease for their own financial benefits. There are better, natural ways to do so.  

Increase exercise to improve blood and oxygen circulation throughout the body, including the pelvis.

Keep your abdomen warm. Use a heating pad or hot water bottle to ease your cramping.

Avoid using tampons as well as IUD (intrauterine device) as your birth control method because they are said to increase cramping

Avoid eating red meat, refined sugars (sweets), milk, and fatty foods. 

Eat lots of fresh vegetables, whole grains, nuts, seeds and fruit. 

Avoid caffeine. It constricts blood vessels and increases tension. 

Meditate, get a massage. 

Have an orgasm (alone or with a partner).

Drink ginger root tea (especially if you experience fatigue). 

Put cayenne pepper on food. It is a vasodilator and improves circulation. 

Take time for yourself and reduce stress by meditating, having a massage, or taking a bubble bath.

TWO TYPES OF PMS

The first type of PMS is characterized by symptoms such as anxiety, irritability and mood swings, which last until the beginning of the bleeding. This type is believed to be linked to the balance between estrogen and progesterone. If there’s a surge of estrogen, anxiety occurs while progesterone dominance often leads to depression. 

The second type of PMS is characterized by sugar cravings, fatigue and headaches. In addition to sugar, women may crave chocolate, white bread, white rice, pastries, and noodles – in one word refined carbohydrates. These cravings are probably caused by the increased responsiveness to insulin related to increased hormone levels before menstruation. Women experience symptoms of low blood sugar and their brains are signaling a need for fuel. A consistent diet with complex carbohydrates will enable a steady flow of energy to the brain and disable the ups and downs of blood sugar variations.

IS IT PREGNANCY OR PMS?

Both of these conditions are characterized by the rise of the two hormones – estrogen and progesterone, so it happens often that the symptoms of these conditions overlap, which more than often leads to panic due to possible pregnancy. I’m sure you’ve been there because I have numerous times. 

Symptoms overlapping are: light cramping, backache, spotting for a day, food craving, breast tenderness, mood swings, bloating, etc

The only way to know if it were a period or pregnancy is to wait for the day you are supposed to get your period or the day after and if missed, to get a pregnancy test done. Only this way, you can tell for sure if it’s pregnancy or PMS symptoms you are experiencing.