What are?
From a purely biological point of view, menstruation represents the emission, through the vagina, of blood coming from the exfoliation of the mucous layer that covers the uterine cavity; this small and physiological bleeding occurs cyclically during the woman's fertile age.
It is however undeniable that menstruation has always been an event that goes far beyond mere reproductive function. For this reason it is good to know, at least briefly, the biological bases and thus avoid feeding all the unfounded beliefs underlying the taboo in some ways still current.
Questions and curiosity about menstruation
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The ovary is an organ, exclusive to the woman, deputed to the production and maturation of female reproductive cells, called oocytes or egg cells; it is also important for the production of sex hormones.
Egg cells are produced exclusively during fetal life, surrounded by cellular structures called follicles; after birth, they partially regress and in part remain quiescent until puberty. From this moment on, about every 28 days, a single follicle is brought to maturity, thanks to the intervention of the hormones produced by the hypothalamus and the pituitary gland (which are activated in an important way during puberty).
When the development phase is complete, the follicle explodes, letting the egg cell (ovulation) escape, which at this point can be, at least theoretically, fertilized.
After release, the egg travels through the fallopian tubes and then enters the uterus; if during this path a spermatozoon penetrates, ascended through the vagina and uterus after sexual intercourse, the egg cell is fertilized and pregnancy begins.
To prepare for this event the organism implements a series of physiological modifications, first of all the increase in the thickness of the endometrium; other transformations follow one another after ovulation, thanks to the intervention of the corpus luteum (a small structure that forms in the ovary by transformation of the follicle after the release of the egg cell). If before the ovulation these changes have above all the purpose to favor the fertilization (assuring a greater survival to the sperm), the transformations induced by the corpus luteum have a different purpose. In this phase, in fact, the purpose is no longer to promote fertilization, but to stimulate nesting.
This term, also known as implant, indicates the complete and progressive penetration of the fertilized egg into the mucosa that covers the uterine cavity internally (called the endometrium). This phase, which begins 5 or 6 days after fertilization, is favored by the endometrial glands, whose secretory activity is stimulated by hormones (progesterone) secreted by the corpus luteum.
If the egg cell does not meet spermatozoa during its course, it undergoes a spontaneous regression within 12-24 hours; within ten days even the corpus luteum ceases endocrine production and regresses, forming a very small scar on the ovarian surface. The endometrial changes no longer have a reason to exist and the alteration of hormonal levels leads to the exfoliation of its external surface, giving rise to menstruation. The menstrual flow is therefore not made up exclusively of blood, but also of proteins, water, mucus and other cellular elements.
If fertilization has not occurred, ovulation always precedes menstruation by about fourteen days, regardless of the length of the cycle; on the contrary the first phase, which goes from the last menstruation to ovulation, is variable and can give rise to more or less long cycles of the four canonical weeks (21-35 days).
Immediately after menstruation, the hypothalamic and pituitary hormones stimulate the maturation of a new follicle; the proliferation of the endometrium is reactivated and the body prepares itself for the umpteenth time for a possible pregnancy.
The first menstruation
Although affected by constitutional, racial and geographic variability that can even appear two or three years later, the first menstrual flow is generally around 13 years. The epoch that coincides with the beginning of menstruation, earlier in the equatorial and subequatorial geographical areas, is called menarche . Very often the menstrual flows following the first are rather irregular, but tend to stabilize within two years. It is not necessary for example to worry if after the menarche the flow does not recur in the next 30 or 60 days.
If the menstrual flow does not appear within 16 years of age, we speak of primary amenorrhea, a condition that can be linked to hypothalamic-pituitary lesions or, more frequently, to anatomical malformations (imperforation of the hymen, congenital malformations of the uterus or of the vagina, ovarian failure). Especially if the breast and pubic hair have started to grow, but menstruation has not yet appeared within the sixteenth year of age, a medical consultation is advisable: the amenorrhea could in fact be linked to a constitutional "delayed puberty", but there it is also the risk that it can be an expression of pathological factors.
CURIOSITY: the prefix men, common also to other medical terms such as menopause, menorrhagia, etc., derives from the name of Mena, daughter of Jupiter, goddess responsible for menstruation and fertility.
How long are menstruation?
Although subject to wide individual variations, the average duration of menstruation can be quantified in 4-5 days, with a more abundant flow in the first 24-72 hours. From the age of 35 onwards this period of time tends to shorten, the flow becomes less abundant and menstruation tends to become less regular.
The use of estroprogestinica contraceptive pills helps to regularize the duration of "menstruation" and decrease the overall flow.
How much blood is lost?
Also under this aspect there is a certain variability, but normally the blood flow emitted together with the endometrium, flaking and necrotic, varies between 20 and 70 ml. There is talk of hypermenorrhea or menorrhagia if the flow is too abundant and of hypomenorrhea if the menstruation is excessively scarce. The eventual appearance of numerous clots in the menstrual blood could be an indication of menorrhagia or uterine hemorrhage.
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