Editing Menstrual cycle (section)

== Menstrual health ==

[[File:Human ovarian follicle.jpg|thumb|A human primary [[ovarian follicle]] viewed by [[microscopy]]. The round [[oocyte]] stained red in the center is surrounded by a layer of [[granulosa cell]]s, which are enveloped by the basement membrane and [[theca cell]]s. The magnification is around 1000 times. ([[H&E stain]])]]
Although a normal and natural process,{{sfn|Prior|2020|p=50}} some women experience [[premenstrual syndrome]] with symptoms that may include [[acne vulgaris|acne]], [[Breast tenderness|tender breasts]], and [[Fatigue|tiredness]].<ref name="pmid32809533">{{cite book |last1=Gudipally |first1=Pratyusha R. |last2=Sharma |first2=Gyanendra K. |chapter=Premenstrual Syndrome |title=StatPearls |date=2022 |publisher=StatPearls Publishing |id={{NCBIBook2|NBK560698}} |pmid=32809533 }}</ref> More  severe symptoms that affect daily living are classed as [[premenstrual dysphoric disorder]] and are experienced by 3 to 8% of women.<ref name="Reed2018" /><ref name="pmid29298169">{{cite journal |vauthors=Appleton SM |title=Premenstrual syndrome: evidence-based evaluation and treatment |journal=Clinical Obstetrics and Gynecology |volume=61 |issue=1 |pages=52–61 |date=March 2018 |pmid=29298169 |doi=10.1097/GRF.0000000000000339 |s2cid=28184066 |type= Review}}</ref><ref name="pmid32809533"/><ref name="pmid33030880">{{cite journal |vauthors=Ferries-Rowe E, Corey E, Archer JS |title=Primary Dysmenorrhea: Diagnosis and Therapy |journal=Obstetrics and Gynecology |volume=136 |issue=5 |pages=1047–1058 |date=November 2020 |pmid=33030880 |doi=10.1097/AOG.0000000000004096|doi-access=free }}</ref>  [[Dysmenorrhea]] (menstrual cramps or period pain) is felt as painful cramps in the abdomen that can spread to the back and upper thighs during the first few days of menstruation.<ref name="nhs1">{{cite web |title=Period pain |url=https://www.nhs.uk/conditions/period-pain/ |website=nhs.uk |access-date=12 November 2022 |language=en |date=19 October 2017}}</ref><ref name=Dysmenorrheastat>{{cite book |last1=Nagy |first1=Hassan |last2=Khan |first2=Moien AB |chapter=Dysmenorrhea |title=StatPearls |date=2022 |publisher=StatPearls Publishing |id={{NCBIBook2|NBK560834}} |pmid=32809669 }}</ref><ref name="pmid30098748">{{cite journal |vauthors=Baker FC, Lee KA |title=Menstrual cycle effects on sleep |journal=Sleep Medicine Clinics |volume=13 |issue=3 |pages=283–294 |date=September 2018 |pmid=30098748 |doi=10.1016/j.jsmc.2018.04.002 |s2cid=51968811 |type= Review}}</ref> Debilitating period pain is not normal and can be a sign of something severe such as [[endometriosis]].<ref name="pmid33132854">{{cite journal |vauthors=Maddern J, Grundy L, Castro J, Brierley SM |title=Pain in endometriosis |journal=Frontiers in Cellular Neuroscience |volume=14 |issue= |pages=590823 |date=2020 |pmid=33132854 |pmc=7573391 |doi=10.3389/fncel.2020.590823 |doi-access=free }}</ref> These issues can significantly affect a [[Women's health|woman's health]] and quality of life and timely interventions can improve the lives of these women.<ref name="pmid31378287">{{cite journal |vauthors=Matteson KA, Zaluski KM |title=Menstrual health as a part of preventive health care |journal=Obstetrics and Gynecology Clinics of North America |volume=46 |issue=3 |pages=441–453 |date=September 2019 |pmid=31378287 |doi=10.1016/j.ogc.2019.04.004 |s2cid=199437314 |type= Review}}</ref>

There are common culturally communicated misbeliefs that the menstrual cycle affects women's moods, causes depression or irritability, or that menstruation is a painful, shameful or unclean experience. Often a woman's normal mood variation is falsely attributed to the menstrual cycle. Much of the research is weak, but there appears to be a very small increase in mood fluctuations during the luteal and menstrual phases, and a corresponding decrease during the rest of the cycle.{{sfn|Else-Quest|Hyde|2021|pp= 258–261}} Changing levels of estrogen and progesterone across the menstrual cycle exert systemic effects on aspects of physiology including the brain, metabolism, and musculoskeletal system. The result can be subtle physiological and observable changes to women's athletic performance including strength, aerobic, and anaerobic performance.<ref>{{cite journal |vauthors=Carmichael MA, Thomson RL, Moran LJ, Wycherley TP |title=The impact of menstrual cycle phase on athletes' performance: a narrative review |journal=Int J Environ Res Public Health |volume=18 |issue=4 |date=February 2021 |page=1667 |pmid=33572406 |pmc=7916245 |doi=10.3390/ijerph18041667 |type=Review|doi-access=free }}</ref> 

Changes to the brain have also been observed throughout the menstrual cycle<ref>{{cite journal |vauthors=Pletzer B, Harris TA, Scheuringer A, Hidalgo-Lopez E |title=The cycling brain: menstrual cycle related fluctuations in hippocampal and fronto-striatal activation and connectivity during cognitive tasks |journal=Neuropsychopharmacology |volume=44 |issue=11 |pages=1867–1875 |date=October 2019 |pmid=31195407 |pmc=6785086 |doi=10.1038/s41386-019-0435-3 }}</ref> but do not translate into measurable changes in intellectual achievement – including academic performance, problem-solving, and memory.<ref>{{cite journal |vauthors=Le J, Thomas N, Gurvich C |title=Cognition, the menstrual cycle, and premenstrual disorders: a review |journal=Brain Sci |volume=10 |issue=4  |date=March 2020 |page=198 |pmid=32230889 |pmc=7226433 |doi=10.3390/brainsci10040198 |type=Review|doi-access=free }}</ref> Improvements in [[Spatial ability|spatial reasoning ability]] during the menstruation phase of the cycle are probably caused by decreases in levels of estrogen and progesterone.{{sfn|Else-Quest|Hyde|2021|pp= 258–261}}

In some women, ovulation features a characteristic pain{{efn|Uncharacteristic mid-cycle pain may be caused by medical conditions such as [[ectopic pregnancy]] or ruptured [[ovarian cyst]]<ref>{{cite journal |vauthors=Kruszka PS, Kruszka SJ |title=Evaluation of acute pelvic pain in women |journal=Am Fam Physician |volume=82 |issue=2 |pages=141–147 |date=July 2010 |pmid=20642266 |url=https://www.aafp.org/afp/2010/0715/p141.html |type=Review |access-date=4 March 2021 |archive-date=27 January 2021 |archive-url=https://web.archive.org/web/20210127180019/https://www.aafp.org/afp/2010/0715/p141.html |url-status=live }}</ref><ref>{{cite book|title= Acute and Emergency Care in Athletic Training |vauthors= Cleary M, Flanagan KW |publisher= Human Kinetics |date= 2019 |page= [https://books.google.com/books?id=_dWLDwAAQBAJ&pg=PA340&q=Mittelschmerz%20ectopic 340]}}</ref> or may be confused with [[appendicitis]].<ref>{{cite book |last1=Brott |first1=Nathan R. |last2=Le |first2=Jacqueline K. |chapter=Mittelschmerz |title=StatPearls |date=2022 |publisher=StatPearls Publishing |id={{NCBIBook2|NBK549822}} |pmid=31747229 }}</ref>}} called ''[[mittelschmerz]]'' (a German term meaning ''middle pain''). The cause of the pain is associated with the ruptured follicle, causing a small amount of blood loss.{{sfn|Tortora|2017|p=945}}

Even when normal, the changes in hormone levels during the menstrual cycle can increase the incidence of disorders such as [[autoimmune disease]]s,<ref name="pmid28390570">{{cite journal |vauthors=Talsania M, Scofield RH |title=Menopause and rheumatic disease |journal=Rheumatic Disease Clinics of North America |volume=43 |issue=2 |pages=287–302 |date=May 2017 |pmid=28390570 |pmc=5385852 |doi=10.1016/j.rdc.2016.12.011 |type= Review}}</ref> which might be caused by estrogen enhancement of the [[immune system]].<ref name="Reed2018" />

Around 40% of women with [[epilepsy]] find that their [[seizure]]s occur more frequently at certain phases of their menstrual cycle. This [[catamenial epilepsy]] may be due to a drop in progesterone if it occurs during the luteal phase or around menstruation, or a surge in estrogen if it occurs at ovulation. Women who have regular periods can take medication just before and during menstruation. Options include progesterone supplements, increasing the dose of their regular [[anticonvulsant]] drug, or temporarily adding an anticonvulsant such as [[clobazam]] or [[acetazolamide]]. If this is ineffective, or when a woman's menstrual cycle is irregular, then treatment is to stop the menstrual cycle occurring. This may be achieved using [[medroxyprogesterone]], [[triptorelin]] or [[goserelin]], or by sustained use of oral contraceptives.<ref name="pmid34528245">{{cite journal |vauthors=Maguire MJ, Nevitt SJ |title=Treatments for seizures in catamenial (menstrual-related) epilepsy |journal=The Cochrane Database of Systematic Reviews |volume=2021 |issue= 9|pages=CD013225 |date=September 2021 |pmid=34528245 |doi=10.1002/14651858.CD013225.pub3|pmc=8444032 }}</ref><ref name="pmid25079452">{{cite journal |vauthors=Sveinsson O, Tomson T |title=Epilepsy and menopause: potential implications for pharmacotherapy |journal=Drugs & Aging |volume=31 |issue=9 |pages=671–675 |date=September 2014 |pmid=25079452 |doi=10.1007/s40266-014-0201-5 |s2cid=21166687 }}</ref>

=== Hormonal contraception ===
{{main|Hormonal contraception}}
Hormonal contraceptives prevent pregnancy by inhibiting the secretion of the hormones, FSH, LH and GnRH. Hormonal contraception that contains estrogen, such as [[combined oral contraceptive pills]] (COCPs), stop the development of the dominant follicle and the mid-cycle LH surge and thus ovulation.{{sfn|Tortora|2017|p=948}}  Sequential dosing and discontinuation of the COCP can mimic the uterine cycle and produce bleeding that resembles a period. In some cases, this bleeding is lighter.<ref name="pmid29940996">{{cite journal |vauthors=Polis CB, Hussain R, Berry A |title=There might be blood: a scoping review on women's responses to contraceptive-induced menstrual bleeding changes |journal=Reproductive Health |volume=15 |issue=1 |pages=114 |date=June 2018 |pmid=29940996 |pmc=6020216 |doi=10.1186/s12978-018-0561-0 |doi-access=free }}</ref>

Progestin-only methods of hormonal contraception do not always prevent ovulation but instead work by stopping the cervical mucus from becoming sperm-friendly. Hormonal contraception is available in a variety of forms such as pills, [[contraceptive patch|patches]], [[Long-acting reversible contraception|skin implants]] and [[Hormonal IUDs|hormonal intrauterine devices]] (IUDs).{{sfn|Tortora|2017|pp=948–949}}