From bruises to blood donation, menstruation to mozzies, the first season of It Can’t Hurt To Ask focuses on blood.
What’s normal and what’s not when it comes to periods? From timing to colour and flow, what should you expect from your period and when should you tell a doctor about something that seems a bit off? If you don’t have periods, what should you know to help better understand and support those who do?
With the help of specialist gynaecologist and obstetrician Dr Michelle Proud, we’ll bust some period myths like whether your cycle can sync up with those around you and discuss how conditions like endometriosis can affect a person’s menstrual cycle and their overall wellbeing.
Featured in this episode
Dr Michelle Proud
Dr Michelle Proud is a specialist gynaecologist and obstetrician, working at Sunshine Coast University Hospital. While she admits she may be biased, Dr Proud considers periods and the menstrual cycle to be among the most important things people who are assigned female at birth experience.
Episode resources
Endometriosis
In this episode, Dr Proud discusses the symptoms and effects of endometriosis.
Nearly 1 million Australians live with endometriosis. If you’d like to learn more about the condition, QNEDO and Endometriosis Australia have resources available for people living with endometriosis and those supporting them.
Transcript
Vox pops:
How long does the average period last?
Is it true cycles can sync up?
What is ‘normal’ when it comes to pain or discomfort?
Can orgasms really ease cramps?
Narrator: Welcome to It Can’t Hurt To Ask, the podcast from Queensland Health exploring all your health questions, concerns and curiosities.
As part of looking at all things ‘In My Blood’, today we’re busting myths and misconceptions about periods.
Hi, I’m Lauren and this episode was recorded on the lands of the Jagera and Turrbal people. We acknowledge the Traditional Custodians and pay our respects to the Elders past, present and emerging.
As always, whatever you hear in our episodes is general information. Always speak to your doctor about your individual circumstances.
Ready?
“Code Red”. “Time Of The Month”. “Aunt Flo”. “Having The Painters In”.
There’s no shortage of alternative terms people prefer to use when talking about periods. In fact, a 2016 study found over 5,000 different slang terms for the word ‘period’ across 10 different languages.
Some are nicer than others.
But it’s proof that for something so common, the topic of periods can sometimes still feel taboo. But it shouldn’t be. Because, fundamentally, they’re the reason any of us are here at all.
So, what do we actually mean when we say “period” and “menstruation”?
Dr Proud: My name is Dr Michelle Proud. I'm a specialist gynaecologist and obstetrician at the Sunshine Coast University Hospital.
Menstrual cycle is a complex hormonal natural process whereby the brain and the ovaries communicate to prepare your body for pregnancy. And part of that preparation involves building up the lining of the uterus in preparation for a fertilized egg or an embryo to implant. And when pregnancy does not occur, the lining that has built up will shed. And that is what we see and is presented as vaginal bleeding or known more commonly as our period.
Narrator: But your cycle involves more than just the days you bleed.
In fact, there are four distinct phases of the menstrual cycle: menstruation, follicular, ovulation and the luteal phase.
Sound confusing? Let’s follow along and discover exactly what each stage involves.
The first phase is menstruation, also known as the menses phase.
If pregnancy hasn’t occurred, this is when the lining of your uterus will shed, resulting in blood appearing.
This phase, while it can vary for everyone, usually lasts about three to seven days.
Before we move to the second phase, let’s refresh ourselves on some important terms. The female reproductive organs are called ovaries and release eggs into the fallopian tubes in your abdomen. Think of your fallopian tubes as narrow ducts or passageways that carry the egg from the ovaries into the uterus. The uterus is also known as the womb, and it’s where a foetus develops and grows.
Dr Proud: And then a follicular phase which is where the hormones are preparing your body for the growth of the follicles, which are just the little fluid sacs in your ovaries that contain eggs. And during that follicular phase, there is hormones secreted from the brain to stimulate those eggs, and in particular one egg, to grow. And there is also during that time some preparation of the uterine lining, where there are hormones that are stimulating the growth or preparation of the lining of the uterus in preparation for the main event in my opinion, which is ovulation and then fertilization as we've mentioned for implantation.
Narrator: This phase usually takes place between days six to 14 of your cycle.
Oestrogen is one of those hormones that causes the lining of your uterus to grow and thicken.
Ovulation is next, usually occurring at around day 14 of the menstrual cycle.
In this third phase, a mature egg is released from an ovary and makes its way along a fallopian tube. When it comes to the final phase of your menstrual cycle, known as the luteal phase, we meet another important hormone: progesterone.
Dr Proud: The final stage is the luteal phase and that's when the egg is actually released from the ovary it leaves behind a very, very special collection of cells called the corpus luteum. What the corpus luteum does is it secretes progesterone. That and a pregnancy are the only two things that can produce progesterone.
And what that does is it usually prepares the lining of the uterus a little bit more, so it thickens it further to stimulate that really nice cosy environment for an embryo to implant.
Narrator: Let’s pause now, because two different paths are now possible.
The first is if pregnancy does occur. This is when the sperm fertilizes an egg and an embryo implants in the uterus.
The corpus luteum hangs around and continues to release progesterone until the placenta takes over in the early stage of pregnancy.
The placenta is the organ that grows to provide the baby with food and oxygen while in the uterus
That usually happens around nine weeks of gestation, which is the length of time the baby has been in the uterus.
What happens if doesn’t and it continues to be a normal period? We’ll go back to Dr Proud for that.
Dr Proud: And if that hasn't occurred, the corpus luteum over time, and it usually takes about two weeks, it degenerates, and the progesterone drops. And that significant fall in your progesterone levels is actually what causes the lining to then shed again, and then we start the new cycle again.
Narrator: Remember, everybody’s menstrual cycle is very different. So, yours could be longer or shorter than other people you know.
A typical menstrual cycle is usually between 28 to 30 days.
But it can vary and ‘normal’ for some may actually be anywhere from 21 to 35 days.
Paying attention to your cycle and noting how you feel at each phase is a great way to better understand your cycle and your body. Whether that’s for fertility purposes or just your periods each month.
And once you know, you can actually use it to your advantage. Call it a natural superpower, if you want.
Dr Proud: So, I think one of the best ways to understand that is a little bit of introspection and looking inside yourself and asking those questions, how am I feeling today? What day am I in my cycle? And getting a bit of a better understanding of how your cycle affects you. And using that to your advantage and doing things when you do have like making sure you're scheduling things in your cycle for when you know you'll be able to do those things and not overloading yourself during times where getting up and running a marathon may be more difficult.
Narrator: If you have had your period, how old were you the first time it came? Had you had ‘the talk’ or were you confused or unsure about what was happening?
Period story 1: When I got my period for the first time, I was 14 years old. I felt relieved just because I'd been waiting for it for so long. And all my friends had their period, and I was sort of one of the last ones to get theirs as I was a little bit older. So yeah, very relieved and happy that for it to finally come through.
Narrator: The age that you first get your period and what it actually looks like, can vary greatly.
And turns out there’s some pretty important-sounding terms for these milestones as well.
Dr Proud: The average age for Menarche, which is the name of the first onset of your first period, is 12 to 13 years in Australia. Now interestingly, there's a few other stages of puberty that are similarly named, and one of the first stages of puberty is breast-budding, and that's commonly named as Thalarche, which is breast-budding. And then Pubarche is the onset of growth of pubic hair.
And this is then followed usually within one and a half to two years with Menarche, which is your first menstrual period.
Period story 2: I was 11 almost 12 years old when I got my first period. (0:37 – 1:00) I was under the impression I'd just get my period and it was like just a once off. It didn't go for five days. Like it was just, I found a bit of blood in my undies and then that was it. And then mum was like, oh, sweetie, you're going to be, you're going to be pleading for a lot longer. And I just remember I was like devastated. Like I just felt so upset by that.
Narrator:
So, we know now that menarche can often happen about one and a half to two years after thalarche and pubarche.
If you, or one of your kids, haven’t had your period yet, there are some other things you can look to that may indicate when it could happen.
It’s not exactly a crystal ball, but it can be a helpful guide.
Dr Proud: If you haven't got your period, your first period yet, then, and you're wondering when it will happen, one of the best guides, although it's not an absolute, is the age that your mother or your older sisters have started menstruating. And that can sometimes be a guide. Other signs that things may be about to occur is though looking at those other stages of development, like breast development and axillary and pubic hair development, and if they're well on their way to developing, then you can probably expect that you will be seeing a period soon.
In terms of signs that it may be about to occur, you can often get some changes in your vaginal discharge before your period starts and that can often be a bit of a thicker or whiter vaginal discharge.
You can also have some cramping or pain leading up to your first period that's very typical of what's called dysmenorrhea and that's the cramping or the uterus almost contracting in a way and releasing some prostaglandins which can cause some mild cramping pains.
But one of the most common ways that you know is when you do go to the toilet and you do find some dark or red blood on your underwear or upon wiping.
Narrator: If you have got your period, were any of these true for you?
When it comes to managing your period, there are many options you can choose from. As well as the more traditional pads or tampons, the last few years have also seen the rise of more environmentally-friendly options including menstrual cups, discs and period underwear. Each type often has options for lighter or heavier bleeding.
Now, despite what traditional period product adverts would have us believe, periods aren’t blue or even always the bright red colour we typically associate with blood. It’s common for menstrual blood to be many different shades – even within one cycle.
Dr Proud:
So, it's really normal for your menstrual period to change colour and I wouldn't expect that it would stay the same redness every time. Often it can be in the beginning when the bleeding can be a little bit heavier, maybe a lot more bright red. The colour is really to do with how quickly the bleeding is occurring and how quickly the blood is leaving your body.
And if you're bleeding quite heavily and the blood hasn't had time to oxidize, then it can present and be a little bit of a brighter red. Whereas if you're on a later day in your cycle or you're passing large clots, the colour can be quite dark.
Narrator: However, while some colour variation is normal, there are a few shades or signs that might indicate something is worth getting looked at by a doctor.
Dr Proud: Things that would not be normal and reasons to certainly see a doctor would be if you were having green tinges or orange tinges that can be signs of certain infections and it would be worthwhile getting that looked at. There also if it's very light pink sometimes and that's all it can be a sign of quite severe anaemia.
Narrator: Can you tell when your period is due? Maybe you experience a change in mood, or have you ever felt a certain way – maybe a little more tired or lacking energy – at particular times of your cycle?
You can thank – or blame – those hard-working hormones.
Vox pops: I can tell when it's coming because I do have an app that tells me, but I actually also can tell physically and mentally because I am craving more food and more unhealthy foods. And I feel like my mood does change. Like I can get a bit more emotional and definitely I feel so much more bloated.
I would say like during my period for the first two days, I feel physically not great. Like I feel quite nauseous. I can get back cramps and stomach cramps. I feel really tired and lethargic, but mentally I feel much better already, just the moment I get my period. And then after probably day two or three of my period, I start feeling physically good again. I actually love doing like some like high intensity exercise on my period, like towards the end of the period. And I feel like for me, it helps my period symptoms go away.
Dr Proud: There are significant changes that occur throughout our menstrual cycle with our hormones, and they can affect how we feel at certain times. So certain times in our cycle, we may have a lot more energy, be more motivated, more focused, that's usually around your ovulation time. And then there are other times where you may feel more irritable or have less energy. And that certainly is seen with these normal, fluctuations in our hormone levels throughout our menstrual cycle. Sometimes those hormonal changes can be quite significant and for some people they can be really debilitating.
Narrator: Let’s talk about those very debilitating hormonal changes, because this is a really important point.
One of the most common times to experience these hormonal changes is in the luteal phase, which is about a week before your menstrual periods start.
Dr Proud: And that's often because of quite significant fluctuations in your hormone levels and most particularly your estrogen levels. And those signs or symptoms that are really common in that phase and can be seen in a condition called premenstrual stress or premenstrual tension is another name it's been given, are things like breast tenderness, headaches, mood irritability or depression.
Narrator: If you experience significant Pre-menstrual Stress (aka PMS) symptoms or even Premenstrual Dysphoric Disorder, commonly known as PMD, which is a severe form, Dr Proud says it’s really, really important to seek help early and chat with a doctor.
Dr Proud: One of the biggest things that you'll hear us talk about quite often is lifestyle changes, being kind to yourself, listening to your body, understanding what your body needs, and not putting too much on your plate during times when you know that things may be more difficult.
There is some really good evidence to show that movement, especially if it's something that we enjoy doing, releases natural endorphins and they're great for mental health, for mood, for serotonin, dopamine and also if you do experience some cramps and pains during that time, also working as some natural pain relievers as well. So, movement and lifestyle changes such as diet and sleeping well, some mindfulness and meditation have all been shown to be really, really helpful during that phase.
If you're trying all these things and doing all the right things and you're still really struggling it is really important to be talking to your GP about this and about seeking some further help, either through a psychologist or coming to see a gynaecologist or starting some certain medications that may be of benefit to you
Vox pops: What is ‘normal’ when it comes to pain or discomfort?
Narrator: If you experience some discomfort around your period, you’re far from alone. Fifty per cent of people who menstruate will experience what’s called dysmenorrhea, which means period pain in some form or another. This can range from normal to abnormal.
It’s often caused by the release of prostaglandins [pros-ta-glan-dins], which are hormone-like substances, that cause that cramping-like sensation. It commonly occurs on day one to two of your menstrual cycle.
But what’s the line between normal and something more?
Dr Proud: I think if you're able to manage with your period without it affecting your quality of life and without it affecting or interfering with your normal activities, then it probably is a little bit of mild or dysmenorrhea, primary dysmenorrhea, which is like we explained quite a normal phenomenon. When it is something that is affecting your ability to go about your normal activities, or when you have any of those other significant symptoms, like pain at other times, pain with intercourse, opening bowels, bladder, or in the middle of your cycle, then it certainly is worthwhile getting that looked at, because that is not normal. And if you do ignore them, unfortunately, we know that pain can worsen over time, and it can be a lot more difficult to manage the longer you ignore those symptoms.
Narrator: Significant dysmenorrhea, or severe period pain, is commonly seen in conditions like endometriosis.
Endometriosis is where tissue similar to the lining of the uterus grows outside the uterus and can cause inflammation, pain and some significant symptoms that can affect and limit your normal activities.
It’s not uncommon for pain experienced by those with endometriosis to be normalised. But that doesn’t make it normal.
Dr Proud: Sometimes it can be so significant that you need to take time off school or from work. It cannot just cause crampy period pain, but it can also cause generalized abdominal pain, back pain, pains that can shoot down your legs.
It can also be associated with some other symptoms like nausea and headaches and breast tenderness and feeling tired all the time. Endometriosis affects about 11% of those assigned female at birth and what it can do is, what it is, is the deposits of cells that are like the lining of the uterus outside the uterus in areas most commonly the pelvis but it can sometimes be found in unusual spots like up on the diaphragm or even in really weird spots like the lung. And that's quite rare.
Narrator: Other common signs of endometriosis include pain with intercourse, when you wee or poo, or with ovulation.
Dr Proud: One of the best things you can do when you think you may have endometriosis is going to see someone early. And traditionally, unfortunately, as a medical profession, we've been really quite poor at diagnosing endometriosis early. And unfortunately, this can leave people with difficulties managing their pain later on in life. But there's certainly some very good evidence to say that getting in earlier and treating this earlier can significantly improve health outcomes for those that suffer with endometriosis.
Narrator: One of the other challenges is that endometriosis can be difficult to diagnose. It’s usually diagnosed through a laparoscopy, also known as keyhole surgery. This is when a camera is inserted into the abdomen through a small incision in the navel.
This makes it easier for a surgeon to see and remove it.
However, improvements to technology mean we can now see certain signs on an ultrasound, although milder cases can still be tricky to find, and a laparoscopy is needed.
While in some cases surgery is necessary, there are alternative methods that may be tried before a formal diagnosis is made or to try manage symptoms without surgery.
These may include making changes to your diet and lifestyle to reduce inflammation in your body.
Dr Proud: And that's okay, as long as we're treating the symptoms and understanding that will improve their quality of life. And I think that's really important. But if you feel like you want some more information or some more understanding of what's going on inside your body, asking for a referral to a gynaecologist is a really good idea. If you feel like you're not getting the information that you need, it's also worthwhile going and seeing seeking a second opinion.
Narrator: So what can be done if you are in pain?
Dr Proud: Moving your body is one of the best things that women and people with endometriosis can do to improve their pain scores. So that alone has been shown to significantly improve pain. And we know that when people stop moving their bodies, pain can escalate and can become worse. So, there's some simple things. Making sure you're not smoking, not doing things that are going to be more toxic to your system or, you know, making poor health choices is really important.
Narrator: As a good general rule – if your period pain is affecting your ability to go about your everyday activities or you experience those significant symptoms, then that is not normal, and it’s recommended you make an appointment with a doctor.
Another common condition affecting people who have periods is heavy menstrual bleeding, or Menorrhoea. How heavy is too heavy?
Dr Proud: So, a normal period you will usually lose about 30 to 80 mils per period, which a lot of us would probably think it was a bit more than that, that's only really two to three tablespoons throughout a whole menstrual period, that's considered normal. Menorrhagia or heavy menstrual bleeding is bleeding that is either very heavy, so over the 80 mils, and can typically get up to around 250 mils or even more, and or lasts more than the typical three to seven days, so lasting longer than seven days, and that is considered heavy bleeding.
Narrator: Heavy menstrual bleeding is typically more common in young people in the first two to three years of periods if their cycles are still not quite ovulatory cycles, meaning they are not yet releasing eggs in the ovulation phase.
Dr Proud: Another really common time that it can present is in what's called the perimenopause phase. And this is the period of about five to 10 years before people go through menopause, which is the final period, the cessation of your periods. And again, it's a little bit like adult adolescence in that it is a time when your hormones are changing significantly and that can cause an overgrowth of the lining of the uterus that can result in much heavier bleeding.
There are also some structural causes for heavy menstrual bleeding that can occur at any time. And they are things like polyps inside the uterus or fibroids.
Narrator: Both polyps and fibroids are small, abnormal lumps or growths that can appear in the inner lining of the uterus. The difference is what they’re made of: fibroids are made up of smooth muscle whereas polyps are endometrial tissue, so the thin tissue that lines the uterus.
Dr Proud: And these are things that can often be treated surgically or with some hormonal suppression. Other things, problems with bleeding disorders, kidney or liver problems, or sometimes really certain cancers can present with heavy bleeding as well. So, really important that if you are having significant bleeding where you're needing to change a pad or tampon or sanitary product frequently, and usually that's more than two hourly, then you need to seek assistance or help through seeing a medical practitioner for that.
Narrator: It doesn’t matter how old you are, we all have those period myths that stick in our minds. That maybe we’re not sure if they’re true or just made up in the playground. So, because it can’t hurt to ask, we did just that.
Starting with: can your cycle really sync up with those around you?
Dr Proud: Ah, real, really good question. Um, yeah, they can. You, I don't know the number of times I hear people who are in families with menstruating, um, with those that are menstruating in families, come to me and say that they just like clockwork. There's also theories of links to the lunar cycle as well.
Narrator: and while we’re busting some myths, what’s a couple more?
Vox pop: Is it true that if you take hormonal birth control the bleeding you experience isn’t a “real” period?
Dr Proud: Yeah, that's true. So yeah, when you're taking any sort of hormonal treatment that, you know, takes over your menstrual cycles, so you're no longer ovulating. So, you're technically no longer having a true menstrual period. You're having what's known as a pill bleed or withdrawal bleed.
Vox pop: Can you get pregnant on your period?
Dr Proud: No, you cannot get pregnant on your period if it's a true period. It usually follows at least 13 to 14 days after ovulation. The egg only lasts 24 hours in your body. So, there is, if it is a true period as opposed to some bleeding that you can get on at ovulation but if it is a true menstrual period, no you cannot get pregnant.
Narrator: As always, we’ll finish up with one last myth-busting question that we’ve received from you.
Vox pop: Is it true orgasms can ease the feeling of cramps?
Dr Proud: So, sometimes orgasms can worsen cramps. Certainly, something in people who suffer from endometriosis can experience is or other conditions that can increase pain with intercourse is that sometimes though when they orgasm that can worsen their pain because it's quite a contraction of the muscle of the actual uterus wall itself.
However, the act of intercourse and the act of release and orgasm and releasing oxytocin and dopamine that you get from having intercourse and orgasming can improve more mild to moderate cramps in some people.
Narrator: There you have it. After all, it can’t hurt to ask.
Of course, there’s always more to know and learn about menstruation but we hope you’ve learnt some facts or tips you can’t wait to try or share.
Like what you’ve heard? Dive into more, with more episodes on blood-related health topics dropping every Wednesday.
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Until next week, goodbye!