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| Menstruation |
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| What is menstruation? |
| Menstruation or 'periods' is part of the female
reproductive cycle, which starts when girls become sexually mature at the
time of puberty. During a menstrual period, a woman bleeds from her uterus
(womb) via the vagina. This bleeding may last from three to seven days.
Each period begins approximately after every 28 days if the woman does not
become pregnant during a given cycle. |
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| Why do women menstruate? |
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Menstruation is a complicated process involving many different hormones,
the woman's sex organs and the nervous system. To understand menstruation,
one has to learn a little about the physiology during each cycle. A woman's
internal sex organs consist of two ovaries, the Fallopian tubes, the uterus
(womb) and the vagina. The ovaries contain the eggs with which the woman
is born and, during each period, a single egg will usually ripen and mature
due to the action of hormones circulating in the bloodstream. When the
egg is mature it bursts from the ovary and drifts through the Fallopian
tube down into the uterus. The lining of the uterus - the endometrium
- is thickened by the action of hormones and made ready to receive the
fertilised egg. If the egg is fertilized and the woman becomes pregnant,
it will fasten itself onto the endometrium.
If the egg is not fertilized, however, resultant hormonal changes cause
the endometrium to slip away and menstruation begins. Menstrual discharge
is composed of the endometrium itself, together with a little fresh blood
caused by the breaking of very fine blood vessels within the endometrium
as it detaches itself from the inside of the uterus. The amount of blood
lost due to the normal monthly period is usually less than 80ml.
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| When does a girl begin to menstruate? |
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Nowadays girls begin to menstruate when they are about 10 to 14 years
old, the average age being 12. Unless they become pregnant or there is
any health condition to prevent it, they will continue to menstruate until
the age of 45 to 55. At about this time menopause (stopping of periods)
begins. A woman will have approximately 500 periods in her lifetime.
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| Can a woman feel when she is ovulating? |
Ovulation usually takes place approximately 14 days
after the first day of the start of a period. The exact timing can vary
from one woman to another. Some women may realize that know when they are
ovulating because they can feel a slight pain in their lower abdomen. Other
women may bleed slightly in the middle of their cycle.
At the time of ovulation, vaginal discharge may increase in amount and become
more watery due to hormonal changes. In fact, some women who practice natural
family planning abstain from sex when they find the mucus test positive.
There may also be a change in the body temperature when a woman ovulates.
Usually there will be a rise in temperature by 0.5 degrees Celsius when
ovulation occurs. A woman practicing natural family planning methods too
can also use this indicator.
The temperature must be taken at the same time every morning before getting
out of bed. Readings taken from different parts of the body such as the
mouth, under the arm, etc, will all give slightly different measurements.
So, it is important to choose one location and stay with it. A rise in temperature
can occur due to many reasons. So this cannot be used as the only method
of detecting ovulation. |
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| What are the factors influencing ovulation? |
| The following factors can influence ovulation:
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- Hormones: If these are not in balance, the cycle will be affected.
If a woman's periods are very irregular, she should consult her doctor
who will request for a test to measure the hormones in her blood to
find out if her hormones are out of balance. This will give an idea
as to whether there is a serious hormonal problem. But the 'normal'
value itself varies from person to person. Blood tests may not indicate
the subtle imbalances in a woman's cycle.
- Weight: This can influence hormonal balance and menstruation.
If a woman is underweight, her hormones may stop working properly and
her periods might stop altogether. Research has shown that obesity can
throw hormones out of balance and make it harder for women to conceive.
- Stress: This too affects the hormones. Many women realise that
if they are worried about something, it can influence menstruation.
In some cases, a woman's period might actually stop if she is very worried
about whether she is pregnant.
- Regular exercise: Keeping fit and healthy can help regulate
the menstrual cycle. But exercising too much and overstressing the body
can have a negative effect on the hormones, to the extent that menstruation
may stop.
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| What are the symptoms of painful periods? |
| The degree of discomfort during menstruation varies
from one woman to another. Some women are least bothered by their periods,
while others can experience unpleasant symptoms. These include: |
- Abdominal pain
- Pain in the vagina
- Nausea and a sense of being ill
- Diarrhoea
- Sweating
- Fatigue
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| How can women relieve their symptoms experienced
during menstruation? |
| Discomfort during menstruation can be relieved
in several ways: |
- Avoiding caffeinated drinks such as coffee, tea, cola or cocoa
- Avoiding stress, including relaxation techniques and massage
- Exercising and staying fit
- Keeping one's abdomen warm
- Using pain relieving drugs if necessary
- Consulting a doctor when simple measures do not bring relief
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| Why do women have painful periods? |
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Painful periods that women experience may be due to several reasons:
Contractions of the uterus similar to those felt in childbirth due to
the hormone prostaglandin The dilatation of the Cervix when the blood
and the tissue are passed out of the womb can cause pain
Earlier infections or inflammations of the uterus, or benign tumours in
the uterus can cause pain
Painful periods may be due to hereditary reasons. If a woman has painful
periods, her daughters may be affected in the same way
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| Why do some women stop having periods altogether?
What is the treatment? |
| This condition is known as amenorrhoea. A woman
can stop having periods due to many reasons. The most common are: |
- Pregnancy
- Premature Menopause (this can affect women in their early twenties)
- Weight loss
- Weight gain
- Certain medications including contraceptive pills or injections
- Drug abuse
- Stress
- Hormonal imbalances such as an underactive thyroid gland or the overproduction
of a hormone called prolactin
- A condition called polycystic ovaries is a very common cause of irregular
or absent periods The treatment for this will depend on the diagnosis.
If a woman is uncertain as to why her periods have stopped, it is best
to seek the advice of a doctor. Physical examination and investigations
may have to be done. A detailed history will also have to be taken.
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| What are the causes of irregular, infrequent periods?
What is the treatment? |
This condition is known as oligomenorrhoea.
Periods may be light or infrequent when a young woman starts having periods
and also when a woman is nearing menopause. This is normal because they
are not producing an egg every month. Women may experience one or two irregular
periods every six months. This is not usually due to any serious condition.
But women are advised to consult a gynaecologist.
The most common cause of infrequent periods is due to polycystic ovaries.
This is a condition affecting about ten per cent of women. In this condition,
a large number of very small (less than 1cm) cysts on the ovaries appear
in association with a hormonal imbalance. This condition results in irregular
ovulation and thus periods are usually infrequent.
The diagnosis of polycystic ovaries is made on the basis of blood tests
to measure hormones and a pelvic ultrasound scan of the ovaries.
Treatment is necessary only if there is concern about the irregularity of
periods or if a woman is having difficulty becoming pregnant. |
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