What is a normal menstrual cycle?
This is what happens in your body over and over until pregnancy occurs. This cycle, therefore a repeating process, prepares your body for pregnancy and when that does not happen, one cycle ends and another begins so that your body can take the same preparatory steps—hormonally. Its length is typically 21-35 days, but is traditionally (normally) felt to be every 28 days, which is the same length as the lunar cycle.
Why is it called a “menstrual cycle”?
The Latin word for “month” is “mensis,” plural being “menses.” These came from the previous Greek word for moon, “mene.” Whether we evolved to synchronize with the moon’s monthly phases or we call the moon that (“moon”) based on a coincidence of similar cycles (moon and periods) isn’t known, although Charles Darwin thought that it was because we evolved from sea creatures who depended on the moon phases and tides for mating.
Some cultures have fabricated ritualized beliefs about menstruation that don’t hold up medically. Women on their periods have been separated from other women by customs ranging from seeing it as a time of rest from the attentions of men to being termed “unclean.” The latter term is as unfortunate as it is misogynistic. Sex during one’s period is safe and without any risks at all. (Theoretically, sex during your period with someone having a sexually transmitted infection—“STI”—would increase your risk of getting that infection, the blood-like debris of your period offering fertile nourishment for bacteria. But that risk is irrelevant, because you’re at risk with any stranger who may have an STI—anytime.)
What is bleeding during my period?
As stated above, your period is called that because it is periodic—repeating. Some read “period” like the dot at the end of a sentence, seeing their periods as the end of each cycle. This is incorrect, because the menstrual period is actually the beginning of a new cycle, “DAY 1” being the first day of bleeding, which coincides when your hormones beginning to build again for the new cycle.
The bleeding you see is the debris of tissue that had built up the previous cycle when pregnancy didn’t happen. Loss of this tissue, seen as bloody menstrual tissue, happens because your hormones stopped at the end of the previous cycle and the tissue was no longer nourished by them. What confuses everyone is that this sloughing of that lining happens as you begin to rebuild your hormones that begin the next cycle.
How does your uterus know?
Your uterus really doesn’t.
Your brain does, and your brain calls the shots for when estrogen begins rising at the beginning of your period by reading the amount of hormone in your bloodstream—the estrogen and progesterone. Your hypothalamus gland then stimulates your pituitary and your pituitary then stimulates your ovaries to act.
Is the menstrual cycle that simple? It begins…it ends? Then it begins again?
It may seem that way. However, since your period is the only outward sign of your cycle each month—the only thing you see—this is why it may seem so simple. But it is really much more complicated than that.
In between periods is each ovulation—the release of a mature egg from your ovary for possible fertilization. Ovulation divides your cycle into two major hormonal phases:
- First half: the “estrogen” phase, in which estrogen rises and this hormone causes the inner lining of your uterus to thicken in preparation for implantation.
- Second half: the “progesterone” phase, in which progesterone rises. While your estrogen caused the lining to thicken, progesterone matures the lining to function as a hospitable place for a fertilized egg to implant and then grow as your baby.
The first half is also called the “proliferative phase,” since thickening of your uterine lining is also called proliferation. It’s also called the “follicular phase,” since the follicles in your ovary are maturing such that one will release an egg during the upcoming ovulation.
The second half is also called the “luteal phase,” since the follicle tissue of your ovary from where the egg was released is now called a corpus luteum (“luteum” is Latin for “yellow,” after the color of this tissue; thus corpus luteum is a “yellow body” of tissue).
Your estrogen rises to build up the tissue of your uterus; you ovulate, which begins progesterone production in the corpus luteum, which matures all that rich, thick lining to receive a fertilized egg.
The fork in the road:
- If no egg is fertilized, the egg falls away with the sloughed lining when your hormones fall again.
- If an egg is fertilized, it implants in your uterus while your corpus luteum continues churning out progesterone to support your pregnancy until the placenta (part of your pregnancy) can make its own progesterone.
Whatever could possibly go wrong?
Well, you could fill a book, so consider this the Cliff Notes on the subject.
But the easiest way to describe problems with your menstrual cycle is by listing things that go wrong with your period, since that is the only thing you actually see. What’s nice about your monthly period is that when you have it every month you know that everything is working right. When something stops working right, you’ll notice it by changes in your period (usually, very inconvenient changes).
- You could have very heavy periods.
This can happen when you have a fibroid tumor or multiple. These are benign structures that interfere with the muscle of your uterus clamping down on bleeding spots where the tissue sloughs away. This monthly loss of menstrual tissue exposes small blood vessels which bleed, but contractions squinch them off. You may perceive these contractions as “cramps,” but a fibroid will interfere with that action, making the bleeding AND your cramps worse.
You could have an endometrial polyp (tissue growth) in your intrauterine cavity (that space surrounded by the lining we’ve been discussing—the “endometrium”). A polyp is fragile and can bleed—sometimes excessively—with the contractions of your uterus. It can also bleed in between your periods [SEE BELOW].
You could have a condition called adenomyosis, in which the glandular components of the lining invade the muscular layer, interfering with the normal bleeding control. The condition also increases the size of your uterus, so there is simply more real estate to bleed.
The tidy sequence of estrogen-then-progesterone-then-estrogen-again can become unsynchronized, thus throwing the whole sequence out of whack. While this usually results in a continuous mess of on-going bleeding throughout your cycle [SEE DYSFUNCTIONAL UTERINE BLEEDING, BELOW], it can sometimes pile up such that you see a very heavy period. This is OK if it only occurs rarely, because everyone’s entitled to a weird period every now and then, but if it happens continuously, you could risk anemia.
- You could have no periods.
The most frequent cause of this is pregnancy, of course. However, [no pregnancy + no period] means something’s wrong.
It can mean that you didn’t ovulate—that you’re stuck in the first half of your cycle. This can occur with an ovarian cyst that delays ovulation—the next most frequent cause of no periods (after pregnancy). It can also occur with a benign tumor in your pituitary gland which makes prolactin, the milk letdown hormone (your body doesn’t ovulate because it thinks you’re breastfeeding).
It can indicate that you’re making estrogen that is independent of the normal cycle between your brain and your ovaries, such as a tumor in either area. Also, being overweight tends to produce estrogen in fat cells, giving a continuous supply that competes with the normal cycle.
Improper nutrition affects your whole body, and your hormonal function has no special protection from its harmful effects.
It can indicate thyroid problems; your thyroid gland contributes to a normal cycle but can mess it up when it misbehaves (overactive, or hyperthyroid; underactive, or hypothyroid).
There can be a blockage of the exit of menstrual blood and tissue, due to a fibroid or a polyp [SEE ABOVE].
It could be medication that you’re taking. Antidepressants, for example, can cause changes in your cycle.
- You could have scant periods.
Periods that are very light, even to the point of being only “spotting,” can indicate that there isn’t a lot of lining built up, and less tissue that sloughs will then be seen as scant. This indicates a problem with the second half of your cycle, in which you don’t make enough progesterone to mature the lining.
- You could have irregular bleeding in no particular pattern.
When irregular bleeding occurs due to failing to ovulate (as with an ovarian cyst), it is called “dysfunctional uterine bleeding,” since it’s due to a normal function that is temporarily abnormal.
The aforementioned fibroid(s), polyp(s), and extra estrogen from obesity or thyroid problems may not limit their inconvenience to just that time of the month you expect your period, but typically have their effects all of the time.
Cervicitis (infection/inflammation) of the mouth of your womb can bleed irregularly at any time and has no relation to your cycle whatsoever. This is due to its being fragile tissue which can bleed with the mechanical act of intercourse or even walking.
Birth control pill dosages are formulated to supply the least amount of hormone that still “sets you up” for a period, but it’s a fake period. Instead of the natural monthly accumulations and then deprivation of your endometrium at the direction of your hypothalamus gland, the buildup is artificially supplied by the pill, then suddenly withdrawn at the end of the pill pack; no longer supported artificially, that tissue sloughs. But if your unique physiology requires a different dosage to mimic your system, you can have irregular “breakthrough” bleeding throughout the cycle. In fact, this happens in the first few months of the pill until you “grow into” it; if you don’t, it’s time to change the pill.
What can you do about your abnormal bleeding?
This depends on the cause, of course. Since all you will see is abnormal bleeding (in timing or amount) and/or cramping, you will need a specialist in abnormal bleeding to evaluate you. An abnormal bleeding specialist like Dr. Ulas Bozdogan of NJEndometriosis can isolate the cause of your bleeding, whether it’s hormonal, a problem with your anatomy (e.g., fibroid or polyp), or even an endocrine problem (thyroid, pituitary, etc.), and can strategize a fix for this.
If it’s the wrong pill, there are many on the market today to choose from. Certainly, one out there will have your name on it!
If it’s a fibroid or polyp, Dr. Bozogan’s minimally invasive robotic technique uses the latest technology to remove the problem in a same-day cosmetically-sensitive surgery which offers fast recovery and minimum discomfort.
If cramping indicates a possibility of endometriosis, he is an endometriosis specialist as well.
Does abnormal bleeding mean I have infertility?
It can. Especially since your whole cycle’s function is to cause ovulation and successful implantation of a fertilized egg. That’s not going to happen if you’re not ovulating regularly, and if your periods aren’t happening regularly, neither is your ovulation.
Even the mechanical problems, such as a fibroid or polyp, can interfere mechanically with the process of fertilization and/or implantation. If cramping with abnormal periods indicates endometriosis, the inflammation that occurs with this disease can block fertilization itself.
Whether you have any of the problems below (as explained above), a specialist like Dr. Bozdogan of NJEndometriosis can track down the cause and offer a remedy, which becomes all the more timely if you’re trying to get pregnant. If you are not, he can discuss different approaches from hormonal therapy all the way to hysterectomy, if indicated or desired.
Dr. Bozdogan is a specialist for
- Amenorrhea (no periods)
- Oligomenorrhea (periods not coming every month, but taking longer; or scant periods)
- Hypermenorrhea (heavy periods)
- Menorrhagia (heavy or prolonged periods)
- Hypomenorrhea (scant periods from low progesterone, due to an inadequate corpus luteum)
- Dysmenorrhea (painful periods, indicating possible endometriosis)
Polymenorrhagia (periods too frequent, that is, less than every 21-28 days)