Q.

1) what is the menstrual cycle

The menstrual cycle is a complex system of changes that occur in the
female body due to the regular rise and fall of hormone levels. These
changes help to prepare your body for a potential pregnancy each
month.
The length of a menstrual cycle is measured from the first day of a
period to the day before the next period begins. The average cycle is 28
days although this can vary between women, and from one cycle to the
next in individuals.
Q. 2) what happens in the menstrual cycle
The menstrual cycle is controlled by a number of glands and a series of
hormonal changes beginning in the brain. A brain structure called the
hypothalamus signals the nearby pituitary gland to release hormones
known as gonadotropins which prompt the ovaries to secrete the sex
hormones, oestrogen and progesterone.
There are four distinct phases of the menstrual cycle. Menstruation
(period) is considered to be the first phase. However, to best understand
what happens during menstruation, we must first understand the other
three phases.
The follicular phase
The follicular phase is the time from the first day of menstruation
until the moment of ovulation.
During this phase, the pituitary gland releases a hormone which
causes between 10 and 20 follicles to begin developing within
the ovary.
These follicles, each housing an immature egg (ovum), bead on
the surface of the ovary. Usually, only one follicle will mature
into an egg.
The growth of the follicles produces the hormone oestrogen,
which causes the lining of the uterus (endometrium) to become
thick in preparation for the possible embedding of a fertilised
egg.

Ovulation
Ovulation is the release of a mature egg from the ovary surface.
In this phase, the pituitary gland increases production of a
hormone which triggers the follicle and ovary to open up and
release the mature egg.
This occurs mid-way through the menstrual cycle, between days
12 and 16 for women with a 28 day cycle.
The luteal phase
The luteal phase is the time from ovulation until the first day of
menstruation.
During this phase the follicle from which the mature egg was
released transforms into a structure known as the corpus luteum
and produces large amounts of the hormone progesterone, as
well as small amounts of oestrogen. These hormones contribute
to the further thickening and maintenance of the lining of the
uterus in preparation for the embedding of a fertilised egg.
If fertilisation of the egg does not occur, the corpus luteum dies
and progesterone levels decline leading to the breakdown of the
uterus lining, which is shed through the vagina as a period
(menstruation)

Menstruation
Menstruation occurs when the broken down lining of the uterus
flows from the body through the vagina.
Menstruation generally lasts from 3 to 7 days. The length of a
period can differ between women, and between cycles in
individuals.

Q.3) Contraception and your cycle

Not all contraceptives are the same. Different methods take effect during
different phases of your menstrual cycle. As a result, some methods can
cause a change in the menstrual cycle whilst others will not.
If you experience heavy or prolonged bleeding, or if you have any other
concerns, you should consult your doctor.
The combined oral contraceptive pill and the monthly ring contain two
types of hormones oestrogen and progestogen whereas the minipill,
the 3-yearly implant and 5-yearly IUS contain just progestogen.
For women using the combined pill or the monthly ring, the lining of the
uterus builds up similar to, but thinner than during a normal menstrual
cycle. This lining is generally stable and begins to break down once the
source of the hormones is stopped; i.e. you begin taking the inactive
pills, or the ring is removed.

When you are using a progestogen-only contraceptive, the continuous

exposure to the hormone progestogen will prevent the usual cycle of
thickening and shedding of the lining of the uterus. The constant
progestogen dose causes the lining to be a lot thinner than it is during a
menstrual cycle or when taking the combined pill. For some, this thin
lining is quite stable and there is little or no bleeding. In others the lining
is fragile and bleeding may be frequent and unpredictable.

-The contraceptive pill

There are two forms of the oral contraceptive pill.
The combined oral contraceptive pill contains two hormones;
progesterone and oestrogen. It is taken every day, at roughly the same
time, for three weeks followed by a weeks break during which you may
take inactive sugar tablets or no tablets at all.
Within a few days of stopping the combined pill, the lining is no longer
held by the hormones and breaks down. You should experience a bleed
similar to but lighter than a normal period. Bleeding should only occur
when the hormones are NOT being taken.
The minipill contains small amounts of one hormone called progestogen.
It is taken regularly at the same time each day without a break. The
minipill causes a change in bleeding patterns. Some women may
experience irregular or unpredictable bleeding patterns.

-The monthly ring

The monthly ring releases a continuous low dose of oestrogen and
progesterone, which prevent ovulation.
The ring is removed after 3 weeks and withdrawal bleeding, which is
similar to that which occurs with the combined contraceptive pill, will
occur in the 4th week.
-The three yearly implant
The three-yearly implant is a small plastic rod that is placed under the
skin of the upper arm, and slowly releases progestogen into the blood
stream. It works by stopping the ovaries releasing an egg each month.
The implant causes a change in bleeding patterns. Some women have
no bleeding at all, while others may experience infrequent, frequent or
prolonged bleeding. Generally the type of bleeding pattern experienced
in the first 3 months predicts the ongoing bleeding pattern.
-The five year IUS
The five-yearly intrauterine system (IUS) is a small plastic device that is
placed in the uterus and slowly releases progestogen directly into the
uterus.
The IUS works in a number of ways; by preventing sperm from fertilising
an egg by stopping the sperm from getting into the uterus; and also, by
preventing a fertilised egg from implanting in the uterus.
The IUS can have an effect on your regular bleeding patterns.
Unpredictable bleeding and spotting is common in the first few months.
Periods usually become light, or stop after about a year.
-The three monthly contaceptice injection
The contraceptive injection is a progestogen-only intramuscular injection.
It works by inhibiting ovulation, as well as preventing sperm from
reaching the egg.
The contraceptive injection is a long-acting method of contraception, and
cannot be reversed once administered. Initially it can have an

unpredictable effect on your regular bleeding patterns. Long term use

may cause your periods to stop, which may be a desired outcome.

References:
Menstrual cycle Better health channel. Available at
www.betterhealth.vic.gov. [Accessed November 2010].

The Ring

What is the contraceptive ring?

The contraceptive ring is a small, flexible plastic ring which is usually
self-inserted into the vagina.
How long does the ring last?

Once inserted, the ring can be left in the vagina for 3 weeks. It is then
removed for a week to allow for a menstrual period.
One week after you have removed your ring, you insert a new
contraceptive ring.

How does the ring work?

The ring works by releasing hormones similar to those found in the

combined contraceptive pill. The hormones are released directly into the
blood vessels in the vaginal wall. The hormones in the ring prevent the
release of the egg from the ovary.

Other considerations
The contraceptive ring is self-inserted and removed. When properly
inserted in the vagina, it shouldn't be felt nor should it interfere with
having sex.
Return to pre-existing fertility is likely to occur within the first cycle after
ceasing to use the ring. Your doctor will be able to answer any questions
you may have about the ring.
The information provided on this website about medicines is taken from
the relevant Product Information/Consumer Medicine Information
leaflets. Please see your doctor or pharmacist for more information on
individual options.

Menstrual cycle: What's normal, what's not

Your menstrual cycle can say a lot about your health. Understand how
to start tracking your menstrual cycle and what to do about
irregularities. By Mayo Clinic Staf
Do you know when your last menstrual period began or how long it lasted? If not, it
might be time to start paying attention.
Tracking your menstrual cycles can help you understand what's normal for you, time
ovulation and identify important changes such as a missed period or
unpredictable menstrual bleeding. While menstrual cycle irregularities usually aren't
serious, sometimes they can signal health problems.

What's the menstrual cycle?

The menstrual cycle is the monthly series of changes a woman's body goes through
in preparation for the possibility of pregnancy. Each month, one of the ovaries
releases an egg a process called ovulation. At the same time, hormonal changes
prepare the uterus for pregnancy. If ovulation takes place and the egg isn't fertilized,
the lining of the uterus sheds through the vagina. This is a menstrual period.

What's normal?

The menstrual cycle, which is counted from the first day of one period to the first day
of the next, isn't the same for every woman. Menstrual flow might occur every 21 to
35 days and last two to seven days. For the first few years after menstruation begins,
long cycles are common. However, menstrual cycles tend to shorten and become
more regular as you age.
Your menstrual cycle might be regular about the same length every month or
somewhat irregular, and your period might be light or heavy, painful or pain-free, long
or short, and still be considered normal. Within a broad range, "normal" is what's
normal for you.

Keep in mind that use of certain types of contraception, such as extended-cycle birth
control pills, will alter your menstrual cycle. Talk to your health care provider about
what to expect.

How can I track my menstrual cycle?

To find out what's normal for you, start keeping a record of your menstrual cycle on a
calendar or with the help of a smartphone application. Begin by tracking your start
date every month for several months in a row to identify the regularity of your
periods.
If you're concerned about your periods, then also make note of the following every
month:

End date. How long does your period typically last? Is it longer or
shorter than usual?

Flow. Record the heaviness of your flow. Does it seem lighter or

heavier than usual? How often do you need new sanitary protection?

Abnormal bleeding. Are you bleeding in between periods?

Pain. Describe any pain associated with your period. Does the pain
feel worse than usual?

Other changes. Have you experienced any changes in mood or

behavior? Did anything new happen around the time of change in your
periods?

What causes menstrual cycle irregularities?

Menstrual cycle irregularities can have many diferent causes, including:

Pregnancy or breast-feeding. A delayed or missed period can be

an early sign of pregnancy. Breast-feeding typically delays the return of
menstruation after pregnancy.

Eating disorders, extreme weight loss or excessive exercising.

Eating disorders such as anorexia nervosa extreme weight loss
and increased physical activity can disrupt menstruation.

Polycystic ovary syndrome (PCOS). This common hormonal

disorder can cause small cysts to develop on the ovaries and irregular
periods.

Premature ovarian failure. Premature ovarian failure refers to the

loss of normal ovarian function before age 40. Women who have
premature ovarian failure also known as primary ovarian insufficiency
might have irregular or infrequent periods for years.

Pelvic inflammatory disease (PID). This infection of the

reproductive organs can cause irregular menstrual bleeding.

Uterine fibroids. Uterine fibroids are noncancerous growths of the

uterus. They can cause heavy menstrual periods and bleeding between
periods.

What can I do to prevent menstrual irregularities?

For some women, use of birth control pills can help regulate menstrual cycles.
However, some menstrual irregularities can't be prevented.
Regular pelvic exams can help ensure that problems afecting your reproductive
organs are diagnosed as soon as possible.
In addition, consult your health care provider if:

Your periods suddenly stop for more than 90 days and you're not
pregnant

Your periods become erratic after having been regular

You bleed for more than seven days

You bleed more heavily than usual or soak through more than one
pad or tampon every hour or two

Your periods are less than 21 days or more than 35 days apart

You bleed between periods

You develop severe pain during your period

You suddenly get a fever and feel sick after using tampons

Remember, tracking your menstrual cycle can help you find out what's normal for you
and what isn't. If you have questions or concerns about your menstrual cycle, talk to
your health care provider.

Menstrual cycles and

ovulation
Your menstrual cycle
You probably already know quite a lot about your menstrual cycle like
how often you get your periods and how heavy they are. In this page we
are going to take a more in-depth look at the female menstrual cycle,
ovulation and periods. Obviously, no website can take the place of
talking to a healthcare professional, but this should give you a good
general understanding of how it all works.

Understanding your menstrual cycle

Womens cycle lengths vary, and the most common cycle length is
somewhere between 23 and 35 days. Any variation in menstrual cycle
length that does occur is more likely to be during the part of the cycle
before you ovulate (which is called the follicular phase). For most
women, the length of time between ovulation (when an egg is released
from the ovary) and their monthly period is between 12 to 16 days (this is
called the luteal phase).

The menstrual cycle

Your period

The first day of your menstrual cycle is the first day of your period (day
1). The period usually then lasts anything from 3 to 7 days. Youll
probably find that if you get any period pains, theyll be at their worst in
the first few days of your period. This is because the hormones in your
body are causing your womb to actively shed the lining that was built up
in the previous menstrual cycle.
Preparing for ovulation
At the beginning of your cycle follicle-stimulating hormone (FSH) is
produced by the pituitary gland in your brain. This is the main hormone
involved in stimulating your ovaries to produce mature eggs. Follicles are
the fluid-filled cavities in your ovaries. Each follicle contains one
undeveloped egg. The FSH stimulates a number of follicles to develop
and start to produce the hormone estrogen. Your level of estrogen is at
its lowest on the first day of your period. From then on, it starts to
increase as the follicles grow.
Now while a number of follicles initially begin to develop, normally one
follicle becomes dominant and this egg matures within the enlarging
follicle. At the same time, the increasing amount of estrogen in your body
makes sure that the lining of your womb is thickening with nutrients and
blood. This is so that if you do get pregnant, the fertilised egg will have
all the nutrients and support it needs to grow. High estrogen levels are
also associated with the appearance of sperm-friendly mucus (or, to
give it its technical name, fertile cervical mucus). You may notice this as
a thin, slippery discharge that may be cloudy white. Sperm can swim
more easily through this mucus and can survive in it for several days.

Understanding the ovulation cycle

Ovulation

The level of estrogen in your body is still increasing and it eventually

causes a rapid rise in luteinising hormone (the LH surge). This LH
surge causes the dominant follicle to rupture and release the mature egg
from the ovary, from where it enters the Fallopian tube. This process is
known as ovulation.
Many women think that they ovulate on day 14, but 14 is an average,
and most women will actually ovulate on a different day of the menstrual
cycle. Your day of ovulation will vary from cycle to cycle.. Some women
claim to feel a twinge of pain when they ovulate, but many feel no
sensation at all and theres no other sign that you are ovulating.

After ovulation

Once the egg (or ovum) has been released, it moves along the Fallopian
tube towards your womb. The egg can live for up to 24 hours. Sperm
survival is more variable, but typically 3-5 days, so the days leading up
to ovulation and the day of ovulation itself are your most fertile when
you are most likely to get pregnant. As soon as you have ovulated, the
follicle starts producing another hormone: progesterone.
Progesterone causes further build up the lining of your womb in
preparation for a fertilised egg. Meanwhile, the empty follicle within the
ovary starts to shrink, but carries on producing progesterone, and also
starts to produce estrogen. You may get symptoms of pre-menstrual
tension (PMS) such as breast tenderness, bloating, lethargy, depression
and irritability at this stage.

Preparing for the next period

As the empty follicle shrinks, if the egg is not fertilised, levels of estrogen
and progesterone decrease. Without the high levels of hormones to help
maintain it, the thick womb lining that has been built up starts to break
down, and your body sheds the lining. This is the start of your period and
the beginning of your next menstrual cycle.

If the egg has been fertilised, it may successfully implant itself into the
womb lining. This usually takes place about a week after fertilisation.
As soon as the fertilised egg has implanted, your body starts producing
the pregnancy hormone, human Chorionic Gonadotrophin (hCG), which
will keep the empty follicle active. It continues to produce the hormones
estrogen and progesterone to prevent the lining of the womb from being
shed, until the placenta (which contains all the nutrients the embryo
needs) is mature enough to maintain the pregnancy.