What is a Period?
What happens to the body?
Period Pain
What does period pain feel like?
There are different ways for a person to alleviate pain during their period; there is no fixed method or technique so you can pick whatever works for you!
There are also events in your life which can make your pains worse - try to identify them in order to prevent them in the future.
Some things you can try:
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Exercise
A simple walk or yoga meditation can get your mind off of the pain and enhance happiness-inducing endorphins.
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Heat
Hot water bottles, teas, and anything warm are your best friends. Be careful of excess heat, don't burn yourself!
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Eating habits
While you may experience cravings, be mindful of overly greasy, heavy, and salty foods to help prevent nausea, bloating, and water retention.
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Pain killers
Pain killers like Paracetamol or Ibuprofen works best. Be careful to track how many you’ve taken and make sure you consult a doctor before taking medication.
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Relieve stress
Studies have shown that stress can cause more painful periods as well as affect your next cycle. Engage in enjoyable activities and hobbies to help you de-stress!
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Sleeping patterns
As you hormone levels change, your body may have trouble controlling its internal temperature causing restless or interrupted sleep. Try going to bed earlier than usual and be as comfortable as possible.
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Speak with your doctor
Your doctor or nurse can also help you soothe your pain with other methods or by prescribing other types of medication or healing.
Self-care during your period
There are many ways you can practice self-care during your period even if you're not experiencing pain.
"when I would go to India, people would tell me 'Oh, you're on raja (holiday).'
I would be exempt from having to do anything. ‘Just sit down and put your feet up' they'd say."
- Avni Chang (HINDU STUDIES SCHOLAR)
Try some of the activities below:
Take a hot bath
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Make yourself a cup of tea
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Do yoga or meditate
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Indulge in some moderate snacking
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Take a nap
Think of your period week as a holiday, be nice to yourself and take it easy!
Contents:
Many people experience slight to severe pain in different parts of their body just before or during their period, while some don't at all. Couple of years after your period first starts, you might confuse period pain with feeling ill, indigestion, or thinking that you might need to poo.
Here are some common symptoms:
A slight pain is normal. Also if you get cramps a couple days before your period, it can even become a convenient signal to indicate the start of your period. But if it disrupts your life every month or if you suddenly start having severe pain after the age of 25, see if your doctor can help because it might be a cause of menstrual related illnesses.
How to Alleviate Pain
CHAPTER TWO
Know Your Period
LEVEL TWO
Each month, one of the ovaries releases an egg - a process called ovulation. The egg moves into the uterus through the fallopian tubes, which are the 'pipes' found on both sides of the uterus and connect the ovaries to the uterus.
The lining of the uterus starts to form with tissue and blood for fertilisation (pregnancy). If ovulation takes place and the egg isn’t fertilised, the lining of the uterus sheds through the vagina along with blood. And then happens all over again!
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Mild to intense throbbing pain in your lower abdomen starting one to three days before your period and gets better after two to three days in to your period.
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Pain in your lower back, thighs, and breasts, as well as headaches.
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Bloating before your period.
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Loose stools or constipation.
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Emotional pain can feel stronger.
Question Corner
Understanding our behaviour during periods
Next time you have your period, you can use this to determine your best and worst habits when you’re in pain, craving certain types of foods, or when you feel blue!
What are your favourite things to eat during your period?
What’s your period exercise routine?
What is stressing you out at the moment?
When was the last time you took time alone to focus on your mind and body? Draw your favourite way to relax.
Know your period texture
Clots, which are small lumps of blood, are common during the first two days. Make sure it’s smaller than 2cm and to always track your period!
Regularity and flow
At the beginning it can often be irregular. That is normal. However if you are familiar with your cycle and go through months without having your periods, this is abnormal.
Everybody has a different cycle. Make sure to journal and track your period.
Tracking means control
I didn't track my period when I was younger but Now i'm way more aware of why i'm tender or phYsically and emotionally sensitive around my period! - A.
How much blood can you lose?
So how do you calculate how much blood you lose per month?
1. Multiply the number of hygiene products you used that month during your period by 5 ml (for regular size products) or 10 ml (for extra absorbent products).
Example:
2. Multiply this number by 0.36 to get the approximate amount of blood you lost that month. Example:
Know Your Flow
Period blood colour - what do they mean?
Brown or Dark red
Beginning or end of period - usually old blood
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Pink
Spotting, anaemia, vitamin deficiency or low estrogen levels.
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Red or Bright red
Beginning of period - fresh blood
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Orange
Period blood and cervical fluid or a possible infection.
Visit a doctor if your period blood is:
Whitish or greyish
Possible bacterial infection of the vagina
Make sure not to mistake white discharge with period blood.
The menstrual cycle, which is counted from the first day of one period to the first day of the next, varies from person to person. Your menstrual cycle might be regular or irregular, be light or heavy, painful or pain free, long or short, and still be considered normal. It's normal for your period to be irregular when you first start. However, it's abnormal if you are familiar with your cycle and go through months without having periods.
In order for you to understand your cycle, it is essential that you track your cycle in terms of flow, regularity, pain, emotional changes and habits! It allows you to truly connect with your menstrual experience and understand any changes in behaviour during that time. Plus, you get to know when your next period is so you can be ready for it. Jump to the next chapter to learn more about how to track your periods.
Normally, you lose around two to three tablespoons (30-50 mL) of menstrual blood each month, but this really depends on each person. Your flow is usually heavier at the beginning of your menstruation, and it tends to lighten as the days go by.
During your menstruation, you’re not just losing blood. Other fluids like mucus, can make up nearly 64% of your menstrual flow. This means that blood only makes up 36% of your flow, although it might look like you are losing a lot more blood.
Heavy Periods
When is it too much?
Heavy periods do not necessarily mean there’s anything wrong. However, if you track your flow and lose more blood than usual, it’s time for a check-up. If you bleed 6-8 teaspoons on average, heavy menstrual bleeding is defined as losing 16 teaspoons or more in each period or having periods that last longer than 7 days. Sometimes it can be both.
Other indications are:
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Having to change your sanitary products every hour or two
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 Passing blood clots larger than 2.5cm
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Bleeding through your clothes or bedding
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Needing to use 2 types of sanitary products together (for example, tampons and pads)
There is nothing wrong with being a heavy bleeder. However, we must remember that people who naturally have heavy periods (without underlying issues or conditions) can have flows which interrupt their daily lives and activities. If you are a heavy bleeder, we empathise with your situation! If you find your flow too problematic, talk to your local doctor to see how you can manage the heavy blood!
Absent Periods
When is it too little?
When you first get your period, it is common that it is irregular for the first year. However, as you grow older, it should become more regular. Amenorrhea is when you don’t have a period for at least 3 to 6 months. This can cause a lot of stress and anxiety and it can feel like your womanhood isn't present anymore (which is untrue of course).
What causes delayed periods?
Diet
If you don’t eat enough, you won’t produce enough energy to sustain your body or a healthy pregnancy. Your brain will save the nutrients that would otherwise be used on ovulation, shutting down your periods.
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Stress
The stress hormone cortisol influences the production of female hormones by communicating the stress to your brain, which stops ovulation until you have overcome the stress. So make sure to take some time off for yourself.
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Exercising
Overexercising can affect women’s periods as your body senses exertion as stress and sends information to your ovaries to stop ovulating.
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Know Your Emotions
Why do you feel this way?
During puberty and your period, you may experience mood swings. That is totally normal! Track your emotions. If you notice that it changes drastically, tracking can help you to identify, understand, and manage your emotions.
What is PMS?
PMS (pre-menstrual syndrome) are the emotional and physical symptoms which happen due to hormone fluctuations before the start of your periods.
Low estrogen levels decrease the release of serotonin (the happy hormone) affecting your mood levels and making you feel depressed or sad.
Don’t worry! These feelings won’t last forever.
the smallest things annoy or upset me during this time! Now I know why... - A.
If you track your period and emotions and notice these emotions significantly worsening during menstruation, you might have Premenstrual Dysphoric Disorder (PMDD). It’s okay.
Between 5-10% of people with periods are affected by this. Symptoms can resemble that of depression or bipolar disorder and are very distressing and disruptive. If you still feel low after your period or think you might have symptoms of PMDD, talk to your doctor or an adult you trust about your emotional symptoms.
"I fight with my friends and family when I am on my period.
What should I do?"
Identify the root of the issue to understand why you may be feeling negative. How can you set healthy boundaries to avoid it upsetting you next time?
Take some time to care for yourself, drink tea and other hot drinks, take baths, go for walks, eat foods that you love (and are relatively healthy), and take a breath of fresh air.
Do not isolate yourself and talk to someone you trust about what’s bothering you; don't be afraid to ask for their support.
Do not repress and ignore bad thoughts or issues you have, as they may worsen during PMS and your anger could become more severe.
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Apologise to your loved ones and take responsibility if you’ve made mistakes.
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Grow from your mistakes. We all make mistakes, it is part of being human - the most important part is learning from them.
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Understand that these feelings are not your fault - there are a lot of hormonal changes happening on in your body so take it easy on yourself.
Question Corner
Understanding your emotions
Whether you have PMS or feel that your negative emotions affect you the worst during your period, it can be useful to know what things, contexts and situations affect, scare, anger, sadden or stress you out the most.
Make a list of things that help you to calm down or cheer up?
If you are upset, how would you like your friends and family to help?
Draw the place you feel the safest or most relaxed.
Endometriosis and PCOS
What is endometriosis?
You might have heard of a well known illness known as endometriosis, which is an example of uterus-related illness! This is when the uterine tissue grows outside the uterus. Although there are theories, nobody knows exactly why this happens. It scars tissues and can cause excruciating pain when menstruating or going to the bathroom because of many different reasons. Endometriosis can happen at any age and can affect your everyday life and your activities. You can have mild to severe back pains and it may affect your fertility as well.
What is polycystic ovarian syndrome (PCOS)?
PCOS is a common hormonal disorder; one in five women are affected by it. The main symptoms are irregular or absent periods, increase in male hormones (which can be detected in a blood test) that lead to excess body hair or acne, and polycystic ovaries. PCOS can differ from person to person; however, environmental and genetic factors can affect and effect people’s lives if they wish to conceive. Although PCOS has no cure, there are ways to alleviate some of the symptoms.
Ways to change your lifestyle
My Mom's friend has PCOS! she said that her period didn't come for a year when she was 20! So she went to the doctor who diagnosed her. - B.
Relaxation
Stress can exacerbate PCOS symptoms. Find ways of managing stress.
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Sleep
Lack of sleep can increase your stress levels and give you cravings.
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Improving diet and exercising
It is one of the most effective ways to help alleviate PCOS symptoms by increasing chances for a healthy pregnancy, improving acne, and reducing risk of diabetes and heart disease. This can also be good for a healthy mind. Find an exercise you can stick to but don’t over push yourself.
Reproductive Tract Infections
Types of reproductive tract infections:
Urinary Tract Infections
(UTIs) are often caused by E. coli bacteria, which usually enter the urethra from the rectum. Symptoms include burning sensation or pain when urinating, blood mixed in urine, no vaginal discharge and not being able to urinate despite the urge.
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Thrush
A common fungal infection that occurs when there is an overgrowth of the fungus (or yeast) called Candida, causing the change in the vaginal pH or hormone levels. Symptoms can include genital itching and/or burning, with watery, white and lumpy vaginal discharge.
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Bacterial Vaginosis
The inflammation of the vagina and infection of the vulva which can affect people of all age, resulting from urinary tract infection (UTI), irritations, and allergic reactions to the chemical residues on sanitary products. Symptoms include unusual vaginal discharge, itching and burning pain.
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Vaginitis
The inflammation of the vagina and infection of the vulva resulting from a urinary tract infection (UTI), irritations, and allergic reactions to the chemical residues on sanitary products. Symptoms include unusual vaginal discharge, itching and burning pain.
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The Menstrual Phases
Follicular, ovulation, and luteal phases
The menstrual cycle is the direct communication between your brain and your body, which happens through hormones influencing your brain. Hormones are what cause us to grow, go through puberty, and have periods!
How long is it?
The menstrual cycle is different from your actual period. The length of the menstrual cycle is the number of days counted from the first day of your period (when you are bleeding) up to and including the day before the start of your next period.
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Day 1 is the first day of your menstrual cycle and day 28 (up to 35) is the last day of your cycle.
For example, if your period starts on the 6th of March and your next period starts on the 3rd of April, then your menstrual cycle is about 28 days long. If you have a short cycle length, you might get your period twice in a month.
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For the first few years after menstruation begins, having a
long cycle is common. However, menstrual cycles tend to shorten and become more regular as you age.
Follicular phase
This starts on the first day of your period. During this time, Follicle-Stimulating Hormone (FSH) is secreted, stimulating follicle production in the ovaries which contain eggs. But what is a follicle? It's a cell which generates hormones. Basically ovaries contain lots of cells, and one cell gets chosen randomly to mature during each cycle. It can then potentially become fertilised (which would make you pregnant).
During this time, the FSH gradually increases the production of estrogen in order to make both your vaginal discharge and the lining of your uterus thin so that sperm can swim through the uterus.
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Ovulatory phase
You have probably heard people saying they're 'ovulating' - M.
LH (Luteinizing Hormone) increases during this phase and releases an egg from the ovaries into the fallopian tubes for fertilisation and pregnancy. This is the ‘hot’ time of the month when you are extra fertile and your body temperature is higher.
Luteal phase
The luteal phase is the second half of the cycle. If you don't get pregnant after ovulation, the empty follicle releases hormones (estrogen and progesterone) to thicken the lining of the uterus to prepare for a possible future pregnancy! After this, the cycle starts again where the uterus lining is shed and you start bleeding!
Irregular cycle
What is defined as an "irregular" cycle?
An irregular cycle is when you detect a significant change to your usual period cycle. You might feel anxious when you experience a lack of period, but this in no way defines your femininity or womanhood.
Irregularities can be caused by different reasons such as extreme weight-loss or excessive exercising, PCOS or other uterine conditions, and some types of medication. Thyroid problems can also mess with your hormone production and make your periods very light, heavy, or irregular. An irregular cycle every now and then is quite common and can be harmless, but make sure to track your period to check if the irregularities continue. Consult your doctor and health care provider if you are worried about your cycle.
irregular periods can be stressful. visit the doctor if you are worried! - S.
Amenorrhea in high level athletes
The lack or interruption of periods within high level athletes is a common phenomenon due to a pause in the secretion of hormones due to an important amount of stress in the body and/or a lack of calorie intake (especially a decrease of body fat).
If you are an athelte undergoing this issue, reducing the amount of sport activity or increasing your calorie intake, specifically consuming enought healthy fats can help. You can also substitute a day in a week of intense sport activity with a milder activity such as yoga.
What is the pituitary gland?
The pituitary gland is a very important gland which is located at the base of your brain. It is small, roundish and pea-shaped. It is responsible for a lot of things as it creates the chemicals which we call ‘hormones’, hence its nickname of the ‘master gland’. These chemicals are what cause us to grow, go through puberty, have periods! It is safe to say that without this gland, this book wouldn’t even exist!
How does the pituitary gland affect my periods?
Once you have reached a certain age, the pituitary gland will start secreting the LH hormone every month. This hormone causes ovulation, which is when your ovaries release an
egg cell which finds its way into the uterus through the fallopian tube.
Emotions During Periods
What is PMDD?
PMDD (premenstrual dysphoric disorder) manifests as severe premenstrual symptoms which affect your everyday life and interfere with your activities. You can feel depressed, anxious, angry, tired, extremely irritable, and suicidal. You might also have very low self-esteem and intense conflicts with your loved ones.
PMDD happens because you are more sensitive to the hormonal fluctuations. PMDD is more common in people with mental illnesses. If you have PMDD, make sure to track your emotions and behaviour during your menstrual cycle. Understanding your emotions and habits during the darkest moments of your PMDD can help you manage your behaviour a bit better. If you feel overwhelmed, please consult your doctor or therapist.
Although PMDD and PMS affect your hormones and mood, it is important for you to take responsibility of your actions by finding ways to alleviate the stress without hurting your loved ones. PMS related stress adds a layer of negativity if you’re already anxious. Tracking your mood can help recognise these signs.
Remember that your stress is always genuine. “It’s just your PMS talking” dismisses your emotions. Although hormonal imbalance during PMDD or PMS worsens your negative emotions, they still come from somewhere.
Gender and Menstruation
Menstruation is a biological function and should not be used as an indication of gender, femininity or womanhood.
While the language used in this book is quite gendered, it is done so to make our book more accessible to people who are not familiar with the evolving language surrounding gender.
While the terms sex and gender are used interchangeably, they are two different things:
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Sex
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Sex is biological and is assigned when a child is born. So your sex is either male, female, or intersex (neither male or female). These are determined by physical attributes like hormones, chromosomes, or anatomy (penis or vulva).
Gender
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Gender is the performance of roles, behaviours, activities, attributes, and opportunities associated with a sex - male, female, or intersex.
Gender Identity
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Gender identity is what we as a person identify as: male, female, non-binary. This is not assigned at birth but relies more on how we feel in our head and heart, what we feel comfortable with, and our behaviour.
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Non-binary
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Non-binary is an umbrella term for people whose gender identity is not defined in terms of traditional binary opposition like male and female.
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Transgender
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Some people's gender identity aligns with their sex assigned at birth (cisgender), and some people's gender identity is different from their sex. Transgender is a person whose sense of personal identity and gender is different from the sex assigned at birth.
For example, a trans woman is someone who was assigned as male at birth but identifies as a woman or has transitioned into a female.
Trans women do not menstruate as they do not have a uterus. Some women who have a uterus, also don't menstruate due to factors like menopause, stress, hysterectomy, or underlying medical conditions. But this does not define them as ‘lesser’ women.
Some women and trans women have to fight to justify themselves as female to others due to not menstruating. Menstruation doesn’t define the essence of a woman.
A trans man is a man who was assigned female at birth. Since trans men are born with a uterus, many will experience menstruation during their lifetime. This can be distressing due to dysphoria and lack of sanitary bins in men's bathrooms, which makes it hard to dispose of sanitary products. Trans men will usually see their periods stop after a few months on hormone therapy, though this can vary and they can come back if the testosterone dosage is changed.
Menstruation can be a tricky subject to navigate as a trans or non-binary person or someone struggling with gender dysphoria. Menstruation is not a ‘woman’s thing’ - it is a biological function and should not be used as an indication of gender, femininity, or womanhood.
You should treat everyone with respect and kindness - S.
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