who has migraines is also taking the birth control pill. many women with epilepsy have more seizures in a pattern linked to the menstrual cycle; this is called "catamenial epilepsy". different patterns seem to exist (such as seizures coinciding with the time of menstruation, or coinciding with the time of ovulation), and the frequency with which they occur has not been firmly established. research indicates that women have a significantly higher likelihood of anterior cruciate ligament injuries in the pre-ovulatory stage, than post-ovulatory stage. sexual activity further information: culture and menstruation sexual feelings and behaviors change during the menstrual cycle. before and during ovulation, high levels of estrogen and androgens result in women having a relatively increased interest in sexual activity, and relatively lower interest directly prior to and during menstruation. unlike other mammals, women may show interest in sexual activity across all days of the menstrual cycle, regardless of fertility. there is no reliable scientific evidence that would advise against sexual intercourse during menstruation based on medical grounds. fertility aspects peak fertility (the time with the highest likelihood of pregnancy resulting from sexual intercourse) occurs during just a few days of the cycle: usually two days before and two days after the ovulation date. this corresponds to the second and the beginning of the third week in a 28-day cycle. this fertile window varies from woman to woman, just as the ovulation date often varies from cycle to cycle for the same woman. a variety of methods have been developed to help individual women estimate the relatively fertile and the relatively infertile days in the cycle; these systems are called fertility awareness. menstrual disorders main article: menstrual disorder infrequent or irregular ovulation is called oligoovulation. the absence of ovulation is called anovulation. normal menstrual flow can occur without ovulation preceding it: an anovulatory cycle. in some cycles, follicular development may start but not be completed; nevertheless, estrogens will be formed and stimulate the uterine lining. anovulatory flow resulting from a very thick endometrium caused by prolonged, continued high estrogen levels is called estrogen breakthrough bleeding. anovulatory bleeding triggered by a sudden drop in estrogen levels is called withdrawal bleeding. anovulatory cycles commonly occur before menopause (perimenopause) and in women with polycystic ovary syndrome. very little flow (less than 10 ml) is called hypomenorrhea. regular cycles with intervals of 21 days or fewer are polymenorrhea; frequent but irregular menstruation is known as metrorrhagia. sudden heavy flows or amounts greater than 80 ml are termed menorrhagia. heavy menstruation that occurs frequently and irregularly is menometrorrhagia. the term for cycles with intervals exceeding 35 days is oligomenorrhea. amenorrhea refers to more than three to six months without menses (while not being pregnant) during a woman's reproductive years. the term for painful periods is dysmenorrhea. there is a wide spectrum of differences in how women experience menstruation. there are several ways that someone's menstrual cycle can differ from the norm: term meaning oligomenorrhea infrequent periods hypomenorrhea short or light periods polymenorrhea frequent periods (more frequently than every 21 days) hypermenorrhea heavy or long periods (soaking a sanitary napkin or tampon every hour, menstruating longer than 7 days) dysmenorrhea painful periods intermenstrual bleeding breakthrough bleeding (also called spotting) amenorrhea absent periods extreme psychological stress can also result in periods stopping. more severe symptoms of anxiety or depression may be signs of premenstrual dysphoric disorder (pmdd) with is a depressive disorder. dysfunctional uterine bleeding is a hormonally caused bleeding abnormality. dysfunctional uterine bleeding typically occurs in premenopausal women who do not ovulate normally (i.e. are anovulatory). all these bleeding abnormalities need medical attention; they may indicate hormone imbalances, uterine fibroids, or other problems. as pregnant women may bleed, a pregnancy test forms part of the evaluation of abnormal bleeding. women who had undergone female genital mutilation (particularly type iii- infibulation) a practice common in parts of africa, may experience menstrual problems, such as slow and painful menstruation, that is caused by the near-complete sealing off of the vagina. dysmenorrhea this section is an excerpt from dysmenorrhea. menstrual cycle and changes in hormone production dysmenorrhea, also known as period pain, painful periods or menstrual cramps, is pain during menstruation. its usual onset occurs around the time that menstruation begins. symptoms typically last less than three days. the pain is usually in the pelvis or lower abdomen. other symptoms may include back pain, diarrhea or nausea. dysmenorrhea can occur without an underlying problem. underlying issues that can cause dysmenorrhea include uterine fibroids, adenomyosis, and most commonly, endometriosis. it is more common among those with heavy periods, irregular periods, those whose periods started before twelve years of age and those who have a low body weight. a pelvic exam and ultrasound in individuals who are sexually active may be useful for diagnosis. conditions that should be ruled out include ectopic pregnancy, pelvic inflammatory disease, interstitial cystitis and chronic pelvic pain. dysmenorrhea occurs less often in those who exercise regularly and those who have children early in life. treatment may include the use of a heating pad. medications that may help include nsaids such as ibuprofen, hormonal birth control and the iud with progestogen. taking vitamin b1 or magnesium may help. evidence for yoga, acupuncture and massage is insufficient. surgery may be useful if certain underlying problems are present. estimates of the percentage of female adolescents, and women of reproductive age affected are between 50% and 90%. it is the most common menstrual disorder. typically, it starts within a year of the first menstrual period. when there is no underlying cause, often the pain improves with age or following having a child. menstrual hygiene management main articles: menstrual hygiene management and feminine hygiene disposable sanitary napkinthe elements of a tampon with applicator. left: the bigger tube ("penetrator"). center: cotton tampon with attached string. right: the narrower tube. menstrual cupcloth menstrual pad menstrual products (also called "feminine hygiene" products) are made to absorb or catch menstrual blood. a number of different products are available – some are disposable, some are reusable. where women can afford it, items used to absorb or catch menses are usually commercially manufactured products. menstruating women manage menstruation primarily by wearing menstrual products such as tampons, napkins or menstrual cups to catch the menstrual blood. the main disposable products (commercially manufactured) include: sanitary napkins (also called sanitary towels or pads) – rectangular pieces of material worn attached to the underwear to absorb menstrual flow, often with an adhesive backing to hold the pad in place. disposable pads may contain wood pulp or gel products, usually with a plastic lining and bleached. tampons – disposable cylinders of treated rayon/cotton blends or all-cotton fleece, usually bleached, that are inserted into the vagina to absorb menstrual flow. the main reusable products include: menstrual cups – a firm, flexible bell-shaped device worn inside the vagina to collect menstrual flow. reusable cloth pads – pads that are made of cotton (often organic), terrycloth, or flannel, and may be handsewn (from material or reused old clothes and towels) or storebought. padded panties or period-proof underwear – reusable cloth (usually cotton) underwear with extra absorbent layers sewn in to absorb flow. due to poverty, some women cannot afford commercial feminine hygiene products. instead, they use materials found in the environment or other improvised materials. "period poverty" is a global issue affecting women and girls who do not have access to safe, hygienic sanitary products. in addition, solid waste disposal systems in developing countries are often lacking, which means women have no proper place to dispose used products, such as pads. inappropriate disposal of used materials also creates pressures on sanitation systems as menstrual hygiene products can create blockages of toilets, pipes and sewers. menstrual suppression due to hormonal contraception main articles: menstrual suppression and hormonal contraception half-used blister pack of a combined oral contraceptive. the white pills are placebos, mainly for the purpose of reminding the woman to continue taking the pills. menstruation can be delayed by the use of progesterone or progestins. for this purpose, oral administration of progesterone or progestin during cycle day 20 has been found to effectively delay menstruation for at least 20 days, with menstruation starting after 2–3 days have passed since discontinuing the regimen. hormonal contraception affects the frequency, duration, severity, volume, and regularity of menstruation and menstrual symptoms. the most common form of hormonal contraception is the combined birth control pill, which contains both estrogen and progestogen. although the primary function of the pill is to prevent pregnancy, it may be used to improve some menstrual symptoms and syndromes which affect menstruation, such as polycystic ovary syndrome (pcos), endometriosis, adenomyosis, amenorrhea, menstrual cramps, menstrual migraines, menorrhagia (excessive menstrual bleeding), menstruation-related or fibroid-related anemia and dysmenorrhea (painful menstruation) by creating regularity in menstrual cycles and reducing overall menstrual flow. using the combined birth control pill, it is also possible for a woman to delay or eliminate menstrual periods, a practice called menstrual suppression. some women do this simply for convenience in the short-term, while others prefer to eliminate periods altogether when possible. this can be done either by skipping the placebo pills, or using an extended cycle combined oral contraceptive pill, which were first marketed in the u.s. in the early 2000s. this continuous administration of active pills without the placebo can lead to the achievement of amenorrhea in 80% of users within 1 year of use. due to breastfeeding main article: lactational amenorrhea breastfeeding causes negative feedback to occur on pulse secretion of gonadotropin-releasing hormone (gnrh) and luteinizing hormone (lh). depending on the strength of the negative feedback, breastfeeding women may experience complete suppression of follicular development, follicular development but no ovulation, or normal menstrual cycles may resume. suppression of ovulation is more likely when suckling occurs more frequently. the production of prolactin in response to suckling is important to maintaining lactational amenorrhea. on average, women who are fully breastfeeding whose infants suckle frequently experience a return of menstruation at fourteen and a half months postpartum. there is a wide range of response among individual breastfeeding women, however, with some experiencing return of menstruation at two months and others remaining amenorrheic for up to 42 months postpartum. society and culture main article: culture and menstruation amra padatik india, celebration of menstrual hygiene day in india etymology and terminology the word menstruation is etymologically related to moon. the terms menstruation and menses are derived from the latin mensis 'month', which in turn relates to the ancient greek mene 'moon' and to the roots of the english words month and moon. some organizations have begun to use the term "menstruator" instead of "menstruating women", a term that has been in use since at least 2010. menstruator is used by some activists and scholars in order to "express solidarity with women who do not menstruate, transgender men who do, and intersexual and genderqueer individuals".: 950 however, use of the term has also been criticized by some feminists who consider sex differences important and the term woman to be necessary to resist patriarchy.: 950 the term "people who menstruate" is also used. traditions, taboos and education many religions have menstruation-related traditions, for example: islam prohibits sexual contact with women during menstruation in the 2nd chapter of the quran. some scholars argue that menstruating women are in a state in which they are unable to maintain wudhu, and are therefore prohibited from touching the arabic version of the qur'an. other biological and involuntary functions such as vomiting, bleeding, sexual intercourse, and going to the bathroom also invalidate one's wudhu. in judaism, a woman during menstruation is called niddah and may be banned from certain actions. for example, the jewish torah prohibits sexual intercourse with a menstruating woman. in hinduism, menstruating women are traditionally considered ritually impure and given rules to follow. menstruation education is frequently taught in combination with sex education at school in western countries, although girls may prefer their mothers to be the primary source of information about menstruation and puberty. information about menstruation is often shared among friends and peers, which may promote a more positive outlook on puberty. the quality of menstrual education in a society determines the accuracy of people's understanding of the process. in many western countries where menstruation is a taboo subject, girls tend to conceal the fact that they may be