The Facts of Life: Examining Reproductive Health

Female Anatomy

Menstruation

17. Menstruation cycle and a helpful guide for those just beginning to menstruate

A young woman's menstrual periods will first occur when she is somewhere between the ages of nine and eighteen. She will continue to menstruate each month for about 40 years, unless she is pregnant, nursing a baby, very underweight, ill, or has a problem with her reproductive system. Menstrual periods occur approximately every 21 to 40 days and typically last from three to seven days. Some women have their menstrual periods at regular intervals (for example, every 28 days); others do not. An infant girl is born with about a million eggs; by the time she reaches puberty there are about 300,000 remaining. Since ovulation occurs before menstruation, it is possibleto get pregnant before getting one's first menstrual period. Many girls get their periods a few times before ovulation begins, but some ovulate right from the start. If they are having unprotected intercourse, they can get pregnant even before they begin menstruating.

The Facts About Menstruation
An average menstrual cycle is approximately 28 days. Five days after menstruation begins, the pituitary gland, located near the brain, sends a hormonal signal to the thousands of eggs contained in the ovaries. Each egg is held in a protective pocket called a follicle. When the ovaries receive the signal from the pituitary gland, ten to twenty of the follicles begin to grow. Although a few of the eggs may begin to develop, as a rule only one per month will mature fully. The growing follicles release estrogens which cause the uterine lining to thicken with blood and tissue.

As the egg reaches maturity the follicle secretes progesterone which causes the uterine lining to secrete fluids to nourish the egg if it is fertilized. On about the 14th day of the cycle, one of the eggs reaches maturity and breaks out of its follicle, rising to the surface of the ovary. This process is called ovulation. The egg then moves into the fallopian tube nearby. Fertilization of the egg occurs in the fallopian tube while the egg is on its way to the uterus. If the egg has not been fertilized it disintegrates or is shed with vaginal fluids.

Next, the miniscule arteries and veins in the uterus pinch themselves off and by the 24th day, the lining that had been building up starts to loosen. By the 28th day, the lining has broken up so much that bits of it break away and pass out of the cervix and vagina as menstrual fluid. It is a mixture of tissue, mucus, and blood. Day 1 of the menstrual cycle begins again.

Side effects of menstruation may include cramps, headaches, backaches, acne, mood swings, depression, nausea, and water retention. Some women experience few side effects, while others are very much affected. Cramps occur when the uterus contracts in order to push out the old lining, and when the muscles of the cervix open to let it out. Lower levels of the hormones estrogen and progesterone just before menstruation begins has been thought to cause many side effects, including depression.

Products Used

Throughout history women have used different versions of tampons and pads. Some were made from natural sponges, grasses, or cloth. Your great-grandmother may have used rags, which she washed out in cold water each night. Today, many women can choose from sanitary napkins (pads), tampons, sponges, and cups.
18 & 19. United States Patents of Catamenial Sacks/Bandages for Sanitary Protection 1859-1914

Although many women prefer internally-worn methods of protection, users should be aware of toxic shock syndrome (TSS). It is a serious bacterial disease that seems primarily to affect menstruating women under the age of 30. Symptoms include fever (over 102 degrees fahrenheit), nausea and vomiting, diarrhea, dizziness or feeling faint, and a painless sunburn-like rash. Immediate medical attention is necessary if any of these symptoms occur while using a tampon during menstruation. In order to prevent this, tampons should be changed regularly, preferably not worn at night, and "superabsorbent" materials should be avoided.

Menstruation and Power
Menstruation is a natural occurrence. It is a part of becoming a woman, yet negative attitudes toward menstruation have been present for hundreds of years world-wide. Well into this century, menstruating women were thought to cause meat to rot, milk and sauces to curdle, wine to turn, bread dough to fall, and with a single touch, cause dogs to go mad. In some European locations, they were not allowed to touch anything on the table: from a newly killed pig, preserves, and pickles to bread and wine. In other cultures, menstruating women are isolated either by themselves or with other women. Menstrual blood was considered "unclean" and was thought to give women supernatural powers which were a cause for fear. But these practices, while they may seem negative and discriminatory to us, can also be seen as social practices which allow women a break from daily work and a chance to share knowledge with each other.

Another Look at Menstruation
In spite of our extensive knowledge of its mechanics, the biological motive for menstruation has remained largely unexplained. The regular loss of blood and tissue seems wasteful and costly to a woman's health. Recently, evolutionary biologist Margie Profet of the University of California at Berkeley asked the question "why do the bodies of premenopausal women go through this inconvenient process of shedding blood and tissue every month rather than keeping the uterine lining until it is needed?" The answer she proposes, is that sperm bring with them harmful microbes which can cause infection in the woman's body. Monthly bleeding and shedding of the uterine lining protects the uterus and fallopian tubes from disease. Menstruation then, would seem to be a useful event rather than a wasted effort.

Scientists have traditionally described the process of menstruation in terms of loss. For many centuries, Western cultures viewed menstrual blood as impure and dirty. Yet the process of excreting it was considered normal. By the 19th century, the very process of menstrual bleeding was considered pathological, a female "disorder."

Even today medical textbooks describe the process of menstruation in negative terms. The fall in progesterone and estrogen when a fertilized egg does not implant is described in terms of deprivation. The "loss" of hormonal stimulation leads to the "death of tissue" and shedding of the uterine lining. The woman's body failedto produce. Profet's theory challenges this image of waste, loss, and failure.

Bacteria and viruses carried on the sperms' tails can originate with the male or be picked up from the vaginal canal during intercourse. Before ovulation occurs each month, a thick layer of cervical mucus protects the uterus and fallopian tubes from pathogens. During ovulation this mucus becomes more permeable allowing the sperm to easily pass into the uterus. Profet argues that a woman's body sheds the outer lining of the uterus because this is where the pathogens are likely to be lingering. The blood which accompanies menstruation carries immune cells which destroy the organisms. Menstruation then, is a double edged attack against potential infection. Personal Hygiene
Circa 1905
"I have read that a woman should not bathe or change her underwear while menstruating....Most especially would I advise a frequent change of napkins, in order to remove those which are soiled from their irritating contact with the body."

Mary Wood-Allen, MD What A Young Woman Ought to Know, 1905

"A full bath during menstruation would, for most people, be unadvisable, but the cleansing of the private parts is imperative."

Mary Wood-Allen, MD What A Young Woman Ought to Know, 1905

"As a minor item, I would suggest that the napkins be fastened to straps that go over the shoulder and are then joined together in front and back to an end piece, on each of which a button is sewn. Buttonholes in the napkins at the corners, diagonal from each other, will make them easily attached or removed. The napkins should be of a material that is quickly absorbent of the flow. Cheesecloth is cheap, and can be burned or otherwise disposed of after using. It may be protected by an outer strip of unbleached muslin which is almost water-proof."

Mary Wood-Allen, MD What A Young Woman Ought to Know, 1905

"A very comfortable way of arranging napkins that are to be used from time to time is to take a piece of linen or cotton diaper sixteen inches square. About three inches from one end, make on each side an incision four inches long. Fold this strip in the middle lengthwise, and sew together up to the end of the incisions. This makes a band with a sort of pocket in the middle. Hem the cut edges. Fold the napkin over, four inches on each side, that is as deep as the incisions. Then fold crosswise until you can enclose the whole in the pocket in the band. This makes a thick center and thin ends by which to attach the napkin to the suspender."

Mary Wood-Allen, MD What A Young Woman Ought to Know, 1905

"Girls are so often told that they must not walk at their monthly periods, must not study, must not ride, etc., etc, that it really is no wonder that they feel it a very undesirable thing to be a woman."

Mary Wood-Allen, MD What A Young Woman Ought to Know, 1905

"I know that many writers say that a girl should spend one day each month in bed, or at least lying down; that there are some things that should always be forbidden to girls, simply because they are girls, such as running up and down stairs. These wholesale restrictions make girls rebellious at their womanhood. I simply want you to use good sense at all times in your care of yourself."

Mary Wood-Allen, MD What A Young Woman Ought to Know, 1905