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The 4 Phases Of Your Menstrual Cycle

The menstrual cycle is a natural process in females. The cycle is divided into four stages- each with different hormonal changes. These phases are commonly broken down into the menstruation, follicular, ovulation, and luteal phases.

The menstrual cycle prepares the female body, specifically the uterus and ovaries for pregnancy each month. If a pregnancy does not occur within the cycle, certain hormones influence changes in the uterus lining, eventually causing menstruation (commonly known as periods). Once a period starts, the menstrual cycle will start over.

A menstrual cycle is measured from day one of the period to the day before the next period, with the average length of a menstrual cycle being 28 days. However, every woman’s cycle is unique and can vary between 26 to 35 days

The start of the first period is known as menarche. This usually begins at the average age of 12 but may vary from 8 to 13 years old. Menarche starts roughly 2 years after the development of breasts and pubic hair.

The end of the menstrual cycle is known as menopause. This is marked by the absence of a menstrual period for 12 months or more. The transition to menopause usually occurs between the ages of 45 to 55 years old.


Menstruation refers to changes occurring in the uterus. Menstruation is more commonly referred to as “the period”. The uterus lining, called the endometrium, is shed during this phase. This tissue, blood, and other secretions pass through the vagina which causes the characteristic “period” bleeding.

This usually lasts between 3 to 7 days and will vary amongst women. The average amount of blood lost during menstruation is 30mls.

The Follicular Phase

The follicular phase, refers to changes that occur within the ovaries. This phase starts on the first day of menstruation and lasts 12 to 19 days till the ovulation phase. Part of the brain, the pituitary gland, releases a hormone known as Follicle Stimulating hormone (FSH). This will stimulate the development of follicles within the ovary, with one dominant follicle maturing into an egg (ovum). This maturation occurs around day 8 of the menstrual cycle.

The dominant follicle is also responsible for producing oestrogen, which assists in priming the endometrium (uterine lining) for the next phases in the cycle.


Ovulation is when a mature egg (ovum) is released from one of the ovaries. This process is governed by a rise in Luteinizing hormone (LH), produced by the pituitary gland.  The mature egg is released and moves along the fallopian tube towards the uterus, roughly 11 to 14 days after the start of the menstrual cycle. The egg will eventually deteriorate if fertilization does not occur within 6 to 24 hours of this release.

Some noted signs of ovulation include:

·        An increase in clear cervical mucous

·        A minor increase in body temperature- noticeable with a thermometer

·        Breast tenderness

The Luteal Phase

After ovulation, the remaining cells in the ovary undergo changes to form a corpus luteum. This group of cells secrete progesterone which helps stimulate the endometrium to thicken. Its primary function is to prepare the uterus to implant a fertilised egg (ovum).

If the egg is successfully fertilised and implanted, the corpus luteum continues the production of progesterone to maintain the early stages of pregnancy.

If fertilisation does not occur, the corpus luteum disintegrates. Progesterone and oestrogen levels decline to result in oedematous changes in the endometrium. The uterine lining is no longer favourable for implantation and will start to detach from the uterus. This will start the menstrual cycle again.

Common symptoms

The decline in progesterone and oestrogen levels during the luteal phase may cause unpleasant symptoms before a period starts. This is referred to as Premenstrual syndrome (PMS). Common symptoms include the following.

·        Breast tenderness and swelling

·        Bloating

·        Abdominal cramping

·        Headaches and fatigue

·        Acne

·        Mood changes such as irritability, depression/ low mood; anxiety and reduced libido


Cramping during menstruation is normal and varies in intensity amongst women. This cramping sensation is thought to be caused by hormonal-driven uterine contractions and prostaglandin release which assist in shedding the endometrium.

Severe cramping or pain during menstruation is known as dysmenorrhoea. It is best to speak to your healthcare provider if you are concerned about the severity of period pains. There are two types of dysmenorrhoea, which may require further investigations for an underlying problem.

Primary Dysmenorrhoea  

Studies have shown that some females have a higher-than-normal prostaglandin level within the endometrium during their luteal phase. This is believed to increase the pain fibres’ sensitivity, causing a heightened pain experience during menstruation. This presents as intense lower abdominal or pelvic pains.

You are more likely to experience Primary Dysmenorrhoea if you:

·        Began menstruation before 11 years of age

·        Menstruate for more than 7 days with a heavier than normal blood loss

·        Smoke cigarettes

·        Have a Family history

·        Experience psychological stress including depression and anxiety

While primary dysmenorrhoea is common, it still requires medical attention for treatment and to rule out any other causes.

Treatment includes adequate pain relief to ensure you can continue your normal everyday activities.

Secondary Dysmenorrhoea

This refers to severe menstrual pains due to an underlying health condition. Common causes include endometriosis, uterine fibroids and ovarian cysts.

If your healthcare practitioner suspects an underlying cause of dysmenorrhoea, he/she will do a pelvic examination and ultrasound to look for possible causes.

Treatment includes management of the underlying cause and adequate pain control.

Treatment for Period Pains


  • NSAIDs: Non-steroidal anti-inflammatories, such as ibuprofen, are most used to manage pain associated with menstrual periods. They are usually used as first-line analgesia provided there are no contraindications to their use. These tablets are available as over-the-counter medicines however it’s advisable to always speak to a qualified medical practitioner before commencing treatment.


  • Acetaminophen (Paracetamol): These tablets are used when a patient’s NSAIDs are not favourable or contraindicated.


  • Hormonal contraceptives: These are commonly used as first-line treatment for controlling pain in dysmenorrhoea. Combined oral contraceptive tablets are most frequently prescribed, but other methods, including patches, vaginal rings, and depot injections, can be considered. Always speak to your healthcare practitioner before choosing a mode of treatment.


Evidence in favour of non-pharmacological treatments is controversial. These treatments are often used as alternatives or in conjunction with pharmacological regimens. Speak to your healthcare provider before commencing any treatment to ensure it is safe and appropriate for you.

  • Heat therapy: Studies have shown that heat therapy (at approximately 39” celsius), such as hot water bottles, bags and towels, effectively eases menstrual-related pains, especially in primary dysmenorrhoea.


  • Exercise: Some studies have shown that regular exercise of 45 to 60 minutes performed 3 or more times a week may significantly reduce menstrual pain.


  •  Acupressure: A systematic review found that acupressure may be as effective as ibuprofen at relieving pain.



  • Supplements: Some women have tried to use supplements such as fish oil, magnesium, and vitamin b12 to reduce menstrual pain. However, there is little evidence or studies done to prove their efficacy.

Affinity Health

Having health insurance such as Affinity Health will help ease the financial burden of seeking medical treatment. Your Affinity Health policy gives you access to unlimited, managed doctor’s consultations with a Network GP. You also have access to various medicines, including non-steroidal anti-inflammatories, subject to the Affinity Health formulary.

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