Menstruation is the shedding of the uterine lining (endometrium).

It occurs on a regular basis in reproductive age

females of certain mammal species. Overt menstruation (where there is bleeding from the vagina) is found primarily
in humans and close evolutionary relatives such as chimpanzees.[1] The females of other placental mammal
species have estrous cycles, in which the endometrium is reabsorbed by the animal (covert menstruation) at the end
of its reproductive cycle. Many zoologists regard this as different from a "true" menstrual cycle.

As part of the menstrual cycle

Main article: Menstrual cycle

Menstruation is the most visible phase of the menstrual cycle. Menstrual cycles are counted from the first day of
menstrual bleeding, because the onset of menstruation corresponds closely with the hormonal cycle.
During pregnancy and for some time after childbirth, menstruation is normally suspended; this state is known as
amenorrhoea, i.e. absence of the menstrual cycle. If menstruation has not resumed, fertility is low during lactation.
The average length of postpartum amenorrhoea is longer when certain breastfeeding practices are followed; this
may be done intentionally as birth control (lactational amenorrhea method).

Evolution
All placental mammals have a uterine lining that builds up when the animal is fertile, but is dismantled
(menstruated) when the animal is infertile. Some anthropologists have questioned the energy cost of rebuilding the
endometrium every fertility cycle. However, anthropologist Beverly Strassmann has proposed that the energy savings
of not having to continuously maintain the uterine lining more than offsets energy cost of having to rebuild the lining
in the next fertility cycle, even in species such as humans where much of the lining is lost through bleeding (overt
menstruation) rather than reabsorbed (covert menstruation).[1][4] However, even in humans, much of it is
reabsorbed.
Many have questioned the evolution of overt menstruation in humans and related species, speculating on what
advantage there could be to losing blood associated with dismantling the endometrium rather than absorbing it, as
most mammals do. The ancient writer Hippocrates considered that menstruation was intended to cleanse the body of
"evil humours", and modern evolutionary biologist Margie Profet contends that the primary function of
menstruation is to remove sperm-borne pathogens from the uterus. In support of this hypothesis, she has pointed to the
relatively high levels of macrophages in menstrual blood.[5][4]
Beginning in 1971, some research suggested that menstrual cycles of co-habiting human females became
synchronized. A few anthropologists hypothesized that in hunter-gatherer societies, males would go on hunting
journeys whilst the females of the tribe were menstruating, speculating that the females would not have been as
receptive to sexual relations while menstruating.[6][7] However, there is currently significant dispute as to whether
menstrual synchrony exists.[8]
Humans do, in fact, reabsorb about two-thirds of the endometrium each cycle. Strassmann asserts that overt
menstruation occurs not because it is beneficial in itself. Rather, the fetal development of these species requires a
more developed endometrium, one which is too thick to completely reabsorb. Strassman correlates species that have
overt menstruation to those that have a large uterus relative to the adult female body size.[1]

Culture and menstruation

Main article: Culture and menstruation

Common usage refers to menstruation and menses as a period. Aside from its biological purpose, this bleeding serves
as a sign that a woman has not become pregnant. (However, this cannot be taken as certainty, as sometimes there is
some bleeding in early pregnancy, and some women have irregular cycles.) During the reproductive years, failure to
menstruate may provide the first indication to a woman that she may have become pregnant. A woman might say that
her "period is late" when an expected menstruation has not started and she might have become pregnant.
Many religions have menstruation-related traditions. These may be bans on certain actions during menstruation (such
as intercourse in orthodox Judaism and Islam), or rituals to be performed at the end of each menses (such as the
mikvah in Judaism and the ghusl in Islam). Some traditional societies sequester females in residences ("menstrual
huts") that are reserved for that exclusive purpose until the end of their menstrual period.
Since the late 1960s, some women have chosen to prevent menstruation with long-acting hormonal birth control.
Injections such as depo-provera became available in the 1960s, progestogen implants such as Norplant in the
1980s and extended cycle combined oral contraceptive pills in the early 2000s.

Characteristics

Physical experience
See also: Premenstrual Syndrome

In many women, various intense sensations brought about by the involved hormones and by cramping of the uterus
can precede or accompany menstruation. Stronger sensations may include significant menstrual pain
(dysmenorrhea), abdominal pain, migraine headaches, depression, emotional sensitivity, feeling bloated, and
changes in sex drive. Breast discomfort caused by premenstrual water retention or hormone fluctuation is very
common. The sensations experienced vary from woman to woman and from cycle to cycle.

Emotional reactions
Women may experience emotional disturbances associated with menstruation. These range from the irritability
popularly associated with Premenstrual Syndrome (PMS), to tiredness, or "weepiness" (i.e. tears of emotional
closeness). A similar range of emotional effects and mood swings is associated with pregnancy.[9]

Flow
The normal menstrual flow follows a "crescendo-decrescendo" pattern; that is, it starts at a moderate level, increases
somewhat, and then slowly tapers. Sudden heavy flows or amounts in excess of 80 mL (hypermenorrhea or
menorrhagia) may stem from hormonal disturbance, uterine abnormalities, including uterine leiomyoma or cancer,
and other causes. Doctors call the opposite phenomenon, of bleeding very little, hypomenorrhea.

Duration
The typical woman bleeds for two to seven days at the beginning of each menstrual cycle. Prolonged bleeding
(metrorrhagia, also meno-metrorrhagia) no longer shows a clear interval pattern. Dysfunctional uterine bleeding
is hormonally caused bleeding abnormalities, typically anovulation. All these bleeding abnormalities need medical
attention; they may indicate hormone imbalances, uterine fibroids, or other problems. As pregnant patients may bleed,
a pregnancy test forms part of the evaluation of abnormal bleeding.

Menstrual products
Further information: Menstrual product

Most women use something to absorb or catch their menses. There are a number of different methods available.
Disposable items:
• Sanitary napkins (Sanitary towels) or pads — Somewhat rectangular pieces of material worn in the
 underwear to absorb menstrual flow, often with "wings," pieces that fold around the panties, and/or an
adhesive backing to hold the pad in place. Disposable pads may contain wood pulp or gel products, usually
with a plastic lining and bleached. Some sanitary napkins, particularly older styles, are held in place by a belt-
like apparatus, instead of adhesive or wings.
• Tampons — Disposable cylinders of treated rayon/cotton blends or all-cotton fleece, usually bleached, that
are inserted into the vagina to absorb menstrual flow.
• Padettes — Disposable wads of treated rayon/cotton blend fleece that are placed within the inner labia to
absorb menstrual flow.
• Disposable menstrual cups — A firm, flexible cup-shaped device worn inside the vagina to catch menstrual
flow. Disposable cups are made of soft plastic.
Reusable items:
• Reusable cloth pads are made of cotton (often organic), terrycloth, or flannel, and may be handsewn
(from material or reused old clothes and towels) or storebought.
• Menstrual cups — A firm, flexible bell-shaped device worn inside the vagina to catch menstrual flow.
Reusable versions include rubber or silicone cups.
• Sea sponges — Natural sponges, worn internally like a tampon to absorb menstrual flow.
• Padded panties — Reusable cloth (usually cotton) underwear with extra absorbent layers sewn in to absorb
flow.
• Blanket, towel — (also known as a draw sheet) — large reusable piece of cloth, most often used at night,
placed between legs to absorb menstrual flow.
In addition to products to contain the menstrual flow, pharmaceutical companies likewise provide products —
commonly non-steroidal anti-inflammatory drugs (NSAIDs) — to relieve menstrual cramps. Some herbs, such
as dong quai, raspberry leaf and crampbark, are also claimed to relieve menstrual pain; however there is no
documented scientific evidence to prove this.....................
From puberty until menopause, a women’s biochemistry waxes and wanes to her own unique monthly rhythm, known
as the menstrual cycle. The word menstruation is derived from the Latin word menses, which means month. Regular
menstruation is a sign that the body is producing appropriate levels of hormones in a balanced fashion according to a
rhythm established over millennia as optimal for human reproduction.
Each monthly period results from a sequential conversation between your brain, your adrenal, pituitary and thyroid
glands, and your ovaries. This conversation tells your body to release an egg, which is then either fertilized and
implanted in the uterus (conception) or shed in your menstrual flow along with the lining of the uterus. The sequence
is orchestrated by a cascade of reproductive hormones, but the main actors are estrogen and progesterone.
Women generally begin menstruating between the ages of 11 and 13; this first period is called menarche. Most of us
will have more than 500 periods during our so-called childbearing years — the time frame between menarche and
menopause, which is defined by the point in time when a woman has gone for 12 consecutive months without having
a period. When menopause will occur varies for the individual, but the average age is 51. And just as there are gradual
changes leading up to menarche, menopause is preceded by a gradual transition phase called perimenopause.
Perimenopause is a premenopausal condition often characterized by irregular cycles, sometimes with heavy bleeding
or skipped periods (amenorrhea), that can begin as early as the mid- to late-30’s.
One thing we’ve learned over the years is that no woman’s menstrual cycle is exactly like any other’s. While some sail
through periods without much thought, others suffer with abdominal cramps (dysmenorrhea), excessive bleeding
(menorrhagia), moodiness, and more. The range of symptoms that correspond with monthly cycles are sometimes
called premenstrual syndrome or PMS, and this time of the month can be extremely difficult to get through for many
women.........................................
A woman's reproductive years begin in puberty when she starts menstruating and ends when she enters menopause,
usually between the age of 45 and 50. While the average length of a menstrual cycle is 28 days, it is perfectly normal
for a cycle to last anywhere from 21 to 35 days. On average, most women have menstrual flow for three to five days
but it is very normal to menstruate for as much as seven days.
Hormones
There are five main hormones involved in the menstrual cycle process: estrogen, progesterone, gonadotropin releasing
hormone (GnRH), follicle stimulating hormone (FSH) and lutenizing hormone (LH).
Estrogen: Although estrogen is thought of as one type of hormone, there are actually different types of estrogen
produced by the female body. The two main estrogens involved in your menstrual cycle are estradiol and androgen.
Estradiol is responsible for thickening the endometrial lining along with making your vaginal and cervical mucus
more inviting for sperm. Androgen, on the other hand, does not actually start out as estrogen. Rather, the ovaries
convert androgen to extra estrogen. This increase in estrogen helps to get rid of the immature egg follicles
Progesterone: This hormone is produced by the follicle from which the mature egg has been released (once the egg is
released, this follicle is known as the corpus luteum). Progesterone helps make the endometrial lining ready for
implantation if an egg is fertilized during the cycle. Progesterone also prevents the egg follicles from developing any
further.
GnRH: Produced by the hypothalamus in the brain, GnRH is the controlling force behind the production and levels of
estrogen in the body. Towards the end of your cycle, your estrogen levels bottom out and the GnRH is notified to start
the production all over again. Once your body starts secreting high levels of progesterone, though, GnRH is no longer
produced.
FSH: Just as the name suggests, increased levels of this hormone help to stimulate egg follicles, thereby aiding the
maturation of the eggs as well as increasing the production estradiol. FSH is secreted by the pituitary gland, which is
stimulated by the hypothalamus' production of GnRH.
LH: Also produced by the pituitary gland in response to your body's production of GnRH. This hormone works with
the egg follicles to produce androgen.
The First Weeks
The first day of your menstrual cycle is the first day of your period. At this time, your estrogen levels are at their
lowest which sends a signal to your brain that more FSH is needed. As your body produces more FSH, about 20 egg
follicles begin to mature. However, only one of these egg follicles will attract the most FSH and begin to produce
estradiol. Once estradiol begins to be secreted, your pituitary gland receives the signal to stop producing FSH in such
high volumes. As the production of FSH tapers off, the weaker egg follicles die off.
With the increase in estrogen production, your uterine lining begins to thicken while your cervical mucus changes
from thick and unwelcoming to sperm to thin and slippery, perfect for sperm to swim in. Not only does the estrogen
change the consistency of your cervical mucus, but it also increases the amount of it, which will also help sperm get to
your egg.
Ovulation
Since the beginning of your menstrual cycle, your estrogen levels have been steadily increasing. Approximately 36
hours before you ovulate, these levels will peak and cause the pituitary to release a surge of lutenizing hormone. When
the follicle releases the egg, the fimbraie of the fallopian tubes (20 to 25 finger-like structures on the end of the
fallopian tubes) collect the egg into the tube where it begins traveling down towards the uterus. This is known as
ovulation.
Once ovulation occurs, the follicle from which the egg was released shrinks and begins to gather lipids, a type of fatty
substance. This follicle then becomes known as the corpus luteum and begins to produce progesterone. As the corpus
luteum secretes more and more progesterone, your uterine lining begins to get ready for implantation by a fertilized
egg.
Once released, the egg is thought to have a 24-hour window during which time it can be fertilized by sperm. However,
sperm can survive within the female body anywhere from three to seven days. Women who are looking to avoid a
pregnancy should not have sex or should use a reliable form of birth control in the week leading up to ovulation.
Menstruation
If an egg is fertilized and successfully implants into your uterine lining during this cycle, your body will begin to
secrete human Chorionic Gonadotropin (hCG). This hormone helps to continue the production of estrogen and
progesterone for the remainder of your pregnancy. The corpus luteum will also continue to produce progesterone as it
is stimulated by the fetus' placenta.
If an egg is not fertilized, it will be expelled along with the endometrial lining from your body. This is your period.
Menstruation will also occur if an egg has been fertilized but fails to implant in the uterine lining. In this case, the
fertilized egg along with the endometrium will be expelled during your period. Additionally, when no pregnancy
occurs during a cycle, the corpus luteum dries up, becoming scar tissue, and your hormonal levels begin to fall. As
they drop, the hypothalamus will be stimulated and start producing GnRH. This will signal the pituitary gland to start
secreting FSH -- and so your menstrual cycle begins again....