I will never forget the day I got my first period. I was dressed in one of my favorite floral skirts sitting in history class when I started to feel uncomfortably crampy.
Menarche by definition is a woman’s first menstrual cycle, which marks the onset of adolescence.1 As if adolescence wasn’t hard enough, communicating about one’s menstrual cycle is unfortunately “mostly taboo in American life” and is established as a reserved topic for discussion in a variety of ethnicities including Arab American, African American, Mexican American, and European American cultures.1 And yet menstruation has been shown to be “inextricably linked to fertility, sexuality, health, and female identity”1 which to me seems to be worth more than a hush-hush discussion.
Improving knowledge about one’s menstrual cycle can come from a variety of resources. For me, this information came mostly from my mom. It is so important to note the role of all of these resources, since it has been shown that “both African American and European American girls have more positive reactions to menarche if they are prepared for it”.1
After padding my underwear with toilet paper for what seemed to be hours I met my mom in the kitchen in tears and I asked…mom, when am I going to get a scab?
Turns out, the female reproductive anatomy is housed in our brains and our pelvises! It consists of the hypothalamus and the pituitary gland (brain), the ovaries and the uterus (pelvis).3 The structures in the brain produce hormones, including follicle-stimulating hormone (FSH) and luteinizing hormone (LH) which direct ovarian function.3 The ovary has responsibility for making “female steroidal hormones, estrogen and progesterone” as well as controlling the “cyclical release of oocytes or eggs” – meaning that they cause an egg to come into the uterus every month in a process called ovulation.3 These eggs develop within a part of the ovary called a follicle and by puberty a female will have 300,000-500,000 follicles however “only 400-500 of these will actually complete the process of ovulation” or the release of one egg per month3. The follicle that is able to produce the most receptors to attract the hormones essentially wins – it becomes the dominant follicle and will produce estrogen to support the egg.3 Once the egg is released the follicle will start producing another hormone, progesterone, to prepare the lining of the uterus if the egg is fertilized and implants (ie. Getting pregnant!!).3
On day two of my first cycle I called my mom to ask her how long this will last…
Once source suggests that a menstrual cycle “can range anywhere from 21 to 35 days in adults and from 21 to 45 days in young teens”.4There are two phases in your menstrual cycle: the follicular phase and the luteal phase (remember them as the “F”irst and “L”ast phases!!).3 The “F”ollicular phase begins on the first day of your menstrual cycle and may last “10-14 days until ovulation occurs”.3 The follicle then produces more hormones – estrogen and, within about 10-12 hrs, luteinizing hormone – and the egg is released, the innermost layer of the uterus grows, and the egg will travel from the ovary to the uterus via the fallopian tube. 3 Once ovulation begins then the “L”uteal phase starts and progesterone levels increase (made by the disintegrating follicle, called the corpus luteum).3 Menses, or bleeding, occurs when there is no fertilization of the egg and your estrogen and progesterone levels decrease, the corpus luteum degenerates and the endometrium breaks down.3 Bleeding can last for 2 to 7 days.4
According to one source girls can start their cycle between 8 and 15 years of age with 12 years of age being the average and most often this occurs “about 2 years after breasts first start to develop”.4Research has shown that “in developed countries the average woman today is expected to menstruate more than 400 times before menopause”.2
First I resorted to using pads, however as a very active adolescent these were not too flattering during swim team practices. When it was time to learn how to use a tampon, my mom coached me through the bathroom door.
So to all of you maturing young women out there, I encourage you to better understand your menstrual cycle – better than you do now, perhaps, and way better than I did when it first started! I hope this brief piece will be a resource and that you can turn to other women in your life, too. Here are a few more resources that may be helpful for you:
(1) Orringer K and Gahagan S, “Adolescent Girls Define Menstruation: A Multiethnic Exploratory Study”, Health Care for Women International, 31:831–847, 2010
(2) Lee CA, Kadir RA and Kouides PA, “Inherited Bleeding Disorders in Women” 1st Edition, Chapter 2: Physiology of menstruation and menorrhagia, pg. 12, 2009
(3) Bates GW and Bowling M, “Physiology of the female reproductive axis”, Periodontology, 61: 89-102, 2013
-Lauren Bilodeau DPT
Lauren Bilodeau DPT, is a pelvic health physical therapy specialist who enjoys working with obstetric health as well as female and male pelvic dysfunctions. She works at Marathon Physical Therapy in Newton and will soon join the Marathon team in the Norwood clinic, as well. She is enthusiastic about continuing to support the Share MayFlowers campaign!