Menstrual Health & Hygiene
Menstruation is a completely normal part of life, but it can be scary to experience for the first time, and periods can be painful! Violet's here to help.
Why is there blood coming out of my vagina?
This is your period, a natural and healthy cycle that happens as you get older. The blood is the inner lining of your uterus; it builds up and then sheds every month.
Imagine your uterus as a baby room that gets decorated with new wallpaper every month, in anticipation of an egg being released. About halfway between 2 periods (so 2 weeks after your period), an egg is released by your ovary - this is called ovulation. If an egg released by your ovary meets a sperm and becomes fertilized, it will find a cozy spot in the uterus to grow into an embryo and eventually a baby. If the egg is not fertilized, the wallpaper will be peeled off the baby room, and you will see this lining come out of your vagina as blood. Then the whole process restarts!
What does a menstrual cycle look like?
Cycles are usually 26-31 days long, with 3-7 days of bleeding on average.
During the first 1-2 years of having your period, your cycles will likely be more irregular, meaning you might not have one every month, or you might bleed longer than 3-7 days. If you bleed for more than 14 days, see a doctor as soon as possible.
How much is too much bleeding?
If you're bleeding through more than a pad an hour, or through more than a tampon an hour, you should definitely see a doctor.
If you bleed as much as pad #4 in 4 hours or shorter, you are bleeding too much.
If you bleed as much as tampon #4 in 2 hours or shorter, you are bleeding too much.
Just because your family says your bleeding is normal does not mean it is normal! Your family members might also be bleeding too much.
Bleeding too much can cause serious health effects, such as fatigue and fainting from low red blood cell counts.
What if I don't get my period?
If you haven’t noticed changes in your body indicative of puberty (like pubic hair, armpit hair, breast development) by age 13, or if you don’t get your period by the age of 15, this could be abnormal, so make sure you talk about it with your doctor.
If you get your period, but then it goes away, there are a few potential reasons:
In the same way that other bodily functions can be affected when you’re stressed (like your sleep or your bowel functions), your period can also be affected. A good place to start if you haven’t gotten your period in a while is to check in with your body about what might be causing you stress.
Have you been staying up late studying every night?
Have you been constantly worrying about something going on with your friend group?
Are you worrying about family?
Are you balancing caretaking, school, and work?
Consider spending more time on selfcare! You can check out our section on mental wellbeing here for tips.
PCOS stands for Polycystic Ovarian Syndrome. This is a very common disease where a woman’s hormones are unbalanced, meaning she might not get her period and she might notice excess body hair (for example on her face) or be gaining excess weight. It can make it harder for a woman to get pregnant when she wants, and it can increase the chance of diabetes. You should feel free to ask your doctor to help you figure out if you might have PCOS, because there’s various medications and lifestyle changes that can help! For example, starting a birth control pill could make your periods more regular.
Have you been skipping meals so your body doesn’t have enough energy to do processes important for your health like having a period? Or have you been over-exercising and not letting your body recover physically between sports practices? It’s really important to talk to someone about this, even if it seems normal to you. It’s a lot easier to talk it out and figure out what’s healthy early on, rather than continuing down a vicious cycle. You can consult with a trusted adult, a doctor, or a counselor/therapist.
If you have had penetrative sex since your last period, and now your next period is late, you could be pregnant. It can be scary, but it is super easy to take a pregnancy test, and then you’ll have more info about what might be going. The sooner you take it, the more options you have, and it will always be up to you what you want to do next.
Different types of birth control methods can affect your period in different ways. People who have the hormonal IUD often won’t get their period anymore. That's totally normal and safe, but also it’s totally up to you—if you prefer to see your period every month, your doctor can provide you with other options.
Managing Period Pain
Pain meds you can buy at the drug store
Examples include ibuprofen, Tylenol (acetaminophen), and naproxen. Aspirin is not recommended for those under 18 yrs old. They work best if you take it in advance - as soon as you feel cramps!
Light exercise can help with blood flow, which can relieve cramps.
Place a heating pad on your back or stomach, or take a warm bath. The heat helps improve blood flow and can relieve cramps.
Some methods of hormonal birth control can help reduce menstrual flow and pain, such as the pill, patch, ring, implant, or hormonal IUD.
Change your position
Lie down in a fetal position (knees to your chest, on your side), or lie on your back with a pillow under your knees. This may help relieve some stomach pressure.
Get lots of sleep and rest! 7-9 hours is recommended.
Change your product
Using pads or period underwear instead of tampons may help relieve discomfort.
Avoid foods that can cause bloating and water retention, such as fatty and salty foods, carbonated drinks, and caffeine.
Tracking Your Period
Why should I track my period?
1. Be prepared with period products
2. Tell when there are changes in your health
3. Know when you're likely to get pregnant
Tracking your period can help you prepare for when it's coming, and anticipate mood changes or pain.
When you track your period, you're more likely to know if you've missed a period or your period is late, which could be an indicator of pregnancy, poor eating, PCOS, or other conditions.
Tracking your period can also inform you of when you're most and least likely to get pregnant during the month. You are least likely to get pregnant in the time during and around your period. You are most likely to get pregnant halfway between your periods - if you get your period once a month, that means you are most likely to get pregnant around 2 weeks after your period. This is because you ovulate.
How to track your period
There's an app for that!
There are many mobile apps that allow you to track when you get your period every month. As you enter more data, the app will average out how many days your period lasts (how many days you bleed, and how many days go by in between). You'll know when you are most fertile (most likely to get pregnant), and when your period is likely to come next.
You can also use the built-in apps in an iPhone or Fitbit, if you have access to these devices.
Experiencing painful periods?
What is it?
Endometriosis is a gynecological disorder (relating to the female reproductive system) that affects about 20% of women. During a woman’s monthly period, she sheds the tissue lining her uterus, called endometrial tissue. People with endometriosis develop this tissue outside their uterus like in their upper and lower stomach areas. Every month, this external tissue breaks down in response to hormonal changes, which can lead to bleeding and swelling in the lower stomach area as well as scarring of other tissue. Endometriosis can range from minimal to severe.
Excessive menstrual cramps
Heavy or abnormal menstrual flow
Painful urination and/or bowel movements during your menstrual period
Endometriosis can be diagnosed through a minor surgery called a laparoscopy. A doctor inserts a thin camera and tube into a small incision where they can examine tissues and the size of growths. They take a biopsy of tissue they suspect to be affected, and examine it under a microscope. Doctors may also choose to use ultrasounds, CT scans, and/or MRI scans to aid their diagnosis!
Treatments depend on the extent of illness and can include pain medication, hormonal therapies, or surgeries to reduce growths and pain. As always, talk to your doctor to determine the best way for you to receive treatment.
PCOS (Polycystic Ovarian Syndrome)
What is it?
PCOS, or polycystic ovarian syndrome, is a disorder where your body produces too many androgens. Androgens are the male sex hormone and are usually present in females in small quantities, but a lot more is produced in people with PCOS. A person with PCOS may have many small cysts in their ovaries, producing even more androgens.
While the cause of PCOS is not known, you may be more likely to have it if other people in your family have it. Other symptoms include:
Excessive body hair
Skin tags or dark skin patches on the back of neck, under the armpits, or below the breasts
Male-pattern baldness or thinning hair
PCOS is diagnosed through ultrasounds and blood tests for androgens.
Treatments include birth control, diabetes medication, changes in diet, and more. PCOS can lead to the development of other serious health problems, so talk to your health provider to create a treatment plan that works for you.
PMDD (Pre-Menstrual Dysphoric Disorder)
What is it?
If you’ve had your period, you may have experienced cramps, been a little more tired than usual, or been a little more short tempered than usual. PMDD is similar to PMS (Pre-Menstrual Syndrome, which is experienced by most people that have periods) but presents with much more severe symptoms.
Like PMS, symptoms of PMDD usually begin 7-10 days before your period, although some experience symptoms as early as 2 weeks before the start of their cycle.
According to the DSM (the psychology diagnostic book!) these symptoms must be present to confirm a PMDD diagnosis:
One or more of the following:
Extreme mood swings, increased sensitivity to rejection
Irritability/anger and more fights with your friends/family than usual
Depressed mood or self-deprecating thoughts
Higher anxiety, tension, and feelings of being on-edge.
At least 5 of the following symptoms:
Less interest in normal activities
Difficulty with concentration
Fatigue / tiredness
Change in appetite: either overeating or undereating
Hypersomnia (sleeping a lot) or insomnia (sleeping very little)
Being overwhelmed or out of control
Physical symptoms (weight gain, breast tenderness, back pain, etc.)
Doctors may ask you to track your symptoms in a journal for a few months and will compare them to the criteria listed above. PMDD can be diagnosed by healthcare providers such as primary care providers, gynecologists, and psychiatrists.
Treatment for PMDD could include taking medication such as antidepressants, changing your diet or taking supplementary vitamin pills, and therapy. You should talk to your doctor to create a treatment plan that works for you.
Menstrual Hygiene Products
feels secure for exercise, swimming
pretty easy and small to insert
change it out often (every 3-4 hours)
vagina can become sore after prolonged use; toxic shock syndrome
don't have to worry about leakage into underwear
might get blood on underwear if moving around a lot
may feel bulkier than a tampon
long-lasting (12 hours)
most economical (cheapest and lasts 1-2 years)
can be difficult to insert or remove until you get the hang of it
if you're out and about for a long time, cleaning it out in a public restroom can be hard
long-lasting (12 hours)
environmentally friendly and lasts several years
have to wash and dry by hand each night
Pads (or sanitary napkins) are thick napkins that catch your menstrual blood. You peel off a sticker to attach the pad to your underwear. Some pads also have sticky wings, or flaps on the sides, to help secure the pad by wrapping the flaps around both sides of your underwear.
The menstrual cup is a soft and bendable cup made of medical-grade silicone, latex, or rubber. It sits in your vagina, and is held in place by your vaginal muscles, which the cup naturally suctions to without any extra effort required on your part. Most brands offer a small and a large size depending on whether you've given birth vaginally before, or have a heavier flow.
Watch a video here on how to insert a menstrual cup. With clean and dry hands, you insert a washed menstrual cup into your vagina (same place a tampon would go) by folding in the cup and gently releasing so it opens against your vaginal walls.
Period underwear are reusable for virtually forever, and absorb your period blood securely. To clean, you just wash in cold water and hang dry.
Not sure if you would like using Menstrual Cups or Period Underwear?
Here are some concerns young people have about using period cups:
It might be uncomfortable
It might be messy putting it in and taking it out
It might be complicated to put in and take out
It might be hard to change in a public bathroom
Here are some concerns young people have about using period underwear:
It might leak or could be messy
It might smell
It would feel like a diaper
It might feel like you’re sitting in your period
Toxic Shock Syndrome
What is Toxic Shock Syndrome, and what does it have to do with menstrual hygiene?
Keeping a tampon or menstrual cup in too long (more than 8 hours) can cause dangerous bacteria to grow in your vagina.
Did you know?
Some common bacteria causing TSS include:
Signs & Symptoms
If you have your period and feel very dizzy like you want to pass out, then call your doctor or seek emergency care. This could be a sign of Toxic Shock Syndrome.
Remember, however, that Toxic Shock Syndrome is pretty rare.
What to do?
If you have more than one of these symptoms, see a doctor immediately. A doctor can treat you with:
And more, depending on the progression of your condition.