Menstruation, also known as menstruation, is the expulsion of blood and other substances from the lining of the uterus every about a month from puberty to menopause (except during pregnancy). The first period usually begins between the ages of twelve and fifteen The point in time is called menarche.
Each month one of the ovaries releases an egg – a process called ovulation . Meanwhile, hormonal changes prepare the uterus for pregnancy. If ovulation occurs but the egg is not fertilized, the lining of the uterus is shed through the vagina. 
The days of a menstrual cycle are counted from the first day of menstruation, when blood begins to flow from the vagina. A typical cycle is 28 days. Cycles 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 and secretory phases.
- Ovarian cycle – follicular phase ovulation luteal phase.
Menstrual Phase (day 1-5)
The menstrual period begins on the first day of menstrual cramps and lasts until the fifth day of the menstrual cycle. The uterus sheds the lining of soft tissue and blood vessels, which exit the vagina in the form of menstrual fluid. Blood loss of 10ml to 80ml is considered normal. Abdominal cramping may occur. These cramps are caused by the contraction of the uterine and abdominal muscles to expel menstrual fluid. The endometrium sheds the lowest levels of estrogen and progesterone.
Proliferative Phase (day 6-14)
Graffi follicles mature, and the endometrium of Graffi follicles secretes estrogen. Increased number of endometrial cells. Endometrial thickness increased from 1mm to 4.6mm. Due to the secretion of estrogen, a new lining of the uterus begins to form.
Secretory Phase (day 15-28)
During the secretory phase, progesterone (as well as estrogen) is secreted by the corpus luteum that develops from the Graafian follicle. Progesterone secreted by the corpus luteum stimulates further formation of endometrial cells. It also stimulates the glands The uterus secretes substances that maintain the lining of the uterus and prevent it from rupturing. The thickness of the endometrium further increases, and the number of endometrial cells also increases. Smooth muscle shows relaxation. The lining of the uterus becomes easier to implant, thereby supporting early pregnancy.
Follicular Phase (day 1-13)
This phase also begins on the first day of menstruation but continues 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 the egg cells matures. When an egg cell matures, its follicle secretes a hormone Stimulates the uterus to form the vascular lining and soft tissue called the endometrium.
Ovulation (day 14)
The pituitary gland secretes a hormone that causes the ovaries to release mature egg cells. The released egg cell is swept into the oviduct by the cilia of the fimbriae. Under the influence of the LH surge, the Graafian follicle ruptures and releases the egg.
Luteal Phase (day 15-28)
This phase begins on day 15 and continues until the end of the cycle. Under the action of the pituitary hormones FSH and LH, the corpus luteum develops and increases progesterone levels. The egg released during ovulation stays in the fallopian tube for 24 hours. if a sperm Cells that do not impregnate the egg cell The egg cell disintegrates and causes the menstrual period of the next cycle to begin. 
Menstrual Health And Hygiene Management
Menstrual health management is a human right  Women and girls must use clean menstrual management materials to absorb or collect blood. Cleaning with soap and water must be used and there must be proper facilities for disposal of used period management materials. menstruation is a Natural process, but it’s contraindicated in most parts of the world. It must be managed properly or it can lead to health problems. 
Different Menstrual Products
- Sanitary pads: These menstrual pads come in different sizes, shapes, lengths and thicknesses. They can be disposable or reusable. Some have wings that fold over the sides of the panties. 
- Cloth pads: These are reusable, but can absorb menstrual blood, making them soggy and not effective for period protection. 
- Tampon: It is inserted into the vagina during menstruation to absorb blood and vaginal secretions. Unlike a pad, it is placed inside the vaginal canal. Once inserted properly, the tampon is held in place by the vagina. It swells when blood is absorbed. 
- Menstrual Cup: It is an environmentally friendly reusable flexible cone that can be inserted into the vagina. It can collect menstrual fluid. The collected liquid can then be disposed of, and the cup can be reused when properly cleaned. 
- Menstrual disk: It is round and has a flexible ring with a clasp at the bottom of the cervix at a place called the vaginal vault. 
- Menstrual panties: These look and feel like regular underwear, but they collect blood. They are washable and reusable
Proper disposal of used menstrual material is still lacking in many countries around the world. Most women dispose of their sanitary pads or other menstrual products in the household waste or trash can, where they end up as part of the solid waste. The best option is to use reusable and Non-commercial sanitary materials, such as reusable sanitary pads and menstrual cups, produce lower amounts of menstrual waste than using commercial disposable sanitary pads. If the product used is reusable, please wash it with water, disinfect it and store it cleanly for next use. If it is a one-time use correct guide. 
- Premenstrual Syndrome – This is a syndrome characterized by physical and psychological symptoms in women of childbearing age. Monthly physical and psychological symptoms including irritability, hot flashes, dizziness, muscle cramps, breast soreness, acne, bloating Headaches Anxiety Depression Poor concentration Appetite changes Low energy etc  Sudden fluctuations in hormones are responsible for this.  The severity of symptoms may vary from woman to woman. 
- 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 and 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 of heavy bleeding, which disrupted her daily activities, and she had saturated enough sanitary napkins that they needed to be changed regularly 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 menstrual pain may cause spasms in the pelvic floor muscles, resulting in hypertonic dysfunction. The pelvic floor muscles may become tight, causing vaginismus, among other things.
- Postmenopausal bleeding – Bleeding from the genital tract after menopause. The etiology includes malignant vaginitis, uterine prolapse, etc. .
The role of physical therapy in menstrual rehabilitation
The management includes two categories
- General management
- Pelvic floor rehabilitation for menstrual disorders: This includes pelvic floor exercises.
This includes diet management, exercise regimes, stress management and yoga. 
Avoid sugary diets Excessive amounts of raw meat Fried foods Fast food Sodas Alcoholic and caffeinated beverages. Foods to eat include green leafy vegetables, oats, avocado, broccoli, olives, walnuts, almonds, beans, lentils, and legumes. Berries can also be taken with naturally processed foods such as milk butter and curd. Salmon and tuna fish oils have great health benefits and are suitable to be taken during menstruation.
Exercises And Modalities
Aerobic  and resistance exercise play an important role in reducing pain  discomfort. 
Method: TENS hot compress acupuncture point sticking. 
It is very important to manage stress and anxiety because it can negatively affect menstruation. Breathing exercises and relaxation techniques can be a great way to help reduce stress and anxiety. Meditation also plays an important role in managing stress. Meditation is usually defined as thinking about Constantly think about an object. It’s important to pick up some hobbies that help divert your attention. Bathing with Luke’s warm water and Epsom salts can also help reduce stress levels. 
Different yoga poses like Bhujangasana Malasana Usthrasana Baddha konasana and Dhanurasana help relieve pain and discomfort during menstruation.  (See Yoga and Mindfulness for Pelvic Health)
Pelvic Floor Rehabilitation
Rehabilitation depends on the discovery of the pelvic floor muscle grade. People with PCOS and endometriosis may experience pelvic floor tightness while breastfeeding, or those with low estrogen levels may experience pelvic floor muscle weakness. It is involved in the treatment of various menstrual disorders.   Rehab includes a variety of pelvic floor exercises.  The pelvic floor muscles are skeletal muscles. They can be strengthened by repeating the same exercises overtime training and retraining.
- Mirror biofeedback, mirrors can be used to visualize pelvic contraction and relaxation. 
- Use of vaginal dilators: After menopause, the vagina becomes dry, less elastic, narrower and shorter. A vaginal dilator can be used to stretch the vagina. 
- Kegel exercises: It’s all about finding the right pelvic floor muscles and making them work. Most of them contract their abs buttocks or inner thigh muscles without benefiting from the exercise. 
- IFT, US.
- NMR: Aids in the rehabilitation of shortened muscles and tendons. 
- Soft Tissue Mobilization: Uses hands-on techniques on your muscle ligaments and fascia with the goal of breaking adhesions and optimizing your muscle function.
- Lower limb stretches.
- Identify and activate the correct muscles.
- Relaxing tight and overactive muscles
- Control and do the right movement at the right time
- Learn to coordinate the pelvic floor muscles with the diaphragm, deep abs and other core muscles.
- Control abdominal pressure and avoid damaging the pelvic area with high-intensity activities, wrong ab exercises or coughing.
- Integrate functional workouts with your daily activities and movements. 
- ↑ 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]
- ↑ Menstrual hygiene. Environmental health group. Available from https://ehg.lshtm.ac.uk/menstural-hygiene/ [last accessed 06/10/2020]
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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)
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- ↑ 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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