News Highlights
Normal changes during the menstrual cycle
A woman’s normal menstrual cycle involves recurring changes in various hormones including estrogen and progesterone, which are produced by the ovary.
The menstrual cycle begins with the onset of menstrual flow (day 1) when the thickened lining of the uterus, the endometrium, is shed. During and following menstruation, multiple follicles in the ovaries which contain eggs grow and develop. This is known as the follicular phase of the cycle and its duration lasts anywhere from 7 to 21 days. Eventually one follicle matures (the dominant follicle) and the egg within is released in a process called ovulation. Estrogen is made by the developing follicles, and levels of the hormone peak just prior to ovulation and then drop abruptly. This drop occasionally results in “mid-cycle” spotting for some women.
For most women, ovulation occurs approximately 14 days before the next menstrual period starts—a time interval referred to as the luteal phase. In this phase, the dominant follicle becomes a specialized cyst called the corpus luteum, which produces the hormone progesterone. This hormone maintains the lining of the uterus, or endometrium, in preparation for a potential pregnancy. If pregnancy does not occur, estrogen and progesterone levels start to decrease, resulting in the breakdown uterus lining and another menstrual period.
How does hormonal contraception prevent pregnancy?
The combined birth control pill, patch and ring contain both an estrogen and a progestin, which are similar to the hormones made by the ovaries. These medications prevent ovulation by stopping a dominant follicle from developing. Women will menstruate in the week off the pill, patch or ring or during the week of inactive pills because levels of estrogen and progestin decrease at this time, resulting in breakdown of the endometrium.
What skin changes may occur during the menstrual cycle?
Skin is one of the organs to respond to various hormones. The ovaries also make testosterone, but women have much less of the hormone than males. Testosterone increases the production of oil in the skin (sebum), but high levels of estrogen decrease it. Using a sensitive ultrasound technique, researchers found that women’s skin was thicker when estrogen levels were highest, around the time of ovulation. The normal fatty layer directly under the skin also changes with hormonal fluctuations, reaching a maximum thickness around the time of menstruation. This may explain why some women feel bloated or “fat” around the time of their period. A similar effect is seen in the breast. Women with acne and skin conditions such as lupus or psoriasis often have a worsening of their symptoms premenstrually.
Changes in vaginal discharge and menstrual blood
Vaginal discharge varies with the menstrual cycle. Menstrual flow contains blood, cells from the endometrium and fluids made by the vagina. It may be red, brown, pink or black depending on the rate of blood flow. Rapid blood loss is often red, whereas slow blood loss allows the menstrual blood to change appearance to a darker brown or black colour. The cervix connects the uterus and the vagina and it produces mucus, which varies in consistency over the cycle. When estrogen levels are high, it is clear and watery, and after ovulation when progesterone levels increase it becomes thicker and sticky, ranging from white to yellow in color.
Related articles:
Farage MA, Neill S, MacLean AB. Physiological changes associated with the menstrual cycle: a review. Obstetrical & Gynecological Survey 2009; 64(1):58-72.
Eisenbeiss C, Welzel J, Schmeller W. The influence of female sex hormones on skin thickness: evaluation using 20 MHz sonography. Br J Dermatol 1998; 139:462–467
Mood symptoms on the birth control pill
When some women take the birth control pill, they experience mood changes such as irritability and mood swings. Mood symptoms are enough to motivate between 14-21% of users to stop taking the pill, though the results of a new study suggest the pill is often not the cause.
Combined oral contraceptives (COC) are not known to cause mood disorders, but their use has been associated with worsening of mood symptoms in women with preexisting disorders.
This study looked at 118 women to see if there was any association between women who tended to experience adverse mood symptoms while taking COC and women who had preexisting mood or anxiety disorders.
- Almost one third of current or past COC users who experienced mood symptoms met criteria for diagnosis of some type of mood or anxiety disorder.
- There was no significant difference in anxiety disorders alone between all groups.
- There were more mood disorders in the women who reported current mood symptoms on COCs (14%) and in past users who discontinued due to mood symptoms (21%) compared to current COC users with no mood symptoms (0%).
Women who experienced mood symptoms while taking the pill had similar rates of ongoing mood or anxiety disorders whether they were still taking the pill or not. This suggests that for some women, mood symptoms are not due to taking the pill, since they did not improve once the pill was discontinued.
Women should be encouraged to speak with their physician if they are having difficulty with mood symptoms while using a COC. In some women, it may be necessary to discontinue the pill to determine if the COC was the cause or if there may be an underlying mood disorder. In this case it is important that another reliable method of contraception is used to prevent unwanted pregnancy. In other women there may be indicators of an underlying mood or anxiety disorder and it may be more appropriate to continue the COC and to treat the diagnosed disorder.
Segebladh B, Borgström A, Odlind V, Bixo M, Sunderström-Poromaa I. Prevalence of psychiatric disorders and premenstrual dysphoric symptoms in patients with the experience of adverse mood during treatment with combined oral contraceptives. Contraception 2009; 79:50-55.
How does douching affect your risk of sexually transmitted infections?
Vaginal douching involves using a liquid solution to rinse the vagina. Although some women believe that douching may provide hygienic or therapeutic benefits, it is not really necessary—the vagina keeps itself clean with healthy bacteria. In fact, vaginal douching may actually be harmful to a woman’s vagina.
A new study of young women whose behaviours put them at high-risk for sexually transmitted infections (STIs) found that douching doubles a woman’s risk of catching one. For three years, the study followed 262 women who were HIV-infected and 147 women who were HIV negative. Researchers analyzed the rates of douching in women who did and did not develop new STIs during this time.
The findings of this study are consistent with many others that have claimed douching increases a woman’s risk of getting catching STIs and developing pelvic infections. This study provides evidence that douching may be a causal factor for developing STIs in this group of high risk women. It is not known whether women who are at a lower risk for STIs would have a similar risk with douching.
Why douching is bad for a woman’s health
It may sound strange, but the balance of various bacteria in the vagina, particularly lactobacilli, is an important part of keeping it healthy. If one bacteria or yeast takes over, you can develop an infection like bacterial vaginosis or a yeast infection.
Douches can destroy the balance of healthy bacteria in the vagina which may disable the protective mechanisms normally in place in a healthy vagina, which may result in infection. Douches can also irritate the vagina, possibly putting a woman at higher risk of other sexually transmitted infections.
Tsai CS, Shepherd BE, Vermund SH. Does douching increase risk for sexually transmitted infections? A prospective study in high-risk adolescents. Am J Obstet Gynecol 2009; 200:38.e1-38.e8.
Ask Sexualityandu
I have heard that abnormal pap smears are caused by HPV, which is sexually transmitted. Since I am a lesbian, do I still have to get Pap smears?
Yes, the recommendations for cervical cancer screening with Pap smears for women who only have sex with other women are the same as for heterosexual women. If you are sexually active, or if you’re 21 or older, your family doctor or health care giver will discuss the necessity of a pelvic exam with you.
Many lesbian women may have also had sex with a male partner at some point in their lives and may have been infected in this way. Regardless, HPV may be transmitted during any type of sexual activity, not just during penile-vaginal intercourse. The same principle applies to women who do not necessarily have penile-vaginal intercourse, but who may have oral-vaginal or digital-vaginal intercourse or share sex toys. HPV transmission is decreased with the use of barrier methods including condoms and dental dams (used for oral sex), but the virus is often present outside of areas covered by the barrier method, and transmitted through skin-to-skin contact.
I sometimes notice an unpleasant odor to my vaginal discharge and I want to get rid of it. One of my friends says I should douche. What is the best way to deal with odor?
Vaginal discharge with a foul odor , discharge that is abnormal in color or amount, itching, and pain with urination and sex may all be symptoms of a vulvar, vaginal or urinary tract infection. Douching does not treat an infection and may even make it worse. It may also make it more difficult for your doctor to diagnose the problem. There are several potential causes for vaginal odors, and you should see your doctor so that they can properly diagnose and treat the problem. Be aware that some vaginal discharge is normal. It may have a mild odor and the amount, consistency, and color will vary with your menstrual cycle from clear and watery to white or yellow and sticky.
My girlfriend was recently treated for an infection called bacterial vaginosis. What is my risk of becoming infected?
Not to be confused with a yeast infection, is actually an overgrowth of certain types of bacteria. Bacterial vaginosis is treated with antibiotics like an infection. It occurs when the healthy bacteria called lactobacilli are decreased and there is an overgrowth of other types of bacteria. This may result in increased vaginal discharge with a foul odor. It is not a sexually transmitted infection and it is not passed to sexual partners.
I think I have a yeast infection, and I’m wondering which treatment is best. I know there are many different ones available in the drug stores without a prescription.
Yeast infections may affect the vagina or vulva. They may cause itching, irritation, swelling, pain with urination, and vulvar pain and redness. Another common sign is a thick white cottage cheese-like discharge.
Many women diagnose and treat themselves for yeast infections. However, they often take treatments that they do not need, or they take the wrong ones, because they may have some other type of infection. Ideally, you should see your doctor to make sure you have been correctly diagnosed before treatment. However, it is often difficult to see a physician on short notice, so if you do decide to treat yourself and the treatment is not effective, ensure that you seek medical advice.
Topical treatments are placed in the vagina and include creams, tablets or suppositories. Given in a single dose or for one to seven days, they all work. Some of these treatments contain azole drugs, which are more effective than treatments that contain a drug called nystatin.
Treatments that fail can be a sign that you do not have a yeast infection. If you have had multiple episodes of infection, it is also important that you are properly diagnosed and treated. Also, if your immune system is compromised because of medications that you take or because of diseases like diabetes or HIV infection, it is important that you see your doctor.
