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COMINSUD/UNFPA: Understanding Menstruation and the Menstrual cycle.


By Pedmia Shatu Tita*
 

Menstruation is the shedding of the inner lining of the uterus (endometrium) with resultant bleeding otherwise known as “the weeping of the disappointed uterus”. This occurs once every 28days+/-7days and is one of the phases(stages) of the menstrual cycle. Each cycle is made up of 4 phases(stages) as follows;
1_The follicular phase (follicle stage).
2_Ovulatory phase(ovulation). 3_Luteal phase(corpus luteum). 4_Menstrual phase(Menstrual flow).
The menstrual cycle is regulated by hormones (chemical substances) between the brain (hypothalamus and pituitary gland), the Ovaries and the endometrium.


When a young girl reaches puberty( sexual maturity), physical growth and environmental factors stimulate the hypothalamus to secret GnRH (gonadotrophin releasing Hormone) which stimulates the pituitary gland to secret follicle stimulating Hormone(FSH) and Luteinizing Hormone (LH). FSH moves in blood and stimulate the Ovaries to produce an egg(Ovum) into the Fallopian tube. This is known as Ovulation. Some women feel pain in the lower abdomen during this phase and such Ovulatory pain is known as ” Mittelschmerz. As follicles ( germ cells in the ovary) grow, the surrounding cells secret Oestrogens which cause a drop in FSH level and stimulate release of LH. Oestrogens also cause uterine lining to grow (thicken)to form the decidua. At Luteal phase, the remaining shell of the ovulated follicle becomes corpus luteum filled with a yellow tissue Corpus luteum secrets progesterone under the influence of LH. Progesterone further encourages growth of endometrial lining and increases uterine secretions .This is why during ovulation(fertile period), vaginal secretions are lighter and slimy making sexual intercourse more enjoyable. Most women find it difficult to resist sex during this phase.


In the menstrual phase, high levels of Oestrogens and progesterone exert a negative feedback on the brain which stops the production of FSH and LH. As a result, the growing tissue or lining (decidua) in the uterus consumes available Oestrogens and progesterone. Decrease in the level of these hormones, leads to shrinking and sloughing of the decidua with resultant bleeding containing the dead egg or the unfertilized ovum. This is known as menstruation usually lasting 3-7days with the average of 5days.proper menstrual hygiene is crucial at this stage. Very low levels of Oestrogens and progesterone stimulate the hypothalamus to secret GnRH and the cycle starts all over. Menstruation occurs when pregnancy fails to come because when the ovum is fertilized, it moves through the Fallopian tube to the uterine cavity where it is implanted into the decidua which supports, feeds or nourishes the fertilized egg (zygote, embryo and fetus) to grow. This is why absence of menses is a presumptive sign of pregnancy. Abnormalities of the above organs can alter this process.
*How to count the days in the menstrual cycle;*

The day menses start flowing is day1, next day is day 2. This continues to the day before next menses. Do this consecutively for 4-6 months in order to understand the pattern of your menstrual cycle. Some women have a 28-30day cycle which is very normal but some may have their cycles up to 35 or down to 21days. When this becomes regular over a period of 4-6months,it is normal for them.If not, they have an irregular cycle that necessitates correction by Health Experts on reproductive Health. The fewer the days of flow, the higher the risk of infertility.

*How to know the fertile period* :
The Luteal phase i.e from ovulation to next menstrual flow is 14days and is the only constant phase of the menstrual cycle.Here, the day of ovulation is 14 days to next menses e.g if you have a 28day cycle, subtract 14 from 28 to have the day you will be ovulating. If you have a 30day cycle, subtract 14 from 30 to have the day you will be ovulating. If you have a 21day cycle, subtract 14 from 21 to have the day of ovulation. Then the fertile period includes the day of ovulation itself plus 3days before and 3days after it.This means that a healthy woman has 7possible fertile days in a month.

Pedmia Shatu Tita is a journalist, a blogger, a social advocate, and a Self-Employed, Manager. She is Communication officer/content manager at BRH website at Bamenda Regional Hospital and Assistant Director at Cameroon Internet Governance -Camig

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