MENSTRUAL CRAMPS ARE REAL: MENSTRUATION IS NO MYSTERY
The letters I have received have shown me that many women, through no fault of their own, don't understand the physical and emotional changes they go through every month. Even many doctors don't comprehend the hormonal fluctuations and the impact they can have on a woman's body. A menstrual period is actually the end result of a delicately-balanced interplay of nervous signals and hormonal responses. Patty Hearst's menstrual period was said to have stopped for a long time during her days of captivity. When she was retrieved from the underground and tried as a bank robber, she was reported to have menstruated almost continuously for more than a year. Once a woman, learns how her menstrual cycle works, she can understand why a female who is under severe stress might either lose her period or bleed without pause.
During the menstrual cycle, which is the time from one period to another, complex but wonderfully-designed hormonal fluctuations occur in a woman's body. If a woman could visualize what is happening, she could understand not only menstruation, but conception, contraception, premenstrual tension, menstrual cramps, menopause. So much can be revealed through the menstrual cycle. Very personal questions about menstruation are in this chapter's letters from concerned women, but it's best to remove the menstrual mystique before these questions are answered.
The Ebb and Flow of the Feminine Cycle
A few days after menstruation, as the blood starts to diminish, the hypothalamus of the brain, which controls the menstrual cycle, sends a hormonal messagethe Releasing Factorto the pituitary gland. The message doesn't have to travel far because the pituitary is located just below the hypothalamus.
When the pituitary receives the message, it releases the Follicle Stimulating HormoneFSHwhich travels through the blood to the ovaries, and then the action begins. The ovaries start to work and all the little follicles, the potential egg cells in the ovaries, begin to grow and to produce the female hormone estrogen. A woman's skin may start to feel smoother as her estrogen builds. The estrogen will also effect the cervical mucus:
The First Mucus Check (Before Ovulation): The mucus secreted by the cervix, the mouth of the womb, is tactile, visible evidence of the events happening inside a woman s body. Right after menstruation the mucus is usually not noticeable, but toward the middle of a woman's cycle the mucus makes an appearance. A woman can thread out the mucus from her vagina with two fingers and if it has the clear, thin consistency of a raw egg white, that's her sign that estrogen is increasing. This phenomenal ability to thread the mucus is called "spinnbarkeit," meaning stretch-ability.
As the estrogen increases, it sends a "slow down" message back to the pituitary. At about this time a woman's breasts are becoming a little bigger and one of the follicles, for some unknown reason, is beginning to surpass the other egg cells in its development. That one egg cell, called the Graafian follicle or the follicle (egg)-of-the-month, bubbles out on the outside of the ovary. This bubble contains the egg that's destined for a trip to the womb.
The Second Mucus Check (During Ovulation): The mucus in the cervix, when the egg is about ready to be released, is in abundance and a woman should be able to feel the wetness in her vagina and to thread the mucus for several inches. (The consistency of the mucus varies from woman to woman. One woman describes it as "rubber cement" and another as "gloppy glue.") Also, the cervix, which had been closed and facing backward, begins turning forward and opening, thereby making it easier for the sperm to move into the uterus. If a woman wants to become pregnant, she could insert a finger into her vagina and if her cervix is open and her wetness is at a peak, she has arrived at the best time for conception.
About thirteen or fourteen days into the cycle, the pituitary responds to the increased estrogen by sending out the Luteinizing HormoneLH-and stopping the FSH. The LH makes the Graafian follicle burst and eject a mature egg cellthis release of the egg is ovulation. The egg then strikes out on a five-to-seven-day journey inside the Fallopian tube to the womb.
The scar tissue that's left behind after the egg pops out becomes the corpus luteum, the producer of progesterone, the pregnancy hormone. Progesterone causes the lining of the uterus to change into a soft, spongy nest rich in blood vessels and glandular tissue that is the perfect bed for the egg coming down the tube. The hormone also relaxes the uterus to give the egg a better chance to implant itself into the endometrium, the transformed uterine lining. Also, progesterone alters the cervical mucus:
The Third Mucus Check (After Ovulation): Once progesterone enters into the cycle, the mucus decreases in amount and rather than being clear and stretchy, it becomes cloudy and thick. It loses its stretchability. It is almost as if the cervical mucus changes to create a natural diaphragm that prevents vaginal bacteria and germs from entering a clean, protected uterus. The egg is being given the best environment for growth.
Estrogen and progesterone increase together after ovulation, as the LH drops off. There are a number of side effects that come from the surge of estrogen and progesterone during this last half of the menstrual cycle. They are specifically covered in Chapter Four and Chapter Five.
Meanwhile, as the menstrual cycle nears an end, if the egg is fertilized and pregnancy occurs, estrogen and progesterone levels stay high. But if there is no fertilization, then the brain doesn't get the stimulus it needs to maintain the corpus luteum. The corpus luteum disintegrates, progesterone and estrogen levels drop rapidly, and menstruation is triggered. The endometriumthe enriched spongy lining of the uteruswhich is useless without a pregnancy, leaves the body as menstrual blood. On this first day of a woman's period, one cycle has just ended and another is beginning. A woman has arrived at Day One of a brand-new cycle.
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Women's Health