Chapter List

• Introduction
• Achilles Tendon
• Adrenal Glands
• Ankles
• Appendix
• Arteries
• Back
• Belly Button
• Birth Control
• Birthmarks
• Bladder
• Blood
• Body Hair
• Body Type
• Brain
• Breasts
• Cervix
• Childbirth
• Chin
• Circulatory System
• Clitoris
• Collarbone
• Digestive System
• Ears
• Elbows
• Emotions
• Endocrine System
• Energy
• Esophagus
• Eyes
• Fallopian Tubes
• Fat
• Feet
• Fertility
• Fingernails
• Gallbladder
• Gums
• Gynecological Exam
• Hair
• Hands
• Heart
• Hips
• Hormones
• Intestines
• Jaw
• Joints
• Kidneys
• Knees
• Larynx and Vocal Cords
• Lips
• Liver
• Lungs
• Lymphatic System
• Medical Tests
• Menopause
• Menstrual Cycle
• Moles
• Mouth
• Muscular System
• Neck
• Nervous System
• Nose
• Nutrition
• Ovaries
• Pain Relief
• Pancreas
• Pelvis
• Pregnancy
• Rectum
• Reproductive System
• Respiratory System
• Ribs
• Salivary Glands
• Scalp
• Sex
• Sexually Transmitted Diseases
• Shins
• Shoulders
• Sinuses
• Skeletal System
• Skin
• Skull
• Spine
• Spleen
• Stomach
• Stress
• Sweat Glands
• Tailbone
• Tear Ducts
• Teeth
• Throat
• Thyroid
• Toenails
• Tongue
• Tonsils
• Underarms
• Urinary System
• Urine
• Uterus
• Vagina
• Veins
• Vulva
• Wrists
• Shaping Up
• The Total Body Shaping Workoout
• Abdominals
• Biceps
• Buttocks
• Calves
• Chest
• Forearms
• Neck3
• Shoulders3
• Thighs
• Triceps
• Aerobic Conditioning

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Menstrual Cycle

Menstrual Cycle

Ever watch a man who's obviously been sent to the store to buy tampons?

First, he does a flyby mission down the feminine products aisle to scan the shelf. Then, he makes another pass without stopping to double-check location. Finally, he swings by a third time--very casually, mind you--and taps the box off the shelf and into the cart, barely allowing himself to touch it. When the box lands, he's off down aisle 6 and 7 for enough items to cover the feminine hygiene product. What's he afraid of--getting caught, maybe?

The Embarrassment in Blood

Unfortunately, men aren't the only ones who get embarrassed by tampons and menstrual blood. As all women are aware, menstruation is a natural sign of good health. Yet many women feel they must hide the evidence.

Think about it. We don't walk down the hall at work toting tampons. If we have an "accident," and blood is visible on our pants or skirts, we run home to change or cover the evidence with sweaters tied around our waists. We avoid changing tampons in front of our partners. We hide tampons out of sight in the bathroom cabinet.

Going Full Cycle Your period may be what you notice most about your menstrual cycle. But a bevy of other changes occur throughout the average cycle of 28 days. Here's a rundown of the events during that average cycle. Using the start of your period as day one of the menstrual cycle, you can expect bleeding from that day through day five (approximately). The uterus is shedding its lining, and that process produces menstrual blood. While bleeding continues the ovaries go through other changes. A number of follicles, or eggs, inside the ovary start to mature. Their growth is influenced by a hormone released by the pituitary gland. During this time the reproductive hormones estrogen and progesterone are at low ebb. By day 5, one follicle has outgrown the rest and is outperforming the other follicles. It becomes the dominant egg in the ovary, and as it churns out increasing amounts of estrogen, it raises the levels of that hormone in your body. From day 6 through day 14 this follicle continues to develop and release estrogen. Under estrogen's influence, the lining of your uterus starts to grow and rebuild. Ovulation comes next. But before that, estrogen levels drop slightly, while levels of the sex hormone androgen rise. If you find that you have increased sexual desire around mid-cycle, this is probably the reason. Somewhere around day 14, enough estrogen has been released by the follicle to trigger a surge of luteinizing hormone, or LH, from the pituitary gland. The surge of this hormone triggers ovulation, which occurs between 34 and 36 hours after the LH surge begins and 10 to 12 hours after it peaks. (Menstruation will begin 13 to 15 days after the LH peak.) After ovulation, the follicle transforms into something called the corpus luteum, which produces the hormones estrogen, progesterone and androgens. The increased levels of progesterone trigger changes in both the cervical mucus and the lining of the uterus. It may also be responsible for some of the mood changes that many of us experience in the second half of the cycle. If the egg, or follicle, does not get fertilized by a sperm, the corpus luteum starts to degenerate, which causes the estrogen and progesterone levels to decline. The withdrawal of hormonal support causes the uterine lining to shed. A woman on a 28-day cycle will resume menstrual bleeding on the 29th day, when the cycle starts all over again. That 29th day becomes day 1 of the next menstrual cycle.

So even though periods come and go regularly, and even though we're living in the enlightened 1990s, women tend to feel that menstruation is something to be hidden, covered up, made invisible.

The cover-up is nothing new, of course. Reviewing menstrual taboos in 64 societies, one researcher found that nearly one-third of the groups forbid menstruating women from preparing food for men. Many of those groups isolated women in special shelters. Among Native Americans of North America, for instance, women were hidden away in special menstrual huts when they had their periods. Even the language that's been used to refer to menstruation has often been negative. Menstrual periods have been referred to as "the curse," "that time of the month," "the nuisance" and even "the plague."

The Female 400

On the average, we start menstruating at the age of 12 and continue having periods until we reach menopause at about the age of 51. We may have a few interruptions--caused by pregnancy or taking the Pill, for instance--but the average woman will have about 400 periods during her lifetime. That's a lot of tampons--probably about 6,000, in fact.

Though women often think that a menstrual period is the same as the menstrual cycle, it's not, points out Ellen S. Mitchell, Ph.D., associate professor at the University of Washington School of Nursing and a nationally certified nurse practitioner in Seattle. The term menstrual period, or period, refers to the days that a woman bleeds. A period lasts about five days, but that's only an average. About half of us bleed for three to four days, while 35 percent of women bleed for five to six days.

The term menstrual cycle, on the other hand, refers to the span of time from the start of one period to the start of the next. The length of the menstrual cycle can range from 21 days to 35 days, with 29 days as the average. During the menstrual cycle, we go through a series of hormonal changes, with related changes in the ovaries and the lining of the uterus.

Knowing Your Pattern

Experts say that it's important to know what a normal menstrual cycle is for you. That will help you detect any unusual changes. Here are some ways to keep track.

Buy a date book. "Keeping a menstrual cycle calendar is an incredibly valuable thing," says Dr. Mitchell. Get a little calendar that fits in your purse that's easy to look at and can help you really see patterns, she suggests. In addition to recording when your period starts, how long it lasts and how heavy or light the flow is, track how your body feels throughout the month.

Asthma Attack? Maybe It's That Time of the Month Okay, so you know that in the days just prior to your period, you can expect to feel bloated, crampy and grouchy. But did you also know that the hormonal changes preceding your period can influence your body in a number of other ways? There's not enough research to tell us why. From the stories that their patients tell them and a few preliminary studies, here's what doctors have observed. * Hormonal changes during the menstrual cycle may affect your allergies. * If you have asthma, the days near the start of your period may be the time when you are most susceptible to severe asthma attacks. * Some women find that they may get cold sores just before menstruation begins. * If you have eczema, you may notice your skin condition gets worse just prior to your period. * Gum disease, or gingivitis, tends to be worse during menstruation. * Some women experience insomnia once a month--and it occurs just prior to their periods. * Other women find that their voices are pitched lower--or get hoarse as if they had mild laryngitis--one to two days just prior to their periods. Also, some women with health conditions find that their symptoms appear cyclically. A woman who has lupus, for instance, might find that her joint pain and facial rash are worse in the two weeks just before her period.

Count it right. When keeping count of your menstrual cycles, be sure to count properly. Start counting on the first day of your period and continue counting up until the day when your next period starts, says Dr. Mitchell. "A lot of women will count through their periods as part of their cycle," she says. If you do that, it looks as if your cycle is longer than it actually is. In other words, if you have a 29-day cycle, day 1 is the first day of your period and day 29 is the day before your next period starts.

Accept yourself. Once you detect your average cycle length, accept that it's normal for you. Some women think there's something wrong if they are not having cycles that are 28 days long, says Dr. Mitchell. "Menstrual cycles are not all 28 days long, as many women believe. It can be very normal between 21 and 35 days," she says.

Play detective. "If you notice there are some differences in your cycle length or in your flow, keep track of them with that calendar for a few months," says Dr. Mitchell. "Then go and talk with your health care provider about it, and take your calendar with you," she says. Your doctor or nurse practitioner can then look to see if you have a very irregular pattern of bleeding that could be a sign of a more serious problem, she says.

It's important to remember that a change doesn't always indicate a problem, says Mary Beth Hasselquist, M.D., staff obstetrician/gynecologist at Group Health Cooperative of Puget Sound, Washington, and clinical instructor in the Department of Obstetrics and Gynecology at the University of Washington School of Medicine in Seattle. Sometimes bleeding is well within normal, and women get alarmed anyway, she says.

Premenstrual Symptoms

Women have a broad range of physical changes around the time of their periods. These are what doctors call premenstrual symptoms--but having them doesn't necessarily mean you have premenstrual syndrome, or PMS.

Some 100 symptoms caused by the menstrual cycle have been reported by women, including pain and cramping, bloating, headache, backache, food cravings, breast tenderness and mood changes. About 95 percent of reproductive-age women will experience one or more of these symptoms just prior to their periods, notes Diana Taylor, R.N., Ph.D., associate professor and director of the Women's Health Program in the Department of Family Health Care Nursing at the University of California, San Francisco.

The PMS Diet While PMS has become a common buzzword, premenstrual syndrome itself is not as common as you may think. Ninety percent of women experience one or more physical or psychological changes before their periods, but only 9 percent meet the criteria for PMS itself. So . . . what's up? Do you have premenstrual syndrome, premenstrual symptoms, both or neither? If you have PMS, experts say, your premenstrual symptoms will recur in two out of three menstrual cycles--and they'll be followed by a symptom-free time before your next period. PMS symptoms will cease abruptly with the beginning of your menstrual cycle. With PMS the symptoms are so severe that they interfere with your relationships--or with some aspect of your work or lifestyle. That's just a thumbnail description of what happens with PMS. Before undergoing treatment for it, you should be sure to get an accurate diagnosis, experts say. After that there are a number of methods you can try to alleviate symptoms. The methods include diet, exercise, stress reduction and time management as well as behavioral and cognitive training, says Diana Taylor, R.N., Ph.D., associate professor and director of the Women's Health Program in the Department of Family Health Care Nursing at the University of California, San Francisco. Dietary changes are only part of the equation, but they can help some women. Experts commonly recommend that you keep your salt and sugar intake low if you have PMS. Here are some other dietary factors that may come into play. Complex carbohydrates. Eating a diet high in complex carbohydrates--including dietary fiber--may help alleviate PMS symptoms, says Ellen S. Mitchell, Ph.D., associate professor at the University of Washington School of Nursing and a nationally certified nurse practitioner in Seattle. Researchers believe that there is a relationship between complex carbohydrates and the production of the brain chemical serotonin, which controls mood, appetite and sleep. Getting adequate, consistent amounts of carbohydrates into your system can help maintain serotonin levels and fend off mood swings, cravings and sleep disturbances. Good sources of complex carbohydrates and fiber include bran, wheat, oats and other grains and grain products. You'll also get plenty of complex carbohydrates from legumes such as peas and beans and from corn and potatoes. Caffeine. Researchers theorize that part of the nervous system is super-aroused--particularly in the second half of the cycle--in women with PMS, according to Dr. Mitchell. Since caffeine is a stimulant that directly affects the nervous system, women with PMS should keep their caffeine intake down, she says. This means cutting back on caffeinated coffee, soda and tea and also limiting the amount of chocolate you eat. Vitamin B6. "There's some data, although it's sketchy, that increasing your B6 intake to about 50 milligrams a day is helpful," says Dr. Mitchell. Just how much B6 helps alleviate PMS symptoms is controversial--and some researchers don't think that it helps--but if you stay at 50 milligrams a day, taking B6 won't hurt, says Dr. Mitchell. (This is still very high, since the Daily Value for B6 is just 2 milligrams.) While you may get some B6 in your diet, you'll probably have to take a supplement to make sure you get 50 milligrams. Do not take more than this amount, however, because B6 is toxic in high amounts. Calcium. "There's some data that suggests that at least 1,000 milligrams of calcium is helpful in terms of PMS symptoms," says Dr. Mitchell. In particular, calcium may help alleviate the anxiety symptoms, she says. Each eight-ounce serving of milk contains about 300 milligrams of calcium, and so does a one-cup serving of yogurt. You might choose skim milk and low-fat yogurt to limit your fat intake. With three or four daily servings of these low-fat dairy products, you'll get about 1,000 milligrams of calcium even if you don't take supplements. Zinc and magnesium. Some research indicates that women who get PMS have less zinc and magnesium in their diets than other women. Researchers suspect that these minerals may influence the brain's production of chemicals that influence mood. Based on the research so far, doctors aren't ready to recommend zinc and magnesium supplements--but there's no harm in reaching for zinc-rich foods such as ready-to-eat cereals, lean meats, seeds and cooked oysters. Good sources of magnesium include dark green, leafy vegetables, legumes such as cooked, dried peas and beans and whole grains.

One symptom that many women get is premenstrual headache, says Joanne Piscitelli, M.D., assistant clinical professor and the division chief of general obstetrics and gynecology at Duke University Medical Center in Durham, North Carolina. "My feeling is that it is related to the drop in estrogen and progesterone that occurs the day prior to the onset of the period." Certainly, if you're prone to migraines, you'll tend to get them more often right around the time of your period, so there seems to be some hormonal trigger, she says. Some doctors have noted that premenstrual headaches seem to become more common as a woman gets older.

Other common premenstrual symptoms range from mood changes to breast tenderness, bloating and backache. According to a national survey of 968 women conducted at the University of Arkansas in Fayetteville, 90 percent experienced premenstrual mood changes and 89 percent had bloating at some time. The same study showed that 88 percent had breast tenderness, and three-quarters of the group experienced premenstrual backache.

In the study of premenstrual symptoms that was done at the University of Arkansas, women who exercised reported less discomfort than women who were inactive. "We feel that moderate exercise, whether it's walking or running or biking, helps," says Inza Fort, Ed.D., professor of kinesiology, in the Department of Health Science, kinesiology, recreation and dance at the University of Arkansas and one of the researchers involved in the study.

To help relieve premenstrual symptoms, you should aim to get 20 minutes of exercise at least three to four times a week, Dr. Fort recommends. The most effective kind is aerobic exercise that raises your pulse and makes you sweat a little--but at a pace that's moderate enough to allow you to carry on a conversation.

For premenstrual bloating doctors recommend a number of foods to help control it. Asparagus, apple cider vinegar and herbal teas are natural diuretics that may help decrease bloating, says Dr. Taylor. If bloating is a recurrent problem, try to incorporate these natural diuretics into your diet.

Menstrual Symptoms

Apart from premenstrual problems--or in addition to them--many women get other symptoms when menstruation starts. Cramping is among the most common, says Dr. Piscitelli. Approximately 50 percent of women get menstrual cramping, and 5 to 10 percent get incapacitating pain.

Pain and cramping originate from the uterus. The pain is caused by special chemicals called prostaglandins that get released by cells in the uterine lining when it starts to shed. When you feel a menstrual cramp, it's actually a contraction of the uterus.

At the start of the yoga "child" pose, kneel with your arms at your sides. Sit back on your heels.

Bend over as shown. Inhale deeply through your nose, exhale through your nose, then pause a second or two before you inhale again. Hold the pose as long as you're comfortable--up to several minutes.

In most women cramps are normal, but in some they are a sign of more serious problems in the abdomen, genital tract or uterus. So if you have pain and cramping when you normally wouldn't, or if it's prolonged and severe, visit your doctor, says Dr. Piscitelli.

Even if you've come to expect cramps, there are ways to fend them off. Here's what doctors recommend.

Look over the counter. Using over-the-counter medications such as ibuprofen can help reduce cramping pain. Ibuprofen is an antiprostaglandin, so it counteracts the chemicals that cause cramps, says Dr. Mitchell.

When should you start taking it? Generally, as soon as the cramping starts, says Dr. Piscitelli. Women who experience nausea, diarrhea and vomiting with their periods may want to take ibuprofen a day or two before they expect their period to start, she says. That way they can get the medicine in their systems before they start feeling nauseous. Ibuprofen can also be effective for relieving backache and headache. Don't go overboard, though: Frequent, regular use of ibuprofen can sometimes lead to stomach trouble, so take it with food or an antacid, doctors say.

Pack up the pain. Some women find that it helps to apply heat to the area where they feel crampy and achy, says Dr. Mitchell. When you're sitting or lying down, cradle a hot pack in the area that hurts.

Let hormones do the trick. Oral contraceptives tend to make cramps less significant, says Dr. Piscitelli. The Pill prevents ovulation and reduces the thickness of the lining of the uterus, so fewer cramp-inducing prostaglandins are produced. The Pill may also help relieve menstrual-related headaches and help relieve pain and cramping caused by endometriosis and fibroids--two conditions that make menstruation particularly painful for some women.

Are Your Times A-Changing? If you're in your thirties, and your periods are different now from what they used to be, don't be alarmed. "Somewhere between the mid-thirties and the early forties there is often a very subtle change in the menstrual period or in the cycle length," says Ellen S. Mitchell, Ph.D., associate professor at the University of Washington School of Nursing and a nationally certified nurse practitioner in Seattle. "It may start getting a little lighter, maybe a day or two or three shorter. The cycles are still regular, but shorter. Many times these changes are so subtle that women don't realize it." When the changes are so slight, it's usually not a sign that anything is wrong, according to Dr. Mitchell. "They're just part of the normal evolution of a woman's reproductive life," she says. Near the ages of 45 to 47, you may notice that your menstrual cycles are becoming more irregular--some months your cycles may be shorter and other months they may be longer. Or you may actually skip some periods. This is the beginning of the menopausal transition. This transition period may last an average of four to six years. The irregularity will increase as a woman gets closer to menopause. Normal menopause (menopause means one year or more with no period) occurs any time from age 40 onward, even though the average age is 51. Remember, a woman can still get pregnant up until the time when she's had no period for at least one year. But even the age range doesn't apply to all women. "You can't take a woman's age and say that something is going to happen then. The reproductive life cycle doesn't necessarily go by age," says Dr. Mitchell.

Say yeah to yoga. In addition to aerobic exercise, yoga may help relieve menstrual symptoms, says Dr. Taylor. The "child" pose--shown in the illustration below--may be particularly helpful.

Try a walk. While helping ease premenstrual problems, regular exercise may also help fend off menstrual symptoms. "Exercise increases the level of endorphins--your body's natural painkillers--and that may have an effect on menstrual cramp pain, but we don't know for sure," says Christine Wells, Ph.D., professor of exercise science and physical education at Arizona State University in Tempe and author of Women, Sport and Performance.

When Your Cycle Changes

Maybe you find you are bleeding more, less, at the wrong time or not at all. Should you be concerned?

Well, sometimes yes and sometimes no, doctors say. Spotting between periods is not a common problem, but it certainly isn't unheard of, says Dr. Hasselquist. Whether you need to be concerned about spotting depends on when in your cycle you experience it, she says.

Tampon Check Most baby boomers remember the toxic shock scare of the early 1980s. There were TV reports about women becoming incredibly ill during their periods, lots of warnings about high-absorbency tampons and news of women dying. Later, the controversy died down--which may have left you wondering whether this was just the passing of another media event. During the ensuing years, manufacturers have changed both the fiber content and absorbency levels of tampons. Today, an estimated 1 in 100,000 women gets menstruation-related toxic shock each year. The symptoms include high fever, nausea and a sunburnlike rash mainly on the torso accompanied by low blood pressure--and if you have these symptoms, you should call your doctor. Because it's so uncommon, your chances of having toxic shock are extremely low. You can lower your risk even more if you follow this advice from doctors. Select the right tampons. "Women who want to decrease the risk of toxic shock can use the lowest absorbency compatible with their needs," says Anne Schuchat, M.D., medical epidemiologist in the Division of Bacterial and Mycotic Diseases at the Centers for Disease Control and Prevention in Atlanta. When your flow is light, go with a lower-absorbency tampon, usually labeled "regular," and when your flow is heavy, try a "super." If your period varies, carry a variety of tampons with you so you have a choice. Follow the instructions. Read the package insert, says Dr. Schuchat. It's important to follow the recommended time-use guidelines for your particular brand and absorbency. In general, it's recommended that you change your tampon every 4 to 8 hours. Tampons have changed over the years, so if you haven't read an insert in ages, take a look. Go alternative. "Women who want to reduce their risk even further can alternate tampon use with pads," says Dr. Schuchat. It's best to use a pad instead of a tampon during your light days, suggests Ellen S. Mitchell, Ph.D., associate professor at the University of Washington School of Nursing and a nationally certified nurse practitioner in Seattle. Prevent an encore. If you've had toxic shock during your period before, the CDC recommends that you avoid tampon use in the future, says Dr. Schuchat. "There is a risk of recurrence."

If spotting occurs in the middle of your cycle--that's about 14 days before your next period --there's a good chance that it's caused by ovulation. In other words, it's not usually a cause for concern, says Dr. Hasselquist. During ovulation, estrogen levels drop, and that's often enough to trigger some bleeding.

Contact your doctor if the spotting does not occur around mid-cycle, Dr. Hasselquist recommends. Erratic spotting between periods could be a warning of some problem, especially if you're over 40 years old, agrees Dr. Piscitelli. Since intermittent spotting can signal a precancerous condition of the uterus, it's important for your doctor to check it out right away.

In these situations the doctor will probably want your menstrual history before deciding whether or not you need a biopsy, says Dr. Hasselquist. Here are some prudent steps that doctors recommend you take from the start of spotting.

Mark it on your calendar. If you experience some spotting, mark the day on your menstrual calendar and wait for your next period. Once your period comes, count backward to the day that you had spotting. If spotting fell on or around day 14, then it's probably mid-cycle bleeding, and you don't have much to worry about, says Dr. Hasselquist.

Consider your contraception choice. If you are on the Pill, you might have some bleeding at times other than when you have your period, according to Dr. Hasselquist. Women who get quarterly Depo-Provera birth control shots might have spotting during the first year that they're getting these hormone injections. The Norplant device--which can stay implanted under the skin for up to five years--can cause irregular spotting the whole time it's in place. If you use any of these methods, be sure to inform your doctor about any spotting and discuss it with her.

Check your eggs. Spotting can sometimes be a sign that you are pregnant, says Dr. Hasselquist. She recommends getting a pregnancy test to find out if that's the cause.

When It's Much Too Much

If you've been having heavy, prolonged bleeding, it may be time to call your doctor.

What's the measure of heavy bleeding? If you find that you soak through a full-size pad or a super tampon in just an hour, and that happens two hours in a row, that's considered heavy bleeding, says Dr. Hasselquist.

One possibility is that the heavy bleeding is caused by fibroids, growths that can form inside the uterus. There is nothing that you can do to prevent fibroids--and whether your doctor recommends surgery depends on their size, which she'll find out during a pelvic exam.

The abnormal bleeding caused by fibroids, however, can sometimes be managed in other ways. According to Dr. Hasselquist, birth control pills can decrease the amount of menstrual flow. And an injection of Depo-Provera, the birth control shot, will stop menstruation, says Dr. Hasselquist. If those approaches don't work, and the fibroids are large enough to require surgery, your doctor might recommend either a hysterectomy or a procedure called myomectomy. (A myomectomy is recommended for someone who wants to preserve her fertility, or does not want a hysterectomy.) But not all fibroids need to be removed. Small ones can often be left in.

Heavy bleeding could signal other changes that are likely to need a doctor's attention. Sometimes women get heavier periods because they're not ovulating, says Dr. Piscitelli. A number of things can interfere with ovulation, including polycystic ovarian syndrome, a condition where multiple cysts form inside an ovary. Also, certain medical conditions, such as thyroid disease or pituitary tumors, can interfere with ovulation.

When Your Period Goes AWOL