By Dr Fatima Ahmed, an Obstetrics & Gynaecology Registrar

(External Content - posted on behalf of author)

It’s important to understand our bodies and health, so that we seek the right help when they don’t function the way they should. Menstrual health is surrounded in stigma and taboo. For years ‘women’s problems’ have been shrouded in mystery and shame; many women have suffered in silence when things weren’t right with their bodies because talking about their menstrual health just wasn’t, and still isn't, the done thing.

Our Prophet PBUH encouraged us to seek answers to questions, even if the topic in question felt embarrassing. In those early days, no topic was off limits in the quest towards seeking knowledge, and everything was discussed openly and without judgement. Why then, in the 21st century we live in, do so many of our cultures silence women’s voices when it comes to talking about and understanding the very nature of what makes us living, breathing women.

Ladies, it’s time we break societal and cultural taboos surrounding our periods. I’m here to get the conversation started about your period health, to give you the permission to openly talk about it, so that you can live a happier and healthier life and feel empowered to seek help when things aren’t as they should be. In the spirit of this, I’ll break down what a ‘normal’ period looks like, and when you should seek medical help.

First some definitions:

Period - this is the part of your cycle where you bleed from your womb and subsequently your vagina. It can also be referred to as the menses. It usually happens every 28 days. For some people it can happen more (every 21 days) or less (every 40 days) frequently than this. It can last between 3 to 8 days and is heaviest during the first couple of days. Period blood is usually bright red at the start of the period, becoming pink, brown, or black as the flow gets lighter towards the latter days. You will lose around 5-12 teaspoons of blood during your period.

Menarche - this is the age at which you start your period, usually between 9-15 years of age. Most girls will have started their period by the age of 16 and some will start it as early as 8 years of age. If you’re a parent, it’s really important you talk to your daughters early about this, and openly, so they are prepared for it when it happens. Talk openly with your children about periods. It doesn’t need to be a formal discussion but could be as simple as normalising buying sanitary products, or explaining why you can’t fulfil your daily prayers that week. By talking openly to your daughters (and sons) about periods, you’re giving them the permission, and a safe space, to come to you about their health, and not feel embarrassed or ashamed to do so.

Ovarian follicle - these are sacs within your ovary, where eggs develop. It takes several months for a follicle to develop and become ready to release an egg.

Ovulation - the release of an egg from your ovary and into the fallopian tube. From there, the egg begins its journey towards the womb, which takes several days.

Menstrual cycle - this is the hormonal process women’s bodies go through. There are 4 stages to the cycle

Uterus - the fancy term for your womb

Anaemia - when you don’t have enough red cells to carry oxygen around the body. Heavy periods can cause what’s known as iron deficiency anaemia. This is because your body has used up your body’s iron stores to try carry oxygen around the body. Symptoms include extreme fatigue, palpitations (racing heart beat), feeling out of breath easily, or not being able to concentrate. Eating iron rich foods, and iron supplements is important in maintaining your iron levels and preventing iron deficiency anaemia.

Fibroids - excess growth of uterine muscle tissue that develop in or around your uterus which can cause heavy periods. They are not cancerous.

Endometriosis - where the lining of your womb (endometrium) is found outside the womb. It can cause pelvic pain, and heavy periods.

Adenomyosis - where the lining of your womb is found within the wall of the womb (can be thought of as endometriosis that is contained within the womb). This can also cause heavy and painful periods.

The Menstrual Cycle:

The menstrual phase - your period. It marks the start of your cycle. It is when the lining of your womb sheds and happens if the egg has not been fertilised by a sperm cell.

The follicular phase - this is the time between your first day (start of your period) and ovulation. The levels of oestrogen in your body rise during this phase.

The ovulation phase - This is when you release an egg from the ovary. It usually happens between days 11-14 of your cycle. Oestrogen rises, and reaches its peak, before your body releases an egg from your ovary, and then the levels start to fall again.

During ovulation, your body temperature is higher than normal and cervical discharge is thicker. Some people experience spotting around the time of ovulation, and ovulation pain.

Ovulation is not always like clockwork and can vary cycle to cycle; some cycles you might not ovulate at all, and thus not get a period. It’s not uncommon to have irregular ovulation when you first start your period, soon after pregnancy and breastfeeding, or when you’re nearing the menopause as the ovaries start to lose their function. Occasional irregularities in ovulation can be normal, however if this is becoming a frequent occurrence it might be a sign of health problems. Furthermore, long periods of time without ovulation (anovulation) can cause serious health problems if you’re in your fertile years when this occurs. The process of ovulation has important roles beyond its role in fertility and is vital in maintaining the health of your heart, bones, metabolism, sleep, and mental health. So, it’s important to see your doctor if you notice any changes or major irregularities in your ovulation.

The luteal phase - The last phase of your cycle, and the longest, lasting between 10 to 16 or 17 days. It begins after ovulation and ends once you start your next period. It’s the bit where your body waits in anticipation for a potential pregnancy. Once the egg has been released from the follicle, the burst follicle closes back up, and becomes the corpus luteum, so called because of its yellow colour. It (the corpus luteum) then releases progesterone and some oestrogen. Progesterone levels will typically be at their highest during your cycle midway through this phase. This is typically on day 21 of your cycle, but will vary depending on the length of your cycle.

Progesterone functions to help grow and thicken the lining of the womb, which is needed for the fertilised egg to implant itself into. If the egg has been fertilised after its released (that is, you get pregnant), then the corpus luteum functions to maintain the levels of progesterone needed to maintain the early part of your pregnancy. If not, then it shrinks back up causing your hormone levels to take a dip. This signals the start of your period, as the lining of the womb (which acts as a cushion to protect a potential pregnancy) sheds in the absence of a pregnancy, and the whole cycle repeats itself.

Your cycle is unique to you. It can be impacted by many things like diet, exercise, sleep, stress and drastic weight gain or weight loss. Changes to your cycle can be normal, however they can be a sign of more serious health problems. It’s important to keep track of your cycle as it’s a window into your general health. Unusual changes could be your body’s way of telling you something is wrong. In fact, the American College of Obstetricians and Gynecologists declared the menstrual cycle the “6th vital sign”. It’s as important as monitoring other vitals such as blood pressure, pulse, and breathing.

So, keeping a diary of each phase of your menstrual cycle will help you understand your body better, and prepare for each phase of it. By understanding your body better, you’ll be tuned in to when something isn’t right, and thus be empowered to take action to address it when needed.

It’s just as important to track your mood and energy changes throughout your cycle, as the different hormone levels could impact these. For example, during your ovulation phase, you might notice that you feel more confident, energetic and productive, whereas during your menstrual phase you may feel like you need to rest and recharge. Each woman is different and keeping a diary will help you learn more about yourself. Noting particular patterns in mood and energy that are linked with your cycle will help you achieve this better insight of your menstrual health.

Things to look out for:

Extremely heavy periods

Heavy periods are common and aren’t always a sign of something being wrong. However, they can affect you physically and mentally as a result. Sometimes bleeding is so heavy that you could develop iron deficiency anaemia, in spite of eating an iron rich diet. Heavy bleeding usually means bleeding more than 80ml per period or for longer than 7 days or both. But this really varies between woman to woman, as one woman’s heavy period, is another’s normal one.

You can tell if your bleeding is heavy if you’re:

· Having to change your sanitary product every 2 hours or less

· Passing blood clots larger than a 10p coin

· Bleeding through your clothes or bedding

· Need to use double protection (tampon and sanitary towel, or 2 towels at a time).

If you’re experiencing really heavy periods, don’t be afraid to discuss this with your doctor, as there are many different treatment options available to you. These range from non-hormonal treatments, to hormonal based ones, to different surgical options.

Sometimes, heavy periods are due to something causing them. They can be because of fibroids, endometriosis, adenomyosis, polyps, cancer of the womb, thyroid problems, bleeding disorders, blood clotting problems, diabetes, and certain medications and herbal supplements. It’s important to see your doctor so that they can arrange the tests needed to exclude these.

Irregular periods

This could be as a result of polycystic ovarian syndrome. This is a common condition affecting the way the ovaries function and can cause:

Excess production of “male” hormones resulting in thick facial and body hair

Irregular periods, and frequent anovulation

Ovaries which look ‘polycystic’ are a little larger than usual and have more follicles than normal, which aren’t fully developed. Despite the name, you don’t actually have cysts if you have PCOS.

Besides causing irregular periods, PCOS can cause difficulty getting pregnant, thinning hair, acne, weight gain and increases your chances of getting diabetes in future. There’s no ‘cure’ but the condition can be managed with different treatments, diets and lifestyle modifications.

Another cause of irregular periods or missing a cycle could be due to pituitary problems. The pituitary gland is a tiny pea sized gland in your brain which releases hormones responsible for regulating your growth, blood pressure, temperature, ovaries, energy levels, thyroid function and some aspects of pregnancy and breast feeding. Irregularities in your menstrual cycle, could indicate problems with the pituitary gland.

Bleeding in-between periods, irregular cycles, or bleeding after the menopause

This could be a sign of uterine cancer. Symptoms include irregular or breakthrough bleeding (bleeding between your periods) or bleeding after sexual intercourse. Another sign to look out for is if you’ve gone through the menopause (meaning you’ve not had a period in 12 consecutive months) and then start bleeding again. The risk of uterine cancer increases with age ( most cases happen in women between 40 and 70), being overweight, having diabetes, PCOS, if you’ve never had children, or if you’ve been on the breast cancer treating medication Tamoxifen (however it is worth bearing in mind that the risk of not being on tamoxifen is higher than its risk of causing uterine cancer in future).

Extreme period pain

This could be a sign of endometriosis. Period pain is common, however, if you’re experiencing debilitating pain that is impacting your ability to carry out your daily tasks, then it could be a sign of endometriosis.

Abnormal uterine bleeding in adolescent girls

Remember when I said it’s important to talk to your daughters about their periods and educate them about this very natural process – well, here’s a list why if you weren’t convinced the first time.

Abnormal bleeding in girls could indicate the following problems:

· Problems with their adrenal, thyroid or pituitary glands

· Eating disorders

· Tumours which produce androgens (male hormones)

· Obesity or malnourishment

· Primary ovarian insufficiency (this is when the ovaries prematurely stop working)

· Cancer

· Bleeding disorders

It’s important to note, that irregular bleeding in adolescents is common, and isn’t always a sign of something wrong. You should always see your doctor if you’re unsure.

Bleeding after sex

This can be normal, and nothing to worry about. However, it could be a sign of cervical cancer. If you’re sexually active and over the age of 25, you should get smears done every 3 years, as smears can pick up if there are any abnormal changes in your cervix which could lead to cervical cancer. Cervical cancer is not hereditary and is as a result of getting HPV, a common type of viral infection that is sexually transmitted. So, if you’re sexually active, make sure you go to your smear appointments.

Final remarks:

Get to know yourself and your cycle. Track each phase of your cycle, and the symptoms you get, including changes in your energy and mood levels. There are different apps on the market that can help, but it can be as simple as keeping a written diary.

Periods are not shameful. Talk about them. Talk to your daughters and sons about them. Educate yourselves and each other about them and learn to look out for the signs that might indicate something might be wrong. Even if nothing is wrong, periods can be more heavy and painful than usual and therefore have an impact on your emotional, physical, and mental wellbeing; don’t be afraid to seek help to manage these symptoms so you can live your life to its absolute fullest.