Menstruation may seem like the end of a cycle, but in fact, it is the beginning. The first day of fresh red bleeding is considered to be the start of a new menstrual cycle. This first day of fresh red bleeding is known as Cycle Day 1 (CD1) in charting. Menstruation is the shedding of the lining of the uterus, following a luteal phase with no pregnancy occurring.
A period can last anywhere from 2-7 days, with most menstrual periods lasting three to five days, including a day or two of light flow or spotting at the end.
Menstrual fluid should be red to brown in colour, and a loss of about 50mls over the bleeding phase is considered healthy. Greater than 80mls of loss is excessive, less than 25mls is considered very light. Not all menstrual fluid is blood, it also contains: cervical secretions, vaginal secretions, bits of endometrial tissue. Two thirds of the endometrial lining will be reabsorbed by the body, with the remaining third being shed. It should be mostly liquid, though a few clots the size of an Australia 5-10 cent piece is also normal.
Bleeding that is excessively heavy, very light, very short or very long, or unusual in colour or content always warrants investigation. Our menstrual flow is a helpful indicator of your overall health and wellbeing, and abnormalities can be indicative of a range of womens’ health, hormonal or autoimmune conditions.
The modern woman is estimated to have approximately 400 periods in her lifetime, more than our ancestors due to wider availability of good nutrition. However, this figure varies greatly due to the widespread use of hormonal contraception.
Did you know that the cyclical bleeding you experience when taking the oral contraceptive pill is not a period? Instead, it is a withdrawal bleed, in response to taking the “sugar” pills without the active ingredient during a particular part of the medication regime – it simulates a period bleed, but was in fact predominantly introduced into the Pill protocol to reassure women they weren’t pregnant, to attempt to satisfy some Catholic criticism of the Pill, and to *ding ding* save money in manufacturing. Taking the placebo pills and allowing a withdrawal bleed to occur does not serve any medical purpose, however it may reduce the incidence of breakthrough bleeding that is more likely to occur if pill packets are run together – at some point the endometrial lining will shed.
While menstruation is an essential part of the cycle if choosing to chart your cycle – many women suffer from excessive pain, heavy bleeding or mood-related symptoms during or immediately prior to their menstrual phase. What do we do about this?
The causes of excessive bleeding and excessive pain are not treated by suppressing the menstrual phase – while the use of hormonal contraceptives may prevent or reduce symptoms, it does not always stop disease progression, and can delay diagnosis. While you may choose to use hormonal methods such as the oral contraceptive pill or hormonal IUD to manage complex conditions such as endometriosis, prescription of these options without investigations of the causes of significant symptoms prevents women from making informed choices. For example, the current delay to diagnosis for women with endometriosis is is 6.5 years – this has a significant impact of quality of life for women, and the delay in diagnosis and treatment has significant impact on the likelihood of conceiving successfully in the future if desired: addressing symptoms alone without diagnosis and investigation reduces the options and informed decision-making of individuals – this is a concern that has been raised by the Royal Australian College of General Practitioners in the routine prescription of the oral contraceptive pill for adolescents presenting with heavy or painful menstrual periods.
While women with complex conditions such as endometriosis will likely require specialised support to manage their conditions, many choose to do so with allied health and alternative health support, not just traditional biomedical approaches. For women without underlying conditions, options such as magnesium supplementation, exercise programs and lifestyle modification, with or without breakthrough medication use, can make marked differences in their menstrual phase, without the need for hormonal contraception.