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How does menstruation proceed during one period?

How does menstruation proceed during one period?


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I'm simplifying things here:

A. Does a woman bleed constantly, like a drop every 10 minutes? Two hours without pad or tampon and your underwear is dirty?

or

B. Does a woman bleed suddenly a bigger amount of menstruation fluid? Then hours might pass before it happens again?

or

C. Both.

Might be a stupid question. I'm sorry. I read all the other information on the internet but no one answers this one for some reason. I read girls should change the pads and tampons a few times a day (like every 6 hours). Does that mean A is correct?

Thanks for any helpful information!

(Well, I guess I'm male.)

Edit:
What I want to know: If I was a woman, how would I experience the days of period bleedings? From what I read in the comments and answer(s), one should expect A (constant bleeding) and should wear pads/tampons all the time (for 2 to 7 days) and sometimes one could also experience an exceptional heavier bleeding (B)? Are there (healthy) women who would experience B most of the time? I visited Wikipedia and other random sites but they all have the other important information without answering my question. (Also I will be glad to accept an answer, which satisfies my need for knowledge.)


This isn't much of an answer but here goes… Two things; it depends on which day of the period it is. There can be rather brief, heavy bleeding on the later part of the first day or sometime during the second. On most others days, the bleeding will be lighter with drop every now and again. I think most women would agree with me on the fact that when there is a rather heavy flow it can be felt. So, to boil things down, the correct answer is C. Here are a couple of links to sites that will back me up on this: Advice From AnnaMarie and Center for Young Women's Health.


The answer is both. Different women experience menstruation differently depending on the levels of different hormones in their body, personal medical conditions, medications, on their age, and the activities they do in their lives. Bleeding is due to the sloughing off of the highly vascularized endometrial lining of uterus which is no longer receiving the appropriate levels of progesterone for its maintenance from the corpus luteum, in the absence of an implanted embryo in the uterus. You can imagine how different this common event would be if a woman was taking warfarin, had a bleeding or coagulation disorder, had polycystic ovarian syndrome, was a runner, or was a 13-year-old vs a 41-year-old. It varies!

Source:

  • Welt et al. Physiology of the Normal Menstrual Cycle. Last updated Feb 28, 2014. http://www.uptodate.com/contents/physiology-of-the-normal-menstrual-cycle.
  • http://www.womenshealth.gov/publications/our-publications/fact-sheet/menstruation.html

Basically there is every variation under the sun possibly but I have structured my answer so that the more common variations are earlier.

On average a woman loses around 30-40 ml of fluid, this is a combination of mucous, secretions, endometrial tissue and around 50% blood. Because of this it is a slightly darker colour than just regular old blood. This of course varies with women with blood disorders or taking medication to "thin" the blood bleeding a lot more. The second day is typically the worst. On the worst day a woman may use 3-6 pads but this can be substantially more and changing every 2-3 hours is not uncommon. It is most typically more or less constant with some worse moments in the day, but there is a huge variation.

Clots are quite common but not all women get them. They're typically more common in older females and may look just like tissue. The size of these clots can very from the size of peas to grapes and even larger than 6-7cm in some women. This is a little more worrying as this may cause anaemia or iron deficiency unlike the regular bleeding above which typically doesn't. Women affected with blood clots are much more likely to have pain.

Pain itself is more common in younger women. However usually this settles down and usually it is not painful enough to affect daily activities. In some women however they get dysmennorrhea which basically means painful uterine cramps. This is because the blood flow to the uterus is restricted due to the hormone balance and the muscle is contracting really powerfully. The lack of blood flow causes the muscle to get starved of oxygen and the pain is said to be similar to angina or like a heart attack (both being caused by a similar mechanism).

Menorrhagia is the medical term for heavy periods. This is characterised by more than 80 ml of fluid each month and affects 1 in 10 women. Usually this is diagnosed by the number of pads and tampons used. Women affected by this may require to double protect, use both a tampon and pad. They may also take a number of extra underwear or trousers to work. The symptom affecting these women is termed flooding. Unexpectedly they get a "flood" which just basically goes everywhere and is uncontrollable and is usually quite a lot of volume. This is sometimes due to an underlying disease, of which, is most commonly fibroids but may also be contraceptive devices that go into the womb/uterus, blood thinners or polycystic ovary syndrome.

There is however much variation. Some women will have only 10ml or so of blood (light periods) and that's normal for them. Some women may have irregular bleeding lasting all month. Other women may have longer periods such as 10 or even 20 days per cycle. And then cycles themselves can vary from short (20 or so days) to very long with only a few cycles per year. Basically there is every variation possible under the sun.


It’s time to squash that age-old myth: Your period doesn’t protect you from pregnancy. There are a couple of reasons why. First, some women may bleed when their ovaries release an egg each month, called ovulation, and mistake it for their period. You’re at your peak fertility when you ovulate. So if you have sex during this time, it could actually make you more likely to get pregnant.

Second, you may ovulate before your period is over or within a few days after the bleeding stops. Since sperm can hang out in your body for up to 3 days, having sex during your period could lead to conception.

Use a condom or other form of birth control to prevent an unplanned pregnancy, no matter what time of the month it is.


Important monthly cycle hormones

The reproductive system is influenced by hormones that are regulated by the hypothalamus and the gonadotropin-releasing hormone (GnRH). GnRH causes the cells in the frontal part of the pituitary gland to produce two types of hormones.

The first hormone is follicle-stimulating hormone (FSH), and the other is luteinizing hormone (LH). These hormones travel all the way to the ovaries, where they influence estrogen and progesterone levels and help the follicles inside the ovaries mature.

Some of the matured follicles will eventually release eggs, which travel down the uterine tubes, where they can be fertilized before moving to the uterus. The complex hormone interaction that makes this possible is called the hypothalamic-pituitary-ovarian axis.

At the end of a cycle right before menstruation, estrogen and progesterone levels drop, causing an increase of FSH and GnRH levels.

All the hormones involved in the hypothalamic-pituitary-ovarian axis rise in one phase of the menstrual cycle and drop in the other. All of these fluctuations affect ovulation and can cause symptoms like acne, negative mood, headache, weight gain, bloating, and appetite changes.

Now let’s take a look at how hormone levels change during the cycle stages.


There are also many possible reasons for irregular periods. The most likely are excessive stress, extreme exercising, or extreme weight fluctuations. Just like with late periods, irregular periods can also be caused by PCOS, high levels of prolactin, or thyroid issues.

Irregular periods can influence the ability to get pregnant. Stress, bodyweight fluctuations, PCOS, hyperprolactinemia, and hyper- or hypofunction of the thyroid gland can all cause irregular periods. Irregular periods are usually associated with problems with ovulation, which may influence the ability to get pregnant.


Women speak sooner than men, they’re more verbally fluent than men, and they’re actually better at spelling than men – Pauline Maki

One way women are different is that they have superior social skills. Women have better empathy and theory of mind – the understanding that other humans may have a perspective different to our own. They also have better communication skills. This is thought to be part of the reason that male children are four times more likely to be diagnosed with high-functioning autism girls are better at disguising their symptoms.

“Women speak sooner than men, they’re more verbally fluent than men, and they’re actually better at spelling than men,” says Pauline Maki, a psychologist at the University of Illinois, Chicago.

Women have better verbal skills than men, perhaps an evolutionary result of needing to convey information to their children (Credit: Getty Images)

This social advantage is thought to have evolved because, thousands of years ago, articulate mothers would have been better at conveying vital information to their children – such as not to eat certain poisonous plants.

But are hormones involved? And if so, how much?

Hormonal balance

Back in 2002, together with colleagues from the Gerontology Research Center in Baltimore, Maki set out to learn how fluctuating oestrogen levels affect women’s abilities over the course of each month. Each participant was assessed twice: once just after their period, when oestrogen and progesterone levels were low, and once about a week after they ovulated, when oestrogen and progesterone were high.

It was a small study, involving 16 women who were asked to complete a range of mental tests. But the findings were notable.

During days when the participants had more female hormones in their systems, they were significantly worse at the things men are usually good at (like spatial awareness) and much better at the things women tend to have an edge in (such as the ability to come up with new words). When their hormone levels were lower, their spatial awareness was restored.

After their period, women have improved spatial awareness – a trait men usually tend to be better at (Credit: Getty Images)

One ability that improved when female hormones was higher was ‘implicit remembering’, which Maki describes as the subconscious, effortless kind of memory. “If I said to you, ‘Oh, what was the last Uber fare you had – was it more or less than the Lyft fare?’ And then later on, I asked you, ‘How do you spell fare?’. You might spell it f-a-r-e, even though most people spell it f-a-i-r. Because somewhere your brain encoded ‘fare’ and that was heightened.”

These implicit word memories are important for developing communication skills. They’re the reason we often find ourselves using obscure words or turns of phrase, like “Oh, he was so obstinate”, just after hearing someone else use them, or reading them in an article.

When study participants had more female hormones in their system, they were better at coming up with new words (Credit: Getty Images)

As a result, Maki believes these monthly changes were primarily driven by oestrogen.

The hormone affects two neighbouring brain regions. The first is the seahorse-shaped hippocampus, which is involved in storing memories. Evidence is mounting that the hippocampus is vital to social abilities, since being able to remember your own experiences can help you to understand the motivations of others. The region gets bigger each month when more female hormones are floating around.

The second is the amygdala, which helps us to process emotions, especially fear and the decision to fight or flee. Intriguingly, the amygdala also may be crucial to avoiding social blunders, because understanding why a person is fearful – and deciding if we should be too – requires us to see the world from their perspective. Once you have this ability, you can use it to your advantage in other ways, such as to make moral judgements or even tell lies.

When they have more female hormones in their systems, women tend to be better at seeing a situation from someone else’s perspective (Credit: Getty Images)


The Two Parts of Your Menstrual Cycle

The first part of your menstrual cycle is called the follicular phase. This phase starts on the first day of your last period and continues until the day you ovulate. This phase of your menstrual cycle may be different for every woman (lasting anywhere from 7 days to 40 days). The second part of your menstrual cycle is called the luteal phase. This phase begins on the day of ovulation and lasts until your next period starts. The luteal phase usually has a more precise timeline—for most women, this part of your menstrual cycle typically lasts around 12-16 days.  


Period lesson plan: guide to menstruation for teachers

For too many girls in South Asia, their first period is a surprise. Without knowing what is happening to their body and why it is happening, menstruation can become a scary and confusing time.

As a teacher, you have a wonderful opportunity to prepare the girls in your class for their monthly period. Teaching a girl about menstruation before she has her first period is the best way to make sure she knows what will happen, explain why she should not be scared and ensure she can keep coming to class. It’s also a great time to combat social taboos and false information about menstruation that can hurt a girl’s well-being.

While most girls get their first period at about 12 years old, some girls will start menstruating as young as nine - so it’s a good idea to start talking early about how your body changes as you grow up. Here’s the essential information you need to teach your class about menstruation.

10 things girls need to know about menstruation

1. It’s normal. Menstruation is a normal process that should happen to every girl once she reaches puberty – usually somewhere between the ages of 9 and 16.

2. Menstruation is not a sickness. Girls can live their normal life during menses – they can go to school, play with their sisters and friends, eat and drink everything they normally would, and attend social gatherings.

3. Girls can have irregular cycles in their first few years of menstruation. But each girl can learn to understand how her own body works by watching the small changes that happen each month. It may take a few years to settle into a regular monthly pattern. This means girls often feel unprepared or are caught short without pads or cloths.

It’s really helpful if girls learn to start observing their menstrual cycle, so they can start to predict fairly accurately when they will get a period and can be ready with a pad or cloth in their school bag.

4. Girls experience many changes around the time they get their first period. A girl’s breasts grow, she grows hair on her body, and her hips widen. Sometimes hormones make both girls and boys a bit more emotional than usual. There is no reason to be scared or ashamed of any of these changes.

5. Menstruation does not have to be a secret. There is a big difference between being discreet and keeping something secret because you are scared or ashamed. Once a girl is informed, she can be of help to other girls even if they are younger than her. She can also help older women in her family who didn’t have the opportunity to learn what she knows. She can be a girl leader.

6. Sometimes menstruation can be painful! The amount of pain can differ a lot from girl to girl and from month to month. Most pain can be eased by going on a short walk, getting eight hours of sleep every night, drinking lots of water and some gentle pain medicine.
There are some things a girl can look out for that will tell her if something is wrong and she needs to get help. If a girl’s period is so painful she can’t stand or walk if she bleeds much more than she usually does or if she stops bleeding for a long time, or bleeds between periods, she needs to get medical help from a community health worker, midwife or doctor.

All girls have the right to receive help if they have menstrual health problems. Help the girls in your class to understand this message: “Don’t be ashamed if something seems wrong. Get help.”

7. Your diet makes a difference to your well-being. The girls in your class might be told by their families and communities to avoid certain food and drinks when they have their period. The truth is, whether a girl is menstruating or not, she can eat and drink anything that’s included in a well-balanced diet. A girl will only feel pain, weakness and sickness if there is something missing from her diet. If girls do not eat lots of different foods, especially foods rich in iron and folic acid, they may face increased difficulty concentrating at school, and may feel tired and depressed.

As a teacher, you can help tell girls the truth. Explain why you, as a teacher, neither follow the taboos about what girls can’t eat and drink during menstruation, and why you don’t want the girls in your class to be influenced by them either.

8. Exercise is really good for girls, no matter which time of the month. There are many benefits to exercise, including the mental boost you get from feeling fit. Exercise is a good way to help prevent cramps, and gentle exercise like a walk can also help relieve pain.

9. A girl’s body will be healthy if she practices good hygiene during her period.

  • Girls must continue to wash normally during menses. Not being clean can leave girls at risk of infections.
  • A girl should wash outside her genital area at least once a day. If she does not have access to a shower or bath, she use a small amount of plain water, soap and a soft cloth
  • She should always wash her hands with soap after she uses the toilet or changes a pad or cloth.
  • A used pad should always be placed in the bin, and never down the toilet. And when a girl changes her cloth at school, she should take the soiled one home in a bag to wash. She can make a simple menstrual cloth bag at the same time she learns how to make reusable menstrual hygiene cloths, so she can carry her used cloths home discreetly.

10. It is okay to use either pads or cloths. Some girls prefer pads or cloths, but both can be a safe and clean way to manage a period. Disposable pads can be more expensive so girls may need to be understanding if their family cannot afford them.

Disposable pads need to be changed regularly, at least every six hours. If a girl uses pads, she can bring a few spare in her school bag so she’s ready if her period suddenly starts or a friend needs help.

Reusable cloths also need to be changed at least every six hours, or earlier if they feel full. After a girl is done with her cloth, she needs to wash it with soap and water and hang it outside to dry in the sun. Before she uses it again, she should check it is fully dry! If a girl changes her cloth at school, she should take the soiled one home in a bag to wash.

As a teacher, you can also help the girls in your class by keeping spare pads and cloths in case someone suddenly needs one.

How to handle difficult situations in class

What can you do when girls are too shy to talk?

If the girls in your class find it difficult to talk about their monthly period or ask questions in front of each other, try a story-writing exercise.

Give each girl a piece of paper, and ask them to write either a simple question, or a story that helps them to raise a question they would like their classmates or teachers to help with. No one should write her name on the page, so no one knows whose story is whose.

Share all the stories among the girls in the class and give them time to read. Invite them to think about responses to the questions. They can write their advice on the back of the story page. When they’re finished, you, the teacher, will collect all the stories. You can read some of the stories and responses out loud so that you help the students share fears, information and experiences.

What else can a teacher do?

As a teacher, one of the best ways you can help girls in your class deal with menstruation is to notice when they need help and let them know they can talk to you. Here are some basic questions you can ask to see if there are things you can do to help girls at your school:


How does menstruation proceed during one period? - Biology

The menstrual cycle

The menstrual cycle refers to the changes and preparation that a woman's body goes through to prepare for pregnancy. About once a month, the uterus grows a new lining (endometrium) to get ready for a fertilized egg. When there is no fertilized egg to start the pregnancy, the uterus sheds its lining starting off the monthly menstrual bleeding also called menstrual period.

The menstrual cycle is from Day 1 of bleeding to Day 1 of the next instance of bleeding. The average cycle is 28 days, although it is perfectly normal to have a cycle that is as short as 21 days or as long as 35 days. A regular menstrual cycle is an important element of successful conception.

Hormones control a woman's menstrual cycle and this cycle is comprised of three distinct phases.

Phase 1 - The Follicular Phase

This phase begins on Day 1 of the menstrual period and lasts until ovulation. The brain's hypothalamus and pituitary gland send hormone signals that get the ovaries and uterus ready for pregnancy. Through the influence of a rise in follicle stimulating hormone (FSH) during the first days of the cycle, a few ovarian follicles are stimulated. These follicles, which were present at birth and have been developing for the better part of a year in a process known as folliculogenesis, compete with each other for dominance. Under the influence of several hormones, all but one of these follicles will stop growing, while one dominant follicle in the ovary will continue to maturity. The follicle that reaches maturity is called a tertiary, or Graafian follicle, and it forms the ovum.

As they mature, the follicles secrete increasing amounts of estradiol, an estrogen. The estrogens initiate the formation of a new layer of endometrium in the uterus, histologically identified as the proliferative endometrium.

Phase 2 - The Ovulatory Phase

This is the key phase in the menstrual cycle. The level of luteinizing hormone (LH) surges during this phase signalling the release of the egg from the follicle into the fallopian tube. The process is known as ovulation and the egg can then be fertilised for up to 24-48 hours. Cervical mucus is most receptive to sperm around this time and a woman has the best chances of conceiving right before and during ovulation.

It is therefore important to accurately identify when a woman is ovulating if trying for a baby, in order to maximise chances of getting pregnant. During this period When a couple has intercourse, the sperms swim through the cervical mucus, into the uterus and along the fallopian tube, where they meet the egg. While millions of sperms are released, only one sperm can fertilize an egg. If fertilization does not occur, the egg passes through the uterus, the uterine lining then breaks down and is shed several days later as the next menstrual cycle begins.

Phase 3 - The Luteal Phase

This is the final phase of the menstrual cycle and lasts from the day of ovulation to the last day before the next period. Glands in the lining of the uterus called the endometrium secrete proteins in anticipation of implantation of the fertilised egg (embryo). If implantation does not occur, the endometrium starts to break down and is eventually sloughed off leading to menstruation. The luteal phase derives its name from the follicle that produces the egg which then becomes a functioning gland called the corpus luteum. The corpus luteum produces progesterone which prepares the endometrium.

Process of conception

The human reproductive process is complex. To become pregnant, the intricate processes of ovulation and fertilization need to work just right. Every month, during a woman's menstrual cycle, a single egg is released at the time of ovulation.

The egg travels through the fallopian tube and can be fertilized within about 24 hours after its release. Conception is more likely to occur when intercourse takes place in and around ovulation.

For pregnancy to occur, a sperm must unite with the egg in the fallopian tube during this time. Sperm are capable of fertilizing the egg for many hours after deposition though they are at their functional best during the initial hours. Ideally sperm must be present in the fallopian tube at the time of ovulation for conception to occur. In order for a sperm to reach an egg, the man must have an erection and ejaculate enough semen to deliver the sperm into the vagina. There must be enough sperm, and it must be the right shape and move in the right way. In addition, the woman must have a healthy vaginal and uterine environment so that the sperm can travel to the egg.

If fertilized, the egg moves into the uterus where it attaches to the uterine lining and begins a nine-month process of growth. For some couples attempting pregnancy, something goes wrong in this complex process, resulting in infertility.

As they mature, the follicles secrete increasing amounts of estradiol, an estrogen. The estrogens initiate the formation of a new layer of endometrium in the uterus, histologically identified as the proliferative endometrium.

Problems with conception

Infertility is the inability to conceive a child. A couple may be considered infertile if, after one year of regular sexual intercourse, without contraception, the woman has not become pregnant. Primary infertility is infertility in a couple who have never had a child. Secondary infertility is failure to conceive following a previous pregnancy.

Health & fertility

Ten Steps to Fertility

Good health, nutrition and a balanced lifestyle can go a long was in improving your chances of conceiving. This 10 step approach is sure to put you on the right track to fertility.

Step One: Time is the key!

Did you know that there are only about 6 days each month when a woman might get pregnant? And the best chance is on the day of ovulation - when one of the ovaries releases a ripe egg. It is important to have sex on and around ovulation day so that the sperm makes contact with the egg and fertilization occurs.

For a woman on a regular 28-day cycle the day of ovulation will be about 14 days after the start of her period, but this can vary from person to person, so it is better to keep a diary. There are also a number of ovulation prediction kits available and you can try one of these.

Step Two: Say No to alcohol and smoking

Heavy drinking (more than six units per day) can lower a man's sperm count and affect the health of the sperm. Women are also recommended to avoid alcohol when trying to conceive as it can affect a developing foetus and cause birth defects. Smoking also harms sperm and can reduce a man's sex drive. It affects ovulation in women and can reduce fertility.

Step Three: Know your Body Mass Index (BMI)

The best indicator of health, Body Mass Index is calculated using height and weight. Find your BMI and work towards maintaining your ideal weight as it greatly impacts fertility. Excess body fat in men is also a significant cause of low sperm counts.

Step Four: Eat nutritious!

Eating a healthy, balanced diet has many advantages. It helps maintain an ideal body weight, keeps the hormone levels of the body normal and improves the health of the reproductive system. Foods that are rich in antioxidants, vitamins C and E, and certain minerals are particularly good. Vitamins C and E and Zinc play key roles in fertility, increasing sperm count and motility (movement) and reducing stress on eggs and the female reproductive organs.

Foods such as green leafy vegetables (folic acid, calcium and iron), eggs and dairy (calcium), nuts and seeds (vitamin E, zinc and selenium) and citrus fruits (vitamin C) provide the essential nutrients.

Step Five: Cut down on caffeine

Caffeine affects the fertility level of both men and women, so cutting back is a sensible precaution. Caffeine is not just found in tea and coffee but also in chocolate and some soft drinks.

Step Six: Work-out regularly

Moderate exercise every day is key to maintaining a healthy body, helping to burn off excess body fat and reducing the effect of stress on hormone levels. For men, it can boost the fertility hormone testosterone. But it is also important that women avoid excessive exercise as this can result in irregular periods. You can indulge in enjoyable, low-impact activities like walking, swimming, cycling, Pilates and yoga.

Step Seven: Avoid hard bicycle seats and hot baths

Overheated testicles can temporarily lower sperm counts in men. So men should avoid saunas, hot baths, sun bathing and tight underwear. In addition, regular and prolonged cycling on hard bike seats can also reduce fertility through pressure on the perineum - potentially damaging nerves and blood vessels to the genital area.

Step Eight: Sleep well

Good, regular sleep of about 8 hours or more per night can help both men and women optimize their fertility. Lack of sleep can have a negative effect on hormone levels, with studies of professions involving sleep deprivation (flight attendants, shift workers etc.) showing an increase in irregular periods among women.

Step Nine: Beware of other medication

Seek medical advice about other medications or herbal remedies that you are taking to see if these may affect fertility. Many over the counter medicines, and some herbal remedies such as St John's Wort, Ginkgo Biloba and Echinacea may have an adverse effect on your fertility.

Step Ten: Relax and take it easy!

Take time off now and then to relax and enjoy each other's company. Emotional stress can interefere with the hormone responsible for egg and sperm production. Consider taking regular exercise, getting home on time and taking more frequent and/ or longer holidays which can all help to reduce the pressure.

Initial workup

The first step for a couple that suspect infertilty is to determine the cause of infertility. The doctor usually begins by asking both partners about their health histories, their medication usage, their sexual histories, and their sexual practices. Tests are then performed to diagnose infertility and these tests are called pre-screening tests. Before a treatment cycle is initiated, it is important to identify any potential obstacles to achieving a pregnancy and the assessment is determined by the results of both male and female pre-screening tests.

Tests for the woman

The tests to determine occurence of infertilty in a woman begins with a full physical examination and cervical smear.

The doctor then makes sure that the woman is ovulating regularly and assesses whether her ovaries are doing their job of releasing eggs. Having regular menstrual cycles and a biphasic basal body temperature curve usually confirms that ovulation is regular. Blood tests are carried out to determine hormone levels.

The ovaries and uterus are examined by ultrasound, and tests to check for tubal blockage or any abnormality in the uterus are done.

Tests for the man

In the case of the man, to determine, the first step is a physical examination. Male infertility is usually related to sperm health or function, which is mostly tested with a spermanalysis.

In certain cases, the man may have enough sperms, but the sperms may not swim well enough to reach the egg. Also, sperms that are not normal in shape may not be able to penetrate and fertilize the egg. But once the doctor has identified all the problems, most of them are treatable.

Once the diagnosis is established for the couple, a treatment plan is drawn up. This treatment plan depends on the age, diagnosis, the duration of infertility, any previous treatments, and personal preferences if any.

In about 80% of couples, the cause of infertility is either a sperm problem, irregular or no ovulation, or blockage of the fallopian tubes. In 15% of couples all tests are normal, and the diagnosis of "unexplained infertility" is made.

Indications for ART

Male factors
  • Severe abnormalities with sperm count, sperm motility or morphology
  • Absence of sperms in the ejaculate or azoospermia
  • Mechanical or psychological issues with erection or ejaculation
Female factors
  • Older age leading to compromised oocyte quality and chromosomal abnormalities
  • Cervical factors
  • Antisperm antibodies - Can be present both in the male or female
  • Disorders of ovulation - e.g. PCOD or polycystic ovarian disease
  • Disorders of fallopian tubes - Tubal blockage either due to infections or scarring
  • Endometriosis
Unexplained infertility

In some couples all the investigations might be normal both in the male and the female and there seems to be no apparent cause for infertility. Such couples are said to be experiencing unexplained infertility though the exact reason might be at a more cellular level - pertaining to the oocyte or sperm or a combination of both. Or sometimes, there could be issues with the binding of the oocyte and the sperm.


What Happens to Your Body Each Day of Your Menstrual Cycle

If you’re a long-time menstruator reading this, theoretically you should be a period expert by now. I mean, the red tide visits us 12 times a year for an average of 38 years. That’s 456 periods (which may seem super depressing, TBH). Point is, most of us just go with the flow and wake up to the gifts Mother Nature has for us for the day and, ultimately, we know that your period (love it or hate it) is an important part of your health &mdash and it’s something that you should want to understand fully.

Have you ever wondered why your boobs hurt at certain times of the month? Why you’re more tired? Whether it’s the right time to take a pregnancy test? Maybe it’s time to take a step back and look at the big picture &mdash the whole cycle. Most menstrual cycles run for 28 days, with periods lasting about five days. But some women run on a 32-day clock, with anywhere between a three-day (lucky!) and a seven-day (sorry) period.

To help keep track of your cycle &mdash or remind you to take the pill &mdash there are several apps you can download. But generally, here’s what you can expect each day during a 28-day series.

Phase 1: Menstrual

Day 1: Ready, set, go! The first day of your cycle begins with the day your period starts. Estrogen is at its lowest, and since estrogen is responsible for increasing serotonin (the “feel-good” chemical), you may be feeling pretty lousy today.

Day 2: Gettin’ heavy with it. On average, the second day yields the heaviest flow. But even though you may be at high tide, you may be feeling a bit more relaxed as estrogen levels start climbing again.

Day 3: pH roller coaster. With all those tampons and extra blood flow, your vaginal pH has increased, which can lead to increased susceptibility to yeast infections.

Day 4: Light at the end of the tunnel. Today your period is a helluva lot lighter &mdash the end is near! The number of your scowled looks continues to decrease too as estrogen climbs higher, and we are nice to our boyfriends again.

Day 5: Crossing the finish line. Thank the heavens, and shove your tampons to the back of the cabinet. You won’t be needing those for a while.

Phase 2: Follicular

Day 6: One in 100,000. After your period ends, the most dominant follicle in your ovaries continues to grow in preparation to eventually release an egg.

Day 7: Carpe diem. You should be your normal self now but possibly a bit more optimistic than usual. You can thank the increasing levels of estrogen for your newly found motivation to ask for a raise.

Day 8: Mirror, mirror on the wall. You’re the fairest of them all. Your skin is glowy and bright, you feel good, and you have the confidence to strike up a conversation with that male model at the bar.

Day 9: Making bed for baby. While you’re chatting it up with all the cute guys at work, your uterus lining is thickening to make the softest and comfiest bed for your golden egg.

Day 10: Oh, happy day! Every cup is half full, and everything is coming up in roses. Your levels of optimism may be making your friends sick but are making you count every blessing.

Day 11: Let the baby-making begin. OK, ovulation is just around the corner, and since your ovulation day can change from cycle to cycle, it wouldn’t hurt to start the baby-making process now. That is, if you want a baby &mdash otherwise, you had better use protection.

Day 12: Got that lovin’ feeling. Some say you are possibly your most fertile a couple of days before ovulation, which would make sense that your libido is at an all-time high.

Day 13: Estrogen reaches Mount Everest. Your estrogen levels peak right before ovulation and then drop suddenly right after. So take this as your last day to make lemonade from life’s lemons.

Day 14: Ovulation! The dominant follicle releases the egg for its journey down the fallopian tube. The egg will live 12 to 24 hours, while sperm can survive three to five days.

Phase 3: Luteal

Day 15: Hello, progesterone. Goodbye, estrogen. Estrogen levels plummet as progesterone levels begin to take its place. You may be a bit irritable, but don’t worry &mdash estrogen will be back soon.

Day 16: It’s getting hot in here. With increased amounts of progesterone, you may notice your body temperature sits a little higher than usual.

Day 17: Don’t waste your money. Anxious to see if you’re pregnant? It might be too early to tell just yet. Hang in there, and check back in next week.

Day 18: Back for round two. Estrogen levels begin to rise again, along with the increasing amounts of progesterone.

Day 19. Easy with the girls. The hormones in your system increase blood flow to your breasts and may cause them to be fuller but extra sensitive.

Day 20: You’re cut off. If your egg hasn’t been fertilized, then your body will call it quits on producing estrogen. Enter: PMS.

Day 21: Baby on board? Now is the time to visit your doctor or buy those pregnancy tests. If fertilized, the egg has had enough time to settle in, and your hormone levels should accurately answer your pressing “am I pregnant?” question.

Day 22: You’re getting sleepy. Today your progesterone levels are at their max, which may equate to an increased tendency to fall asleep in the middle of that super-exciting board meeting.

Day 23: Cool! Small pores. Progesterone activates the production of sebum and swells the skin, causing your pores to appear smaller in size. But the swelling is actually compressing your pores, and the sebum is building up underneath &mdash a situation that will rear its ugly head in a few days’ time.

Day 24: Reschedule your waxing appointment. At this time, your body is more susceptible to pain than during other times of the month. Avoid tweezing, waxing or laser hair removal.

Day 25: Don’t you dare step on that scale. You might scare the crap out of yourself when you see that you are up to 10 pounds heavier. Just remember that the number doesn’t matter. With all the hormone changes, our bodies tend to hang on to extra water in our system. One of the most ironic cures? Drink more water.

Day 26: Burn, baby, burn. In the midst of your catastrophic mood swings, I’ll tell you some good news: Your body burns up to 11 percent more calories now than it does during any other time of the month.

Day 27: Me want food. If you go overboard with your cravings, you will lose the benefit of that extra-calorie burn. (But, also, truly, who cares?)

Day 28: Hi, Acne, not nice to see you again. What better way to end your cycle than with a visit from the Whiteheads? Remember those small pores and sebum production? Well, here’s the result. Additionally, now that your hormones are at an all-time low, your constant testosterone level is actually higher than estrogen and progesterone, causing more stimulation of sebum and a higher chance of cystic acne &mdash not to mention oil-slick skin and large pores.

A version of this story was published in January 2016.

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What Do Estrogen and Progesterone Do in Menstrual cycle?

Actually, your menstrual cycle is the series of changes your reproductive system goes through to prepare for a possible conception of pregnancy. The length of the cycle can vary from woman to woman (about 21 to 35 days). In each cycle, your uterus grows a new. Both your estrogen and progesterone can do & play a key role in each of your menstrual period.

Major phases of your menstrual cycle

Normal menstrual bleeding is the process of elimination of endometrium (the thickened uterus lining). This can be a sign that there is no any sperm that fertilize the egg released during ovulation.

Typically, the fluids of menstruation contain endometrial cells (these cells comes from the uterus lining), blood, and some mucus. On average, the length of this bleeding is about 3 day to 7 days.

During menstrual flow, it’s important for women to use appropriate tampons or sanitary pads to help absorb the bleeding. And these tampons /pads should be replaced regularly or at least every 4 hours.

The following are 3 major phases of your period [1].

Follicular phase is the first half of the period. It occurs from the first day you notice the bleeding of menstruation and will ends with the release of egg (ovulation).

In each follicular phase, the female body can make around 5-20 cysts or tiny nodules (follicles). Each of these follicle houses an egg (immature egg).

But typically, most of these follicles end with death and eventually there is only one follicle that successfully house and release the fully-matured egg.

As well we know, the phase of ovulation is very crucial if you with your partner are expecting a pregnancy. In ovulation, your ovary releases an egg (mature egg).

If you do intercourse without birth control during this phase, your chance of getting pregnant is very high. Therefore, it’s important to know the days of your ovulation if you are trying to get pregnant.

How long does ovulation last? Typically, it can take about 2 days. But the life span of egg is not more than a day (24 hours).

While follicular phase is your first half cycle, luteal phase is your second half cycle. The ruptured follicle during ovulation then will go into the structure called corpus luteum.

The female body can maintain the corpus luteum if there is egg fertilized by sperm and implant on the lining of the uterus.

If there is no pregnancy, the corpus luteum will disappear and your body returns to the first phase of your menstrual cycle to release a new egg. This is followed with the production of hormones called prostaglandins to trigger the smooth muscles of the uterus lining to contract and eliminate endometrium.

The large amounts of prostaglandins can play a key role in affecting the occurrence of some symptoms of premenstrual syndrome (PMS), particularly such as menstrual cramps, diarrhea, and abdominal bloating.

What does estrogen do in your menstrual period?

As mentioned before, estrogen is one of the most crucial hormones in regulating the cycle of your menstruation. Estrogen plays a key role in the first half phase of your menstrual cycle.

In general, there are two main functions that your body needs to prepare in this first half phase. These include [2]:

  1. To prepare maturation of an egg that will be released during ovulation.
  2. And to thicken the lining of uterus. This is purposed for the place of implantation of fertilized egg.

Estrogen is not the single hormone that plays a key role in this first half cycle. It works with another hormone called follicle-stimulating hormone or FSH.

Follicle-stimulating hormone can trigger the ovary to mature one egg for ovulation. In line with the process of maturing an egg, FSH triggers the cells of follicles to produce and secrete estrogen.

And then estrogen will trigger the uterus lining to thicken, preparing for the possible conception for pregnancy.

When there is an egg within a follicle has fully matured, the female body will release hormone called luteinizing hormone (LH) to cause this egg to get released from the ovary. This fully-ripened egg then will move to the fallopian tube, waiting to be fertilized by sperm.

How about progesterone, what does it do in your menstrual cycle?

After ovulation, you then go into the second half phase of your period. In this phase, there are two major possibilities:

  1. You get a fertilized egg, if you do intercourse (particularly if you do it without protection or birth control). Then this egg attaches /implants to the endometrium (the thickened uterus lining), and your pregnancy begins.
  2. Or there is no any sperm that fertilize the egg, and you do not get pregnancy. And then your endometrium starts to disappear which then eventually break down in the days of your menstrual bleeding.

Generally, the main function of this second half phase is to support a pregnancy, and this can be a starting point why your body produces progesterone.