Periods
Why we bleed
Whether we like it or not, many bodily functions are directly and solely related to making babies. Periods are one of those things! Let’s cover a few basic definitions before we discuss. A fetus (what we call a baby-in-development) is created when a sperm (from someone with testicles) “fertilizes” an egg (in someone with ovaries). The only time an egg can be accessed is after something called “ovulation” which is the term for one ovary releasing an egg into the uterus. It hangs out for about 24 hours and then passes out of the vagina if it isn’t fertilized by a sperm. (You can learn more about pregnancy by clicking the link below).
Now, on to periods. The uterus spends about a week every month building up a nice, comfy environment in preparation for a “maybe baby” — you know, just in case. When the uterus is super sticky and welcoming, an egg is released from an ovary into the uterus (ovulation). If the egg fails to be fertilized by a sperm (which happens the vast majority of the time), it simply passes through the uterus and out of the vagina,. The uterus then thinks, “dang! missed that one! let’s freshen up and try again later.” For the next couple of weeks the uterus prepares to shed its lining and then, when it’s ready, releases it in the form of a period. (Think of this process kinda like peeling an orange.) After the shedding (period) is complete, it starts the process all over again. And that’s the period cycle.
Is there a way to know when my first period will come?
There’s no way to know for sure, but I have a few suggestions. The first is to figure out where you are in puberty. The period usually starts 2.5 years after the first sign of breast development. Another thing you may notice about 6-12 months before your first period is a clear-white vaginal discharge when you wipe or on your underpants. This is called physiologic leukorrhea and is a normal part of having a vagina. It’s also a sign that your period may not be too far behind. And lastly, you could ask your mom or other folks in your family who menstruate when they had their first period. Genetics plays a factor in when you’ll have your first period.
Schedule
As discussed above, periods are a sign that the body has matured to a point that carrying a fetus is possible (though, again, not going to happen during most, if any, period cycles). This occurs a couple of years into puberty around the age of 12.5, though age definitely varies from person to person. Ultimately, period should be quite predictable (meaning that you can know ahead of time when your period should be coming). However, it’s VERY normal for periods to be irregular during the first couple of years.
When things finally settle into place, a period should happen every 21-45 days (anywhere within that huge range is considered average) and the bleeding last for 3-7 days. Bleeding is usually most heavy on day 2 but lightens during subsequent days. But if it’s been a few years and you’re still off, check out the section below (and talk with your doc).
My period is watery and pink! Am I anemic?
The consistency of your menstrual flow really isn’t a reliable indicator of anemia or poor nutrition. Instead, heavy blood loss can cause anemia, and insufficient calorie intake can stop your period. However, the color and consistency of your period flow can be watery and pink one day and turn chunky and bright red the next. It also depends on hormone levels, other medications and cervical mucus, so don’t count on period blood flow to be an indicator of anemia or nutrition.
Colors and textures
Periods come in a variety of colors and textures — often rotating through them all during the same cycle! When it comes to colors, anything from brown or black-ish to bright red or pink can all be healthy. A brown/rust or black appearance just means that the blood has “oxidized” and turned a darker color. It is nothing to worry about, unless it’s accompanied by other symptoms like vaginal pain or itching.
Textures can be explained by understanding what exactly is happening with a period (see above section). Thin and watery blood is generally from an exposed blood vessel in the uterus. Clumps of tissue are likely small pieces of the lining of the uterus. And mucus can arise from vaginal or cervical discharge. All are healthy!
What’s this brown, thick discharge when I’m not on my period?
This sounds like spotting. Even though it’s not bright red blood, brown discharge is generally still blood that has just been hanging out for a little while.
Periods produce bright red blood because shedding of the lining of the uterus exposes blood vessels. These blood vessels leak blood that comes out right away. However, it’s possible for blood to hang out in your uterus for a little while and, when it does, it turns brown. That’s why we still call it “spotting.”
Why is it called spotting? When you aren’t on your period, blood that comes from the uterus (whether brown or red) is generally called spotting (when you don’t need to wear a pad or tampon but you notice stuff in your underwear or when you wipe) or breakthrough bleeding (when you need a product to catch the blood). Other things that cause strange vaginal discharge (like STIs, BV or yeast infections) tend to be white, yellow or greenish, though in a small percentage of cases the discharge can be brown. If you have concerns about STIs, or if you have other vaginal symptoms like itching or burning when you pee, you should see a doctor.
Honestly, we don’t always know what causes spotting. Common causes are changes in birth control and missing a dose of birth control, though conditions like endometriosis and PCOS can also be to blame. Spotting every once in a while is nothing to be alarmed about, but if your periods become irregular or if the spotting continues, it would be best to speak with a doctor.
The hymen
Why are we talking about the hymen here? Because many individuals discover the hymen around the time of tampon or menstrual cup insertion.
The hymen is a piece of tissue that surrounds the vaginal opening. It’s usually a loose flap of skin (think of curtains around a window) that needs a little stretching or loosening before anything can be inserted into the vagina (including a tampon or a penis). The way this is accomplished is different from person to person. Sometimes the hymen can tear a little while riding a bike or running around as a child. Other times the hymen will tear only after it has been penetrated by a penis or a finger (this is where the old term “popping the cherry” comes from). And because everyone’s hymen is a little different, it’s impossible to look at a hymen and determine if that person has had sexual intercourse or if anything else has been inserted into the vagina.
There are some conditions when the hymen is a little…extra. Specifically, sometimes it can partially cover the vaginal opening with an extra strand of tissue (called “septate”) or completely cover the vaginal opening with or without little holes (called “cribriform” and “imperforate,” respectively). In these cases it may be difficult to fit in a tampon, finger or penis. You can look for yourself with a mirror and/or a doctor can make an official diagnosis. If you have one of these variants—don’t worry! It’s absolutely treatable, and your doctor can help you with next steps.
Why won’t my tampon go in?
Tough to say, but there are generally three main causes of difficulty with vaginal entry.
First is more hymen tissue. That flap of skin that surrounds the vaginal opening can sometimes make the hole a little tight, or there might be an extra strand of hymen that crosses the vaginal opening. Sometimes just using a little water-based lube will help you slide the tampon in, but other times it may require the assistance of a doctor (we can take a look and discuss vaginal dilators or other therapy).
Second is tight vaginal wall muscles. When we are tense and anxious our muscles can tighten up, and this can be the case for the muscles in the vaginal walls, too! This can make tampon insertion difficult. Try to relax and position yourself with one leg up (like on the tub or toilet seat) or lay down on the ground.
Third is vaginal dryness. Even if you’re on your period, the inside of the vagina can be moist one minute and dry the next (depending on your flow). In order to make sure things are lubricated you can use that water-based lube to help with insertion.
Bad behavior
As discussed, it can take a couple of years for period hormones to regulate, so a wonky period schedule can be normal…at first.
Now let’s say you’ve had your period for a couple of years. If you’re finding that your period still lasts longer than 7 days, or if it happens outside the “normal” window of every 21 to 45 days, you may need a little extra hormone regulation to get your period on schedule. This is accomplished with the use of birth control or a hormone burst. Check out the link to learn about the different types of birth control and how they can be used to regulate a period schedule.
Another indication for birth control (or “hormone” control) is very heavy bleeding or very painful periods. Just because you have a uterus doesn’t mean you need to suffer every month.
(And one last little bonus: combination birth control pills may also help with acne!)