40 days menstrual cycle
Periods and fertility in the menstrual cycle
The length of the menstrual cycle varies from woman to woman, but the average is to have periods every 28 days. Regular cycles that are longer or shorter than this, from 21 to 40 days, are normal.
"The menstrual cycle is the time from the first day of a woman's period to the day before her next period," says Toni Belfield, a specialist in sexual health information, and a trained fertility awareness teacher.
"Girls can start their periods anywhere from age 10 upwards, but the average is around 12 years," says Belfield. "The average age for the menopause (when periods stop) in this country is 50 to 55."
Between the ages of 12 and 52, a woman will have around 480 periods, or fewer if she has any pregnancies.
Read more about starting periods.
What happens during the menstrual cycle?
To understand the menstrual cycle, it helps to know about the reproductive organs inside a woman's body. These are:
- 2 ovaries – where eggs are stored, developed and released
- the womb (uterus) – where a fertilised egg implants and a baby develops
- the fallopian tubes – two thin tubes that connect the ovaries to the womb
- the cervix – the entrance to the womb from the vagina
- the vagina
The menstrual cycle is controlled by hormones. In each cycle, rising levels of the hormone oestrogen cause the ovary to develop and release an egg (ovulation). The womb lining also starts to thicken.
In the second half of the cycle, the hormone progesterone helps the womb to prepare for implantation of a developing embryo.
The egg travels down the fallopian tubes. If pregnancy doesn't occur, the egg is reabsorbed into the body. Levels of oestrogen and progesterone fall, and the womb lining comes away and leaves the body as a period (the menstrual flow).
The time from the release of an egg to the start of a period is around 10 to 16 days.
Watch an animation about how the menstrual cycle works.
Video: menstrual cycle
This animation explains in detail how the menstrual cycle works.
Media last reviewed: 21 October 2020
Media review due: 21 October 2023
What are periods?
A period is made up of blood and the womb lining. The first day of a woman's period is day 1 of the menstrual cycle.
"Periods last around 2 to 7 days, and women lose about 3 to 5 tablespoons of blood in a period," says Belfield.
Some women bleed more heavily than this, but help is available if heavy periods are a problem.
Find out about treatments for heavy periods.
What happens during ovulation?
Ovulation is the release of an egg from the ovaries.
A woman is born with all her eggs.
Once she starts her periods, 1 egg develops and is released during each menstrual cycle. After ovulation, the egg lives for 24 hours.
Pregnancy happens if a man's sperm meet and fertilise the egg. Sperm can survive in the fallopian tubes for up to 7 days after sex.
Occasionally, more than 1 egg is released during ovulation. If more than 1 egg is fertilised it can lead to a multiple pregnancy, such as twins.
A woman can't get pregnant if ovulation doesn't occur. Some methods of hormonal contraception – such as the combined pill, the contraceptive patch and the contraceptive injection – work by stopping ovulation.
When are you most fertile?
"Theoretically, there's only a short time when women can get pregnant, and that is the time around ovulation," says Belfield.
It's difficult to pinpoint exactly when ovulation happens but in most women, it happens around 10 to 16 days before the next period.
"It's not accurate to say that all women are fertile on day 14 of the menstrual cycle," says Belfield. This might be true for women who have a regular, 28-day cycle, but it won't apply to women whose cycles are shorter or longer.
Find out more about fertility awareness (natural family planning)
Normal vaginal secretions
Vaginal secretions (sometimes called vaginal discharge) change during the menstrual cycle. Around the time of ovulation, they become thinner and stretchy, a bit like raw egg white.
See your GP if you are concerned about a change in your vaginal discharge.
Read more about getting pregnant, fertility and period problems.
Page last reviewed: 05 August 2019
Next review due: 05 August 2022
What Does Your Menstrual Cycle Say About Your Fertility?
One of the most common questions OB/GYN’s have for their patients is “When was the first day of your last period?”. The answer to this question may feel like part of the usual routine at your annual OB/GYN appointment. If you have been trying to conceive without success, the answer could provide important insight into factors central to the menstrual cycle and conception such as hormonal imbalances and ovulation.
Medical contribution by Isaac E. Sasson, M.D., Ph.D.
Isaac E. Sasson, M.D., Ph.D., FACOG, is board certified in obstetrics and gynecology and reproductive endocrinology and infertility. He has expertise in the diagnosis and treatment of infertility, including in vitro fertilization, donor egg treatment, endometriosis, polycystic ovary syndrome, and preimplantation genetic diagnosis. Dr.
Sasson sees patients at SGF’s Chesterbrook, Pennsylvania, office.
What is a menstrual cycle?
Hint, it is more than just your period.
The menstrual cycle is a series of changes a woman’s body goes through each month whereby the ovary releases an egg and the uterus prepares for pregnancy. The cycle can be divided into two phases: the follicular phase and the luteal phase.
The first day of your menses – or period – is day 1 of your cycle and the start of the follicular phase. During this phase, follicle stimulating hormone (FSH), is released from the brain to stimulate the development of a single dominant follicle which contains one egg. During its maturation, the follicle releases estrogen which stimulates growth and thickening of the uterine lining. The follicular phase concludes at the start of ovulation – the process of releasing a mature egg from the dominant follicle. The length of the follicular phase is variable between individuals, resulting in most variations of total cycle length.
The luteal phase starts after ovulation and continues until the onset of the next menses. During this phase, the ovary releases progesterone which changes the uterine lining and opens the window of implantation – the time during which the embryo can attach to the uterus. If pregnancy does not occur, the progesterone level drops and bleeding occurs. The luteal phase is usually between 12-14 days.
Does the length of a menstrual cycle matter?
The length of a menstrual cycle is determined by the number of days from the first day of bleeding to the start of the next menses. The length of your cycle, while not on any form of birth control, can be a key indicator to hormonal imbalances and whether or not ovulation is occurring in a predictable manner. Hormonal imbalances can affect if and when ovulation occurs during your cycle. Without ovulation, pregnancy cannot occur.
Normal menstrual cycle:
Days: 24 to 35 days
Ovulation Indicator: Regular cycles indicate that ovulation has occurred
What Do Normal Cycles Tell Your Doctor?Cycles of a normal length suggest regular ovulation and that all of the sex hormones are balanced to support natural conception.
Short menstrual cycle:
Days:Less than 24 days
Ovulation Indicator:Ovulation may not have occurred or occurred much earlier than normal
What Do Short Cycles Tell Your Doctor?Shortened cycles can be an indication that the ovaries contain fewer eggs than expected. This is typically a pattern seen in women in the years leading up to perimenopause. Alternatively, a short cycle could indicate that ovulation is not occurring. If blood work confirms this to be the case, natural conception can be more difficult.
What Causes a Shorter Cycle? As a woman grows older, her menstrual cycle shortens.
As the number of eggs available in the ovary decrease, their quality also declines. These dysfunctional ovaries lose their ability to effectively communicate with the brain. Additionally, the brain needs to release more follicle stimulating hormone (FSH) to stimulate these abnormal eggs to mature. As a result, the dominant follicle is ready for ovulation very early in the follicular phase and consequently produces a short cycle length. In addition, sometimes bleeding can occur even when ovulation does not occur, and this may appear as shortened and irregular cycles.
Learn about fertility testing.
Long or irregular menstrual cycle:
Days: More than 35 days
Ovulation Indicator: Ovulation is either not occurring or occurring irregularly
What Do Longer Cycles Tell Your Doctor?Longer cycles are an indicator that ovulation is not occurring or at least not in a regular manner which can make conception difficult.
What Causes Long Menstrual Cycles?Longer cycles are caused by a lack of regular ovulation. During a normal cycle, it is the fall of progesterone that brings upon bleeding. If a follicle does not mature and ovulate, progesterone is never released and the lining of the uterus continues to build in response to estrogen. Eventually, the lining gets so thick that it becomes unstable and like a tower of blocks, eventually falls and bleeding occurs. This bleeding can be unpredictable, and oftentimes very heavy and lasting a prolonged period of time.
There are many causes of oligo-ovulation, the medical term used to describe when ovaries do not grow a dominant follicle and release a mature egg on a regular basis. Polycystic ovarian syndrome (PCOS), the most common cause for oligo-ovulation, is a syndrome resulted from being born with too many eggs. This can result in an imbalance in the sex hormones, and failure to grow a dominant follicle and unpredictable or absent ovulation.
In addition, irregularities with the thyroid gland or elevations of the hormone prolactin can disrupt the brain’s ability to communicate with the ovary and result in anovulation.
When menstrual bleeding lasts more than 5-7 days:
Days:More than 7 days
Ovulation Indicator:It is possible that there is a hormonal problem resulting in a delay in follicular growth or a structural problem in the uterus making the lining unstable.
What Do Longer Cycles Tell Your Doctor?Prolonged bleeding tells your doctor that the ovary is not responding to the brain signals to grow a lead follicle. This can be a sign of a delayed or absent ovulation. Alternatively, there may be something disrupting the lining of the uterus.
What Causes Long Periods of Bleeding?There are many causes of prolonged bleeding. From a hormonal perspective, what stops a woman’s period is estrogen from the growing follicle. If follicular growth is not occurring regularly, then prolonged and irregular bleeding can occur.
Intermenstrual bleeding or prolonged bleeding may be caused by structural problem like polyps, fibroids, cancer or infection within the uterus or cervix. In these situations, should an embryo enter the uterus, implantation can be compromised resulting in lower pregnancy rates or an increased chance of a miscarriage. Although rare, a problem with blood clotting can also cause prolonged bleeding and this requires evaluation and care by a specialist.
What if I never menstruate?
Days:Rarely or Never
Ovulation Indicator: Ovulation may not be occurring
What does a Lack of Menstruation tell your Doctor? Either ovulation is not occurring or there is something blocking menstrual blood flow. The patient will have difficultly conceiving naturally without intervention.
What Causes Cycles to Stop Occurring?When a woman does not have a period, this can be caused by a failure to ovulate. Hypothalamic amenorrhea is a potential cause, as well as any of the hormonal imbalances that can cause irregular cycles can also stop the cycles completely.
It is common in women who are considered underweight by the body mass index (BMI) standards to stop having a cycle. The body requires a certain level of body fat for reproduction and menstrual cycles to occur, and many women who are able to gain weight will see the return of their cycle.
Weight is not the only cause to consider. There are several other causes that should be evaluated as well. If a woman has never had menstrual bleeding, there may have been a problem with the normal development of the uterus or the vagina. If a woman had menstrual cycles previously, but then stopped, this could be due to a problem with the uterus itself, like scar tissue inside the cavity, or may be due to premature menopause. If the uterus has not formed or if menopause has occurred, pregnancy is not possible. If the absence of menses is due to scar tissue inside the uterus, then this scar tissue will need to be removed as it can interfere with implantation.
If you do not have a normal monthly menses, no matter the amount of time you have been trying to conceive, you should be evaluated by a specialist.
Irregular or absent ovulation makes conception very difficult without intervention. Any woman less than 35 years of age with normal cycles who has not gotten pregnant after a year of trying should see an infertility specialist. If you are 35 or older with a normal menstrual cycle and have been trying for 6 months without success, you should seek care as well. Normal menstruation indicates that you are ovulating; however, there are other reasons why you may not be able to get pregnant, and these should also be evaluated.
Editor’s Note: This post was originally published in October 2014 and has been updated for accuracy and comprehensiveness as of March 2021.
For more information about your menstrual cycle or to schedule an appointment with one of our physicians, please speak with one of our New Patient Liaisons at 877-971-7755 or fill out this brief form.
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Menstrual cycle is a regular natural biological cycle in a woman's body, during which a mature oocyte (ovum) is released.
The menstrual cycle is a mirror of a woman's reproductive health, so keeping a menstrual calendar is important.
The menstrual cycle reacts to our entire environment (emotions, mood, stress, sleep, weight fluctuations, etc.). And most often, rare violations of the cycle are not a problem, but only tell us that we need to take care of ourselves. But frequent and persistent violations can signal probable health problems. nine0005
Let's figure it out.
Four parameters are used to determine normal menstrual bleeding:
- frequency;
- regularity;
- duration;
*test* The first day of the menstrual cycle is:
- 1st day of spotting;
- Last day of spotting;
- Ovulation day.
The normal menstrual cycle in the reproductive period lasts 21-40 days.
If you have fewer than 9 periods per year or cycle more than 21 days, you should consult a gynecologist.
Menstruation does not have to come every day.
Changing the cycle length, i.e. the difference between the shortest and longest cycles depends on age:
• 18 to 25 years - cycle change ≤9 days
• 26 to 41 years - cycle change ≤7 days
• 42 to 45 years - cycle change ≤9 days
Women aged 45 may have more variability.
These age-related fluctuations are associated with the physiological processes of the formation of the menstrual function and its extinction.
The normal number of bleeding days per menstrual cycle is ≤8 days.
There is no consensus on the lower limit of the normal duration of menstruation, since there are no specific pathological formations associated with a short duration. nine0005
If menstruation has changed dramatically, consult a gynecologist.
Normal - a volume that does not affect the physical, social, emotional and / or material quality of a woman's life
Research definition of normal volume - loss of menstrual blood ≤80 ml.
per cycle
How to understand that menstruation is heavy?
To do this, you need to answer a few questions:
- Do you have your period for more than 8 days? nine0018
- do you change hygiene products at night, do you wake up to change hygiene products?
- on days of heaviest bleeding, do your hygiene products get completely wet by 5 drops in 2 hours of use?
- Are there any clots larger than 2 cm?
- Do you have to use 2 hygiene products at the same time to avoid leakage?
- have you ever had anemia (low hemoglobin)? nine0018
- Do you experience weakness, malaise and dizziness during your menstrual days?
- is there a need to organize your life during menstruation: choose special routes so that you can go to the toilet, refuse long walks or trips, skip events?
If you answered “yes” to at least one question, contact your gynecologist.
Sometimes intermenstrual bleeding can be associated with ovulation, but you should always consult a gynecologist to clarify the condition. nine0005
It is necessary to immediately dispel the myth that pain is normal and must be endured.
Pain during menstruation (dysmenorrhea) occurs in more than half of women and needs to be dealt with.
Dysmenorrhea is primary, not associated with any disease. Why does it hurt then?
At the onset of menstruation, prostaglandins are released that cause uterine contractions. Being released in large quantities, they cause irregular strong and frequent uterine contractions, resulting in increased pressure in the uterine vessels, ischemia and the release of anaerobic metabolites that stimulate pain receptors. nine0005
There is a myth: when you give birth, everything will pass. This may work for 20-25% of women.
Secondary dysmenorrhea is caused by gynecological diseases such as endometriosis or uterine fibroids.
To assess the severity of pain, exclude diseases and choose a method of anesthesia, please contact a gynecologist.
Author: Egorycheva Anastasia Andreevna, obstetrician-gynecologist in Moscow
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Menstrual disorders
Gynecology
Today, menstrual disorders are one of the most common gynecological abnormalities. Almost all women experience this at least once in their lives. But one thing is a “random” failure caused by stress, another thing is constant delays. In women born and raised in our latitudes, the first menstruation occurs, as a rule, from 12 to 13.5 years. During the first year, the cycle is established. And yet in this first year at least 8 cycles must pass. If, after the age of 14, menstruation has not yet begun, the girl needs an examination. nine0005
The duration of the cycle is counted from the beginning of one menstruation to the beginning of the next: a minimum of 21 days, a maximum of 35.
A serious problem is a delay of 14 days or more (sometimes up to 6 months). There are also reverse situations when menstruation, on the contrary, comes too often. On the other hand, if for many years the cycle was 21-22 days, and then suddenly became longer, this is also an alarm. It is worth paying attention to the duration of the discharges themselves: for example, if from five to seven days this process has been reduced to two or three. nine0005
So, menstruation can be:
Painful. Often, pain in the lower abdomen and severe spasms are provoked by prostaglandins - biologically active substances that cause the uterine muscle to contract to remove blood. It is believed that after childbirth, such pains become weaker. If menstruation becomes painful after 35 years, then you should be wary, as these pains may have an organic cause: endometriosis, polyps, or uterine fibroids. Consult a gynecologist, he will determine the true cause of the pain. nine0005
Abundant When you change your pads or tampons every two hours, your blood comes out in large clots or your period lasts more than a week.
In both young girls and women approaching menopause, such periods are the result of a hormonal imbalance and are easily corrected if you see a doctor. If the periods become too heavy, then this may indicate gynecological inflammation. The coil can also cause excessive bleeding. In this case, you need to tell your gynecologist about it. Now there are spirals, the use of which eliminates these problems. nine0005
Scanty when the bleeding is very slight and lasts only one to three days. This sometimes happens when taking birth control, at the beginning of menopause, or due to a sudden change in weight that provokes a slight hormonal disorder. But if your period began to pass with light bleeding after abortion , diagnostic curettage of the uterus or curettage after childbirth, then you need to see a doctor. Sometimes this is a consequence of fusion (gluing) of the walls of the uterus, in which case a small surgical intervention may be necessary. nine0005
Irregular.
"Standard" periods come every 28 days, with a difference of 24-48 hours. Both a shorter cycle (25 days) and a longer one (30-32 days) are not abnormal. Only if the cycle becomes either short or long, or lasts less than 25 days or more than 35 days, we can talk about irregular periods. In young girls, the regularity of the cycle is most often established one to two years after the first menstruation. So don't worry. In the premenopausal period, before the ovaries completely stop working, periods can also become very capricious. In other cases, irregular periods most often indicate a lack of ovulation or its violation. nine0005
Absence of menstruation. What is the reason for - pregnancy, early menopause, hormonal or psychological problems, only a doctor will determine, sometimes after a series of studies and analyzes. The absence of menstruation is by no means normal.
Menstrual irregularities include:
- absence of menses (amenorrhea),
- too frequent or too infrequent menstruation (oligomenorrhea),
- painful menstruation (dysmenorrhea, algomenorrhea),
- excessive menstruation (hypermenorrhea, menorrhagia),
- occurrence of intermenstrual uterine bleeding,
- development in a woman of the so-called premenstrual syndrome (PMS)
The most common causes of menstrual irregularities are:
1.
The most common and most banal cause of failures is infection of the pelvic organs. Therefore, first of all, it is necessary to be examined and, if necessary, to carry out treatment. And if the reason was only in the infection, then the cycle will be restored. nine0005
2 . The situation is much more complicated if the irregularity of the cycle is caused by hormonal disorders , which can occur at different levels of hormone formation. A certain list of them has been scientifically confirmed, which is checked if this cause of cycle disorders is suspected. The general examination plan also includes a study of the function of the thyroid gland and adrenal glands , , and violations here can be associated both with their hyperfunction and with a decrease in activity. nine0206
3 . Previous rubella and chickenpox can affect the laying of follicles in the ovary, and then violations occur from the very first cycles.
The difficulty is that adolescents themselves rarely pay attention to this, and such disorders are diagnosed much later.
4. It happens that the follicular apparatus is genetically incorporated in such a way that a woman will have cycle disorders all her life, such as, for example, with polycystic ovaries.
5. And finally, quite often cycle disorders are caused by a whole range of reasons - both hormonal, inflammatory and others. nine0003
REMEMBER! Violations of the cycle should never be ignored, because, being not only a signal of existing health problems, they can also lead to very serious diseases. Self-diagnosis here is elementary - it is only important to notice any deviations in time and contact a qualified gynecologist. First of all, cycle disorders are associated with the risk of developing uterine tumors , such as fibromyoma, as well as ovarian cysts . Disorders such as endometrial hyperplasia ( thickening of the inner layer), polyps may occur.
