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The menstrual cycle and cystitis are closely related. The menstrual cycle actually promotes the onset of cystitis and vaginal infections caused by candida or other pathogenic germs.
Further information: Specific treatment plans for each type of cystitis developed by cistite.info APS can help you combat and prevent cystitis.
The urethra and bladder (the trigone, to be precise) have the same embryonic origin as vaginal tissue, so they are also significantly affected by hormonal changes, which expose women to urinary and genital infections to a greater or lesser extent depending on the phase of their menstrual cycle.
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In-depth analysis: how to cure cystitis with mannose
The menstrual cycle prepares the female body for pregnancy and produces the egg to be fertilised. Female fertility is regulated by hormones, the nervous system and the ovaries, which interact and influence each other in a cyclical manner.
A menstrual cycle lasts an average of 28 days and can be divided into four phases. Understanding what happens in each of the four menstrual phases will help you identify the period most at risk of recurrence and prevent it with appropriate measures.
Cystitis does not cause delays in the menstrual cycle. It is more likely that the opposite is true, i.e. that hormonal changes (responsible for delays or early onset of menstruation) also cause cystitis.
Menstruation
Is it possible to develop cystitis during your period?
At this stage, acute cystitis is rare, and chronic painful symptoms diminish or disappear completely.
By convention, the days of a menstrual cycle are calculated starting from the first day of menstruation. Menstruation is the bleeding caused by the breakdown of the endometrial tissue, which is expelled in tiny fragments through the vaginal canal together with blood from the uterine blood vessels. It lasts an average of 5 days.
At this stage, the follicle (the part of the ovary that contains the egg) is very small, there is a sharp drop in oestrogen and progesterone, the endometrium thins considerably, and body temperature drops.
At this stage, the painful symptoms usually diminish or disappear completely. There is an increase in urinary frequency at this stage. This is due to the sharp drop in oestrogen, the increase in which during the premenstrual phase had caused water retention, accumulating body fluids. In addition to increased urinary frequency, there may be an increase in bowel movements and a change in stool consistency, which becomes softer (sometimes diarrhoeic) due to the increased expulsion of fluids in the intestines and increased peristalsis (bowel movements) caused by the drop in progesterone.
By emptying the bowels and reducing the volume of the uterus, the pressure exerted on the bladder and pelvic nerves is automatically reduced, offering the woman a moment of well-being.
The discomfort generally experienced towards the end of menstruation is usually due to irritation from synthetic sanitary pads, tampons, menstrual blood and prolonged contact with moisture and wetness. To avoid these discomforts, you can use a menstrual cup, disposable cotton sanitary pads or washable sanitary pads. In addition, when your period ends, you can use a D-mannose wash to cleanse the vaginal canal of irritating menstrual residues.
Further information: vaginal douche containing D-mannose
Post-menstrual phase (or follicular or proliferative phase)
Is it possible to develop cystitis after your period?
At this stage, most women experience a period of well-being.
It lasts about 8 days. The follicle containing the egg grows, oestrogen levels increase dramatically to allow it to survive, reaching their peak, the endometrium begins to thicken (2-3 mm), and body temperature remains consistently low. During this phase, most women also experience a period of well-being due to the increase in oestrogen, the decrease in the thickness of the uterus (which therefore does not compress the bladder) and the increase in vaginal secretions. Under the influence of oestrogen, vaginal mucus increases until it reaches its peak during ovulation.
Ovulation
Is it possible to develop cystitis during ovulation?
At this stage, many women experience a flare-up of symptoms.
Many women who want to become pregnant experience recurrence during ovulation. In addition to factors related to ovulation, this is also due to two variables: increased sexual intercourse during this phase and the alkalinity of semen, which further raises the vaginal pH, hindering the survival of beneficial lactobacilli.
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Find out how to prevent post-coital (or honeymoon) cystitis.
The ovulatory phase lasts approximately 48 hours. The maturation of the follicle leads to the secretion of luteinising hormone and a sharp drop in oestrogen and progesterone. Following these hormonal changes, the walls of the follicle weaken until they rupture, resulting in the expulsion of the egg. The fallopian tubes capture the egg, which can then be fertilised by male sperm. The vaginal mucus changes to allow the sperm to survive: it becomes more alkaline, more fluid and more abundant (10 times more than on the eighth day of the cycle). Women who are ovulating may experience ovarian pain and slight bleeding.
Symptoms flare up for various reasons. Vaginal secretions contain glycogen, which keeps the vaginal pH acidic, thus promoting the growth of “good” lactobacilli and inhibiting the survival of pathogenic microorganisms. The amount of glycogen present is proportional to the amount of oestrogen secreted. Oestrogens also increase the defence capacity of tissues containing their receptors, improving the nutrition and vascularisation of these mucous membranes. Healthy tissue is better able to cope with bacterial, chemical, mechanical and inflammatory attacks. Oestrogen levels drop sharply during ovulation. As a result, there is a greater risk of bacterial contamination because the pH rises, vaginal lactobacilli decrease in favour of pathogens, the vaginal and vulvar mucous membranes become more delicate and hypersensitive to any external stimulus, and lose some of their defensive capabilities.
The alkalinity that the mucus acquires at this stage also hinders the reproduction of lactobacilli in favour of pathogens. Furthermore, while the greater dilution of the mucus facilitates the passage of sperm towards the uterus, it also facilitates the passage of pathogens, causing the mucus to lose its protective barrier function.
Discover how to acidify or alkalise your urine to protect yourself from cystitis
Premenstrual phase (or luteal or secretory phase)
Is it possible to develop cystitis during the premenstrual phase?
This is the most critical phase, when infectious, inflammatory or painful cystitis is most likely to occur.
Find out what type of cystitis you have and how to treat it.
It lasts about 14 days. The follicle that released the egg turns into the corpus luteum (it becomes yellowish, atrophied and smaller and smaller), the endometrium grows to a thickness of 5-6 mm and fills with new blood vessels to accommodate and nourish any implanted embryo. Progesterone production increases dramatically. To a lesser extent, oestrogen production also increases. Body temperature rises by about half a degree. The egg will travel through the fallopian tubes and, if fertilised, will implant itself in the uterus, triggering the secretion of HCG (human chorionic gonadotropin), which will keep the corpus luteum stable and able to maintain the high level of progesterone necessary for the embryo to survive. If the egg is not fertilised, the corpus luteum will disappear, and progesterone and oestrogen levels will drop sharply. This hormonal decrease will cause the destruction of the endometrium, which at this point will have reached its maximum growth. Menstruation will then begin. A new menstrual cycle will then start again.
While the other phases may vary in length, the luteal phase will always have the same duration. Therefore, once it has been established that the luteal phase lasts, for example, 14 days, if a menstrual cycle lasts up to 30 days, the phases that have been extended will certainly be those preceding the luteal phase, which will remain unconditionally 14 days long.
This is the most critical period for recurrences of cystitis, candida and flare-ups of vulvodynia.
There are numerous reasons for this:
- Increase in progesterone
After ovulation, the increase in progesterone significantly reduces the quantity and fluidity of cervical mucus, which concentrates in the cervix and fills with elements (leukocytes, macrophages, fibronectin, antibodies, chemokines, cytokines, defensins, lactoferrin, zinc, uterine and cervical mucosal cells, etc.), which form a barrier impenetrable to sperm.
The concentration of secretions causes vaginal dryness, which makes the genital mucosa more sensitive and increases friction and microtrauma during sexual intercourse, thus promoting post-coital (or honeymoon) cystitis and vulvodynia symptoms.
The disappearance of vaginal mucus is also associated with a decrease in its antibacterial components, so in the premenstrual phase, vaginal dryness increases the risk of bacterial vaginal infections.
Progesterone also reduces the body's immune response. In fact, during the premenstrual phase, it is common to experience not only cystitis, but also a series of disorders related to immune deficiency, such as cold sores, sore throat, mouth ulcers and vaginal thrush.
Finally, during this phase, the uterine wall thickens. The enlarged uterus presses on the bladder, preventing it from filling completely and causing frequent urination. The physiological increase in urinary frequency is often mistakenly interpreted as a warning sign of a new recurrence.
Progesterone causes a reduction in peristalsis (the involuntary movement of the walls) of both the intestine and the urethra, increasing not only constipation but also difficulty in emptying the bladder and therefore bladder stagnation. - Decrease in oestrogen
The drop in oestrogen levels that occurs 24/48 hours before menstruation causes a decrease in glycogen in the vaginal environment, leading to an increase in bacterial and candida infections. Women with amenorrhoea due to oestrogen deficiency are more prone to urogenital infections for this very reason. The same applies to women in menopause and those with ovarian and therefore hormonal changes.
Oestrogen fluctuations in the premenstrual phase also stimulate mast cell degranulation, i.e. they activate inflammatory processes, exacerbating pain even in the absence of infection. This is the case with vulvodynia, chronic pelvic pain and pelvic neuropathy. The pain in turn increases the contracture of the pelvic muscles. - Water retention
The increase in progesterone after ovulation leads to water retention. This reduces the amount of fluid reaching the bladder, concentrating the urine and reducing its flushing action. Water retention also leads to a decrease in fluids in the stool, making it much harder and accentuating or causing constipation. In turn, constipation is a risk factor for both cystitis and pelvic muscle contracture. - Increase in the volume of the uterus
The increase in the thickness of the endometrium and its blood vessels causes a greater flow of blood to the uterus, diverting it from other nearby pelvic structures (bladder, urethra, rectum, vagina, vulva), which, without an adequate supply of oxygen and nutrients from the bloodstream, suffer and remain more vulnerable. - Irritability and depression
In questo periodo premestruale infine aumentano sintomi quali irritabilità e depressione a causa During this premenstrual period, symptoms such as irritability and depression increase due to hormonal changes. Anxiety, stress and depression lower the pain threshold, increase muscle tension and weaken the immune system.
Christiane Northrup (gynaecologist and author of the book “Happy Menopause”), going against the grain, believes that premenstrual mood swings are not due to this hormonal change. Hormones merely act as the detonator for the bomb. According to her theory (which I totally agree with), hormones in this phase simply increase individual sensitivity to external events, bringing unresolved conflicts to the surface.
It is convenient for both society and ourselves to think that our anger and sadness are due to these “fluctuating” hormones, rather than acknowledging a real problem and rolling up our sleeves to solve it. It is easier to wait passively for them to “pass” so we can return to feeling calm. It is easier for our partners, our family and our colleagues not to admit that there is a problem that we all need to tackle together. It is easier to delegate responsibility to something inevitable and unchangeable, such as premenstrual hormonal changes.
So if, three days before our period, we get angry because our partner has heated up his tea but not ours, we will conventionally tend to put up with it rather than analyse the situation. In reality, the anger at that seemingly insignificant gesture is a request for more attention, a desire for him to be more aware of our needs. On a normal day, such behaviour would leave us indifferent, but in the premenstrual phase, with our sensitivity at its peak, the problem becomes obvious. If we were completely calm and satisfied, premenstrual irritability and depression would not arise. Take advantage of this sensitivity to analyse the situation around you and resolve it, because this phase will give you greater clarity to do so. Do not bury your head in the hormonal sand! Otherwise, in 28 days, you will be forced to relive the same negative feelings, probably even more intensely because an unresolved problem tends to become bigger and bigger.
It is therefore normal that depression, irritability, muscle spasms, painful symptoms and cystitis will recur at every premenstrual phase until you resolve these relationship issues!
Evidence of the correlation between cystitis and the menstrual cycle
“With ovulation, I always have worse symptoms too!!!
I don't understand... whether I have sex or not... right after ovulation, they're there!!”
Debby76 12 and 19/09/2005 (forumsalute.it)
“I confirm that I also feel worse during ovulation. In fact, I had my last severe bout of cystitis in August, during that period.
The following month, I did not have cystitis, but I did have several other symptoms: various burning sensations and urinary urgency.”
Sara69 19/09/2005 (forumsalute.it)
"I have been suffering from very painful cystitis (often haemorrhagic) for 10 years. It is very frequent, but for the past year, since my husband and I have been trying to have a baby, it has become even more frequent. In fact, the cystitis always coincides with ovulation. This is a problem because I am forced to take antibiotics, which I would gladly do without, as I doubt they would be good for me if I were to become pregnant."
Solesu75 08/03/2006 (forumsalute.it)
“Last night I got up about every two hours to go to the toilet... and today I feel heavy again... maybe my period is coming...”
Selma 27/06/2007(forumsalute.it)
“I've been suffering from cystitis almost every month for a year now!
The attack comes a few days before my period!!”
Pattyna 19/07/2007(forumsalute.it)
"About 10 days before my period arrives, I need to urinate very frequently, as if I had cystitis!! I have had many, many urine cultures done... all negative. I feel a sense of pressure in my abdomen, that is, even if I have very little urine to pass, if I try to pull my abdomen in, I immediately feel my bladder pressing me to go to the toilet! Now, since this problem occurs periodically during this time of my cycle, do you think it could have something to do with my uterus? Am I mistaken, or does the uterus swell before menstruation?"
Essimply 21/10/2007 (alfemminile.com)
“Have you ever had an attack... after having sex in the period immediately before your period? I have to say that I mark everything on a calendar and I have often noticed that I only have attacks during that period and nothing during the rest of the month (even though I have sex)! I don't know if there could be any connection...”
Anniep 12/06/2009 (cistite.info)
"I'm curious, but do you think it's normal to urinate more often during your period? Or is it a symptom of something wrong?"
Marrone 30/08/2009 (cistite.info)
Read more information on the Forum about the influence of the menstrual cycle on cystitis.
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- Gattei, U. (2007). Il corpo delle donne: Storia del ciclo mestruale. Meltemi Editore