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Let's Talk Periods.

The Basics

What are periods and why are they happening?

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Photo credit: Virginia Physicians for Women

Every month, your menstrual cycle prepares your body for pregnancy by building up the lining of your uterus so that an egg can implant there if it has become fertilized by sperm. If pregnancy does not occur, your hormones send a signal to your uterus to shed its lining. The shedding of the uterine lining through your vagina is your period. It contains blood, mucus and cells that are no longer needed. Unlike urine, you will not be able to “hold it” to prevent your period from flowing out of your vagina.

Your menstrual cycle is measured from the first day of your period until the first day of your next period. Once you start your period, the cycle begins all over again.

Your menstrual cycle is guided by your hormones. Hormones are “chemical messengers” that travel throughout your body telling different tissues, organs, and body processes how and when to do their jobs. They let your uterus know when to thicken up its lining to prepare for pregnancy and tell your ovaries when to ovulate (release an egg).  If the egg is fertilized by sperm, hormones let your uterus know when to implant the egg into its lining. If the egg is not fertilized, hormones tell your uterus when to shed its lining.

Your cycle is powerful – and so are you! Learn how it can affect your energy levels, mood and mental and physical health so that you can be ready to manage it each month.

"Every time my period comes, I rejoice in the fact that my body is functioning correctly."

Phases of the Menstrual Cycle

Day 1 of menstruation (your period) marks the beginning of a new menstrual cycle. During menstruation your uterus contracts (tightens up) and sheds its lining through your vagina. These contractions are the cause of cramps. Cramps and other premenstrual symptoms you may feel in the days leading up to your period usually end within the first 1-3 days of your period.

Menstruation typically occurs for 3-7 days.

The follicular phase also starts on the first day of your period. Your brain releases a hormone to stimulate the production of follicles (fluid-filled sacs) inside your ovaries that hold immature eggs. Typically, one of these follicles will contain one egg that matures until it is larger and healthier than the others. This is the egg that will be released during the ovulation phase. 

During the follicular phase, your body will increase its production of the naturally-occurring hormones estrogen and testosterone. (Yes, females produce testosterone – about 1/10 the amount that males do!) This rise in estrogen and slight boost in testosterone can give you more energy, motivation, and confidence. Many menstruators feel more social and outgoing during this phase. 

The follicular phase starts at the beginning of your period and ends at ovulation.  You are most fertile (able to become pregnant) towards the end of this phase.

During ovulation, the egg that has matured in its follicle is released from your ovary to begin its journey through the fallopian tube to the uterus. Once released, the egg is available to be fertilized by sperm that has either already entered the vagina in the days leading up to ovulation or sperm that enters the vagina within one day after ovulation.

While some women feel abdominal cramping or bloating at ovulation, many do not feel either of these symptoms. You may notice some other changes, such as your cervical mucus becoming more clear, stretchy, and slippery. Your body temperature will also rise slightly after you ovulate.

On average, ovulation occurs on day 14 of a menstrual cycle, but this timing can vary widely.

The luteal phase starts at ovulation. During this phase, your body produces progesterone, often called “the pregnancy hormone.” Progesterone causes the uterine lining to thicken and helps a fertilized egg to implant in the lining and grow into an embryo and then a fetus.

If the egg has not been fertilized by sperm or does not implant, progesterone and estrogen levels drop back down, sending a signal to your uterus to shed its lining because it is not needed to maintain a pregnancy. Levels of serotonin (“the happy hormone”) also drop just a bit, which can trigger many of the PMS symptoms we will cover below – particularly those dealing with mood.

What to Expect

Having a period comes with changes to your body as well as your mood, and the symptoms can vary extensively from person to person. Some do not feel any different throughout their menstrual cycle, some have mild premenstrual symptoms, and others have severe discomfort and/or mood swings that can disrupt their lives. (If this is you, read on to learn ways to manage your period pain and symptoms or find help!)

Here are a few of the changes you might experience leading up to or during your period and a little guidance on what is normal vs. when to see a doctor.

PMS

Premenstrual syndrome (PMS) refers to the physical and emotional symptoms experienced leading up to your period that are a result of hormonal fluctuations throughout your menstrual cycle. These hormonal changes are normal and symptoms often start after ovulation (roughly days 14-21 of the menstrual cycle).

PMS symptoms can manifest in many ways: bloating, moodiness, tender breasts, headaches, acne, diarrhea/constipation, anxiety, joint pain…the list can go on and on. We will cover many of these PMS symptoms in more detail below.

PMS symptoms usually begin about 5 days before menstruation and improve 1-3 days after your period has started.

When to see a doctor:

If PMS symptoms are severely painful and/or disruptive to your everyday life, causing you to miss school or work each month, you should see a doctor for assistance in managing these symptoms.

Physical Changes

The average menstrual cycle (measured from day one of your period until your next period starts) is 28 to 30 days, but many women do not fall within this schedule for various reasons. Cycle length varies from person to person and can also vary from month to month for the same person. For example, someone in their 20s or 30s might have cycles that last 21 to 38 days whereas preteens or teenagers might have cycles that last up to 45 days.

There are many reasons someone may have irregular cycle lengths. Many teens and preteens have irregular periods because their cycles have not yet fallen under the hormonal regulation that is expected for adults. Timing of ovulation, body weight, medications, dietary/lifestyle factors, and exercise can all cause changes in your menstrual cycle. (Learn more about the effects of exercise on a teen’s cycle in Dr. Jennie Draper’s blog post, Teen Girls and Running: the Benefits of Getting Active and Tips for Establishing Healthy

When to see a doctor: 

  • If you have not gotten your period by age 15
  • If your cycle has been regular and you see a sudden large fluctuation in cycle length
  • If your cycle is irregular (shorter than 21 days or longer than 35 days) for more than 3 cycles in a row
The average period lasts 3-7 days and varies from a light flow to a heavy flow during this time. On heavier days (usually days 2-4 of their period), women tend to change their pad or tampon about every 2-4 hours. The color of period blood varies and is not usually cause for concern. It can appear pink-tinged, the usual bright red bleeding most women see at some point in their cycle, dark red (almost black), or brown. When to see a doctor: 
  • If bleeding that lasts more than 7 days.
  • If you’re saturating more than 1 pad or tampon per hour, which is often considered abnormally heavy menstrual bleeding. Saturating a pad (or tampon) means it is so full you can no longer wear it, you fear leaking through it, and it must be changed.
  • If bleeding between periods occurs 3 cycles in a row.
Blood clots are thick, jelly-like globs of blood, tissue, and protein in your period that range in color from bright red to almost black. Blood clots are common during the heavier days of your period and actually help prevent too much blood from passing. Clots are natural and rarely cause for concern. When to see a doctor: Passing blood clots the size of a quarter or larger is a sign of abnormal bleeding that could indicate an underlying health problem. We recommend seeing a doctor if you experience clots this large.

Menstrual cramps, which feel like throbbing waves of pain in your lower abdomen, are the result of your uterus contracting (tightening up) in order to expel its lining just before and during your period. It’s normal to have mild to moderate cramping for a few days at the beginning of each period. Cramps can range from mild to severe, and treatment options are available.

When to see a doctor:
If cramps are causing severe pain and discomfort each month or if they persist longer than your period, we recommend seeing a doctor. A medical provider can help you find a treatment option that will provide relief.

Changes in the levels of hormones throughout the menstrual cycle cause the body to retain more water and salt. Cells throughout the body can become swollen with water, causing the feeling of bloating.

Bloating is most commonly felt in the lower abdomen, starting right after ovulation and lasting through the luteal phase. Once your period flow starts, bloating often goes away in 1-3 days.

When to see a doctor:
We recommend seeing a doctor if pain from bloating is disrupting your daily life, or if it consistently continues more than a few days into your period.

The slight drop in serotonin leading up to your period often causes cravings for carbohydrates. These cravings can cause menstruators to overindulge during their period, but be warned: eating greasy, salty, or heavy foods will increase your feeling of bloating, while eating healthy foods and drinking water will help reduce it.

Your vaginal discharge will vary in thickness and color throughout your cycle due to hormonal fluctuations. You may have increased amounts of discharge at times–particularly during and right after ovulation. It can often be visible on your underwear. Vaginal discharge is most commonly a white or off-white mucus-like substance and should be mostly odorless.

When to see a doctor:
If vaginal discharge is discolored (not white or clear) or has a foul, fishy, or abnormal odor, that is reason for a check-up. Discharge should never fill your underwear or a pad. Too much discharge can be an issue indicating infection, illness, or pH imbalance.

Periods can affect pooping and cause diarrhea at times. This is caused by a chemical change within the body which helps regulate menstruation.

When to see a doctor:
Painful bowel movements or nausea could be signs of more severe conditions that would require diagnosis and treatment by a gynecologist.

Emotional Changes

Hormonal fluctuation throughout your menstrual cycle can also cause emotional and mood changes.

After the rise in progesterone and estrogen surrounding ovulation, both of these hormones drop significantly. The drop in estrogen causes a decrease in serotonin, the “happy hormone” that helps stabilize your mood and well-being. This decrease in serotonin can result in irritability and feelings of sadness. When progesterone, the hormone with a calming effect, drops dramatically, anxiety can creep in.

Premenstrual mood symptoms often include irritability, sadness, angry outbursts, anxiety, and mood swings.

You may not feel like yourself during this time, but the good news is that period-related symptoms are temporary. They usually begin a week or two before your period and often resolve once your period starts or a few days into your flow.

Just because a menstruator is angry or sad, doesn’t mean they are on their period, and it’s offensive to suggest it.

When to see a doctor:

If your mood changes have become disruptive to your life, it’s time to see a doctor. Moods and emotions may not be related to your period:

  • If they become uncontrollable
  • If you find you are lashing out at loved ones
  • If you find that the quality of life for yourself and those around you is affected by your emotional changes

An OB/GYN can help you determine if your mood symptoms are related to your menstrual cycle or if there are other issues going on that need to be addressed. Either way, know that there are treatments available that can help you feel better and make your symptoms more manageable.

Emotional changes do not always indicate someone’s period is coming

Female hormones can fluctuate in various stages of the menstrual cycle, and emotions vary even from period to period. Mood swings can be related to stress from relationships, school, career, or whatever else may be going on in life, and should not always be attributed to it being “that time of the month.”

How to Alleviate PMS Symptoms and Period Pain

Period pain and PMS can be difficult to treat on your own, but there are some methods you can try to help reduce your symptoms.

Exercise

Exercise is one of the best things you can do for PMS and overall menstrual cycle symptoms. Movement will increase your endorphins, the “feel good” hormone that can boost your mood and relieve pain and stress. Exercise also reduces the feeling of bloating, gives you a boost of energy, gets your blood flowing, and improves overall circulation.

Heating Pad

Placing a heating pad on the lower abdomen can help decrease bloating and reduce the pain of cramping. DIY heating pad: Fill a sock with uncooked rice or oatmeal, tie it, microwave it for 1-2 minutes, and voila!

Diet

Eating a nutritious diet has major benefits for your energy and mood. Avoiding junk food before your period will help with both. Opt for “real foods” like fruits, veggies, nuts, beans, seeds and whole grains instead of fried foods, fast foods, processed foods, and foods with added sugars. Fruit, sweet potatoes, and carrots have natural sugar that will boost your mood and energy rather than crashing it like junk food does. They also provide many other nutrients and health benefits!

Make sure to drink plenty of water, too.

Learn more about sugar and hormones in Dr. Pound’s blog post, Understanding Sugar and Hormones: FAQs and 9 Tips for Feeling Better.

Ibuprofen & Acetaminophen

Over-the-counter pain medications such as ibuprofen (Advil or Motrin) and acetaminophen (Tylenol) are often recommended for period pain. Taking ibuprofen on a schedule starting 2 days leading up to your period and the first 2 days during your flow has shown to help decrease period pain. It can also reduce menstrual blood flow.

Do not exceed 4000mg of acetaminophen per day, as well as no more than 4 doses (every 6 hours) of 800mg ibuprofen per day recommended.

Prescription Hormonal Birth Control

When at-home methods don’t offer enough relief, gynecologists often prescribe hormonal birth control for period pain and symptom management. Giving the body some additional hormones to work with its natural hormones reduces the uterine lining – decreasing the amount you have to shed – and reduces the contractions of the uterus that cause cramping.

Visiting a Gynecologist

If PMS symptoms and period pain are disrupting your life, know that it’s normal to visit a gynecologist who can help you manage your symptoms and find relief. In fact, it is recommended that teens make their first visit to a gynecologist between ages 13 and 15, or earlier if they are experiencing any problems.

We know, visiting a doctor to talk about these private problems can seem scary or embarrassing

Gynecologists treat all kinds of period-related symptoms every day, and their goal is to make you feel comfortable talking about any issues you may be experiencing. They will answer any questions you have and provide you with the treatment options that work best for you and your lifestyle.

A visit with a doctor is an opportunity to discuss any issues you are having and receive counseling on birth control – whether for period symptom management or contraception.

If you’re not sure if you need to see a doctor, Virginia Physicians for Women has experienced phone nurses who are available for questions and advice. Call 804-897-2100 and press 2 to speak with a phone nurse; they can advise you on whether the symptoms you are experiencing are normal or if you should schedule an appointment with a gynecologist.

We have more information on free or low-cost health clinics in the Richmond area below.

Tracking Your Period

Why You Should Track Your Period

You may have experienced the fear that comes with being away from home when your period starts unexpectedly, and you do not have a pad or tampon. Period tracking can help you get an idea of when your next period is coming so you can be prepared with the supplies you need when you need them. 

Tracking your period can also help you see patterns in the physical changes and mood swings you experience and help you know when you may be experiencing a problem. For example, a menstruator who is not tracking their period may not realize if it has been over 45 days since their last period started, or if their flow has lasted longer than 7 days. These are possible causes for concern, and a doctor will want to know these details in order to understand whether there is a problem and how it could be treated.

"Your period is not your enemy. On the contrary, it’s a sound barometer of your overall health."

Tracking your symptoms

Tracking your symptoms throughout your cycle can be just as helpful as tracking your period. Having a record of when you experience certain symptoms in relation to when you get your period will help you see patterns in how and when your cycle may affect your energy levels, cramps, mood, and more.

Symptom tracking can also help your doctor determine whether you have PMS or something more serious. We recommend keeping a symptom diary or tracking symptoms in an app (see next section) and bringing it to your doctor’s appointment.

How to track your period and symptoms

You can use a basic calendar or paper and pen to jot down your flow and symptoms each day. Here is a free, downloadable period and symptom tracker created by Mama Knows It All that you can print or edit on your computer to track the dates and details of your period, mood changes, and physical symptoms.

If you are experiencing any issues, we recommend tracking your symptoms for 3 months and bringing this record to your doctor’s appointment. Record your period plus the symptoms you are experiencing and when they happen in relation to your period.

Bright girls are bold and confident. They’re not ashamed or scared of their period or their body.

Period Products

There are a number of products that can help you stay dry and comfortable during your period. These products help make it possible for you to participate in everyday activities like school, work, sports, and social events without anyone knowing it’s that time of the month.

You may want to try a few different products to see what works best for you and your lifestyle. Some may be more comfortable for certain activities or during certain days of your flow, and some are more cost effective than others.

You should never use a product to catch blood that is not meant for managing your period, such as rags, socks or newspaper.

 If you have trouble affording or accessing pads or tampons, please contact Sylvia’s Sisters. We can help!

Panty liners are very thin, absorbent pads that line the inside of your underwear to absorb a light period flow. There is an adhesive strip on the back of the liner that sticks to the inside of your underwear. Liners are great to wear the day you expect your period to start to catch the first drops. They can also be helpful to wear at the end of your period when your flow starts to slow down but you are not sure if it is  finished.  

How often should panty liners be changed?

Panty liners should be changed when they are saturated and should not be worn for more than 8 hours. Never flush a panty liner down the toilet. Most bathrooms have a trash can inside the stall or just outside for you to dispose of your panty liner.

Pads are thick napkins that stick to your underwear to absorb period blood. Sometimes called “sanitary napkins,” pads have different levels of absorbency for different days of your period. It can be helpful to have a variety of sizes and thicknesses for different flow days and activities.

Pads are sometimes rated on a scale of 1-5, which determines their level of absorbency. Size 1 is for lighter days, and size 5 is for heavier flow days or overnight. Pads also come in different thicknesses; “ultrathin” pads are thinner and less bulky. “Maxi” pads are thicker; some women prefer the security of a thicker pad. Both ultrathin and maxi can be equally absorbent; your choice of pad is just a matter of what you prefer.

Peal off the wrapper, then the paper strip covering the adhesive on the back of the pad. Center the pad on the crotch of your underwear and press lightly. The sticky side is always towards your underwear, not your skin.

Some pads have “wings,” which extend out from the sides of the pad to wrap around your underwear and provide more protection and help keep pads in place. “Overnight” pads are longer to catch your period during different sleeping positions throughout the night.

How often should pads be changed?
Pads should be changed at least every 4-8 hours or more often if necessary. Like most menstrual products, pads should never be flushed down the toilet because this will cause the toilet to become clogged. Instead, dispose of your pad in the trash can. If you are replacing your pad with a new pad, you can use the wrapper of the new pad to dispose of the old pad. You can use toilet paper if a wrapper is not available.

Reusable pads are washed after each use, which makes them a very environmentally-friendly option. Reusable pads can also save you money. They can be found online or in natural health stores.

Reusable pads are completely hygienic if used correctly. They should be rinsed after use and then washed in the washing machine on a cool setting. Do not put reusable pads in the dryer. After washing, pads should be stretched back into shape and layed out to air dry. If reusable pads are taken care of in this manner, they should last about two years. 

Normal pads (reusable or disposable) cannot be worn in the water. However, waterproof pads can be very helpful when you’ll be swimming, especially if you prefer using pads to tampons. They work best inside snugly fitting swimwear. Here are a few good options for reusable waterproof pads

How often should reusable pads be changed?

Like regular pads, a reusable pad should be changed every 4-8 hours. Rather than discarding the pad, it should be rinsed, washed, and then reused.

Waterproof pads should be changed every 1-2 hours, or as soon as you leave the water.

It’s a good idea to carry a bag that you can place your reusable pad into to transport it home if you need to change it while you’re out and about. 

Tampon in an applicator (left) and tampon outside of the applicator (right).

Tampons are cylinders of absorbent material with a pull-string attached for easy removal. Tampons vary in size and absorbency. Some are more slender for light days, some are made for regular flow days, and some are larger and super absorbent for heavier days. You may want to experiment with different sizes on different days of your period to see what works best and is most comfortable. Some menstruators use a panty liner or pad in addition to a tampon for extra protection, especially when they have a heavy flow.

The tampon slides into the vagina, either via an applicator or your finger. For tampons that come with applicators, the tampon is encased in a plastic or cardboard tube that you insert into your vagina, then push the tampon through the tube so it goes into the vagina. You’ll see the string hanging out of your vagina. If a tampon is properly inserted, you will not be able to feel it. Once the tampon is inserted, Remove the applicator and dispose of it in a trash can (not in the toilet!). 

How to insert a tampon (video):

VIDEO: How to insert a tampon.

Tampons can be a great option when you are swimming or doing water sports (pads should not be worn in the water).

How often should tampons be changed? 

Tampons should be changed every 4-6 hours; but if not needed to be changed, a tampon can safely stay in the vagina for up to 8 hours. After 8 hours, you risk developing an infection.

If a tampon is not ready to be changed, you likely will not be able to feel it inside you. You should still remember to change it every 4-6 hours. You can sometimes feel when a tampon has become full and needs to be changed; it may become a little uncomfortable or feel like it is starting to push out of you.

When it’s time to discard the tampon, you can wrap it in toilet paper and dispose of it in the trash can.

How do I remove a tampon?

Tampons are removed by pulling the string and disposing of it in a trash can. While many tampons and applicators say they are flushable, flushing them is bad for a bathroom’s plumbing. They should be disposed of in a trash can to prevent toilet clogs or plumbing backups.

If you are unable to find the string when you go to retrieve your tampon, do not panic. The tampon is too large to go anywhere beyond your vagina. If you are unable to use your fingers to pull the tampon out, you can visit a doctor who will retrieve it for you. Don’t be embarrassed – it won’t be the first time they’ve had to do it!

Can I pee with a tampon in?

Yes, your urine comes out of your urethra, a different hole than your vagina, where your tampon sits. Pee might get your tampon string wet.

Menstrual cups are small, reusable cups that are inserted into the vagina to catch your period flow before it exits the vagina. They are soft and flexible. They are also more environmentally friendly than disposable pads and tampons. Proper insertion and removal vary by brand and will be included in the instructions that come with your menstrual cup. Here’s a helpful video. It can be tricky to learn to insert and remove a menstrual cup, but you’ll get the hang of it with practice.

How often should menstrual cups be changed?
With clean and dry hands, menstrual cups should be emptied, washed, and reinserted (if necessary) every 8-12 hours. Since you won’t be able to see if your menstrual cup is full, you will need to stay on top of these changes.

Can I pee with a menstrual cup in?
Yes, your urine comes out of your urethra, a different hole than your vagina, where your cup sits.

Period underwear is another product that is convenient and highly regarded for its sustainability. They are comfortable, washable, and reusable. Period underwear wicks the moisture (blood) away from your skin into an absorbent material.

To wash period underwear, you can put them in the washing machine with your regular load of laundry and wash them in cold water on a delicate cycle. Some period underwear should not go in the dryer. Check the tag to see if they can be tumble dried or if they need to air dry.

How often should period underwear be changed? 

How often to change period underwear depends on the type of underwear, how heavy your flow is, and whether you are using them to replace other products or in combination with other products as a backup. Some period underwear are less absorbent and may need to be changed multiple times a day. Some are super absorbent and can be worn all day. If they feel wet or you see blood at the seam, it is time to change your period underwear.

Period Hygiene

Good period hygiene, including daily bathing and changing period products as directed above, can help you feel more clean and comfortable during your period. It is also important for preventing vaginal odors and infections.

Never use anything other than a period product (pads, tampons, etc.) to catch your period blood. Items such as socks, newspaper, toilet paper, paper towels, rags and anything else might seem like an appropriate substitute but can cause infection.If you have trouble getting period products, email information@sylviassisters.org. We can help.

Wash outside of the vagina (not inside!)

The inside of the vagina is “self-cleaning,” which means it does not require soap or other products. However, daily washing of the skin outside the vagina, called the vulva (see diagram), with warm water and mild soap such as Dove is appropriate and often welcomed, especially during periods. Use a warm, wet washcloth or your hands to clean around the labia (the folds of skin or “lips” around the opening to the vagina) while avoiding getting water or soap inside the opening of the vagina.

Do not use douches or sprays or soap advertised to go inside your vagina. Products like douches, which claim to make your vagina cleaner and fresher, can actually increase your risk of infection by altering your natural pH level (a measure of how acidic it is) and removing “good” bacteria that help to keep it clean and healthy.

Bathing soon after exercise will also help prevent odors and infection. If you cannot bathe immediately, you should change out of sweaty clothing as soon as possible.

When wiping after using the bathroom, make sure you wipe from front to back (from your vagina towards your anus–not anus towards vagina!) to keep bacteria from entering your vagina.

How Often to Change Period Products

Here’s a quick guide to how often period products should be changed to maintain hygiene and help prevent odors and infections.

Panty Liners

Every 4-6 hours or more frequently if needed. Do not wear longer than 8 hours.

Pads

Every 4-8 hours or more frequently if needed. Do not wear longer than 8 hours.

Tampons

Every 4-6 hours. Do not wear longer than 8 hours.

Reusable Pads

Every 4-8 hours or more frequently if needed. Do not wear longer than 8 hours.

Menstrual Cups

Menstrual cups should be emptied, washed, and reinserted (if necessary) every 8-12 hours. 

Period Underwear

Depending on the absorbency of the period underwear, it should be changed anywhere from every 4-6 hours to once per day.

Period Odors

As hormones change and period bleeding begins, some women may notice a change in their overall odor. This odor can be due to the blood itself, lack of hygiene, or unavoidable hormonal changes. Temporary odor is normal, but odor that persists or is accompanied by other symptoms could indicate a problem.

Vaginal odor can be improved with more frequent pad or tampon changes and regular bathing. and use of over-the-counter products such as deodorants, wet wipes to ensure cleanliness, oral probiotics (such as those in yogurt or dietary supplements), period underwear, and period cups. All of these products can help fight odor during your period.

When to see a doctor:

If an odor does not go away and/or is accompanied by a change in vaginal discharge, itching, swelling, or pain, you should see a doctor.

Vaginal Infections

Vaginal infections can happen at any time throughout the menstrual cycle and are not often directly related to menstruation. Good menstrual hygiene can help prevent infections.

Most women will have some form of bacterial vaginosis (BV) and/or a yeast infection in their lifetime. BV is a bacterial overgrowth in the vagina, and yeast is a fungal overgrowth. Both are related to vaginal pH. Your body maintains a certain pH level that helps it ward off infections. If the vaginal pH is altered even just a little, an infection can occur. Both BV and yeast infections can easily be treated with over-the-counter options as well as prescription medications. Products like Boric Acid and RepHresh can also help rebalance vaginal pH. 

Toxic Shock Syndrome (TSS), though rare, is a serious, life-threatening infection that can occur in relation to tampon use. Leaving a tampon in longer than 8 hours could potentially put you at risk for health concerns such as TSS.

When to see a doctor:

If you have any signs of infection, including itchiness, heavier than normal discharge, odor, redness, swelling, or abnormal bleeding, you should see an OB/GYN rather than trying home remedies or over-the-counter treatments. Most infections can be treated easily with medication. If you have recurrent infections, your OB/GYN can work with you to develop a plan to break the cycle. Recommended clinics in our area can be found below.

FAQs

Yes! It is safe to swim using tampons or menstrual cups. It is not advisable to swim in a regular pad or panty liner; however, there are now reusable, waterproof pads available that are a great option for getting in the water when you’re on your period.

NO. There is nothing sexual about a tampon.

No. There are times where a woman may struggle to get the tampon out, however it will not get “lost” inside of your body. The vaginal canal is a small, enclosed space. Your cervix, that leads to other parts of your body, is much too small for the tampon to fit through. The purpose of the string on the tampon is to be sure it is available to pull it out.

Advice on how to remove a “lost” tampon: Sit on a toilet and “bear down” as if you are trying to poop. This might help push the tampon down.

If that doesn’t work, wash your hands well and insert one finger into your vagina as far as possible, feeling around with circular motions. Try to reach the top of your vaginal canal. If you feel the tampon, insert 2 fingers into the vagina, trapping the string between them, then gently pull it out.

If you think you have a retained tampon that you cannot remove (it happens!), you may need to seek medical help for removal.

If you don’t tell them, they’ll never know!

Of course! Exercise is one of the best options for menstrual cycle management. Exercising regularly will improve overall menstrual symptoms extremely well, and exercise during cycles is recommended!

Yes. A common misconception is that everything “comes from the same place” when in reality you bleed from your vaginal canal and you pee from your urethra. A tampon will not alter your ability to empty your bladder.

100%. Anything that causes stress, hormonal, or overall system changes to your body can alter your period timing, flow, and symptoms.

No. Menstrual blood comes from the uterine lining and is a mix of blood, mucus, and endometrial cells.

This is personal preference. There is no medical reason that you cannot be intimate while on your period.

This is a difficult question with many misconceptions. The short answer is YES, however medically it is extremely difficult to conceive on your period. Because sperm can survive in the female reproductive system for up to five days, if you ovulate within 5 days of having unprotected sex during your period, there is a small opportunity for becoming pregnant.

The amount varies a lot between people. On heavier days (usually days 2-4 of their period), most menstruators tend to change their pad or tampon about every 2-4 hours. You should see a doctor if bleeding lasts more than 7 days, if you’re saturating more than 1 pad or tampon per hour (which is often considered abnormally heavy menstrual bleeding) or If bleeding between periods occurs 3 cycles in a row.

As hormones change and period bleeding begins, some women may notice a change in their overall odor. This odor can be due to the blood itself, lack of hygiene, or unavoidable hormonal changes. Temporary odor is normal, but odor that persists or is accompanied by other symptoms could indicate a problem.

Vaginal odor can be improved with more frequent pad or tampon changes and regular bathing of your body and the outside of your vagina. Do not ever wash inside your vagina. More info here.

The color of period blood varies and is not usually cause for concern. It can appear pink-tinged, the usual bright red bleeding most women see at some point in their cycle, dark red (almost black), or brown.

Those are blood clots. Blood clots are thick, jelly-like globs of blood, tissue, and protein that range in color from bright red to almost black. Blood clots are common during the heavier days of your period and actually help prevent too much blood from passing. Clots are natural and rarely cause for concern.

The different phases of your cycle often come with a variety of physical symptoms (bleeding, bloating, diarrhea, cramping, cravings, discharge) and emotional changes (anger, depression and anxiety), especially in the week leading up to menstruation. These are natural. More info here.

Exercise, eating healthy (see above), over-the-counter pain meds, heating pads, epsom salt baths, and prescription birth control can all help manage PMS symptoms. 

Emotional changes do not always indicate someone’s period is coming. Mood swings can be related to stress from relationships, school, career, or whatever else may be going on in life, and should not always be attributed to it being “that time of the month.”

We have written instructions here or you can watch a great video about inserting a tampon here:

A perfectly “regular” period that comes at exactly the same time every month is rare. Changes in your period’s length, the heaviness of your flow, and the symptoms you experience during your period are all subject to change from month to month, or even day to day. In most cases, that is perfectly normal.

Yes! When you’re sitting or lying down for a long time, period blood may collect in your vagina. Sometimes gravity causes this pool of blood to exit your vagina when you stand up. It may feel surprising, but it’s totally normal!

Help & Resources

Talking About Periods

Getting your period is a natural, healthy part of growing up for half the world’s population. It’s normal to feel embarrassed about the physical and emotional changes your body is going through each month. Just remember that you’re not alone – and it’s okay to talk about these changes, ask questions, and ask for help when you need it.

In fact, talking about your period with your friends, a parent, siblings or trusted loved ones who have already started their period, will help you feel more confident about your ability to master this monthly challenge. 

You might also find that school nurses, counselors, and teachers are easier to approach and much more open to a conversation about periods than you might have guessed. While it may seem like nobody is talking about it, there are a lot of people who are happy to share their insights, advice, and a pad or a tampon when you need it.

"Society has placed a taboo surrounding periods and menstrual health as if we should be ashamed of this natural and miraculous process that ultimately kept the human species alive."

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Seeking Medical Guidance

Periods, hormones, and menstrual cycles are a normal part of life, but they are also complicated and can be difficult to navigate. If you have any cause for concern, we encourage you to seek medical advice. 

  • Free Clinics

    You can find a list of free clinics via the Virginia Association of Free and Charitable Clinics.

    Please keep in mind that each clinic sets its own eligibility requirements and guidelines.

  • Virginia Physicians for Women

    Virginia Physicians for Women (co-author of this website) is an OB/GYN practice with 6 locations in the greater Richmond area and Prince George that provides personalized, compassionate, OB/GYN care for all ages. You can call VPFW at 804-897-2100 to ask questions about cost of care, make an appointment with an OB/GYN at a location near you, or press 2 to speak with one of the experienced nurses for questions and guidance.

  • Sylvia’s Sisters

    Are you in need of menstrual products? Sylvia’s Sisters has a network of safe locations that will provide products to you for free. See this map for more information. If you are a school or organization, please fill out this form.

Other Resources

  • Amaze
    Amaze takes the awkward out of growing up. Fun, animated videos about sex, healthy relatipships & your body. 
  • Violet Project
    Sexual & reproductive health care and education by Johns Hopkins. Plus, submit your own questions!

Still Have Questions?

Please send us any menstrual health-related questions using the anonymous form below and we’ll do our best to answer!