Menstruation: From Fertility to Menopause—Everything You Need to Know

What is menstruation, and how does the menstrual cycle work?

Menstruation is the monthly bleeding that results from the shedding of the uterine lining (endometrium) when fertilization does not occur. The average cycle lasts 28 days, but a duration ranging from 21 to 35 days is considered physiologically normal. It is divided into four phases: menstrual, follicular, ovulatory, and luteal. Two ovarian hormones regulate this process: estrogen, which builds up the endometrium during the first part of the cycle, and progesterone, which prepares it to receive an embryo during the second part. A simultaneous drop in both hormones triggers menstruation if pregnancy has not occurred.

What symptoms accompany menstruation?

Symptoms vary from person to person and from cycle to cycle, but several are common:

• Abdominal cramps and pelvic pain, sometimes radiating to the back or thighs.
• Bloating and a feeling of heaviness in the lower abdomen.
• Mood swings, irritability, mild anxiety, or sadness.
• More pronounced fatigue at the start of menstruation, linked to blood and iron loss.
• Changes in appetite and, sometimes, headaches or catamenial migraines.

Very intense symptoms may indicate severe dysmenorrhea or an underlying condition such as endometriosis, which warrant a medical consultation.

How can menstrual cramps be managed effectively?

Several non-medicinal strategies can relieve cramps:

• Applying heat (hot water bottle, heating pad) to the lower abdomen, which relaxes the uterine muscles.
• Light physical activity—such as walking or yoga—which releases natural pain-relieving endorphins.
• Magnesium supplementation, which reduces muscle contractions and fluid retention.
• Omega-3 intake, which has documented anti-inflammatory effects on the prostaglandins involved in cramps.

In cases of severe, persistent pain, nonsteroidal anti-inflammatory drugs (NSAIDs) remain the standard treatment and should be taken at the onset of bleeding, as recommended by a healthcare provider.

Should irregular periods be a cause for concern?

Some variability is normal, particularly after stopping birth control or during periods of intense stress. However, cycles that are consistently shorter than 21 days or longer than 35 days, or the absence of periods for several months (amenorrhea), warrant a medical evaluation. Common causes include:

• Polycystic ovary syndrome (PCOS), often associated with hyperandrogenism.
• Thyroid imbalance, whether hypothyroidism or hyperthyroidism.
• Chronic stress or rapid weight loss, which disrupt the hypothalamic-pituitary axis.
• Ovulation disorders of other origins, particularly hyperprolactinemia.

Hormone testing (FSH, LH, prolactin, TSH, AMH) and a pelvic ultrasound can generally help identify the cause and tailor treatment. Do not wait more than three consecutive abnormal cycles before seeking medical advice.

What is the relationship between the menstrual cycle and fertility?

Ovulation, which generally occurs around the 14th day of a 28-day cycle, marks the window of peak fertility. Several signs help identify it: changes in cervical mucus (becoming more stringy and transparent), a slight rise in basal body temperature, and sometimes lateral pain (mittelschmerz). Hormonal contraceptives work precisely by suppressing or blocking ovulation, which can alter the menstrual pattern, making periods lighter, less painful, or even absent.

How does menopause change the menstrual cycle?

Menopause marks the permanent cessation of menstruation, confirmed after 12 consecutive months without a period. The perimenopause that precedes it can last several years, with irregular cycles, variable flow, and menopausal symptoms (hot flashes, sleep disturbances). Diet plays a supportive role throughout a woman’s menstrual life: an adequate intake of iron compensates for blood loss, while foods rich in antioxidants and essential fatty acids help limit the underlying inflammation that exacerbates cramps. During menopause, the focus shifts to calcium and vitamin D to maintain bone density, as well as to phytoestrogens from legumes to alleviate menopausal symptoms—always under medical supervision.