The document discusses the menstrual cycle in women. It begins by explaining what menarche and menopause are, and that a normal menstrual cycle lasts 28 days. It then explains each phase of the menstrual cycle in detail, including ovulation on day 14, when a woman is most fertile. If the egg is not fertilized, the thickened uterine lining is shed through menstruation. Common disorders like irregular bleeding, increased or decreased bleeding are also covered. The document provides information about the menstrual cycle to help women understand their monthly visitor.

1. 24-1
The Menstrual Cycle

2. 24-2
The Reproductive Process in Women
As women, we all know about our “periods” or our “menses”. Since the age of twelve or thirteen years, month
after month we have been visited by our periods. Many a times we must have wondered about this monthly
visitor of ours and at times even got angry when it came at the wrong time. Let us try to understand this
“visitor” called our periods and see the role that it plays in a woman’s body.
From “menarche”, (the first time a girl has her “periods”) until her “menopause” (when she stops having
her “periods”), a woman bleeds a few spoons every month while she undergoes her menstrual cycle.
When a girl first starts “bleeding”
“Menarche” is the first time a girl has her “periods”. Usually a
girl starts bleeding from her uterus when she is between 11 to A girl
14 years old. But there are some girls who start bleeding as becomes
early as nine or as late as eighteen. As long as everything else a woman
is normal, there is nothing to worry. and she
gets her
If a girl has turned eighteen and not yet got her first “periods”, do “peri-
check the person for anaemia (Page 19-11). It could be the reason.
ods”
For girls above 18 who are yet to bleed refer to a doctor because there
may be a reason which can be corrected by a small operation.
Our Menstrual Cycle
Every month a woman goes through a “cycle”. Bleeding or “periods” is just one part of
this monthly cycle.
Why do we have our menstrual cycle?
The menstrual cycle is to allow the egg from a woman to meet the sperm from a man and
create new life. This new life is quickly taken to a cushioned site in the mother’s womb
where it may stay for nine months.
Understand the “Menstrual Cycle”
Let us look at what hap-
pens in a menstrual cycle
and how it happens. To un- Days 22- 28 Days 1 -5
derstand better, let us mark If no fertilised egg Bleeding (menses
the first day of bleeding / reaches the womb, its or “periods”)
“periods” as Day 1 of the thick lining gets ready
woman’s cycle. The aver- to break down
age normal cycle of a
woman lasts 28 days and Day 6-7
so, the cycle would last Egg begins to
from Da1 to Day 28. 28 Day
grow in ovary
Menstrual
If the “month” of a Cycle
woman from Day 1 of her Day 8 - 11
periods is divided into Womb thickens
Fertile Period to get ready to
three parts, the middle
part is the one when she Can get pregnant receive fertilised
can get pregnant. She egg
must use contraceptives if
she wants to avoid preg- Days 15-21
nancy. For a 30 day cy- Egg moves towards Days 12-14
cle, Day 11 to Day 20 need fallopian tube Ovulation (egg released)
contraceptives. The other (even if it does not Very Fertile; mucus
days are “safe”. meet sperm) thin & slippery

3. The Menstrual Cycle of Women
A new egg (ovum)
starts ripening in
the ovary
I.
V. II.
1. If the egg does not meet the 1. The inner walls of
sperm, it dies within 24 hours of the uterus (womb)
release. starts becoming
2. If there is no conception, the thick.
walls that were made ready to 2. At the same time,
receive the baby are then shed. the egg grows inside
3. The layers come out of the a balloon-like sac of
vagina as mentrual blood or the the ovary.
24-3
bleeding that we experience as
monthly periods.
IV. III.
1. Inner walls of the womb keeps thickening.
1. If the egg meets the 2. Blood vessels are made on the lining of the womb;
sperm inside the fallopian so that blood can be supplied to the baby if the woman
tube, it results in the for- conceives.
mation of an embryo 3. The bag around the egg bursts and the egg is re-
(baby) leased.
2. The embryo moves to 4. The egg then enters the fallopian tube (usually on
the womb and gets at- Day 14 of the of cycle)
tached to it. It grows here 5. A sticky transparent watery fluid comes out of
into a baby for 9 months. thevagina at this time; the chance of a woman getting
pregnant is highest at this time.

4. 24-4
Disorders of Menstrual Cycle
I. Less or No menses
a. Pregnancy: This may be b. Anaemia : Less
the most important reason why blood is another
“periods” (menses) stop in a common reason why
woman. Throughout pregnancy women do not get
and till a few months after a child periods or bleed very
is born , the “periods” do not begin little during her “pe-
again. No “periods” is not a certain riods”. Treating the
sign that the woman will not get anaemia (II Phase
pregnant. After a few months of a Manual, Page 19-11) brings the “pe-
child being born, even without riods” back and reassures the woman
“periods” returning, she could get that she is not pregnant.
pregnant.
c. Body chemical problem: Women who have never been able to bear a child, have a short
height (and may be has a man-like built and hair on face & body) also do not get their
monthly “periods”. Such women may need to see a doctor if they want to have a child.
The body may not be producing some hormone (chemical in the body) as much as is
needed. A doctor may be able to give such hormones to the women to make them normal.
d. Menopause: A woman undergoes menopause around the age of 45 years (between 45
and 55 years). This phase lasts from a few months to a few years in some women. In this
phase, hormones (body chemicals) of women start decreasing to the levels similar to that
of men. Many changes take place:
1. The “periods” become less and irregular; After the menopause
and they slowly stop. age, a woman’s chance
2. The woman undergoes “hot flashes” – she of losing Calcium from
feels unusually hot especially in the upper her bones increases (es-
part of the body and face. pecially if her life be-
3. The woman may get mood swings (prob- comes less busy and she
ably from an awareness that she is grow- gets little exercise). She
ing old) may suffer fractures
4. Her skin may get rougher; and slowly a few from simple falls. A
woman’s risk of getting
hair may be seen in the face in the beard &
heart diseases may also
moustache area.
increase after meno-
5. The vagina and the uterus slowly become
pause.
smaller.
II. Increased Bleeding III. Irregular Bleeding
The amount of blood during “pe- Many women complain that their periods are not regular.
riods” may be different for differ- For some, the “periods” may be coming too often (say once
ent women. What is “heavy bleed- in 15 days). For others, their periods may be delayed by a
ing” for one woman may be nor-
week or two (which may cause quite a bit of anxiety).
mal in another. Generally, the
presence of clots in the “periods”
can tell of heavy bleeding. If it con- What to do if “periods”are not regular?
tinues for a number of days or it If the woman is less than 35 years of age, one can try to correct
happens every month, it may cause the irregular bleeding by giving her Oral Contraceptive Pills
some worry. (OCPs) for three months continuously. The pills contain hormones
and often set the cycles right when they are given regularly. Do
If no symptoms of P.I.D tell the woman that such pills are normally taken to avoid hav-
(see II Phase Manual, ing children but may also be given for such purposes.
Page 15-15), do not try to Or else, other people may scare her to stop the pills.
treat it. It is better to re-
fer the patient to a doctor. If the woman is more than 35 years of age, it would be
better to refer the woman to a doctor.

5. 24-5
Know the Answers
The Menstrual Cycle
a. Please Fill in the Blanks :
1. The first menses is called _____________ and a girl normally gets her first menses between
the ages of _____ and _____.
2. A woman normally gets her monthly periods till she is around _______ age. The last stage of
menses in life is called _____________.
2. A normal menstrual cycle lasts for ____ days and the egg is released on the ____ day of the
cycle.
3. Sperms from the man meets the egg in the ____________________________ and if fertilised
the new life moves to the ________________ where it stays for _________ months.
4. If the egg does not get fertilised, then the _________ sheds its thick lining which comes out of
the vagina as a woman’s ________________.
5. A woman is most fertile (could get pregnant) during the _____________ phase of the
menstrual cycle which falls on the _______ day of the cycle. She should not have sex without
some contraceptive from the __________ day to the _______ day of the cycle.

6. 24-6
My Notes