Menstruation and Menopause

Menstruation is the normal periodic loss of blood and uterine lining, by way of the vagina, in a woman who is not pregnant. The flow usually lasts 4 to 5 days and recurs about every 28 days. Menstruation starts with puberty and continues for about 30 years in most women. The first menstrual period is called the menarche and the ending of menstruation is called the menopause.

In developed countries, the menarche usually occurs at 12 or 13 years of age. However, some girls start having periods as early as 9 or as late as 16. The age of onset of menstruation depends on many factors, both genetic and environmental. It is closely associated with body weight and usually occurs when the girl or young woman has reached a weight of at least 84 to 88 pounds.

Improved nutrition, better standards of general health, and earlier attainment of the adolescent growth spurt are the primary factors that have led to a gradual lowering of the age of onset of menstruation in many socio-economically advantaged countries.

Most women reach the menopause around the age of 50, but it may occur as early as 40 or as late as 55. Just as the age of onset of menstruation is getting lower, so the age of the menopause is rising, for reasons that are not understood.

Monitoring Menstruation

Menstruation is a natural, healthy aspect of a woman's life cycle, defining her fertile years. The menstrual period is the end result of a series of hormonal interactions in your body. You will experience some normal variations and everyday problems in your menstrual cycle. More serious complications can arise as a result of such factors as pregnancy in a very young girl or the long-term use of oral contraceptives.

The Start of Menstruation

At the onset of menstruation, periods are irregular in length and are usually relatively painless. The amount of blood loss varies. After regular ovulation begins, you can expect that your menstrual periods will become more regular.

In the early, irregular cycles around the time of puberty, ovulation may not occur. However, a young girl cannot assume that she will not become pregnant. Anemia and many other serious complications of pregnancy are more likely to develop in very young girls.

The Pill

The hormones in oral contraceptives effectively "take over" the natural hormonal control of menstruation. Women who take oral contraceptives typically have lighter, shorter, and very regular periods.

The Normal Menstrual Flow

The length of the period varies among healthy women from 2 to 7 days. The volume of blood and uterine lining (endometrium) lost during each period also varies considerably.

The average loss of blood is about 2 fluid ounces but the amount may vary from 1 ounce to 6 ounces. Menstrual blood does not clot because of the absence of fibrinogen, an ingredient essential for blood clotting.

However, the passage of lumps of compacted blood and tissue is common.

Menstrual Problems

Dysmenorrhea - painful menstruation caused by powerful muscular contractions of the uterus (cramps) - was once a serious disorder for many women. It can now be effectively treated in up to 90 percent of cases with combined estrogen-progesterone oral contraceptives. An alternate treatment is with drugs that block the effects of prostaglandins, the substances that cause the painful contractions.

Irregular cycles should be evaluated by your doctor. The condition may be linked with weight loss or gain, stress, or illness. Oral contraceptives can be used to control irregular cycles.

Amenorrhea is the absence of menstrual periods. If your periods stop and you are not pregnant, possible causes include abrupt weight change, severe stress, excessive exercise (more than 20 to 40 miles of running per week), or problems with your pituitary or thyroid gland.


You probably cannot predict when your menopause will occur. Studies have not demonstrated any reliable relationship between the age of the onset of menstruation and the age of menopause. Some research suggests that factors such as use of oral contraceptives, childbearing experience, and obesity may influence age of menopause, but these associations are not fully understood.

The first sign of the approach of the menopause is a change in the pattern of your menstrual cycle. At first the cycle usually gets shorter-often by as much as a week - and then it tends to lengthen, with smaller, shorter, bleeding periods.

A woman may have no periods for several months and then resume having irregular periods for a while. After 2 or 3 years or more of such irregularity, menstruation stops altogether.

During many of these later cycles, a woman does not ovulate. It is believed that, in women 40 to 45, a quarter of the cycles do not involve the release of an egg. After 45, the proportion of cycles without ovulation increases, so the chances of pregnancy are reduced.

Altered Hormone Production

As a woman approaches the age of menopause, her body produces less estrogen. Her pituitary gland increases production of other hormones. These hormonal changes are responsible for the symptoms commonly associated with the menopause, which include sudden flushing and severe sweating (hot flashes), insomnia, dryness of the skin and of the vagina, depression, irritability, and fatigue.


Both men and women lose bone mass and strength steadily after age 35 as part of the natural aging process. However, for women, the rate of bone loss rapidly accelerates at the time of menopause be-cause of the effects of altered hormone production. Osteoporosis, a condition that leaves the bones more porous, more fragile, and more susceptible to fracture, affects about one third of all postmenopausal women in the US, many of whom do not experience any symptoms. Lost bone tissue cannot be easily replaced, but you can minimize further bone loss. Include calcium (found in milk and milk products and green leafy vegetables) in your diet, and exercise regularly. Smoking and alcohol and caffeine consumption are among the factors that reduce bone density. Hormone replacement therapy can compensate for reduced estrogen production.

Submitted By
Dr. Rafeza karim Md
The author is a consultant at Taronto General Hospital.

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