Girija Hospital & Fertility CenterAzad nagar, near Gujarat Colony, Kothrud, Pune
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Menstruation or monthly cycles or menses or ‘chums’ in our friendly conversations are expected to be regular and so has been told to us by our moms, senior ladies in the family and the doctors. When they become irregular, scanty, painful or heavy, we are certainly worried. Many questions come to our minds and many concerns are associated. It’s but natural, as getting normal, cyclical bleeding devoid of pain, is identified with normal functioning of the internal hormonal system and women or girls do not want to be truly hassled about what is a natural process of the body.
Let us find out from this post the reasons, the preventive measures and treatments for such an occurrence and deal with it. Yes, indeed we believe in empowerment through knowledge and yes we are a smart generation.
What is menstruation ? What is menstrual cycle ?
The bleeding or the bloody discharge experienced by women of the reproductive age group (menarche to menopause) is called as menstruation. This usually lasts for a duration of 3-7 days. Stops on its own and is unique for every woman. The blood passed, is not as fresh or bright red as bleeding when hurt on any other part of the body but is a little darker and brownish and does not clot. It may be a little more in amount during the first 2 or 3 days and later is lesser and then stops. On an average women need to change two to three pads during the heavier days. It is associated with some cramps or heaviness in the lower part of the body but is bearable.
What is this bleeding and where does it come from ?
The bleeding or the bloody discharge comes from the womb. The womb is the place in a woman’s body where embryos get attached and grow into babies. The lining of this womb is a special tissue which grows under the influence of oestrogen and progesterone hormones secreted by the ovary. These hormones cause a complex and special development of the lining tissue ( endometrium ) which is conducive for the embryo to attach and grow into a baby.
The bleeding, is the shedding of this special lining, when the embryo does not get attached, when there is no possibility of pregnancy. This bloody discharge consists of the tissue lining the womb and blood. It is self limiting due to the complementary actions of the hormones involved.
How do I know that the bleeding is normal or abnormal or irregular ?
The ideal pattern of bleeding is every 27-32 days and bleeding for 3-7 days, devoid of pain or weakness. Every woman has a unique cyclicality but the pattern is by and large 4-5 days, bleeding every 28-30 days. Less than this or more than this is abnormal. Also delay or frequent cycles are abnormal. Women normally bleed about 40-85ml during menses and this is well compensated by the body.
What is dysmenorrhea ?
Dysmenorrhea is painful menses. Excessive pain which is unbearable can occur in some women and needs treatment. There can be some underlying disease processes like infection, inflammation, spasm, fibroids, endometriosis which needs to be identified and treated. Its a good practice to approach your doctor for dysmenorrhea and take appropriate treatments. Simple things like walks can help but if no relief some anti inflammatory and pain relieving medicines are needed in addition to the spefici treatment of the underlying cause
What are the causes of heavy menstrual bleeding ?
Hormonal imbalance due to absence of ovulation, infection in the uterus, fibroids, polyps of the uterus, diseases of the thyroid, anaemia, raised blood pressure and problems in blood clotting mechanisms (puberty menorrhagia ) can cause heavy bleeding at menstruation.
What causes less bleeding ?
Obesity, Polycystic ovarian syndrome, thyroid abnormalities, medications, infections in the uterus can cause scanty periods
Are irregular cycles a cause of concern ?
Irregular periods both the once which come frequently or which are delayed are a sign of hormonal irregularity and signify that the process of ovulation is not normal. Such irregularities if not evaluated and treated can cause some irreversible consequences leading to inability to have babies or diseases of the womb. Alterations in the circadian rhymes, stress mental as well as physical can cause changes in these hormones making them erratic resulting in irregular cycles.
How does the doctor evaluate such a case ?
A detailed history including the durations, medications, birth control methods, number of pregnancies is noted. it is important to rule out a pregnancy as it can be responsible for bleeding irregularities. Some lab tests may be ordered to determine the causes such as thyroid or other hormonal abnormalities and effects such as anaemia. Sonography may be ordered to study the basis of the abnormality in more details if deemed necessary.
What are the medications used to treat ?
These can be hemostatic medicines to control bleeding or anti-inflammatory medications to reduce pain. It can sometimes be antibiotics or even hormonal medications, nutritional supplements or medicines to treat the underlying cause. What is important is that these medications are taken properly as advised to avoid abnormalities.
It is important that these irregular periods are not taken as an eventuality and ignored. It is vital to consult a doctor and get them treated well in time.
Lesson learnt : seek help when irregular menstruation occurs and get it evaluated
Lesson learnt : if life throws you lemons make lemon squash and enjoy
Lesson learnt : irregular bleeding is not always cancer and can be treated by conservative surgical approach and prevented by special therapies
Dr. Girija Wagh, MD (Obstetrics & Gynaecology), FICOG, FICP, Diploma (Endoscopy, Infertility), Fellowship of Indian College of Ob-Gynec, Women health care specialist, Academician, Acclaimed Orator & Researcher, B. J. Medical 1990-1992, Topper University Of Pune 1992
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