hope you have found this chapter more fascinating than when you studied female anatomy in that awkward biology lesson at school. These are the key facts that you may not have learned back then that I want you to keep in mind:
Your uterus can face forwards or backwards and contracts during your period to help the blood get out, which is what causes period pain.
It also doesn’t like being poked very much, which is why it can be normal to get a bit of an ache after sex.
Bleeding after sex is rarely caused by the big C.
Your fallopian tubes are pretty flexible guys, flapping around like a Mexican wave, so that they can pick up an egg from either ovary.
Ovarian cysts are very common (often a result of the normal functioning of your ovary) and do not increase your risk of ovarian cancer.
Periods are one of society’s biggest taboos. Over half of the population has had or will have one at some point during their lifetime. Yet we barely talk about them.
I’ve noticed an interesting three-way split in the way women feel about periods. In the first group are women who are ambivalent; they don’t mind either way whether they come or not. The second group hate them and would do anything to make them go away (‘Give me anything you’ve got to make them stop!’). The third group love them and are horrified at the thought of not having their period every month – some, because they see it as a sign that their bodies are working, and many because they feel like it’s ‘cleaning their body from the inside’ (although I’m always quite keen to point out that having a period doesn’t clean your body of germs or toxins; in fact, I think period blood often has a ‘dirty’ connotation, which is probably one of the reasons we’re so reluctant to address the issue).
There are some types of contraception – for example, the hormonal coil – that will stop your periods (see Chapter 7), and if that happens it’s not a bad thing. It doesn’t mean your uterus will become ‘unclean’. The medication is simply preventing the lining from building up, so there’s nothing to shed. I once offered the hormonal coil to a lady whose periods were so heavy that she’d had several blood transfusions. However, for her the possibility of having no period at all was unacceptable and she declined, explaining that she ‘wouldn’t feel like a woman any more’. I really like the fact that some women appreciate their period as a sign that their body is working. This is so true, and I always tell my patients that their period is a reflection of what’s been going on in their bodies for the last month, even slightly longer.
The next three chapters will cover the basics of periods, the menstrual cycle and what can, and commonly does go wrong.
Me: How long is your menstrual cycle?
Patient: Three to four days.
Many people think that the length of a cycle is how long you bleed for, but this is a common misconception. Your cycle is actually the number of days from the start of one period until the start of the next.
Education about periods is pretty mediocre at best. In fact, at my school it was so dire that I genuinely thought a period was the contents of an egg cracking and being released through the vagina, which often makes me laugh when I think of the irony that I now spend my life explaining periods to others. But rest assured, I’ve done my fair share of reading since then.
In this chapter I want to start with the absolute basics, so do bear with me if you’re a period pro, although I hope there will be something to be gained for you geeks too.
If you fall into the ‘I’m-in-need-of-period-101’ group, you are not alone. A recent survey by ActionAid UK revealed that one in four women in the UK does not understand her periods, and that 20 per cent feel embarrassed to talk to their friends about them. If we can’t talk about periods, we will never work out what is normal or abnormal. And this results in so many women suffering unnecessarily because they don’t realise that there are things that can be done to help the problems they experience on a monthly basis.
What is a period?
A period is what happens when the lining of the uterus (the endometrium) falls away. Even though most of us are not trying to get pregnant the majority of the time, the entire reason for having a menstrual cycle is to prepare your uterus for a fertilised egg to implant. When this doesn’t happen, your uterus chucks out the lining it had prepared. But in order to actually have a period there is a lot of work going on behind the scenes throughout the menstrual cycle.
‘Day 1’ is the first day of your period. If you have a textbook twenty-eight-day cycle, Day 28 is therefore the last day before your next period. We are, however, humans, of course, and not everyone goes by the book, with only about 15 per cent of women actually having a twenty-eight day cycle,1 and anything between twenty-one and thirty-five days being considered a ‘normal’ cycle length.
The menstrual cycle: more than just a bit of bleeding
Let me take you through the different stages of your cycle.
Follicular phase: fifty shades of period blood
It all starts on ‘Day 1’ – this is the first day of your period – and the bleeding usually lasts for three to eight days (on average five). Bleeding is classically heaviest on Day 2.
The blood during your period can come in a huge range of shades and hues. It won’t look the same as the blood you see when you cut your finger, because it’s not just plain blood. It’s mixed with mucus and cells from the inside of the uterus and the reason there is blood in the first place is because the juicy lining that’s built up over the month contains an intricate network of blood vessels that were meant to feed that elusive pregnancy it was planning on accommodating. The colour also depends on the time taken for the blood to come out. Just as an apple goes brown when it is cut and left exposed to the air, so blood starts to darken and, ultimately, go brown or almost black if it’s left to hang around for long enough.
It’s not uncommon for a period to start as spotting. This means light bleeding that’s not really enough to need a pad. It can be pinkish, which is usually due to the lining starting to fall away, or various shades of brown, which means it’s coming out very slowly or could even be old blood from your last period. Don’t be overwhelmed by this; it’s normal. New red bleeding tends to be thinner and often a bit watery because it’s the freshest. It can get a bit thicker and more crimson in colour because it has had a bit of a wait before show itself. Then normally it becomes quite light and turns brown to black before it stops completely. A wide range of colours is completely normal and to be expected.
The blood that’s being shed will clot in the uterus, so your body has to make anticoagulants – chemicals to break them down – in order to
