What happens when menstruation happens: A Primer on Unasked Questions About Periods

For many of us, menstruation is a daily reality. From the moment we hit puberty, we experience it, agonize over it, and also internalise a whole bunch of negative beliefs surrounding it. Though it’s a completely natural occurrence, there’s so much stigma around any and every conversation about menstrual health (that emerges largely from a lack of understanding of the female anatomy) that even adult women continue to have certain misconceptions about the process. This leads to a neglect of menstrual hygene, and potential health risks. Hence, it’s important to understand exactly what happens when you get your period, and what the possible risks are, and how they should be combated.

What is menstruation?

Menstruation is really nothing but the discharge of uterine tissue that the body no longer needs. Every month or so, the lining of the uterus gets thicker to prepare for a fertilized egg in case of pregnancy, and, if the egg does not fertilize, the lining is released from the body in the form of blood or ruptured skin through the vagina. This monthly process is called what we commonly call a period.

What does it feel like?

A lot of women feel virtually nothing except a slight trickling sensation during the process, while some may get severely painful cramps or backache. If the pain is too unbearable, that’s usually a sign of some kind of anomaly – most commonly, a Polycystic Ovary Syndrome. It’s best to consult a doctor and get on the appropriate hormonal medication in that case, but to immediately combat the pain, many gynaecologists prescribe mild painkillers or a heat massage in the abdominal area.

Sanitary Pads v/s Tampons

Sanitary napkins, which is the most common form of protective gear against menstrual blood used in India, is nothing but a stretch of absorbent material that soaks up the blood and discharge. Unlike what most sanitary napkin ads would have you believe, they can't really soak up large amounts of blood for longer durations of time. No matter how thick they are, they all need to be changed at least every four hours during the day, sometimes more often if the blood-flow is too heavy.

Tampons, too, are like pads, except the absorbent material is pressed together so that it is shaped like a small tube that can be inserted inside the vagina. The vaginal muscles usually hold the tampons in place, which is why, contrary to common belief, they don’t disappear into your internal organs. Though tampons too can’t soak up too much blood at a time, they’re, in a way, less messier because there’s less chance of bloodstains.

The debate between which of the two are the safer and more convenient option has raged for decades. A lot of women prefer pads because they’re less intrusive and worn on the outside of the body — and because of this, it also makes it easier for you to keep track of your menstrual flow and helps you know how often you need to change it. But tampons are cleaner, they don’t smell like pads often do, and are easier to carry around. There is no clear winner among the two, they both come with their pros and cons and both essentially carry out the same function – the choice of one over the other really just depends on the comfort levels of the user.

Menstrual Cups

Menstrual cups are a somewhat newer invention, which is why they’re not as widely used yet. However, they’re actually far more efficient and environment-friendly than both pads and tampons. A menstrual cup is nothing but a piece of flexible silicone rubber that folds up. You gently push it into your vagina and it sort of opens up to cover the walls of the vagina and traps the menstrual blood in it. When you need to remove it (which is every few hours) you tug on a little flap with your forefinger to help it fold up a little, and then slowly get it out. You then rinse it of all the blood and discharge and reinsert it back into your vagina.

It’s not only environmentally sound (because there’s less waste in the form of used pads/tampons), but also collects a lot more blood than a tampon or sanitary pad, which means that you have to change it (or in this case, rinse and reinsert it) less often. There’s no smell or the fear of getting stains, so it’s great for when you have to wear tight clothes or have to engage in any kind of vigorous physical activity.

Some Common Menstrual Disorders

There are four common types of menstrual disorders:

• Abnormal Uterine Bleeding (AUB): When the menstrual blood flow gets excessively heavy, it’s usually not a good sign. This disorder can be  a result of hormonal imbalances (either a lack in or excessive production of oestrogen and progesterone), structural abnormalities within the uterus like fibroids or polyps, or irregular ovulation. It’s important to consult a doctor immediately when you experience such a phenomenon.

• Amenorrhea: This is the exact opposite of heavy menstrual bleeding, and is the absence of a period (any time after crossing puberty). Primary Amenorrhea is diagnosed when you turn haven't menstruated at all even after turning 16, and is usually caused due to some kind of abnormality in your endocrine system (aka the part of your body that produces hormones). Secondary Amenorrhea, on the other hand, is diagnosed if you’ve had regular periods, but they suddenly stop for three months or longer. It can be a result of a drop in estrogen levels, or stress, sudden weight loss, or any other kind of medical complication. Both types can usually be treated with the right kind of medication.

• Dysmenorrhea: This is when you experience menstrual cramps that go beyond being bearable. Menstrual cramps are usually caused by uterine contractions, which are triggered by prostaglandins — hormone-like substances that are produced by the uterine lining cells that circulate in your bloodstream. If you have severe menstrual pain, especially to the point where you occasionally feel like you might faint, or become pale and sweaty, it is because the prostaglandins have speeded up thecontractions in your intestines. Sometimes, this also lowers your blood pressure by relaxing blood vessels, leading to lightheadedness.

• Premenstrual syndrome (PMS): PMS is a common umbrella term that’s used to describe a wide variety of physical and psychological symptoms associated with the menstrual cycle, including bloating, extreme mood swings, swollen breasts, constipation, headaches, and so on. The widely accepted cause for PMS is the rising and falling levels of estrogen and progesterone, which sometimes influences  brain chemicals (especially serotonin, a substance that affects a person’s mood). It's not clear why some women develop PMS while others do not, but researchers suspect that some women are more sensitive to changes in hormone levels.

Now that we know a little more about what menstruation is, and the various abnormalities that can occur during the cycle, hopefully, we’re a little more equipped to deal with the challenges our periods throw at us. But more importantly, it’s necessary for us to know all this to avoid feeding into the false patriarchal taboos that surround the subject of menstruation, and to accept it as a completely valid and natural process.