Almost all my patients have had doubts about their menstrual cycle, what are their fertile days, the reliability of the ovulation calculator, the importance of a delayed menstrual period, etc. This article was born from these conversations in my office and I hope it will be useful to all of you, especially to those of you who do not have a trusted gynecologist to ask them in person.
What is menstruation, menstruation or menstrual period?
First of all, I would like to tell you that menstruation or menstruation occurs when the endometrium is shed and comes out through the cervix into the vagina.
What is the endometrium?
The endometrium is the layer of tissue that lines the inside walls of the uterus. It develops and is eliminated every month when there is ovulation, but it also develops when there is hormone production in the ovaries even if there is no ovulation (in this case there are usually alterations in the menstrual period). This happens, for example, in polycystic ovaries.
The endometrium is like the cradle of the embryo, and a good endometrium is necessary for pregnancy to occur. Therefore, in assisted reproduction treatments, great importance is given to the preparation of the endometrium.
Therefore, keep these two important concepts in mind:
- Ovulation does not occur every time there is a period. Cycles without ovulation are called anovulatory cycles and are especially frequent in the first years of menstruation and also in the years prior to menopause.
- You cannot have your period if you do not have a uterus, because even if the ovaries function, the endometrium could not develop. Therefore, in hysterectomized patients (without uterus) the absence of menstruation does not mean that menopause has arrived, and to confirm if this is the case, other tests are needed.
The absence of menstruation is known as amenorrhea, and may be due to different reasons, for example, there is no endometrial development, but nothing is retained in the uterus.
How can we calculate the fertile days and can we rely on ovulation calculators?
The main idea is that when there is an ovulatory cycle the period comes 14 days after ovulation. Thus, in a perfect 28-day cycle, ovulation would be fourteen days after the start of the menstrual period. The fertile days would be the days immediately before and after the day of ovulation.
The menstrual cycle is counted from the first day of heavy bleeding until the first day of the next period. When there is a delay in menstruation, it may be due to delayed ovulation or no ovulation. And that difference cannot be told by an ovulation calculator.
The first part of the menstrual cycle is called the follicular phase, and the second part of the cycle, after ovulation, is called the luteal phase. When the period is late, it is because the first part is longer.
It is useful to make a menstrual calendar or use a fertility calculator to note the days of your period, but you will only be able to calculate the days of ovulation if your cycles are always the same length. If this is not the case, it is preferable that you consult your family gynecologist so that through medical history, vaginal ultrasound and, sometimes, hormone analysis, she can tell you how your situation is and if you need to undergo any treatment in case you want to get pregnant, as well as know which is the best contraceptive method for you.
My periods are not regular, when should I worry?
If after your first menstruation you have irregular periods, do not worry, it is almost usual, since at that stage, as in the years before menopause, ovulation alterations (anovulatory cycles) are very frequent, and therefore, menstrual delays. In these cases it is sufficient to note your period on a calendar or a calculator.
You should consult your gynecologist if your cycles are usually delayed by more than 10 or 15 days, or if you have not had a period for more than three months. Also, logically, if you think you may be pregnant or have a positive pregnancy test.
What does hypermenorrhea mean?
Hypermenorrhea means excessive menstruation. It is normal that in the first two days of menstruation bleeding is greater, but if it lasts more than 4 days and you have iron deficiency or anemia you should consult. It is not serious but you may need treatment.
What is hypomenorrhea?
This term refers to light menstruation. It is common when taking the pill and is not a problem.
What does dysmenorrhea mean and when should we consult a gynecologist?
Dysmenorrhea refers to painful menstruation. Moderate pain that subsides with painkillers and does not prevent you from going about your normal life is considered normal. On the other hand, if the pain is excessive and interferes with your activities (or if you have never had period pain and now it does) it is preferable that you discuss it with your gynecologist. There may be some gynecological pathology, always benign, with these symptoms. Do not worry but ask.
What are amenorrheal bumps?
This complicated name does not refer to bumps in the road but is used to refer to closely spaced periods. For example, women who have periods every two, three or even more months. They are usually related to ovulation disturbances and have different causes, so each individual case must be evaluated.
Remember that we are not all the same and that the best advice will not come from a friend or a patient forum, but from a good professional.