Every month, the female body prepares for fertilisation. If a woman does not become pregnant, the next period starts. It is the first of four phases in the female menstrual cycle.
Menstruation is a shedding process in the body. In each cycle, a mature egg is discharged from an ovary during ovulation and passes through the Fallopian tube towards the womb. In preparation for a possible pregnancy, the womb uses the mucus on its inner wall to build a sort of nest for the fertilised egg. If the egg is unfertilised when it reaches the womb, the mucous membrane dies and detaches from the womb wall. The womb is cleaned in preparation for the next cycle: the muscles contract in an irregular rhythm and relax again in order to discharge the detached womb lining, along with some blood and mucus, through the vagina. A regular period lasts between three and seven days.
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Even though it may feel like more, women normally only lose 40 to 60 ml of blood during their period. This is approximately 10 teaspoonfuls. As a rule of thumb, with “normal” bleeding, you should need to change your tampon or towel less than every two hours. Doctors talk about “heavy” bleeding when the amount of blood is more than 80 ml. This is also called hypermenorrhoea. It affects about 10 in every 100 women. If bleeding lasts longer than five to seven days, it is regarded as prolonged bleeding (menorrhagia). Both often occur together, as the cause is the same: the womb cannot properly contract. Reasons for this include larger benign tumours such as myoma in the womb muscle, or mucosal polyps.
Toxic shock syndrome (TSS) can occur if you wear tampons for too long during menstruation. Toxins build up in the body which enter the bloodstream via the vaginal mucous membrane and can result in toxic shock. If TSS is not treated with antibiotics when symptoms first appear, organ failure can occur.
Heavy bleeding is often triggered by adhesions in the womb. This can be hereditary, or develop after surgery, or as a result of extensive endometriosis.
Spotting can occur independently of regular menstrual bleeding. It is mostly caused by hormonal changes. However, it can also be caused by infections or more serious factors, such as cervical or ovarian cancer.
The colour of the blood can be used to draw conclusions about your health. If the blood is deep red, everything is fine. It mainly turns brownish near the end of your period or at the very beginning, when old blood is discharged. Light-coloured blood can indicate low oestrogen levels and nutritional deficiencies, and orange-grey blood is usually a sign of an infection. In this case, you should consult your gynaecologist.
The days leading up to menstruation put a strain on many women and cause a variety of physical and mental discomforts: abdominal cramps, headaches and joint pain, fatigue and hypersensitivity are just a few examples. These symptoms are known as premenstrual syndrome (PMS).
The first period in young girls is called menarche and, for girls in Switzerland, it usually occurs between 9 and 14 years of age. Researchers believe that body mass index has a connection with the onset of menstruation. The higher the body fat percentage, the earlier menstruation begins. The average time between the first and last menstruation is 37.1 years.
Restless nights, sweaty nightclothes and sweating during meetings can be a clear sign of menopause. There is no specific age for the onset and it varies from woman to woman. In some, the onset of menopause is so gradual that they don’t notice it. Others have physical symptoms from the very beginning. In some women, the bleeding is sometimes heavier and sometimes lighter, in others the intervals between periods become irregular.
The following symptoms may – regardless of age – be an indication of menopause:
This starts between the ages of 38 and 44. The activity of the ovaries is decreasing and confuses the menstrual cycle. Instead of the usual 28 or 30 days between periods, it can suddenly drop to 20, or even 14 days. This may be because the follicles no longer mature properly. The egg is released too early. The womb lining therefore does not have enough time to fully build up. Your periods begin earlier and are less heavy than usual. You do not have to treat this, but it is unpleasant, as you constantly have to be ready for your next period.
Up to this point, a woman can still become pregnant. Menopause occurs with the last ovulation. After that, menstruation stops. It can only be determined in retrospect – as a rule of thumb: if menstruation has not occurred for 12 months, the last bleeding was most likely menopause.
If the last menstruation was 12 months ago, the ovaries have completely and definitively stopped working. The final phase of menopause then begins. The body makes the final adjustments in the composition of its hormones so that the hormone balance finds a new and stable equilibrium.
Nadia Cifarelli (BSc Psychology, certified holistic health advisor) works for the Helsana health consultation service. She assists customers with questions about nutrition, psychology and the female reproductive organs. Nadia Cifarelli advised the editorial team on this article.