Menstrual cycle in the context of Endometrium

The combined oral contraceptive pill (COCP), often referred to as the birth control pill or colloquially as "the pill", is a type of birth control that is designed to be taken orally by women. It is the oral form of combined hormonal contraception. The pill contains two important hormones: a progestin (a synthetic form of the hormone progestogen/progesterone) and estrogen (usually ethinylestradiol or 17β estradiol). When taken correctly, it alters the menstrual cycle to eliminate ovulation and prevent pregnancy.

Combined oral contraceptive pills were first approved for contraceptive use in the United States in 1960, and remain a very popular form of birth control. They are used by more than 100 million women worldwide including about 9 million women in the United States. From 2015 to 2017, 12.6% of women aged 15–49 in the US reported using combined oral contraceptive pills, making it the second most common method of contraception in this age range (female sterilization is the most common method). Use of combined oral contraceptive pills, however, varies widely by country, age, education, and marital status. For example, one third of women aged 16–49 in the United Kingdom use either the combined pill or progestogen-only pill (POP), compared with less than 3% of women in Japan (as of 1950–2014).

Menstruation (also known as a period, among other colloquial terms) is the regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina. The menstrual cycle is characterized by the rise and fall of hormones. Menstruation is triggered by falling progesterone levels, and is a sign that pregnancy has not occurred. Feminine hygiene products are used in order to maintain hygiene during menses.

The first period, a point in time known as menarche, usually begins during puberty, between the ages of 11 and 13. However, menstruation starting as young as eight years would still be considered normal. The average age of the first period is generally later in the developing world, and earlier in the developed world. The typical length of time between the first day of one period and the first day of the next is 21 to 45 days in young women; in adults, the range is between 21 and 35 days with the average often cited as 28 days. In the largest study of menstrual app data, the mean menstrual cycle length was determined to be 29.3 days. Bleeding typically lasts two to seven days. Periods stop during pregnancy and typically do not resume during the initial months of breastfeeding. Lochia occurs after childbirth. Menstruation, and with it the possibility of pregnancy, ceases after menopause, which usually occurs between 45 and 55 years of age.

Menarche (/məˈnɑːrki/ mə-NAR-kee; from Ancient Greek μήν (mēn) 'month' and ἀρχή (arkhē) 'beginning') is the first menstrual cycle, or first menstrual bleeding, in female humans. From both social and medical perspectives, it is often considered the central event of female puberty, as it signals the possibility of fertility. Girls experience menarche at different ages, but the most common age is 12. Having menarche occur between the ages of 9–14 in the West is considered normal.

The timing of menarche is influenced by female biology, as well as genetic, environmental factors, and nutritional factors. The mean age of menarche has declined over the last century, but the magnitude of the decline and the factors responsible remain subjects of contention. The worldwide average age of menarche is very difficult to estimate accurately, and it varies significantly by geographical region, race, ethnicity and other characteristics, and occurs mostly during a span of ages from 8 to 16, with a small percentage of girls having menarche by age 10, and the vast majority having it by the time they were 14.There is a later age of onset in Asian populations compared to the West, but it too is changing with time. For example a Korean study in 2011 showed an overall average age of 12.7, with around 20% before age 12, and more than 90% by age 14. A Chinese study from 2014 published in Acta Paediatrica showed similar results (overall average of age 12.8 in 2005 down to age 12.3 in 2014) and a similar trend in time, but also similar findings about ethnic, cultural, and environmental effects. The average age of menarche was about 12.7 years in Canada in 2001, and 12.9 in the United Kingdom. A study of girls in Istanbul, Turkey, in 2011 found the median age at menarche to be 12.7 years. In the United States, an analysis of 10,590 women aged 15–44 taken from the 2013–2017 round of the CDC's National Survey of Family Growthfound a median age of 11.9 years (down from 12.1 in 1995), with a mean of 12.5 years (down from 12.6).

In mammals and other animals, the vagina (pl.: vaginas or vaginae) is the elastic, muscular reproductive organ of the female genital tract. In humans, it extends from the vulval vestibule to the cervix (neck of the uterus). The vaginal introitus is normally partly covered by a thin layer of mucosal tissue called the hymen. The vagina allows for copulation and birth. It also channels menstrual flow, which occurs in humans and closely related primates as part of the menstrual cycle.

To accommodate smoother penetration of the vagina during sexual intercourse or other sexual activity, vaginal moisture increases during sexual arousal in human females and other female mammals. This increase in moisture provides vaginal lubrication, which reduces friction. The texture of the vaginal walls creates friction for the penis during sexual intercourse and stimulates it toward ejaculation, enabling fertilization. Along with pleasure and bonding, women's sexual behavior with other people can result in sexually transmitted infections (STIs), the risk of which can be reduced by recommended safe sex practices. Other health issues may also affect the human vagina.

The human female reproductive system is made up of the internal and external sex organs that function in the reproduction of new offspring. The reproductive system is immature at birth and develops at puberty to be able to release matured ova from the ovaries, facilitate their fertilization, and create a protective environment for the developing fetus during pregnancy. The female reproductive tract is made of several connected internal sex organs—the vagina, uterus, and fallopian tubes—and is prone to infections. The vagina allows for sexual intercourse and childbirth, and is connected to the uterus at the cervix. The uterus (or womb) accommodates the embryo by developing the uterine lining.

The uterus also produces secretions which help the transit of sperm to the fallopian tubes, where sperm fertilize the ova. During the menstrual cycle, the ovaries release an ovum, which transits through the fallopian tube into the uterus. If an egg cell meets with sperm on its way to the uterus, a single sperm cell can enter and merge with it, creating a zygote. If no fertilization occurs, menstruation is the process by which the uterine lining is shed as blood, mucus, and tissue.

Vaginal bleeding is any expulsion of blood from the vagina. This bleeding may originate from the uterus, vaginal wall, or cervix. Generally, it is either part of a normal menstrual cycle or is caused by hormonal or other problems of the reproductive system, such as abnormal uterine bleeding.

Regular monthly vaginal bleeding during the reproductive years, menstruation, is a normal physiologic process. During the reproductive years, bleeding that is excessively heavy (menorrhagia or heavy menstrual bleeding), occurs between monthly menstrual periods (intermenstrual bleeding), occurs more frequently than every 21 days (abnormal uterine bleeding), occurs too infrequently (oligomenorrhea), or occurs after vaginal intercourse (postcoital bleeding) should be evaluated.

Progesterone (/proʊˈdʒɛstəroʊn/ ; P4) is an endogenous steroid and progestogen sex hormone involved in the menstrual cycle, pregnancy, and embryogenesis of humans and other species. It belongs to a group of steroid hormones called the progestogens and is the major progestogen in the body. Progesterone has a variety of important functions in the body. It is also a crucial metabolic intermediate in the production of other endogenous steroids, including the sex hormones and the corticosteroids, and plays an important role in brain function as a neurosteroid.

Fertility awareness (FA) refers to a set of practices used to determine the fertile and infertile phases of a woman's menstrual cycle. Fertility awareness methods may be used to avoid pregnancy, to achieve pregnancy, or as a way to monitor gynecological health.

Methods of identifying infertile days have been known since antiquity, but scientific knowledge gained during the past century has increased the number, variety, and especially accuracy of methods.

Progestogens, also sometimes written progestins, progestagens or gestagens, are a class of natural or synthetic steroid hormones that bind to and activate the progesterone receptors (PR). Progesterone is the major and most important progestogen in the body. The progestogens are named for their function in maintaining pregnancy (i.e., progestational), although they are also present at other phases of the estrous and menstrual cycles.

The progestogens are one of three types of sex hormones, the others being estrogens like estradiol and androgens/anabolic steroids like testosterone. In addition, they are one of the five major classes of steroid hormones, the others being the androgens, estrogens, glucocorticoids, and mineralocorticoids, as well as the neurosteroids. All endogenous progestogens are characterized by their basic 21-carbon skeleton, called a pregnane skeleton (C21). In similar manner, the estrogens possess an estrane skeleton (C18), and androgens, an androstane skeleton (C19).

Estradiol (E2), also called oestrogen, oestradiol, is an estrogen steroid hormone and the major female sex hormone. It is involved in the regulation of female reproductive cycles such as estrous and menstrual cycles. Estradiol is responsible for the development of female secondary sexual characteristics such as the breasts, widening of the hips and a female pattern of fat distribution. It is also important in the development and maintenance of female reproductive tissues such as the mammary glands, uterus and vagina during puberty, adulthood and pregnancy. It also has important effects in many other tissues including bone, fat, skin, liver, and the brain.

Ovulation is an important part of the menstrual cycle in female vertebrates where the egg cells are released from the ovaries as part of the ovarian cycle. In female humans ovulation typically occurs near the midpoint in the menstrual cycle and after the follicular phase. Ovulation is stimulated by an increase in luteinizing hormone (LH). The ovarian follicles rupture and release the secondary oocyte ovarian cells.

After ovulation, during the luteal phase, the egg will be available to be fertilized by sperm. If it is not, it will break down in less than a day. Meanwhile, the uterine lining (endometrium) continues to thicken to be able to receive a fertilized egg. If no conception occurs, the uterine lining will eventually break down and be shed from the body via the vagina during menstruation.

Uterine glands or endometrial glands are tubular glands, lined by a simple columnar epithelium, found in the functional layer of the endometrium that lines the uterus. Their appearance varies during the menstrual cycle. During the proliferative phase, uterine glands appear long due to estrogen secretion by the ovaries. During the secretory phase, the uterine glands become very coiled with wide lumens and produce a glycogen-rich secretion known as histotroph or uterine milk. This change corresponds with an increase in blood flow to spiral arteries due to increased progesterone secretion from the corpus luteum. During the pre-menstrual phase, progesterone secretion decreases as the corpus luteum degenerates, which results in decreased blood flow to the spiral arteries. The functional layer of the uterus containing the glands becomes necrotic, and eventually sloughs off during the menstrual phase of the cycle.

They are of small size in the unimpregnated uterus, but shortly after impregnation become enlarged and elongated, presenting a contorted or waved appearance.

Vaginal discharge is a mixture of liquid, cells, and bacteria that lubricate and protect the vagina. This mixture is constantly produced by the cells of the vagina and cervix, and it exits the body through the vaginal opening. The composition, quality, and amount of discharge varies between individuals, and can vary throughout the menstrual cycle and throughout the stages of sexual and reproductive development. Normal vaginal discharge may have a thin, watery consistency or a thick, sticky consistency, and it may be clear or white in color. Normal vaginal discharge may be large in volume but typically does not have a strong odor, nor is it typically associated with itching or pain.

While most discharge is considered physiologic (represents normal functioning of the body), some changes in discharge can reflect infection or other pathological processes. Infections that may cause changes in vaginal discharge include vaginal yeast infections, bacterial vaginosis, and sexually transmitted infections. The characteristics of abnormal vaginal discharge vary depending on the cause, but common features include a change in color, a foul odor, and associated symptoms such as itching, burning, pelvic pain, or pain during sexual intercourse.

The African bush elephant (Loxodonta africana), also known as the African savanna elephant, is a species of elephant native to sub-Saharan Africa. It is one of three extant elephant species and, along with the African forest elephant, one of two extant species of African elephant. It is the largest living terrestrial animal, with fully grown bulls reaching an average shoulder height of 3.04–3.36 metres (10–11 ft) and a body mass of 5.2–6.9 tonnes (11,000–15,000 lb); the largest recorded specimen had a shoulder height of 3.96 metres (13 ft) and an estimated body mass of 10.4 tonnes (23,000 lb). The African bush elephant is characterised by its long prehensile trunk with two finger-like processes; a convex back; large ears which help reduce body heat; and sturdy tusks that are noticeably curved. The skin is grey with scanty hairs, and bending cracks which support thermoregulation by retaining water.

The African bush elephant inhabits a variety of habitats such as forests, grasslands, woodlands, wetlands and agricultural land. It is a mixed herbivore feeding mostly on grasses, creepers, herbs, leaves, and bark. The average adult consumes about 150 kg (330 lb) of vegetation and 230 L (51 imp gal; 61 US gal) of water each day. A social animal, the African bush elephant often travels in herds composed of cows and their offspring. Adult bulls usually live alone or in small bachelor groups. During the mating season, males go through a process called musth, a period of high testosterone levels and heightened aggression. For females, the menstrual cycle lasts three to four months, and gestation around 22 months, the longest of any mammal.

Premenstrual syndrome (PMS) is a disruptive set of emotional and physical symptoms that regularly occur in the one to two weeks before the start of each menstrual period. Symptoms resolve around the time menstrual bleeding begins. Symptoms vary, though commonly include one or more physical, emotional, or behavioral symptoms, that resolve with menses. The range of symptoms is wide, and most commonly are breast tenderness, bloating, headache, mood swings, depression, anxiety, anger, and irritability. To be diagnosed as PMS, rather than a normal discomfort of the menstrual cycle, these symptoms must interfere with daily living, during two menstrual cycles of prospective recording. PMS-related symptoms are often present for about six days. An individual's pattern of symptoms may change over time. PMS does not produce symptoms during pregnancy or following menopause.

Diagnosis requires a consistent pattern of emotional and physical symptoms occurring after ovulation and before menstruation to a degree that interferes with normal life. Emotional symptoms must not be present during the initial part of the menstrual cycle. A daily list of symptoms over a few months may help in diagnosis. Other disorders that cause similar symptoms need to be excluded before a diagnosis is made.