Do any of these sound familiar?

• Irregular periods
• Pain during sex
• Cramps that interfere with daily activities
• Low mood or depression around your period
• Very heavy bleeding

Menstrual symptoms shouldn’t disrupt your studies or daily life at KCL.

Brought to you by the KCL Women’s Network, we’ve designed this guide to help you better understand your cycle, recognise changes, and know when/how to seek support!

Contents:

1. The 4 Phases of Your Cycle
2. Normal & Abnormal Symptoms
3. Seeking Medical Advice
4. Preparing for a Specialist Appointment
5. Symptom Tracker
6. Additional Resources and References

THE 4 PHASES OF YOUR CYCLE

The Women’s Network at KCL created this guide to help readers understand what a typical menstrual cycle looks like and to recognise signs of an abnormal one. Irregular cycles and disruptive symptoms can significantly affect daily life, wellbeing, and access to opportunities.

We aim to equip readers with the knowledge to reflect on their own experiences and, if they decide to seek medical support, the practical tools to prepare for a productive and informed doctor’s visit.

The 4 Stages of Menstruation: A guide to better understanding your body

A menstrual cycle varies from person to person, ranging between 21 and 35 days. Below are the 4 cycles of the menstrual cycle, and what occurs during each phase:

1. 🩸 Menstrual Phase (Approx. days 1-5)

• Begins on the first day of your period
• Typically lasts 3–7 days
• Estrogen and progesterone levels are low
• The uterus sheds its lining
  • (blood, mucus, and tissue)
  • when pregnancy has not occurred
• Low hormone levels contribute to common symptoms
  • (e.g., cramps, fatigue, mood changes)
• KEY TIP: 💊 Ibuprofen is often effective for menstrual cramps
  • Ibuprofen is an anti-inflammatory medication
  • It works by reducing prostaglandins (substances that trigger uterine contractions)
  • Fewer prostaglandins = less cramping

2. 🌱 Follicular Phase (Approx. days 1-13)

• Overlaps with the menstrual phase
• The ovaries prepare an egg for release
• Estrogen levels gradually rise
• Usually one egg fully matures
• Rising estrogen often supports:
  • Higher energy
  • Improved focus
  • Feeling more active/motivated

3. 🥚 Ovulation Phase (Approx. days 14-16)

• A mature egg is released from the ovary
• The egg travels through the fallopian tube
• This is the phase when pregnancy can occur
• If fertilisation doesn’t happen → the cycle continues
• Possible Ovulation Signs:
  • Slight rise in basal body temperature
  • Increased sex drive
  • Thin, slippery, stretchy discharge
  • Mild lower abdominal discomfort

4. 🌕 Luteal Phase (Approx. days 15-28)

• The body produces progesterone
• Progesterone prepares the uterus for pregnancy
• If pregnancy doesn’t occur:
  • Hormone levels fall
  • Menstruation begins
• Hormonal changes may contribute to:
  • Mood changes
  • Bloating
  • Fatigue
  • Breast tenderness

NORMAL & ABNORMAL SYMPTOMS

The following symptoms are part of a normal (pre)menstrual change, occurring during the luteal phase and/or the menstrual phase:

✅ Normal ✅

• Mild abdominal or period discomfort (does not prevent day-to-day activities)
• Mild muscle or joint aches
• Mild digestive changes (e.g., bloating, altered bowel habits)
• Changes in appetite
• Temporary weight or fluid retention
• Changes in skin appearance
• Changes in sleep patterns
• Fluctuations in energy levels
• Tearfulness or emotional sensitivity
• Mild mood changes (e.g., feeling more emotional or slightly irritable)
• Occasional mild dizziness
• Changes in concentration
• Menstrual bleeding within a typical range (generally 20-90 ml per period)

The following symptoms are part of an abnormal (pre)menstrual change, occurring during the luteal phase and/or the menstrual phase:

⚠️ Abnormal ⚠️

• Sudden or intense changes in mood
• Bleeding lasting longer than usual or between periods
• Thoughts about harming yourself or feeling unsafe
• Bleeding between periods or after sex
• Periods becoming irregular or stopping unexpectedly
• Very heavy periods (e.g., soaking through a pad/tampon every 1–2 hours on your heaviest days, bleeding longer than ~7 days)
• Periods that are consistently very painful (especially if pain interferes with daily activities)
• Persistent itching, discomfort, or soreness
• Unusual discharge (e.g., change in colour, texture, or strong odour)
• Sudden, severe abdominal or pelvic pain
• Unusual sensitivity to light, sound, or smells
• Difficulty controlling your bladder
• Pain or discomfort with penetration (e.g., tampons or sex)

SEEKING MEDICAL ADVICE

If you are experiencing any of the symptoms outlined in this guide (or other symptoms that are causing you distress) the first step is to seek professional medical advice.

If you are registered with a General Practitioner (GP), consider booking an appointment to discuss your concerns.

If you are not yet registered with a GP, you can sign up at the KCL NHS Health Centre located on the Strand Campus. The clinic is open to all King’s students and staff, including international students. Further information and the registration form can be found at: https://www.kclnhshealthcentre.com/registration

Before your medical appointment, it’s very important to prepare a concise list of your symptoms and their frequency. At the end of this guide, we have attached a symptom tracking sheet to help you keep track of the relevant symptoms, although this can also be done with most period tracking apps available to download on your phone.

Use the tables below to organise your symptoms, questions, and key information ahead of your appointment. The information below is kindly provided by Dr. Jemma Johns, Consultant Obstetrician & Gynecologist at King’s College Hospital, and Honorary Senior Lecturer at KCL.

🩺 GP APPOINTMENT 🩺

EXPECT	PREPARE	REMEMBER
💡Expect some personal/intimate questions — this is routine. Questions about your menstrual cycle cycle length, bleeding duration bleeding between periods bleeding after sex	Bring a concise symptom list what’s happening how long impact on daily life 💡 Try to complete a symptom tracking sheet before your GP visit with as much relevant information as possible, or use a period tracking app to record your symptoms/moods if you prefer!	GP appointments are often ~10 minutes Being prepared with the relevant information helps you get more from your visit 💡Missing background info can consume valuable consultation time
Questions about symptoms pain, mood changes, discharge bowel & bladder function	Know your: Current/past medications Allergies Past conditions/surgeries Contraception name/type	Your GP can offer effective interim treatment: Use prescribed/recommended analgesics Gentle movement & exercise (can reduce pain) Heat therapy
Questions about contraception methods (current & past)	If you think you may feel uncomfortable during a physical examination: It’s important to mention this early to avoid uncomfortable situations	Accepting symptom relief does not prevent diagnosis 💡Many patients delay treatment until they receive a diagnosis -- this may mean months of avoidable discomfort.
Questions about sexual health STI risk/screening Pap smear test history	If English isn’t your first language: Make sure you request the interpreter/translator you need while booking the appointment It is your right to have a trained interpreter to support you at each GP or hospital appointment It is the responsibility of your healthcare provider (GP or hospital) to book an interpreter for you.	Follow-up appointments are normal & appropriate 💡If you feel like your symptoms weren’t properly addressed, it’s encouraged to book a follow-up appointment to: Raise remaining concerns/questions Clarify what you feel was missed
Pregnancy history (if relevant)	For mobility/access needs: Check GP practice website Notify the clinic ahead of time
General health questions medical/surgical history medications & allergies lifestyle factors (alcoholuse, tobacco use, drug use)

PREPARING FOR A SPECIALIST APPOINTMENT

 

🌸 OB/GYN APPOINTMENT 🌸

EXPECT	PREPARE	REMEMBER
More detailed symptom discussions	If you feel anxious/unsure about an examination: Mention it to the doctor beforehand Ask them to stop if you start feeling uncomfortable during the examination	You may receive a provisional diagnosis early
Possible physical/intimate examination Ultrasound scan (vaginal or abdominal) Swabs/smear Blood or urine tests	Remember that you may request: Explanation of exam steps Abdominal scan instead of vaginal scan (note that abdominal scans can be less accurate than vaginal scans)	Some conditions require multiple appointments/steps/tests to receive a diagnosis Within the NHS, waiting times can be weeks or months between appointments
Some diagnoses may require staged testing (e.g., laparoscopy for endometriosis)	Consider asking someone you trust to come with you as a support person	Communication about comfort & boundaries to your healthcare provider is encouraged

 

Possible Referrals to Other Specialists

Depending on symptoms, your OB/GYN or women’s care specialist may further refer you to:

• Pelvic floor physiotherapy
• Psychosexual therapy
• Gastroenterology/colorectal
• Neurology
• Urogynecology
• Psychiatry (occasionally)
• Hematology

Does the NHS cover all the appointments/tests?

• Most investigations & treatments are NHS-covered
• Some outsourcing may occur (backlog management)
  • If you are being recommended a consultation that is outside of NHS coverage, that will be communicated to you
• Exceptions mainly relate to eligibility/entitlement to care

SYMPTOM TRACKER

You can also download a PDF version of the Menstrual Matters Symptom Tracker.

ADDITIONAL RESOURCES

• Interpreters and translator services provided by the NHS
  • https://www.gov.uk/guidance/language-interpretation-migrant-health-guide
• Information about getting healthcare in the UK
  • https://www.nhs.uk/nhs-services/visiting-or-moving-to-england/how-to-access-nhs-services-in-england-if-you-are-visiting-from-abroad/