Girl's reproductive organs include vagina which opens in the groin region and connected to a muscular bag called uterus.

The ovaries present on either side of the uterus pass one matured egg every month to the Fallopian tube where the fertilization can take place.

On either side of the uterus are the Fallopian tubes which carry the fertilised egg to the uterine cavity.

After puberty the uterus gets lined every month by an epithelial lining called endometrium which is required for supporting the fertilized egg and to pass nourishment for development of the baby.

While the egg is getting ready for release, the hormonal changes in the body form a lining inside the uterus in which the fertilized egg gets embedded.

If the fertilization does not take place, within the specified duration, the lining of the womb gets disintegrated and is expelled through the vagina.

This shedding of the lining and the unfertilized egg along with blood is called Menstruation or Period.

Formation of lining of the womb, formation of a matured egg,  expulsion of the disintegrated lining of the womb along with egg through vagina occurs in a cyclic fashion is called a Menstrual Cycle.

The release of hormone called prostaglandin just before menstruation may cause variety of physical symptoms like severe pain and cramps in lower abdomen, headache, illness, fatigue, sickness, nausea, cold sweat, constipation or Diarrhoea.

Woman may also experience emotion related symptoms like depression, irritability, excitement. 

Common signs also include change in appetite, feeling of tiredness and getting upset more frequently.

It is not necessary that most of these or any of these symptoms must exist with each menstrual period.

These symptoms are natural and related to change in hormonal level. Hence, should not be considered psychological,

Some women put on weight during menstruation because of accumulation of water in the body, which gives feeling of being bloated.

For most women, these physical and emotional symptoms become part of monthly chorus. 

With experience a woman can predict starting of a period or keep track of dates of the period and get adjusted to the expected changes in body, behaviour and circumstances. 

In some cases, tight cervical opening does not allow easy passage of menstrual flow thereby causing severe pain.  A simple procedure of widening of the cervical canal by your gynaecologist can facilitate menstrual flow.

1.  Scanty bleeding does not indicate any accumulation of blood inside the body.

2.   Menstrual bleeding does not poison the body. 

3.   Heavy period does not mean that too much of blood is lost.  The blood loss is made up quickly by just regular balanced diet.

4.  Menstrual blood is different from the normal blood.  It contains mucus, degenerated cells from the lining of the womb and the blood that has clotted inside the womb.

5.  There is nothing dirty about Menstrual Bleeding and no need for a girl to remain away from routine activities.

6.  In some religions, especially Hindus, woman is not allowed to perform religious rituals during menstruation. It is however up to the individual to decide.

7.   One can participate in sports while period is on. Exercise and sports in fact help in relieving cramps and sensation of fatigue experienced during a period.  Use of tampon and sanitary napkin provide good protection during menstruation.

8.  The menstrual blood does not have any odour unless it comes in contact with air.  Hence, use of perfumes should be avoided. Perfumes or deodorants can not only cause irritation, but also kill protective bacteria of vagina and allow growth of harmful bacteria.

9.   Men do not have any such hormonal cycle.

More about menstruation

• A woman gets about 400 menstrual periods in her lifetime
• During each period they lose about 50 to 75 ml of blood over 4 to 7 days
• Interval between two periods vary between 20 to 30 days
• Drop in estrogen level at the end of menstruation triggers release of chain of hormones which finally stimulates the ovary to ripen the egg in their follicles.
• This process produces estrogen which starts formation of lining in the womb.

The first menstrual period is usually unforgettable incidence. This being indication of woman becoming fertile, is a joyous moment. Many girls remember the exact date it started first.

Girls must be made aware much before the first period about menstruation and about why, when and how it occurs.

Girl must also be told that menstruation means her body is developing and working in a new way. She is now capable of getting pregnant, if she has sexual intercourse.

Starting of menstruation as well as her ability to get pregnant does not mean that her body is ready for sex or have a baby.

The vagina at that young age is small and immature till girl reaches 18 yrs of age. In addition, the hip and pelvic bones are not developed sufficiently for normal delivery of a baby.

For girls who have been made aware of possibility of getting menstruation by their mother or elder sister, it is easier to handle the situation without anxiety. But, girls who get menstruation unexpectedly feel shocked and unhappy.

Menstrual bleeding does not occur like water from the tap. The blood dribbles out slowly.

Usually first menstruation starts with feeling of wetness in panties due to lesser amount of blood coming out, which does not affect their outer garments.

But for some, more blood comes out suddenly or for girls who take longer time to realize the onset of bleed, an embarrassing situation may arise. Persons around should advise her to remain calm and overcome any anxiety or guilt.

For most girls it takes time to get adjusted to sudden arrival of menstruation. Therefore, guiding them to keep track of onset of each menstruation, helps them in anticipating next menstruation and remain prepared. Because the menstrual cycle is roughly of 28 days, the date of onset of each period will differ every time.

In some cultures period of menstruation is considered dirty for women.

Although menstrual blood is clean when it leaves body, bacteria can grow in it when it comes in contact with air. This causes bad smell.

Therefore, extra hygienic care is required during periods.

You must wash the genital area at least twice during day to keep it clean.

Never use deodorants or perfumes on your genitals during periods as well as other times. They can cause irritation and infection in genital area.

Many girls have swelling and tenderness in breasts just before starting of periods or when the ovulation takes place in their body.  Although it causes lot of discomfort, it is a normal and natural process.  The soreness in breasts is due to accumulation of more water.

Eating less salty food will help in reducing the extra water accumulation in body and using a well fitting bra will make the breasts feel more comfortable.

Periods also affect the mood of a girl. Some girls feel depressed because of soreness in breasts and swelling or bloating of body. She also becomes more irritable even over petty issues.

This change in mood is described as Pre-Menstrual Tension. Realizing about it yourself and remaining pleasant will make the situation less unpleasant for people around you.

Many girls as well as women get cramps in lower abdominal area during periods due to contractions of muscles of uterus while shedding its lining.

Although this pain during menstrual period is normal and can be managed with experience, if the pain is unbearable, one should lie down and relax the body with deep breathing.  You may massage the abdomen and back or use hot water fomentation for lower abdomen. Medicines to relieve the pain may be taken with advice of your doctor.

Remaining active and busy with work, doing routine exercises, and playing helps in reducing the cramps and making the pain bearable. If you wish to go for swimming, you may use tampons to absorb the blood by remaining within the vagina.

In any case, periods should not deprive you of things you enjoy doing.

Some girls experience excruciating pain especially when there is heavy bleeding during periods.

Menstrual cramps and pains are usual feature during adolescence up to the age of 20 years and reduce considerably thereafter.

Girls with heavy bleeding during periods need more pads in a day and sometimes experience stained clothes and bed-sheets at nights.

For making the period easier and comfortable

• Remain prepared for it by keeping track of its probable date of occurrence.
• Always carry sanitary pad in your school bag or purse. Sometimes it may help your friend.
• Eat less salt to avoid retention of water in body which gives you feeling of swelling, bloating or heaviness in abdomen and legs.
• Drink plenty of water.
• Eat food rich in iron like beans, green vegetables to help your body replace the iron lost due to bleeding. Eat whole grain cereals which are rich in vitamin B complex.
• Supplementary vitamins or iron tonics be taken if advised by a doctor.

Girls who have to miss the school often, particularly due to heavy period or pain, may take help of their gynaecologist who may prescribe hormone pills which can reduce flow as well as pain for the periods. These pills make the periods more regular and reduce amount of blood loss each month.

These hormone pills are prescribed only for virgins and not for those having sex.

Gynaecologists, who do not prefer to prescribe hormone pills, may give medicines to reduce the pain due to cramps.

You may also see the doctor if your periods last longer than usual 3 to 5 days or when you find unusual bleeding or spotting of blood between the periods.

Use of sanitary Pads Napkins

Sanitary pads are designed to fit neatly between your legs covering entire genital area. They have string or adhesive strip to hold it in place under your panties. These pads have lining which protects your clothes from leakage of blood.

Person may choose the sanitary pad most suited in respect of comfort and cost.

Use of Tampons

Tampon is hard cotton pallet like object which is inserted into the vagina during menstruation.

Once placed into vagina, the cotton in the tampon softens as it absorbs blood coming from uterus.

A string is attached to the tampon which remains out of vaginal opening so that tampon can be pulled out easily.

Tampon cannot slip inside your body or enter uterus; but stays inside vagina till you remove it.

Advantage about the tampon is you cannot even feel its presence in body. 

Extra care is required while handling tampons. Your hands must be washed thoroughly before and after inserting the tampon into vagina.

Tampon should also be replaced every 3 to 4 hours depending on blood flow, because infection can creep in if it remains inside for too long.

Use sanitary pad during nights because 6 to 8 hours of sleep is too long a period for keeping tampon inside vagina.

If tampon remains inside for too long a period, it may cause a rare but serious illness called “Toxic Shock Syndrome”.

If you experience vomiting, fever, diarrhoea, or rashes in the genital area remove the tampon immediately and see your doctor for advice..

 Always use correct size of tampon depending on expected flow of blood.

Whatever the means used to manage flow of menstrual blood, change it frequently and keep the area clean.

If you find your panties stained with blood, soak it in cool and mildly salty water and wash with soap and water. Using hot water can set the blood and cause stains.

While using tampon, let someone, your mother, sister or doctor show you how to insert it in the vagina correctly.

Inserting tampon inside vagina may not be painful, if you remain relaxed.

Change the tampon or pad every 3 to 4 hours to avoid bad smell and staining of clothes.

Use high-absorbing tampons only when blood flow is more. Else, it may cause dryness and infection inside vagina.

If you are using tampon while swimming, there is less chance that blood will ooze out in the water.

Never flush sanitary pads or tampons in the toilet because they can block its drainage system. Always wrap properly in paper and throw in the dust bin.

 Loss of Menstrual Period may occur in following situations

1. Wilful starvation to become ‘thin’ adversely affects desire for sex.  This leads to symptom called ‘Anorexia Nervosa’ leading to loss of periods in adolescent girls.

2. Sometimes habit of compulsive eating leads to estrogen getting absorbed by body fat which affects Menstruation.

3. Extreme emotional stress during adolescence caused by parent’s divorce, unhealthy family atmosphere, death in the family or even change in school or break in friendship can interrupt normal hormonal cycle leading to stopping of period.

4. Women in menopause do not get periods because their menstrual cycle stops permanently.

5. Periods also stop when a woman becomes pregnant. However, stopping of period does not prove pregnancy unless there is sexual intercourse.

Absence of egg formation during the menstrual cycle is called Anovulatory Period.
 
In young girls hormones start development of breasts, pubic hair, and the lining of the womb but making of an egg starts few months later.
 
The egg formation also stops when woman approaches menopause. 

Following factors related to ‘egg’ can lead to infertility in female -

1. Basic fault in ovaries which stop egg formation, or

2. When there is blockage in fallopian tube which prevents egg from reaching the cavity of Uterus (womb), or

3. When emotional disturbance cause hormonal imbalance leading to non release of egg, although womb lining is formed normal.

It is not true that having sex during menstruation removes or reduces pain during menstruation.

In fact, sex during periods may increase chance of infection or sexually transmitted diseases.

Menstrual bleeding being an environment most suitable for growth of harmful bacteria and virus, sex during menstruation can increase risk of inducing these infections inside the vagina.

Germs of Sexually Transmitting Diseases can travel into uterus and Fallopian tubes to cause infection there which may result in causing infertility.

The menstrual cycles are mostly irregular during adolescence. And it is easily affected by stress, sorrow, physical strain, and due to other changes taking place in girl’s body during growth.

Most boys, girls as well as adult couples are mistaken about “safe days”. Although there is less chance of getting pregnancy during some days of menstrual cycle, i.e. during menstruation or immediately after menstruation, the risk of getting pregnant persists on all days.

This is because the sperms that enter vagina if survive to reach fallopian tubes through uterus may remain there for 3 to 4 days. During this time if the ovulation has taken place, there is chance of pregnancy.

As regards HIV or other sexually transmitting Infections, none of the days are safe.