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LAURA BARDELL
Laura Bardell is a registered counsellor working with HFACT and a former midwife.
Starting conversations about periods and the menstrual cycle before the onset of periods, which usually occurs between the ages of 9-151, can help to normalise menstruation and reduce the stigma and shame associated with periods. These early conversations help to create a safe space for young people to share their experience with menstruation, while helping them to feel more prepared practically and emotionally for the transition into adolescence.
Many young people feel some level of worry about starting their menstrual cycle.
But for those who live with a bleeding disorder, this worry can be heightened due to the uncertainty of how the bleeding disorder may affect their experience.2 It’s important to prepare for having periods with the Haemophilia Treatment Centre (HTC) team so that young people and their parents can be ready and well-informed, with a treatment plan in place, if appropriate.
Understanding the menstrual cycle, knowing what to expect, how to look after yourself and tracking the cycle can assist in reducing these worries and help in identifying any concerns that may need to be addressed.
Tracking the menstrual cycle is the best way to do this as it helps the young person understand what is happening in their body across the month and may assist in identifying any bleeding concerns.
There is no right way to track the menstrual cycle. Some people like the ease of a period tracker app on their phone, while others prefer recording their observations in a diary.
You can begin tracking your cycle on any day. Start by recording how you’re feeling, your energy levels, any physical experiences you notice and anything else that feels important. Include a menstrual assessment chart that records how often and how much bleeding you experience. This will further assist you in understanding your cycle and help in identifying any bleeding concerns. These records can then be used at medical appointments to discuss your menstrual cycle as necessary.
An example of a menstrual assessment chart can be found at on the Canadian Hemophilia Society website under Women and Bleeding Disorders.
The average menstrual cycle is 28 days long but there is a wide variation in what is considered normal (21 to 35 days) and the length of the menstrual cycle will vary from person to person.1 It is common to experience irregular periods during early adolescence and perimenopause.
The cycle is composed of 4 phases known traditionally as the menstruation phase, follicular phase, ovulation and luteal phase.
Language is powerful and when thinking of the menstrual cycle it can also promote understanding. Author Lucy Peach (Period Queen) refers to each of the phases as Dream, Do, Give and Take.3 This simple language change can be empowering and help provide insight into the physiological and emotional experiences of each phase in the cycle. This language shift can also help guide conversations and further reduce stigma and shame.
These diagrams show a typical 28-day menstrual cycle from one period to the next. If your period is shorter or longer then ovulation may happen sooner or later.
Source: Haemophilia Foundation Australia. Female Factors. HFA: Melbourne, 2018. Adapted with permission from Jean Hailes for Women’s Health. Yarning about periods (menstrual cycle). jeanhailes.org.au
The cycle starts on the first day of your period, as the body works hard to shred the lining of the uterus it had built up over the previous cycle. Bleeding during the first few cycles is often lighter as the body hasn’t yet learnt to build up a thick uterus lining – known as the endometrium, but will likely increase as the body establishes its own unique rhythm.
The hormones progesterone and oestrogen are the lowest they will be throughout the cycle during the dream phase and trigger the uterus to break down the endometrium and for bleeding to occur. This can be accompanied by potential cramping, pain, bloating, feelings of heaviness and tiredness.4
Some people feel emotionally vulnerable and withdrawn during this phase and feel a need to spend more time by themselves, while others may feel an emotional release or relief as their bleeding starts.
Rest, recover and retreat as needed, try a heat pack or simple analgesia for period cramping or gentle exercise if feeling up to it. Nourish your body with healthy meals and participate in activities that bring you joy such as spending time in nature, journaling, listening to music, drawing or painting.
Defined as:
If you experience any of these symptoms, please discuss it with your HTC team who can assist with assessments and management.
From when bleeding beings to slow and stops, from around day 6 until ovulation around day 14.
Hormones levels, especially oestrogen, start to rise as the body prepares an egg for release from the ovaries. Energy levels increase and peak just prior to ovulation (release of the egg), coinciding with a surge of testosterone that can increase overall drive and determination.
With increased energy can come a strong desire to get stuff done, increased mental clarity and determination. Alternatively, there can be feelings of overwhelm and pressure to get everything done this week!
Slowing down, making a list, taking some deep breaths or having a chat with a trusted person can all help if noticing any of these feelings popping up.
Enjoy that newfound energy and engage in things that bring joy. Fuel the body with good food. Harness the power of improved mental clarity this week by ticking off some hard to do task that may have been put off during the dream phase.
From the time of ovulation (day 14-ish) until day 20-ish.
Once an egg is released, the body prepares for a potential pregnancy. Progesterone begins being produced which promotes the development and maintenance of the lining of the uterus (the endometrium). Oestrogen levels although initially dipping after ovulation, begin to increase again throughout this phase.3
Physical signs the body is ovulating and entering the give phase include:
Some people may experience a pang of pain or discomfort in their lower abdomen usually on one side just before, during, or after ovulation as the follicle in the ovary ruptures to release an egg. For some this pain can be small and sharp, others may notice a more dull, pressurised ache.
For those with a bleeding disorder there is an increased chance they will experience mid cycle pain due to the potential for a larger amount of blood loss at ovulation. They may also experience vaginal spotting when ovulating.6
Mid cycle pain should not last too long or be unbearable. If pain is not settling with simple pain relief, rest and a heat pack, it is important to seek medical attention as soon as possible. Mid cycle pain and/or spotting should also be discussed with your doctor and the HTC at your next appointment.
With more hormones and energy circulating in the body than any other time during the cycle, this phase can be accompanied by feelings of joy, celebration and increased desire to connect to others. There may also be an inclination to say yes to things you wouldn’t say yes to during other phases of the cycle. Checking in with yourself and making sure you really want to do something and not just because you’re riding high on hormones is a good way to care for yourself and make sure your choices are aligned with your values and goals.
Celebrate yourself and all the wonderful things that make you, you! Indulge in things that make you feel good. Continue to exercise, stay hydrated and fuel your body with good food so you can spend your time enjoying this phase. Including friends and family into these activities can assist with enhancing connection, something you may also be seeking in this phase.
From day 21-ish until the day before your bleeding starts.
If no pregnancy occurs, hormone levels start to fall as the body and uterus prepare to let go and begin the bleeding, dream phase, of your cycle again. This sudden drop in hormones over a few days can increase acne, headaches, breast tenderness and bloating.7
This can be a challenging time of the cycle as overall sensitivity increases as the feelings of this phase become big and deep. You may notice a decreased pain tolerance, feel easily overwhelmed and experience feelings of irritability and frustration.
There can also be a lot of social stigma and dismissal of feelings as PMS (premenstrual syndrome) related to this phase and sometimes it can truly be the hormones taking over. But maybe there is something in your life that is significant and needs addressing. The power of this phase is the courage it gives you to speak up and let others know what’s not working for you.
Increased feelings of hunger during this stage of your cycle are normal as your metabolism increases to meet the body’s demands as it processes high levels of hormones. You can aid the body by getting enough fibre from vegetables, drinking water, eating until your satisfied and listening to your body’s needs during this demanding phase. Some people find they slow down, exercising less or in more gentle ways as the body adjusts its focus inwards. Others find channelling big emotions into an active form of exercise beneficial – do what feels right for you.
Other ideas for exploring the feelings that come up in this phase include:
Understanding and learning how your cycle affects you is an ongoing process and one that may change over time. Tracking your cycle will help you to do this; it can also help you to feel more confident and prepared for each phase. If you need help or support tracking, managing periods or you have any concerns about your period and cycle please reach out to your local HTC care team.
Look out for Part 2 – Period products in the next issue of National Haemophilia.
1. The Royal Women’s Hospital, Victoria, Australia. Period overview. Accessed 27 January 2025.
2. Arya S, Wilton P, Page D, et al. “Everything was blood when it comes to me”: Understanding the lived experiences of women with inherited bleeding disorders. Journal of Thrombosis and Haemostasis. 2020;18(12):3211–3221. https://doi.org/10.1111/jth.15102
3. Peach L. Period Queen. Murdoch Books: Sydney, 2020.
4. HealthDirect. Menstruation (periods). November 2022, accessed 27 January 2025.
5. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Heavy menstrual bleeding. RANZCOG: Melbourne, 2018. Accessed 27 January 2025.
6. Haemophilia Foundation Australia. ‘Women’s bleeding explained’ in Female factors: information for young women with bleeding disorders. Haemophilia Foundation Australia: Melbourne, 2018. Accessed 27 January 2025.
7. Reed, R. Reclaiming childbirth as a rite of passage weaving ancient wisdom with modern knowledge. Word Witch Press: [Queensland], 2021.
Haemophilia Foundation Australia acknowledges the Traditional Owners and Custodians of Country throughout Australia, the land, waters and community where we walk, live, meet and work. We pay our respects to Elders past and present and extend that respect to all Aboriginal and Torres Strait Islander peoples.
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