Adolescent Health: Menstruation and the Menstrual Cycle

WHO Definition: The regular natural process of shedding blood and tissue from the uterus through the vagina as part of the menstrual cycle.
Also known as a "period."

Menarche: The first occurrence of menstruation, marking the start of the reproductive cycle.
Timing: Typically begins between ages $9$ and $16$ , roughly $2-3$ years after breast development.
Teen Cycle Length: Commonly ranges from $21$ to $45$ days.
Flow Duration: Bleeding typically lasts between $2$ and $7$ days.

Menstrual Phase ( $\text{Days } 1-5$ ): Shedding of the endometrium (uterine lining) when no pregnancy occurs. Hormone levels (oestrogen and progesterone) are low.
Follicular/Proliferative/Regenerative ( $\text{Day } 1-13$ ): Pituitary gland releases Follicle-stimulating hormone (FSH) to develop ovarian follicles; one egg matures.
Ovulation Phase: A surge in Luteinizing Hormone (LH) triggers the release of the egg into the fallopian tube. This is the peak fertile window.
Luteal Phase/Secretory: Ruptured follicle becomes the corpus luteum and secretes progesterone to maintain the lining. If no fertilization occurs, the lining breaks down.

Physical: Headaches, pelvic pain, fatigue, bloating/gassiness, breast soreness, and acne flare-ups.
Emotional: Irritability, mood swings, insomnia, brain fog, anxiety, sadness, and changes in appetite or sex drive.

Products: Reusable/organic pads, tampons (cardboard applicators), menstrual cups (medical-grade silicone), period underwear, menstrual discs, and sponges.
Usage: Pads should be changed every $4-6$ hours; tampons every $4-8$ hours. Menstrual cups can be worn up to $12$ hours.
Disposal: Pads should be rolled inward, wrapped in paper, and placed in a bin. Never flush products down the toilet.

Bathing/Exercise: Safe and helpful for relieving cramps.
Pregnancy: Possible even during a period, especially with irregular cycles.
Purity: Menstrual blood is not "dirty"; it is simply uterine lining and blood.
Virginity: Using tampons or cups has no medical impact on virginity.
Pain: Severe pain is not normal and should be evaluated by a professional.

Menstruation is a natural reproductive process starting at menarche ( $9-16$ ) and ending at menopause ( $45-55$ ).
Sources: American College of Obstetricians and Gynecologists ( $2020$ ), CDC ( $2022$ ), Mayo Clinic ( $2023$ ), UNICEF ( $2019$ ), and WHO ( $2021$ ).