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Why Do Women Have Periods?

Menstruation is like a new block that has stumbled out of the closet in recent years, breaking away from the shackles of dogma and taboos that have grappled with it for centuries. Why do women have periods??? This question has been asked for ages but in hushed tones. It is only in recent years that youngsters are voicing their doubts, fears, and apprehensions, and it is becoming imperative to empower them with the right knowledge and wisdom.

Book an online appointment with Dr. Nidhi Agrawal for Pregnancy & Gynecology related issues.

To some, periods would appear to be a waste of energy, and that too on a monthly basis in the most productive years of life. However, as various studies conducted by scientists on tissue and molecular levels show, menses appear to have some evolutionary advantage over humans.

In scientific terms, menstruation can simply be seen as a by-product of spontaneous decidualisation (shedding of the thickening of the womb). It gives the womb the power to select the embryos with the best chance of implantation and growth. It is also proposed that the monthly regeneration cycle may allow the uterine endometrium to adapt and improve. In other mammals, this renewal would only occur at the end of their pregnancy.

A menstrual cycle represents the interval between successive menstrual periods. Every month, there is an intricate interaction between the pituitary glands in the brain, the ovaries, and the uterus (or womb). There is an HPO (hypothalamic-pituitary-ovarian) axis in place. Hormones are released through positive and negative feedback mechanisms to prepare the body for a possible pregnancy. An egg is released during ovulation, the endometrial lining of the uterus builds up, and changes also occur in the cervical mucus. If pregnancy doesn't occur, hormonal changes induce shedding of the built-up endometrial lining, which is the period. This then restarts the cycle.

  • First day of the menstrual cycle - is the first day of the period. This is when the uterus starts shedding the endometrial lining it has built up over the past month.
  • Once the period is over, the endometrial lining of the uterus starts forming again in wait for a possible pregnancy.
  • On day 14 (for most women), either of the ovaries releases an egg, which makes its way through a fallopian tube and eventually to the uterus (ovulation).
  • On day 28 (for most women), if there is no fertilisation and conception, the lining of the uterus starts to shed. This is the menstrual period.

Normal menstrual cycle lengths range between 21–35 days, including a menstrual phase (menses) of about three to seven days. The beginning of menstrual bleeding is defined as a new menstrual cycle (i.e. day one of the cycle). A healthy woman loses approximately 43 mL (30-60 mL) of blood over the days of her menstruation. Blood constitutes about one-third of this discharge; menstrual fluid volume and composition vary considerably among women, including cell debris from the endometrial endothelium and endometrial gland secretions. Cervical mucus and vaginal discharge are also present in much lesser proportion.

The average menstrual cycle lasts 28 days, but for some women, it is as short as 21 days, and for others, it is as long as 35 days. When periods begin( i.e., Menarche), it can also take a while before they develop a regular pattern. The cycle also changes as we get older.

The menstruation cycle (and period) takes a temporary pause during pregnancy. Breastfeeding also affects the cycle and can make it irregular. At the end of menopause, the menstrual cycle stops permanently.

Although menstruation is a natural process, some women experience premenstrual syndrome (PMS) with varied symptoms like acne, tender breasts, mood swings, headache and tiredness. Some women experience increased severity of these symptoms that affect their daily living, called premenstrual dysphoric disorder (PMDD), affecting 3-8% of women. Dysmenorrhea (menstrual cramps or period pain) is felt as painful cramps in the tummy during the first 2-3 days of menses that can spread to the back and upper thighs. Debilitating period pain should not be thought of as normal and can be a sign of some underlying condition like endometriosis. Such issues can significantly affect a woman's health and quality of life. One should not hesitate or lose time to seek advice from a gynaecologist as timely interventions can improve these women's lives.

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