Stomach ache, fatigue, depression… Several changes can occur during menstruation. They vary according to women but are always linked to hormonal variations. Explanations and decryptions with our gynecologists.
The rules. This monthly physiological phenomenon punctuates women’s lives and is sometimes accompanied by pain, bad mood, fatigue… But what actually happens in the body during the period of menstruation ? “It’s complicated because every woman is different, what happens in their bodies is therefore very variable” immediately answers Doctor Océane Pécheux, gynecologist-obstetrician at the Douai Hospital Center (North). It already encourages us to distinguish a woman on contraception and one that doesn’t : “When the woman has contraceptionthe unpleasant signs observed during menstruation are very diminishedor even disappear, especially if contraception is taken continuously like an estrogen-progestogen pill where the platelets are chained for example. She recommends that women who have a bad period because of really bothersome symptoms each cycle consider use continuous contraception to block them. “Whether the symptom is measurable or not, the important thing is tolisten to the patient and find solutions. Here are the most common signs that occur in the body of women during menstruation.
What happens in the uterus during menstruation
THE female cycle lasts on average 23 to 35 days And “it is directed by the brain, by the hypothalamus which produces gonadotropic hormones which act on the pituitary gland, which in turn produces hormones, which have a action on the ovaries or the uterus“ explains Dr Pécheux. FSH (follicle-stimulating hormone) and LH (luteinizing hormone) are the two main hormones and will act on the ovaries which, in turn, will produce progesterone and estrogen. The cycle can be split into two phases:
→ From first day of menstruation at ovulation : “This is the period of growth of the follicles, which each contain an egg, only one will mature” explains the gynecologist. As follicles grow, estrogen levels increase. It is estrogen that allows the lining of the uterus to thicken (with blood and nutrients) to accommodate an embryo in the event of fertilization.
→ From the end of ovulation on the first day of the next period : the production of estrogen causes the secretion of another hormone, LH. The latter will release the egg contained in the dominant follicle, into the fallopian tubes. It is also from ovulation that progesterone appears. It allows the lining of the uterus, also called “endometrium” to be even thicker. Then its rate drops. This fall and non-fertilization lead to a detachment of the mucous membrane, then at its maximum thickness (about 10 millimeters according to the gynecologist). Menstrual bleeding corresponds to the detachment of the mucous membrane and occurs about 14 days after ovulation. “During this period, the endometrium is therefore thinner and it will grow again over the next cycle.”
Fatigue and lack of iron caused by menstruation
A study conducted in 2019 analyzed the impact of periods on patients: 71% said they were more tired than usual. 38% even said they couldn’t do all their usual daily activities while on their period. “All hormonal variations have an overall impact on fatigue or mood, observes Dr Pécheux. The fact of losing blood also has an impact since we lose hemoglobin, ironand according to patients, it can lead to fatigue”. This phenomenon is exacerbated if the person leaves with low hemoglobinthat is, if she is anemic.” “This cause of fatigue is biologically measurable with a blood test, reassures the gynecologist. If your hemoglobin is less than 12 grams per deciliter”.
Menstruation can cause digestive upset like diarrhea
Diarrhea and digestive upset are common during menstruation and many women complain about them. In a 2014 study, 28% of 156 women surveyed said they noticed signs of diarrhea and 55% said they had gastrointestinal upset.
Nausea from menstruation
“Nausea is a very subjective sign” warns the gynecologist. The feeling of nausea could be explained physiologically by several hypotheses:
► Variations in hormones: “Women who have higher rates of change are more likely to experience this nausea” explains Dr Pécheux.
► Vomiting and nausea may be related to vagal reactions, “for example in the event of painful and intense periods: vagal excitation causes gastric atony (a lack of tone) and contractions of the thoracic and abdominal muscles (including the diaphragm in particular) hence the vomiting.”
► THE estrogen could play a role. For what ? “Because some patients on estrogen-progestogen contraception complain of nausea, and because in early pregnancy, when patients often experience nausea, estrogen rises. But it peaks in the third trimester, when nausea is much rarer, so their role is in doubt” nuance the gynecologist.
► “The involvement of progesterone has already been mentioned, with a role in gastric relaxation, but nothing is certain” says the practitioner.
Sexual desire increases during menstruation
Some women have more sexual desire when they have their period. Blame the hormones? “There libido increases during menstruation in some women while it would be supposed to be weak as progesterone and estrogen drop, which proves that it is not hormonal variations that dictate unanimous behavior” answers the gynecologist. Another hormone could play a role here: testosterone. It is produced in very small quantities but increases during menstruation gold “studies show that this hormone increases libido”. What’s more “Periods can also be considered a natural lubricant, which may play a role in increasing libido.”
Libido and ovulation: “The increase in libido is observed also often in the peri-ovulatory period (just before ovulation) and could be related to the estrogen peak, inform the gynecologist. After ovulation, progesterone increases and many patients complain of a drop in libido during the premenstrual period.
Sore breasts during menstruation due to hormones
“Breast pain can often appear shortly before menstruation,” says Dr. Joelle Robion, gynecologist. This pain can be explained by two factors:
► A hormonal variation. “In the second part of the cycle after ovulation and before menstruation, the ovaries normally secrete progesterone and in the event of a small progesterone deficiency, or even no progesterone at all, this deficiency causes pain in the breasts” details Dr. Robion.
► A genetic predisposition to the breasts. “With an equivalent hormonal variation, some women will have breast pain every month and others never”, explains the gynecologist. “It all depends on the nature of the breasts, they are more or less dense, glandular and more or less sensitive.”
Acne pimples during menstruation
Some women notice theappearance of small pimples or skin problems during their period. “This is due to the drop in hormones, estrogen and progesterone, which makes the skin finer, drier, more fragile and more sensitive to external aggressions.” explains Dr. Joelle Robion, gynecologist. “The slight increase in testosterone secretion by the ovary may also play a role in the appearance of pimples.”
Depression and bad mood during menstruation
“It’s once again the fault of the hormones“informs the gynecologist, “The drop in hormones as your period approaches causes these emotions. Specifically, it is the neurotransmitters that are responsive to hormone crashes that cause women’s moods to change under the impact of hormone crashes.” It is also “very genetic” : “There are women who are not going to experience mood swings, while for others, it will take on proportions.”
Thank you to Doctor Océane Pécheux, obstetrician-gynecologist at the Center Hospitalier de Douai and
Sources :
Gastrointestinal symptoms before and during menses in healthy womenUS National Library of Medicine, 2014
The impact of menstrual symptoms on everyday life: a survey among 42,879 womenNational Library of Medicine, Pubmed.com, 201