Menstruation, also known as periodization, is a process in which blood and other substances are removed from the uterus over a period of approximately one month from puberty to menopause except during pregnancy. The first period usually begins between the ages of twelve and fifteen if period of time known as menarche.
Every month, one of the ovaries produces an egg — a process called ovulation. At the same time, hormonal changes prepare the uterus for pregnancy. If ovulation occurs and the eggs are not retrieved, the lining of the uterus sheds through the vagina.
The countdown to menstruation begins on the first day of menstruation when blood begins to flow from the vagina. A typical cycle is 28 days.The cycle may be as short as 21 days or as long as 40 days.
There are 2 cycles to be understood.
- Uterine cycle – Menstrual phase Proliferative phase and Secretory phase.
- Ovarian kyinhyia – Follicular phase Ovulation Luteal fã.
Menstrual Phase (day 1-5)
The menstrual phase begins on the first day of the menstrual cycle and continues until day 5 of the menstrual cycle the water is poured. A blood loss of 10 ml to 80 ml is considered normal. They can have stomach ulcers. These cramps are caused by contraction of the uterine and abdominal muscles to expel menstrual fluid. Endometrial estrogen and progesterone are secreted at very low levels.
Proliferative Phase (day 6-14)
There is growth of the graffian folllicles and estrogen is secreted by the theca interna of the graffian follicle. Increased number of endometrial cells. The thickness of the endometrium increases from 1mm to 4.6mm. Due to secretion of estrogen formation of new endometrial layer begins.
Secretory Phase (day 15-28)
During the secretory phase, progesterone (as well as estrogen) is produced by the corpus luteum, which arises from the Graafian follicle. Progesterone secreted by the corpus luteum stimulates further accumulation of cells in the endometrium. It also stimulates the nervous system of. the uterus to remove substances that preserve the uterus and prevent degeneration. The thickness of the endometrium further increases and the number of endometrial cells increases. Smooth muscles reflect relaxation. Endometrium becomes recognized for implantation and thus supports early pregnancy.
Follicular Phase (day 1-13)
This phase also begins on the first day of menstruation but lasts until day 13 of the menstrual cycle.The pituitary gland secretes a hormone that stimulates the growth of egg cells in the ovaries. One of these egg cells develops. As the egg cell matures its gland secretes a hormone which stimulates the uterus to form a lining of blood vessels and soft tissue called the endometrium.
Ovulation (day 14)
The pituitary gland secretes a hormone and causes the uterus to release mature egg cells. The membranes of the fimbriae are used to sweep the released egg cells into the uterus. Under the influence of LH surge the Graafian follicle ruptures and releases the ovum.
Luteal Phase (day 15-28)
This phase begins on day 15 and lasts until the end of the cycle. Under the influence of pituitary hormone FSH and LH stimulate corpus luteum growth and increase progesterone levels. Eggs released at the ovulation stage remain in the fallopian tube for 24 hours the cells do not fertilize the egg cells the egg cells divide and the menstrual phase of the next cycle begins.
Menstrual Health And Hygiene Management
Menstrual health care is a human right. Women and adolescent girls should use clean menstrual pads to absorb or collect the blood. should be cleaned with soap and water and there should be adequate places for menstrual supplies. Brain is a a natural phenomenon but in most parts of the world it is taboo. It must be carefully managed otherwise it can cause health problems.
Different Menstrual Products
- Sanitary napkins: These are menstrual napkins available in different shapes and sizes. It may be disposable or recyclable. Some have wings that fold down the sides of the underwear.
- Fabric covers: Reusable but absorb menstrual blood making it wet and ineffective for period protection.
- Tampons: Absorbs blood and vaginal secretions by being inserted into the vagina during menstruation. Unlike a pad it is placed inside the vagina. Once properly inserted, a tampon is held in place in the vagina. It spreads with blood circulation.
- Menstrual cups: It is ecofriendly reusable flexible cone shaped which can be inserted into the vagina. It can accumulate menstrual fluid. The collected water can then be discarded and the cup reused after thorough rinsing.
- Menstrual discs: They are round and have a soft ring with a catch that sits below the uterus in an area called the vaginal fornix.
- Menstrual panty: They look and feel like regular underwear but can collect blood. Washable and reusable.
There is still no proper disposal of used menstrual products in many countries of the world. Most women dispose of their sanitary products or other menstrual products in the household solid waste or garbage cans that eventually become part of the solid waste. The best choice is to use reusable and non-commercial sanitary products such as cloth covers for reusable menstrual cups and thus generate less menstrual waste compared to using commercial disposable cloths. If the container is recyclable, clean it with water sterilizer and store it clean for further use. If it’s disposable use it properly guidelines.
- PREMENSTRUAL SYNDROME – A syndrome characterized by the combination of physical and psychological symptoms seen in women of reproductive age. Monthly symptoms are both physical and mental including irritability hot flushes vertigo muscle cramps breast pain acne bloating headache anxiety depression depression difficulty concentrating appetite changes low energy etc. This is caused by sudden changes in cells. Sometimes it can be so severe that it is necessary to miss work or school.The severity or severity of symptoms can vary between women.
- Menorrhagia – frequent periods, 2-3 weeks apart. Blood loss is usually normal.  In this case, ovulation may occur earlier than usual, or at an irregular time during the cycle. Some women may have a shorter luteal phase. 
- Oligomenorrhea – This condition is characterized by infrequent or very infrequent periods when previous periods were normal. Causes include hormonal imbalances eating disorders such as anorexia nervosa stress (both physical and psychological) chronic diseases etc. 
- Amenorrhea – characterized by the absence of menstruation in women of childbearing age. There are two types of amenorrhea, primary amenorrhea and secondary amenorrhea. In primary amenorrhea, puberty may be delayed, usually in thin or athletic women. in middle school Amenorrhea Absence of menstruation for more than 3 cycles. It can be caused naturally by pregnancy, breastfeeding and menopause. Other causes include obesity, sudden weight loss, high stress, frequent strenuous exercise, PCOS or PCOD, etc.
- Dysmenorrhea – It is characterized by severe painful cramps during menstruation. It includes 2 types; primary refers to the usual menstrual cramps due to uterine muscle contractions, and secondary due to underlying pathology such as endometriosis.   Symptoms may include cramping or lower abdominal pain, lumbago or lower extremity radiating pain, nausea, vomiting, diarrhea, fatigue, weakness, fainting, headache, etc.
- Menorrhagia – heavy or prolonged bleeding at regular intervals.  It is considered the most common type of abnormal uterine bleeding. The woman complained that heavy bleeding disrupted her daily activities and that she had saturated enough pads to require regular changes Hour. Her menstrual bleeding can last more than 7 days. 
- Menstruation – Irregular heavy bleeding and bleeding between periods.  Vaginal bleeding occurs at irregular intervals, which is usually not associated with menstrual bleeding. It does not represent normal times. A woman may feel as if she is having a second period at another time moon. 
- Polycystic Ovary Syndrome – This is a hormonal and metabolic disorder. In this type, the ovary is unable to release an egg due to the many small fluid-filled follicles. Causes include hyperinsulinemia and genetic hyperandrogenism. Symptoms include weight gain, acne, susceptibility to diabetes, etc. 
- Polycystic Ovary Disease – Symptoms are almost the same as PCOS. The ovaries contain immature eggs that can become cysts due to the stress of excessive junk food consumption or being overweight. 
- Endometriosis – A condition in which endometrial tissue is outside the uterus. This can lead to adhesions and scar tissue formation, which can cause severe pain and discomfort. Common symptoms include dysmenorrhea, dysuria, intercourse bleeding, etc. .
- MUSCULAR PAIN
- PELVIC FLOOR DYSFUNCTION – Chronic and severe pain can cause pelvic floor muscle to spasm resulting in hypertonus dysfunction. Pelvic floor muscles can tighten causing vaginismus dysareunia and more.
- POST MENOPAUSAL BLEEDING – Bleeding from the vagina after menopause. Causes include malignancy vaginitis uterine prolapse and so on.
The Role of Exercise in Menstrual Regulation
The management includes two categories
- General management
- Pelvic floor rehab for menstrual disorders : This includes pelvic floor exercises.
This includes diet plan exercise methods stress management and yoga.
Avoid sugary food Excess raw meat fried Fast foods soda alcohol and caffeinated beverages. Foods to eat are green vegetables oats avocado broccoli olives walnuts almond beans and legumes and legumes. Berries Organic foods such as milk butter and curds can also be consumed. Fish oil salmon and tuna have great health benefits and are best consumed during menstruation.
Exercises And Modalities
Aerobics and resistance exercise play an important role here to reduce pain discomfort.
Method : TENS Hot pack Acupuncture Acupressure Taping.
Managing stress and anxiety is very important as it can have negative effects on menstruation. Breathing exercises and relaxation techniques can positively help reduce stress and anxiety. Meditation also plays an important role to manage stress. Meditation is often defined as meditation go on about one consideration. It is important to have some hobbies to help divert your attention. Luke’s warm water and Epsom salt baths also helped reduce stress.
Various yoga poses such as Bhujangasana Malasana Usthrasana Baddha konasana and Dhanurasana help to ease the pain and discomfort associated with menstruation.(see Yoga And Mindfulness For Pelvic Health)
Pelvic Floor Rehabilitation
Rehabilitation is based on findings of pelvic floor muscle grade. Individuals with PCOS and endometriosis may experience lower pelvic tightening while breastfeeding or individuals with low estrogen may have weakness in pelvic muscles. It involves the treatment of menstrual disorders. Rehabilitation includes a variety of spinal exercises. Pelvic floor muscles are skeletal muscles. They can be trained back trained reinforced by over repeating the same exercises.
- Mirror biofeedback in which mirrors can be used to visualize pelvic contractions and relaxation.
- Use of vaginal dilators: After menopause, the vagina becomes less dense and narrower and shorter. Vaginal dilators can be used to dilate the cervix.
- Kegel exercises: It involves finding and activating the right muscles in the pelvis. Most of them contract the pelvic floor or thigh muscles and do not reap the benefits of the exercise.
- IFT, US.
- NMR : Helps repair shortened muscles and tendons.  .
- Soft tissue mobilisation: Use gestures on your muscle ligaments and fascia with the goal of breaking down adhesions and allowing your muscles to function more efficiently.
- Lower limb stretches.
- Identifying and activating the right muscles.
- Relaxing tight and overactive muscles
- Complying with the right exercises and doing them at the right time
- Learning how to coordinate the pelvic floor muscles with the diaphragm forming the deep abdomen and other major muscles.
- Controlling abdominal pressure and avoiding damage to the pelvic area through high impact activities wrong abdominals exercises or inflammation.
- Combining functional exercise according to your daily routine and sport.
- ↑ LiveScience. What is ovulation? Available from https://www.livescience.com/54922-what-is-ovulation.html [last accessed 26/10/2020]
- ↑ Office of womens health. Menstrual cycle. Available from https://www.womenshealth.gov/menstrual-cycle/your-menstrual-cycle [last accessed 26/10/2020]
- ↑ Nemours KidsHealth.The Menstrual Cycle. Available from: https://www.youtube.com/watch?v=vXrQ_FhZmos [ Last accessed, 26/10 /2020]
- ↑ Homework Clinic. Uterine (menstrual) cycle – phases. Available from: https://www.youtube.com/watch?v=NeEEQPAg5ms [ Last accessed, 21/10/2020]
- ↑ Saint Augustine. Part 4 The Follicular Phase. Available from: https://www.youtube.com/watch?v=A83rVAhIc3w [ Last accessed, 21/ 10 /2020]
- ↑ Fletcher.J. Medical News Today. What are the phases of the menstrual cycle? Available from https://www.medicalnewstoday.com/articles/326906 [last accessed 06/10/2020]
- ↑ Saint Augustine. Part 5 The Luteal Phase. Available from: https://www.youtube.com/watch?v=axTYshn9stk [Last accessed, 12/10/2020]
- ↑ Janux. Human Physiology – Hormonal Secretion during the Luteal Phase. Available from: https://www.youtube.com/watch?v=l2vYxvD3F9E [ Accessed, 12/10/2020]
- ↑ Pitre.S. Innovations in health care. Menstrual health management is human right. [last accessed 06/10/2020]
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- ↑ Kaur R, Kaur K, Kaur R. Menstrual hygiene, management, and waste disposal: Practices and challenges faced by girls/women of developing countries. Journal of environmental and public health. 2018 Feb 20;2018.
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- ↑ Jump up to:19.0 19.1 19.2 19.3 19.4 19.5 19.6 19.7 Hiralal Konar. DC Dutta’s Textbook of Obstetrics, Jaypee Brothers Medical Publishers; eigth edition (1 January 2015)
- ↑ Premenstrual syndrome. Office of womens health. Available from https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome#:~:text=Premenstrual%20syndrome%20(PMS)%20is%20a,bloating%2C%20headaches%2C%20and%20moodiness. [last accessed 08/10/2020]
- ↑ polymenorrhoea. Health line. Available from https://www.healthline.com/health/polymenorrhea#:~:text=Polymenorrhea%20is%20a%20term%20used,form%20of%20abnormal%20uterine%20bleeding. [last accessed 08/10/2020]
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- ↑ Dysmenorrhea. Cleaveland clinic. Available from https://my.clevelandclinic.org/health/diseases/4148-dysmenorrhea#:~:text=Dysmenorrhea%20is%20the%20medical%20term,Dysmenorrhea%20Menu [last accessed 08/10/2020]
- ↑ WebMD. What Is Adenomyosis? Available from https://www.webmd.com/women/guide/adenomyosis-symptoms-causes-treatments#:~:text=Adenomyosis%20is%20a%20condition%20in,can%20result%20in%20heavy%20periods. [last accessed 26/10/2020]
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- ↑ PCOD. Columbio Asia . Available from https://www.columbiaindiahospitals.com/health-articles/what-polycystic-ovarian-disease-pcod-causes-treatment#:~:text=Polycystic%20Ovarian%20Disease%20(PCOD)%2C,difficult%20for%20her%20to%20conceive. [last accessed 08/10/2020]
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- ↑ FoxChase cancer center. 5 things to know about Postmenopausal Bleeding. Available from https://www.foxchase.org/blog/5-things-know-about-postmenopausal-bleeding#:~:text=In%20most%20cases%2C%20postmenopausal%20bleeding,a%20small%20number%20of%20cases. [last accessed 26/10/2020]
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