The menstrual cycle: FAQs

Every menstrual cycle, just like every body, is different. This can lead to many misconceptions which results in people gravely misunderstanding what is normal for menstruation, and what should be brought to the attention of their gynaecologist. In this article, consultant gynaecologist Ms Neelima Dixit answers pressing questions, and clears up prevalent menstruation myths.

Why does my period start, stop, and start again?

The menstrual cycle is not a fixed process, and it can be susceptible to changes. Things like hormonal fluctuations, stress, changes in the uterine contractions, and irregular shedding of the endometrial tissue (which is what the period is ‘getting rid of’) can cause stuttered bleeding. An irregular period is not necessarily indicative of a gynaecological disease.

Benign growths in the endometrial tissue, called polyps, can also obstruct the shedding, and can further trap blood which is later released in gushes, staggering the period. Polyps, and other growths in the womb, can easily be diagnosed with a non-invasive pelvic ultrasound.

Why is the flow of my period irregular?

Heavy spurts of blood and tissue may occur due to the build-up of the uterine lining being expelled all at once, whereas a steady flow indicates consistent shedding. Gushes can also occur due to changes in position – such as standing up after having lain down. In a majority of cases, this is very normal and not typically symptomatic of disease.

When should I be concerned about period pain?

Period pain, to a degree, is to be expected as the womb lining is detaching from the endometrial structures to shed. However, if the pain is debilitatingly severe, inhibits normal function like work and domestic tasks, lasts after bleeding has stopped, or is accompanied by heavy bleeding, nausea, and dizziness, then something is likely to be abnormal and a doctor will need to be consulted.

Possible causes of excessive period pain include endometriosis, adenomyosis, and fibroids.

How much blood is ‘too much’?

Too much and irregular blood flow that will require the assessment of a physician will look like:

• Soaking through a pad or a tampon every one to two hours
• Dizziness and nausea
• Large clots that are bigger than a 50p coin
• Bleeding that lasts longer than 10 days

Can you ‘lose’ a tampon inside your body?

A tampon cannot get ‘lost’ in the sense that it disappears, as the vaginal canal is closed at the other end with the cervix, but there is a possibility of it shifting, particularly during physical activity or sexual intercourse. It cannot enter the womb or the pelvic cavity, but it can become difficult to retrieve, stuck, or even forgotten about, particularly if the string finds its way inside. Some people may accidentally put in a second tampon before removing the first, further complicating the issue.

Tampons ideally should not be used for more than six hours at a time, so a tampon that is inside for eight to 12 hours poses a risk of inducing toxic shock syndrome (TSS). It is rare, but a serious concern. Symptoms of TSS include sudden fever, rash, dizziness, and vomiting.

Are menstrual cups reliable, and can they fall out?

Menstrual cups are indeed a safe and trustworthy way to handle menstrual blood – provided they’re inserted correctly. They work by creating a vacuum seal around the opening of the cervix, catching blood and tissues and leaving no mess. But, the vacuum seal can falter and the cup can shift, slide, or fall out due to improper insertion, weak pelvic floor muscles, or using the wrong size.

Menstrual cups can hold more fluid and can be worn longer than a tampon or sanitary pad, and they are reusable, making them eco-friendly and cost-effective. They typically come in 2-3 sizes (differing by brand), and which size works best for you will depend on flow intensity, length of the cervix, age and if there has been previous childbearing. It is important to note that menstrual cups require some time to learn how to insert properly and to get used to the feeling of; some may find them uncomfortable and struggle to remove them.

Why does my period affect my bowel movements?

Prostaglandins are hormone-like compounds that trigger uterine contractions during periods, and can also affect the bowels. This often leads to changes in bowel habits like diarrhoea and cramp-like sensations in the gut. The bowel movements are further influenced by the sudden reduction of progesterone just before the period starts, which can also cause looser stool and diarrhoea.

Why do I get such bad bloating on my period?

Bloating is quite common before and during the period due to hormonal changes and bodily water retention. Following ovulation, there is an increase in oestrogen which contributes to water retention. This, coupled with the increase of progesterone that relaxes the bowel muscles, leads to the body slowing down its processing, contributing to bloating and constipation. These hormonal changes can further influence the gut microbiome, leading to an increase of gas production.

Those struggling with the effects of bloating may find their experiences eased by incorporating dietary and lifestyle changes, such as:

• Reduction of salt
• Reduction of ‘gassy’ foods like beans, cabbage, and carbonated drinks
• Hydrating well daily
• Regular exercise
• Utilising heat pads
• Eating small but frequent meals
• Drinking soothing teas for digestion, like peppermint and ginger
• Eating more probiotics