The human body is full of intricate systems, and considering the enormous responsibility of creating new life, it’s not surprising that a woman’s reproductive system is one of the most complex. It’s tasked with one of the human race’s most important jobs, but how does such a sophisticated system function and how can you know if something goes awry? Often, the first clues come from your period.
The term menstrual cycle is used typically to refer to the one week or so each month when serious period action is happening. But the menstrual cycle, in textbook terms, is always going on. Here’s what your internal little ladies are up to all month long.
Day 1
It’s the first day of your period. You might be a little cranky, crampy or otherwise bothered. Your last menstrual cycle just ended and signaled your body to spike in hormones, giving your body the purge-system-now signal. As you know, bleeding usually lasts five to seven days.
Day 7
Hell week is over by now for most women, and our reproductive systems are settling back in. Hormones during your period have caused follicles—sacs filled with fluid and each containing an egg—to develop on the ovaries. Only one of them will remain active by the end of the week as it waits for the uterus to build up its endometrium, or lining, to receive a fertilized egg.
Day 14
Let ovulation begin! A spike in estrogen causes the follicle to release its egg into the ovary. The egg makes its way through the fallopian tube. Here is where a sperm can meet it to make the magic happen, or it will pass on into the uterus without fertilization. A fertilized egg will embed itself in the endometrium while unfertilized eggs wait around for the next menstruation to begin.
Day 25
Around this time, hormone levels are dropping to signal the start of the next menstrual cycle. The egg breaks down and exits the body with the rest of the uterine lining, and the process begins anew.
Egg-ceptional Numbers: The average woman is born with approximately 2 million eggs in her ovaries. Crazy, right? They’re lost over time, and usually by the beginning of puberty, a young girl will have roughly 300,000 to 500,000 eggs.
Uteruses, unite!
Ever synced cycles with a close friend? Numerous studies have been conducted on the idea of close friends and roommates matching up cycles, known as the McClintock effect in honor of the scientist who first studied it. She believed pheromones and undetectable chemical signals caused women’s cycles to sync after spending a significant amount of time together over many, many months. However, most studies since have found no evidence this occurrence is real. Ladies who’ve had roommates may be believers, but as of yet, there’s no science to back this old menstrual myth. In any case, the idea of our uteruses syncing without our permission sounds very Invasion of the Body Snatchers, no?
How Much Is Too Much?
Although it may feel like a lot more, 2.4 tablespoons is the average amount of menstrual fluid most women lose during their cycles. The normal range is 1 to 6 tablespoons, but some women with the heaviest flows may lose up to a cup.
As with any part of the period, flow differs between all women and can depend on genetic, emotional and psychological factors. That makes knowing when your flow is too heavy a little subjective. Most doctors agree if you feel like you’ve barely had enough time to use one tampon or pad before you need a new one, it may be time to schedule an appointment.
Dr. Mary M. Gallenberg of The Mayo Clinic suggests blood tests to check for anemia in women who frequently have heavy periods.
“A number of conditions can cause heavy menstrual bleeding. Hormonal imbalance, uterine fibroids or certain types of intrauterine devices are just a few,” she explains. “Your doctor may recommend taking a daily vitamin containing folic acid, vitamin C, vitamin B-12 and other vitamins that help build red blood cells.”
Painful periods?
The unfortunate reality of periods is that they kind of suck, and the average woman will endure 450 periods in her lifetime. Bloating, cramps and constant bathroom trips aren’t any woman’s idea of fun, but over time, most ladies know what to expect from their monthly guest. But when is the pain too much to be normal?
The medical term for menstrual cramps is dysmenorrhea. It’s the No. 1 cause of missed school and work for women in the United States, with over 3 million reporting they are unable to function for one or two days each month because of the intensity of the condition.
Primary dysmenorrhea cramps typically occur in the abdomen or lower back after a woman has had her period for one to two years. Cramps from secondary dysmenorrhea may start earlier, last longer and be the result of a reproductive disorder. Either way, they don’t feel good.
Experts say that when your cramps and period pain start affecting your quality of life or your ability to go about your day as usual is when you should talk with your doctor, especially if they last more than two or three days. Birth control is the most common method of alleviating severe cramps and heavy flow and can also make periods more regular and predictable.
But it’s important to know, cramping isn’t the only pain relevant to that time of the month. Some pains may point to a bigger problem lurking somewhere in the reproductive system. It’s essential for each woman to know what her normal feels like and seek the opinion of a medical professional when something goes awry. What could that something be?
Endometriosis
This disorder occurs when the endometrium, the uterine lining, spreads outside the uterus and into surrounding organs in the abdomen (usually the ovaries). There, it forms little growth nodules. Like normal uterine tissue, it breaks down during the menstrual cycle. Unlike normal uterine tissue, the body can’t expel it, so it causes inflammation and swelling.
The cause of endometriosis is unknown, but it results in painful urination, intercourse and bowel movements and more painful period cramps. It can also make it difficult for the patient to become pregnant. Currently, there’s no known treatment for endometriosis, but the condition can be treated with hormones or birth control pills. In more severe cases, surgery may be needed. Many women fear endometriosis will mean they cannot become pregnant, but with the help of a doctor, most women are capable of conceiving.
Premenstrual Syndrome
Ah yes, the infamous PMS. Often cited as the reason for cranky behavior but rarely understood, this occurrence is still a bit of a mystery even to the medical community. It’s likely the cause of cyclic hormone changes occurring throughout the menstrual cycle, as they happen at the same time each month and disappear during pregnancy and after menopause. Some theories also suggest PMS is the result of fluctuating serotonin levels in the brain, which can cause bouts of depression and fatigue. Some women with particularly severe PMS have even been found to have undiagnosed depression.
PMS, as many women know (and are reminded by men), can lead to mood swings, random crying, cravings, irritability and more. Physical symptoms are numerous as well and include but aren’t limited to bloating, new skin blemishes, tenderness of the breasts and fatigue. Thankfully, most of these symptoms dissipate and vanish entirely within the first four days of the period.
Visit your doctor if the symptoms become disruptive to daily life. Antidepressants, NSAIDs and hormonal contraceptives have all been known to effectively treat PMS. Fortunately, most women can improve their monthly struggles with simple lifestyle changes, like adding 30 minutes of light exercise to their daily routines or cutting back on salty foods to prevent bloating.
Premenstrual Dysphoric Disorder
Premenstrual dysphoric disorder, or PMDD, is PMS’s very ugly cousin. It causes many of the same symptoms as PMS and, similarly, begins seven to 10 days before the beginning of a woman’s cycle. However, in PMDD there are significant differences in heightened emotional responses, like notable irritation, anger, anxiety or tension and feelings of hopelessness. The main difference between PMS and PMDD is intensity.
The cause of PMDD is unknown, but some believe the hormonal changes occurring during a menstrual period are simply worsening the symptoms of a preexisting mental or emotional condition, such as depression. For this reason, treatments like antidepressants, specialized diets and birth control pills are usually effective at alleviating the symptoms.
Uterine fibroids
Also known as leiomyomas, these noncancerous growths develop from the tissue of the uterus when one cell divides itself multiple times. It creates a hard, rubber-like mass. Some grow, some don’t, but many cause symptoms like heavy or prolonged periods, back and leg pains, pelvic pressure and difficulty emptying the bladder. Experts aren’t sure of their cause but point the finger at heredity or hormonal imbalances. Treatments include watchful waiting, NSAIDs, hormonal blockers or the use of a progestin-releasing intrauterine device.
Ovarian Cysts
Many women will have ovarian cysts—little fluid-filled sacs on or embedded in the surface of an ovary—at some point in their lives. However, most will come and go without any discomfort or sign they were there. It’s when they rupture that the trouble begins. Pelvic pain, especially during intercourse or bowel movements, can be a good indicator of ruptured cysts. A feeling of fullness in the abdomen or pressure on the bladder is also something to call the doctor over. If you or someone you know experiences sudden and intense abdominal or pelvic pain or pain with fever and nausea, it’s officially an emergency.
Have no fear: These little pests are totally treatable. Usually, when cysts are found, doctors choose to keep an eye on them for a few months to see if they’ll disappear on their own. Often, they do. When a woman encounters a more persistent cyst that continues growing, causes pain or lasts through multiple menstrual cycles, surgical removal is recommended. Often, doctors will prescribe birth control to help prevent future cysts and keep everything on the up and up.
Toxic shock syndrome
Have no fear ladies, TSS has a scary name, but the stats are on our side. Only one in 100,000 menstruating women in the United States suffers from the illness each year. TSS is a result of toxins produced by the bacteria Staphylococcus aureus (street name: staph) and has been linked to using superabsorbent tampons. Studies haven’t been able to pinpoint why they lead to a stampede of staph, but most physicians guess it’s because users tend to change the tampons less often because of their high absorbency. Because they remain in the warmth of the body longer, they become the perfect breeding grounds for these microscopic toxin producers. Symptoms of TSS include sudden fever, vomiting, a sunburn-like rash on the palms or soles of the feet and more. If any of these happen to you while using tampons or if you have open wounds in the skin, call your doctor immediately.
Infertility Troubles
As always, complicated systems suffer complicated issues. Infertility is scary and can stem from any number of causes and complications within the reproductive system. Fortunately, there are just as many treatments.
The one we hear of most is probably in vitro fertilization (IVF) and means all the fertilization occurs in a lab. Eggs are surgically obtained after a period of treatment using infertility drugs to stimulate them. The partner’s sperm is used to fertilize the eggs, and, after three to five days of hanging out and turning into real embryos, they’re returned to the cozy confines of the uterus in the hopes that one will embed itself and begin developing.
Zygote intrafallopian transfer (ZIFT) and gamete intrafallopian transfer (GIFT) offer other infertility options depending on the particular issue each woman faces. GIFT is used most commonly for unexplained infertility, while ZIFT is the answer to fallopian tube blockages, which prevent the magical meet-up between sperm and egg.
IVF also enables doctors to test the genetics of each embryo for inherited illness, disability or other conditions. The process is called preimplantation genetic disorder, or PGD, and can help couples with problematic gene combinations that may lead to conditions such as muscular dystrophy, sickle cell anemia and more.
Egg donors donate their own healthy eggs to be implanted into infertile mothers, which can also benefit mothers whose eggs are older or those couples who may pass on genetic conditions.
Dr. Angeline Beltsos, medical director at the Fertility Centers of Illinois, says one of the best things a couple can do is do their research and then question the statistics thoroughly.
“Some centers have high success rates, which may reflect that they only take easier cases. Other centers may have lower success rates but deal with harder diagnoses. Every patient and medical problem is unique, so ask questions that pertain to you. Inquire about your doctor’s experience with your particular problem, as well as their success rates with women of your age,” says Beltsos.
Keep in mind that all data gets a little skewed, and more important than the numbers is finding a physician you can connect with.
Mitochondrial Methods
There’s a new method of treating infertility showing high success rates in Canada. Although it’s still not authorized to be performed in the United States, the procedure, called Augment, uses a woman’s own cell power to her advantage.
Mitochondria are referred to in every science textbook as the powerhouse of the cell, providing energy for all of the cell’s little functions. Doctors are now able to use women’s own mitochondria from immature egg cells to reenergize the mature eggs and make them viable once again. After surgically removing a small piece of an ovary and harvesting some mature eggs from the patient, doctors add sperm and mitochondria to the mature egg and transfer the embryo back into the womb later.
Sound familiar? It is. This procedure is IVF plus the extra ingredient of mitochondria. The purpose of the additive is to raise the successful fertilization rate in women who are older and may have trouble becoming pregnant due to age.
“Like a flashlight sitting on a shelf in a closet for 38 years, there really isn’t anything wrong with the flashlight,” says Dr. Robert Casper, a reproductive endocrinologist at the Toronto Center for Advanced Reproductive Technology. “But it doesn’t work when you try to turn it on because the batteries have run down. And we think that’s very similar to what’s happening physiologically in women as they get into their 30s.”
So far the FDA is prohibiting the treatment until there is more proof of its benefits. Professionals certainly hope to bring Augment to the United States and help women in our fair nation achieve their family goals—but only after there are fewer unknowns about its safety.
Get to know yourelf
Dear reader, the most important thing you can do to ensure your reproductive health is to know thyself. Become as familiar as possible with your menstrual cycles, like what kind of cramping and flow is normal for you. The afflictions above may sound scary, but knowing your body well is your best defense. Talk to your doctor if you notice something is amiss, and use the power of early detection to your advantage.
