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What is Menstruation? | Get Facts About Having Your Period

In This Section

• Menstruation
• What is PMS (Premenstrual Syndrome)?
• How do I know if my menstrual cycle is normal?

• How do I use tampons, pads, period underwear, and menstrual cups?
• What is premenstrual dysphoric disorder (PMDD)?

What is menstruation?

Menstruation — aka having your period — is when blood and tissue from your uterus comes out of your vagina. It usually happens every month.

What’s the menstrual cycle?

Your menstrual cycle helps your body prepare for pregnancy every month. It also makes you have a period if you’re not pregnant. Your menstrual cycle and period are controlled by hormones like estrogen and progesterone. Here’s how it all goes down:

You have 2 ovaries, and each one holds a bunch of eggs. The eggs are super tiny — too small to see with the naked eye.

During your menstrual cycle, hormones make the eggs in your ovaries mature — when an egg is mature, that means it’s ready to be fertilized by a sperm cell. These hormones also make the lining of your uterus thick and spongy. So if your egg does get fertilized, it has a nice cushy place to land and start a pregnancy. This lining is made of tissue and blood, like almost everything else inside our bodies. It has lots of nutrients to help a pregnancy grow.

About halfway through your menstrual cycle, your hormones tell one of your ovaries to release a mature egg — this is called ovulation. Most people don’t feel it when they ovulate, but some ovulation symptoms are bloating, spotting, or a little pain in your lower belly that you may only feel on one side.

Once the egg leaves your ovary, it travels through one of your fallopian tubes toward your uterus.

If pregnancy doesn’t happen, your body doesn’t need the thick lining in your uterus. Your lining breaks down, and the blood, nutrients, and tissue flow out of your body through your vagina. Voilà, it’s your period!

If you do get pregnant, your body needs the lining — that’s why your period stops during pregnancy. Your period comes back when you’re not pregnant anymore.

When in life do periods start and stop?

At some point during puberty, blood comes out of your vagina, and that's your first period. Most people get their first period between ages 12 and 14, but some people get them earlier or later than that. There's no way to know exactly when you’ll get it, but you may feel some PMS symptoms (link to PMS section) a few days before it happens.

If you don't get your period by the time you're 16, it’s a good idea to visit a doctor or nurse. Read more about getting your first period.

Most people stop getting their period when they’re between 45 and 55 years old — this is called menopause. Menopause can take a few years, and periods usually change gradually during this time. After menopause is totally complete, you can’t get pregnant anymore. Read more about menopause.

Your period may start and stop around the time it did for other people you’re related to, like your mom or sisters.

When can I get pregnant during my menstrual cycle?

You have the highest chance of getting pregnant on the days leading up to ovulation (when your ovary releases a mature egg) — these are called fertile days.

Ovulation usually happens about 14 days before your period starts — but everyone’s body is different. You may ovulate earlier or later, depending on the length of your menstrual cycle.

Your egg lives for about 1 day after it’s released from your ovary, and sperm can live in your uterus and fallopian tubes for about 6 days after sex. So you can usually get pregnant for around 6 days of every menstrual cycle: the 5 days before you ovulate, and the day you ovulate. You can also get pregnant a day or so after ovulation, but it's less likely.

Many people track their menstrual cycles and other fertility signs to help them figure out when they’re ovulating. This is called fertility awareness — some people use it to prevent pregnancy, and others use it to try to get pregnant. Check out our app, which makes it easy to chart your cycle and figure out your fertile days.

Some people have very regular cycles, and other people’s cycles vary from month to month. It’s really common for young people to have irregular periods. Since your period can be unpredictable, it’s hard to know for sure when you’ll ovulate (even if you’re carefully tracking your menstrual cycle). So if you don’t want to get pregnant, use birth control every time you have vaginal sex.

Do transgender guys get a period?

Not everybody who gets a period identifies as a girl or woman. Transgender men and genderqueer people who have uteruses, vaginas, fallopian tubes, and ovaries also get their periods.

Having a period can be a stressful experience for some trans folks because it's a reminder that their bodies don’t match their true gender identity — this discomfort and anxiety is sometimes called gender dysphoria. Other trans people might not be too bothered by their periods. Either reaction is normal and okay.

Sometimes trans people who haven’t reached puberty yet take hormones (called puberty blockers) to prevent all of the gendered body changes that happen during puberty, including periods. And people who already get periods can use certain types of birth control (like the implant or hormonal IUD) that help lighten or stop their periods. Hormone replacement therapy, like taking testosterone, may also stop your period.

If you start taking testosterone, your period will go away. But this is reversible — if you stop taking testosterone, your period will come back. There can be some changes in your menstrual cycle before it stops for good. Periods get lighter and shorter over time, or come when you don’t expect it. You may have spotting or cramping every once in a while until you stop getting your period, and sometimes even after it seems to have stopped — this is normal. Testosterone injections make your periods go away faster than testosterone cream.

If you experience gender dysphoria when you get your period, know that you're not alone. It may be helpful to check out our resources and find a trans-friendly doctor in your area that you can talk to.

More questions from patients:

What are the menstrual cycle phases?

Your menstrual cycle is your body’s way of preparing for pregnancy every month. It also makes you have a period if you’re not pregnant. Your menstrual cycle is controlled by hormones like estrogen and progesterone.

These are the menstrual cycle phases:

Menstruation

The 1st day of your menstrual cycle starts on the 1st day of your period (AKA menstruation). During your period, blood and tissue from the lining of your uterus flows out of your vagina. If you get your period, it means you didn’t get pregnant during your last cycle. Your uterus doesn’t need the lining to grow a pregnancy, so it sheds the lining.

Follicle Growth

This is when your body starts getting ready for the release of an egg. You have 2 ovaries, and each one holds a bunch of eggs. During your period, follicles (pockets) in your ovaries are stimulated to grow — there’s 1 egg in each of these follicles. During the week or so after your period ends, 1 of the eggs becomes totally mature each month. When an egg is mature, it means it’s ready to be fertilized by a sperm cell.

During this week after your period ends, the lining of your uterus starts getting thick and spongy again — which would either support a pregnancy, or get released through your vagina at the beginning of your next cycle (AKA your period).

Ovulation

During ovulation, the most mature egg is released from the follicle, out of the ovary. Once the egg leaves your ovary, it moves through one of your fallopian tubes towards your uterus. This takes several days. The egg waits for a sperm cell in the uterus for about 24 hours before it dissolves. Because sperm can hang out in the fallopian tubes for several days, pregnancy is most likely from sex that happens in the 6 days leading up to, and including, ovulation.

If your regular menstrual cycle is 28 days long, ovulation usually happens around day 14 — the halfway point in your cycle, about 2 weeks before your period. But everyone’s cycle is different, so it can be really hard to predict when you’ll be ovulating.

Luteal Phase

In the luteal phase, the empty follicle in your ovary (where the egg leaves) makes hormones that tell the lining of your uterus to get ready for a fertilized egg.

If pregnancy doesn’t happen, your body releases hormones that cause the uterine lining to break down. Eventually it flows out of the body, at which point you get your next period — and a new menstrual cycle starts.

Your menstrual cycle lasts from the first day of your period to the first day of your next period. A normal cycle can be as short as 21 days or longer than 35. This makes the average 28 days, but tons of people don’t have a 28 day cycle. The number of days in your cycle can vary from month to month too.

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Menstruation during pregnancy - maternity hospital "Leleka"

Young women often wonder if pregnancy and menstruation can happen at the same time. Indeed, during pregnancy, some women experience spotting, which is mistaken for menstruation. But it's not.

There can be no full menstruation during pregnancy. The endometrium, the layer of cells that lines the inside of the uterus and is shed during menstruation, helps the placenta develop during pregnancy and stays in the body. The cycle of monthly renewal of the endometrium during pregnancy stops. nine0003

However, spotting during pregnancy is not uncommon. Their appearance indicates that there are some malfunctions or pathological conditions in the woman's body. It can be a hormonal imbalance, a threatened miscarriage, and even an ectopic pregnancy.

Unfortunately, many young women underestimate this symptom, believing that periods during pregnancy are possible, and do not worry about discharge. They do not go to the doctor until the situation becomes critical. And in some cases, a timely reaction can save not only the unborn child, but also the life of the mother. nine0003

What causes bleeding during pregnancy

In order to understand how menstruation can start during pregnancy and what should be done, let's turn to the processes that occur in the body of a pregnant woman.

During intercourse, semen enters the vagina and then into the uterus. But fertilization may not occur immediately: spermatozoa remain active for three days. After the sex cells fuse, the fertilized egg attaches itself to the wall of the uterus. This, too, may not happen immediately, but within a few days. If these processes are delayed in time, the usual regular menstruation may begin. In this case, the egg will be fixed in the uterus, the pregnancy will develop normally. A pregnancy test will show a positive result. Alas, this rarely happens. More often, spotting is an alarming symptom. nine0003

Pregnancy and early periods

In some cases, the fertilized egg does not implant in the uterus, but in the fallopian tube or outside the genitals. An ectopic pregnancy develops - a severe pathology that poses a serious threat to the life of the mother and excludes a favorable outcome for the fetus. In an ectopic pregnancy, spotting may indicate a ruptured fallopian tube. The walls of the fallopian tubes are only 2-3 mm thick, they are inelastic. If an embryo develops and grows in the tube, the wall breaks, internal bleeding begins. This usually happens within 3-4 weeks. In this situation, urgent surgical intervention is necessary. nine0003

With detachment of the epithelium and the threat of miscarriage, characteristic discharge may also appear. This is possible with hormonal disruptions in the body of a woman. But sometimes spontaneous abortion occurs due to some internal failures that are almost impossible to predict in advance. If a young woman leads an unhealthy lifestyle - drinking alcohol, other toxic substances, or doing a lot of physical labor - this can increase the risk of spontaneous abortion. Allocations will just mean that the process of rejection of the embryo has begun. nine0003

Sometimes the cause of discharge is the death of one of the fetuses during a multiple pregnancy. If the pregnancy is multi-ovarian, that is, several eggs were fertilized, the development of other embryos can continue. But the risk of death of other embryos in this situation is quite high.

In some cases, the cause of the discharge is pathology or disease of the uterus. The egg does not manage to gain a foothold in the uterus successfully, especially if the uterus has pathologies or neoplasms. If the pregnancy develops normally, but the woman continues to have discharge similar to menstruation, this indicates a hormonal imbalance. Insufficient production of the necessary hormones is an alarming, but usually not a dangerous condition. nine0003

If menstruation starts during pregnancy, is there a chance to keep the baby?

Fortunately, the appearance of spotting does not mean termination of pregnancy. Of course, in the case of severe pathologies, such as an ectopic pregnancy, it will not be possible to save the fetus. But if in all these cases you do not consult a doctor, the risk of losing a child, and in some cases, a mother, is very high.

The SM-Clinic gynecologist told if menstruation can occur during pregnancy

Is bleeding in a future mother a reason to see a doctor or is it normal for early pregnancy? We understand.
Tatyana Vladimirovna Grigoryeva, an obstetrician-gynecologist at SM-Clinic, told the readers of Letidor about what the menstrual cycle is, as well as about menstruation during pregnancy.

Tatyana Vladimirovna Grigorieva, obstetrician-gynecologist "SM-Clinic"

Can menstruation guarantee that pregnancy has not occurred

First, let's remember what the menstrual cycle is. This is the alternation of the menstruation itself (lasts 3-7 days), the follicular phase, ovulation and the luteal phase. During menstruation, the mucous membranes of the uterus are shed. The process is accompanied by bleeding (this happens at the end of the ovulatory cycle). If there was no ovulation, then the bleeding is called menstrual-like.

It is extremely rare for two eggs to mature in one cycle (but this happens!): one is fertilized, and the second is rejected by the body and causes the onset of menstruation. nine0003

Menstruation during pregnancy is not normal.

However, do we always understand the nature of bleeding from the vagina without medical diagnosis? If during the alleged menstruation a woman noticed spotting, but their nature is different from the usual menstruation (the discharge is scarce, ends quickly, has a brown or bright scarlet color) and you remember that unprotected intercourse took place - this is a reason to do pregnancy test and see a doctor. nine0003

What can menstruation mean during pregnancy

After fertilization of the egg and the onset of pregnancy, menstruation does not occur throughout the entire process of bearing the fetus.

It should be remembered that the appearance of any bloody discharge from the vagina during a confirmed pregnancy (positive urinary pregnancy test, ultrasound data, hCG values) indicates possible pathologies. For example, when there is a threat of miscarriage and termination of pregnancy (started spontaneous abortion), placenta previa (low, marginal, complete). nine0003

Scanty spotting during the first days of pregnancy may be nothing more than implantation bleeding. Implantation of a fertilized egg (blastocyst) into the endometrium occurs 7-10 days after conception, that is, in fact, approximately on the days when menstruation should come in case of late ovulation.

The introduction of the blastocyst is accompanied by the destruction of the capillaries, and, consequently, there is a release of blood in a small amount. But, unlike true menstrual bleeding, implantation does not last long: in most cases, a day, or even less. nine0033

What effect does progesterone have on the mucous membranes of the uterus

Progesterone is the most important hormone throughout pregnancy. It is involved in the preparation of the endometrium for the implantation of a fertilized egg, the development of the fetus, and prevents premature birth. The reason for the occurrence of bloody discharge from the vagina, including on the days on which the woman previously had menstruation, may be a lack of this hormone.

Left unattended, hormonal bleeding can lead to spontaneous abortion. nine0047