This decade-by-decadge guide to menstruation covers irregular cycles, heavy bleeding, sudden pain and all the other issues that can pop up as we age.
Until Sarah turned 38, her Aunt Flo was nothing but predictable; she showed up every 27 to 29 days, accompanied only by a tinge of lower-back pain. There would be a slightly heavier flow on days 1 and 2, and no symptoms at all by Day 6. Then, one month, all hell broke loose. "Suddenly, my period was extremely heavy and clumpy," says Sarah. "I was changing a pad and a super-absorbent tampon every 10 minutes. It was like a murder scene." It wasn't just the amount of blood that threw both Sarah and her cycle for a loop; new symptoms surfaced over the next few months. "My whole midsection and vagina hurt. Plus, I had an overall sick feeling. I was in so much pain."
Though Sarah initially thought this was just her period changing with age, after about six months, when the excessive bleeding had become a regular occurrence, she made an appointment with her doctor. And it's a good thing she did. As it turned out, she had two uterine polyps, small tissue growths that are attached to the inner wall of the uterus and extend into the uterine cavity. Following two years of unpredictable flow, clotting and pain, Sarah's doctor performed an endometrial ablation and removed her polyps for testing—and her monthly visitor relented.
We'd bet there isn't a woman out there who hasn't been bugged, caught off guard or inconvenienced by her period. "Women just don't know a lot about their periods," adds Dr. Ashley Waddington, an obstetrician-gynecologist and assistant professor at Queen's University in Kingston, Ont. "We get a lot of questions from patients about what's happening and what will happen in years to come." Here's a decade-by-decade breakdown of what you need to know.
By this point, you've probably had your period for almost two decades, and, unless you've been pregnant, it likely hasn't changed much since your late teens. A typical cycle lasts between 21 and 35 days, counting from the first day of your period up to (but not including) the first day of your next period.
That cycle is made up of two phases: The follicular phase starts on the first day of your cycle and lasts until ovulation day, when the luteal phase, which begins once the ovary releases an egg, takes over. Because the luteal phase almost always lasts about 14 days, you can estimate the date of your last ovulation by counting backward from the end of your cycle. For example, if your cycle was 30 days, you likely ovulated on Day 16.
In general, menstruation lasts four to seven days. But don't worry if that number fluctuates somewhat, says Dr. Melissa Mirosh, an ob-gyn in Saskatoon. You're still in the normal range if, one month, your period arrives on Day 26 and lasts for five days, and, next month, it doesn't come until Day 31 and it lasts for seven days. But if the duration of your period or cycle varies more drastically, there could be a problem. "The concern is that, if the cycle isn't normal, it could be because of an underlying medical issue or it could affect fertility potential," says Dr. Suzanne Wong, an ob-gyn at St. Joseph's Health Centre in Toronto.
Prepare for: Pregnancy
Women who have irregular periods and are trying to conceive can have a rough go of it. "Predicting ovulation becomes harder when cycles are irregular, which makes achieving pregnancy more difficult," says Dr. Wong. Pregnancy can also affect what happens with your period postpartum. "After having a baby, when your hormones are still getting back to their usual routine, it can be quite normal to have chaotic cycles for six to 12 months," says Dr. Waddington.
Most women who breastfeed will resume menstruating six to nine months after delivery; those who don't may ovulate as early as three weeks after delivery and menstruate five weeks postpartum. "This is important to consider if you're resuming sexual activity, because you can get pregnant quite soon after delivery," says Dr. Waddington. And about that post-pregnancy period: There's no way to tell if it will be heavier or lighter than before, but many women who experienced excruciating cramps prepregnancy find that the pain has subsided, perhaps thanks to stretching of the uterus during those nine months.
"Between the late teens and the age of 40, women tend to get into a rhythm with their period; it comes in regular intervals, lasts about the same duration and has the same volume of blood, except perhaps in the years around pregnancies," says Dr. Mirosh. "But from about 40, things may get irregular."
Say hello to perimenopause, the seven- to 10-year stretch leading up to menopause. It usually kicks in at about age 45, though, in rare instances, it can start as early as 35 or not taper off until 59. "That's when the brakes come off and chaos occurs," says Dr. Jerilynn Prior, a professor of endocrinology and metabolism at The University of British Columbia and the founder and scientific director of the Centre for Menstrual Cycle and Ovulation Research in Vancouver. "Because estrogen levels are higher, it's a time of great unpredictability." Cue mood swings, heavy flow (in 25 percent of women), hot flashes and night sweats (in about 80 percent), shorter or longer cycles, skipped periods, sore breasts, low libido, insomnia, painful cramps and changes to skin, hair or weight. It's a misconception that these symptoms indicate you're in the throes of menopause; they're actually signs of perimenopause.
Prepare for: Heavy Flow
According to Dr. Prior, heavy bleeding is so common in perimenopause that it's often one of the first symptoms a woman will notice. But what's considered too heavy? "The definition of abnormal uterine bleeding is based on when a patient says there's too much blood," says Dr. Mirosh. Red flags (pardon the pun) include excessive clotting or cramping, accidents where blood soaks through to your clothing and simply feeling like your period is interfering with your life.
Heavy bleeding may be just that, or it might be a sign of another medical condition. Dr. Mirosh says one of the first signs of thyroid disease can be a change in menstrual flow. Uterine polyps or fibroids, usually benign growths that develop in or on the uterus, are other potential culprits. And, as a patient creeps toward 50, Dr. Mirosh begins to worry about endometrial cancer, which can also bring with it increased flow or clotting.
If you're like the average Canadian woman, you'll have your last period when you're 52. Whenever it happens, you won't actually know that you've been through menopause (which means the end of menstruation, when the ovaries run out of eggs and your body produces lower levels of estrogen and progesterone) until a year after the last time you menstruate. "It's a retroactive diagnosis," says Dr. Wong. "A woman who hasn't had a period in 12 months, who's been to her doctor to make sure there is no underlying cause for the missed periods (other than hormonal reasons) and whose period doesn't come back has gone through menopause."
Prepare for: Menopause
While many women find that their periods gradually taper off, some have a regular cycle right up until their last period, then never have one again, says Dr. Waddington. And though women will experience the most upheaval during perimenopause, most will also have at least some symptoms—such as vaginal dryness, hot flashes and insomnia—in menopause. But for many women, menopause can be a relief. "You no longer have to deal with the heavy flow," says Dr. Prior. "Bloating, swelling, breast tenderness and other high-estrogen symptoms come to an end."
What to know about melanoma
54-year-old Susan Cox is a three-time survivor of advanced melanoma. She spoke to us about her approach to sun safety before getting diagnosed, not losing hope and what she’s learned.
One morning in 2007, Susan Cox woke up to a blueberry-sized mole on her back that was, suddenly, bleeding. She hadn’t paid much attention to the mole before, but now it was making itself known—and she immediately knew that something was wrong.
“It sounds ridiculous to think that my life could be in jeopardy from a mole,” she says. But it was. After a three-month wait to see a dermatologist, Cox was diagnosed with stage three skin cancer and a 10-inch strip of skin was removed from her back.
The 54-year-old, whose cancer has recurred three times, is among the one in 73 Canadian women who will be diagnosed with melanoma in their lifetime. The deadliest form of skin cancer, melanoma accounts for 3% of all new cancer cases in Canada. It’s very treatable if caught early, but over the past 25 years, the incidence rate has increased significantly. The numbers are staggering—which is why, at five years cancer-free, Cox is still fighting the disease head on. But this time, she’s focusing on public awareness. “My mole was itchy for a couple of years before [I was diagnosed]. I should have recognized there was something different about it then, but I didn’t,” she says.
That’s why she has contributed to an e-book of photo essays by melanoma survivors published by the Save Your Skin Foundation and Novartis Pharmaceuticals Canada Inc. (See a selection of her photos throughout this story.) Many people think it’s “just skin cancer,” but Cox’s mission is to convey just how serious a diagnosis melanoma is, how much it changes your life—and how easy it is to prevent.
What was getting diagnosed like?
I had a mole on my back that popped. I thought it was just a pimple, so I called a dermatologist and ended up waiting three months to get an appointment. I didn’t realize it was serious—and then I was diagnosed stage three melanoma right out of the gate. So, that means, you are already pretty much in trouble before you’ve even known what has hit you.
“While time goes on, the physical and emotional impact of melanoma can fade, but it never really disappears. It’s something I’ll never be free of, but I can live with the scar and I can try to move on.”
When it did hit you, how did it feel?
At first, I went to the internet, which was the wrong thing to do. It freaked me out. I cried into a towel in my bathroom with the door locked. I was frozen, I actually didn’t know what I was supposed to be doing. When you’re told you have this disease and it’s going to keep coming back and keep coming back… I wanted to run away, frankly. It sounds silly, but I just wanted to go somewhere… but how do you run from your own body?
Were you cautious about sun safety before you were diagnosed?
No. Not at all. As a matter of fact, I used tanning beds, religiously. I encouraged others to use them. I took my daughter. I read the literature and it sounded safe enough, but I didn’t understand what I was doing. I didn’t understand they were carcinogenic, as a whole. And I didn’t use any sun safety product.
How did having melanoma change you?
I was so scared. I wasn’t really living. I was only living between my doctor’s appointments, truthfully. If you are told your appointment is in two months, you put everything on hold for two months. You don’t make holiday plans, you don’t buy a ticket on an airplane, you don’t book a hotel—it’s almost like you’re expecting to be told you’re dying. But after a couple of surgeries, I decided I wasn’t going to be afraid to try things anymore. Once I had survived cancer twice, I felt as though I better start getting my bucket list double-checked and so I did.
What kinds of things did you check off your bucket list?
I’m a designer and I always wanted someone to hire me to design a beach house, or decorate a beach house, and nobody ever did—so I bought one. I did it myself. I wanted to know I could do it myself, and I was very pleased with how it turned out. I had a magazine come shoot it, I took some design risks that I wouldn’t have taken before. I wasn’t afraid anymore.
“When I was diagnosed with advanced melanoma, I was in tears. It absolutely demolished me.
The stormy times and fear kept me from living my life vibrantly. I decided I needed to build my beach house and it’s now a reality. It’s a place I can go to relax and regroup, and express my passion for design. I may have never taken this risk before I fell sick.”
Melanoma is the deadliest form of skin cancer, and the incidence rate has increased significantly over the past 25 years. So why don’t we talk about it?
It’s the mentality that it won’t happen to me. People don’t want to hear about melanoma because they want to be outside in the sun. Since the ‘60s and ‘70s, we’ve had a culture of tanning the skin. We see tanned skin as attractive, sporty, athletic. I was absolutely drunk with the idea of having brown skin and looking Mediterranean. But guess what? I’m not. I’m fair-skinned, I had white hair as a kid, I should never have been in the sun, ever. But it’s a cultural thing. I get it. I feel like I look better with a tan. I wear less makeup when I’m tanned. But it’s okay to look pale and be in the skin you’re in. I wear pale skin as a badge of honour. Tanned skin is damaged skin. You might see a tan, but a dermatologist sees damaged skin at a cellular level. When you come out of the shower in January and you can still see your tan lines, that’s damage. I still have tan lines and I haven’t been in the sun in 10 years. I’m rarely in the sun in a bathing suit, but I still have my tan lines. That tells you how badly I damaged my skin.
What was treatment been like for you?
I took a targeted therapy because I had a mutation (which means the cancer mutates), and they’ve been able to look at that mutation and bind a protein to that mutation, therefore choking it out so it doesn’t multiply and doesn’t continue to grow. It’s available through an oncologist and it’s a pill. I took it twice a day. So for me, it was taking a pill twice a day and my tumours shrank immediately and completely away.
How did you keep yourself from losing hope?
It would be very easy to lose hope, [but] it would be almost impossible not to lose hope. I refuse to give up. I absolutely refuse. I refuse to lose. I don’t like to lose and if I’m going to lose this battle sooner than I should, I’m going to go out on my terms. I’m not going to go out on my knees.
After being educated about sun and skin care, what have you learned about the importance to take sun safety precautions all year round?
There was a famous skier in Whistler, Dave Murray, who died of melanoma. You actually get more sun exposure in the winter than you do in the summer because snow and ice reflect the sun.
What advice do you have with individuals with concerns about the disease?
Get educated. But not on the internet! Do not look at pictures of melanoma in the images of your Google search. I don’t know anybody’s melanoma that looks like those pictures I have seen on Google. Don’t be afraid to have something looked at. If in doubt, cut it out.
Why did you get involved with the Save Your Skin “Melanoma Through My Lens” campaign?
One word: Hope. I want patients to not be afraid to help themselves and I know it’s hard because you want to run away, but there’s no running away from it. It goes with you, where you go. You have to stay and fight. It’s not a death sentence anymore. There’s hope.
“Being honest with my family about what I was dealing with made a difference in my journey. Everyone helped me get through this. My son is a very caring boy. My daughter always shows me she cares. My husband is always by my side. What could be more hopeful than more time with my loved ones?”
Image courtesy: Susan Cox
What are three words you use to describe yourself with this disease?
Loud. Numb. Scared.
What are three words do you use to describe yourself without this disease?
Loud. Educated. Empowered.
Check out the Save Your Skin Foundation to find the Melanoma Through My Lens e-book.
Ginger may not be the first spice you think of to incorporate in your snacks, salads and dinners but it's one of the healthiest on the planet! Here's why:
1. It's healthy for your heart.
Research has shown that ginger may lower cholesterol and help prevent blood clotting, which could, in turn, help prevent blood vessel blockages that can lead to heart attacks or strokes.
A recent study out of Pennsylvania State University found that a meal made with a spice blend that included ginger (along with garlic, rosemary, oregano, cinnamon, cloves, paprika, turmeric and black pepper) reduced levels of triglycerides by 30 percent when compared to an identical non-spiced meal.
2. It helps your tummy!
Ginger has long been associated with relieving nausea and morning sickness, motion sickness, and even menstrual pain, as it's original use was for pain relief. A 2012 study shored up that wisdom, showing that ginger can reduce nausea after chemotherapy when taken as a supplement.
3. It can help you breathe easy.
Ginger tea is a classic remedy purported to ease cough and cold symptoms. And it turns out, there’s some science to its soothing powers when you’re sick. In 2013, research out of Columbia University found that ginger might help asthma patients breathe more easily.
4. It has anti-inflammatory effects.
Osteoarthritis causes joint pain and stiffness, but the anti-inflammatory effects of ginger can help that. In a trial done by the National Centre for Biotechnology Information, participants who took ginger extract had less pain and needed less pain medication than those who didn't.
*Although rare, too much ginger can cause heartburn, diarrhea and irritation of the mouth, according to the University of Maryland. There can also be interactions with medications, such as acetylsalicylic acid.
But most of us can indulge in ginger for its flavour and health benefits. Try it in:
Apple Cran-Curry Salsa
Apricot Almond Energy Bars
Asparagus and Orange Salad With Ginger Dressing
Broiled Tofu With No-Cook Peanut Sauce
Seared Cherry Tomato Pasta
Photography by Jeff Coulson Image by: Seared Cherry Tomato Pasta <br /> Photography by Jeff Coulson