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    Menstruation

    About menstruation


    Menstruation (also called periods) is the monthly shedding of the inner layer of uterus presented as bleeding through the vagina.

    In females the body is getting prepared to have a child in future years, there is an onset of the cyclical vaginal bleeding that occurs as a part of a woman's monthly cycle called the Menstrual cycle.

    A normal menstrual cycle has an average length of 28 days (+_ 7 days). Normal menstruation lasts for 3-5 days.


    Menarche usually starts about 2-3yrs after the initiation of puberty. Menstruation may be irregular initially for the first few years before the attainment of regular ovulatory cycles.

    During the cycle, the egg gets released from the ovary and eventually travels towards the uterus anticipating fertilization with sperm. When there is fertilization, pregnancy occurs and when this doesn't happen, the lining of the uterus sheds down and flows out of the body and this is called menstruation. This cyclical occurrence of events that occurs under the influence of hormones release from pituitary gland i.e. brain, is called the menstrual cycle.


    A woman may have the following symptoms which are considered quite normal:



    Although considered normal if these increases in the severity it is highly recommended to consult a doctor.


    Menstrual cycle irregularities

    Menstruation is the end result of a complete periodic cycle which is controlled by the hormones released by the brain and the changes happening in the female reproductive organs. Any disruption in this cycle leads to menstrual irregularities. The most common issues are as follows:


    Amenorrhoea: It means the absence of menstruation. It may be primary or secondary amenorrhoea depending upon its onset:

    • Primary amenorrhoea: Primary amenorrhoea is a condition in which a girl fails to menstruate by the age of 16yrs. This can be due to some structural, hormonal or functional abnormality. It is highly advisable to consult a specialist in such cases.
    • Secondary amenorrhea: It is the absence of menstruation for 6months or more with previous normal menstrual cycles. It can be of the following types:
    • Physiological or Natural amenorrhoea: e.g. before puberty, during pregnancy, lactation and after menopause.
    • Pathological amenorrhoea: because of any of the following issues-
    • Genetic diseases – genital tract abnormalities, genital tuberculosis
    • Systemic diseases- PCOD, tuberculosis
    • Hormonal issues- Hypothyroidism, diabetes
    • Nutritional issues – Anorexia nervosa, bulimia nervosa
    • Drugs usage: OCPs


    Clinical examination, hormone assays, ultrasonography, endoscopic procedures, and genetic testing may be required for the diagnosis of amenorrhoea.

    • Oligomenorrhoea: Oligomenorrhoea is a condition in which the length of the menstrual cycle is more than 35 days.
    • Polymenorrhoea: Polymenorrhoea is a condition in which the length of the menstrual cycle is less than 21 days.
    • Menorrhagia: Menorrhagia is a condition in which there is increased menstrual flow or increased duration of menstrual flow (days).
    • Metrorrhagia: Metrorrhagia is a condition in which there is irregular bleeding or spotting during the cycles
    • Endometriosis: Endometriosis is an unpleasant state in which the endometrium (tissue that normally lines the inside of the uterus) increase in the outer side of the uterus. It may also involve ovaries, fallopian tubes and the tissue lining of the pelvis.
    • DUB (Dysfunctional Uterine Bleeding): It is an abnormal or irregular uterine bleeding that occurs without any identifiable pelvic pathology, pregnancy or general medical condition.


    Dysmenorrhea

    Dysmenorrhea simply means difficult monthly flow. Although it is absolutely normal for most women to experience some sort of abdominal pain or cramps during the first day or two of their periods, some women experience severe pain that hampers their day to day activity.


    Dysmenorrhea is of following two types:

    Primary dysmenorrhea is which there is no underlying gynecologic problem related to menstrual cramps. Cramps or pain occur due to the normal process of menstruation.

    Secondary dysmenorrhea is when menstrual pain is due to some kind of gynecologic disorders like fibroid, Adenomyosis, sexually transmitted infection (STI), endometriosis, pelvic inflammatory disease (PID), an ovarian cyst or tumor or due to an intrauterine device (IUD).


    Symptoms of dysmenorrhea include:

    • Severe or moderate aching pain in the stomach
    • A feeling of pressure in the stomach
    • Pain in the hips, inner thighs, and lower back
    • Upset stomach (loose stools)
    • Nausea and vomiting
    • Light-headedness
    • Headache
    • Fatigue

    Common Concerns about menstruation

     

    Menstruation is a new beginning for every girl as she transforms from a girl to a woman and her body gets ready for future pregnancy. There can be so many concerns or queries that may arise in the girl’s mind regarding menstruation. Here we discuss some of the major concerns related to menstruation.


    What are periods?

    Periods are also known as menstruation and are the first five days of the menstrual cycle where the uterine lining is shed and discharged from the vagina along with the ruptured blood vessels and blood.


    When are periods normally supposed to start?

    Periods usually start between 9-12 years. The onset of periods is also known as menarche and this determines the start of puberty. After menarche, females become reproductively active.


    What are the factors that determine menarche?

    Genes, population, nutritional habits, hormonal levels of the body, etc. are some of the factors that determine menarche. 


    How many days, periods are supposed to last?

    Periods usually last 3-5 days but may extend to 7 days.

     

    How do I track whether my periods are regular or not?

    Normally menstrual cycle lasts for about 21-35 days. At the end of each cycle, another cycle starts. The first day of the cycle is the day when bleeding starts. So, to count a cycle, start from the day of bleeding and count till the next bleeding appears. This is one menstrual cycle. Every month there can be 2-3 days variation in the number of days of the cycle. So if your cycle continues like this all around the year, your periods are regular.


    What are irregular periods?

    Delayed periods, advanced periods (before time) and missed periods are known as irregular periods or irregular menstruation. Irregular periods may be the presentation of some underlying problem (e.g. PCOD) therefore, it is important to consult the gynecologist to resolve the problem. 


    Is it normal to have irregular periods?

    Usually two years after menarche or when a woman is nearing menopause, periods can be irregular. But if it continues, it is always better to consult the doctor and know the root cause.

    What are the causes of irregular periods?

    • Stress
    • Depression
    • Intake of birth pills
    • Level of progesterone and estrogen
    • Change in weight
    • Anorexia
    • Obesity
    • Lack of nutrition
    • Environmental factors
    • Genes 
    • Polycystic Ovary Syndrome (PCOS)  
    • Thyroid Disorder (over- or underactive thyroid)
    • Diabetes 
    • Pelvic inflammatory diseases etc.

    If menstrual pain is a concern for you, consult a doctor and know the real cause of it and get treated. 


    Premenstrual Syndrome (PMS)

    Premenstrual Syndrome (PMS) is a condition that affects almost 90% of menstruating women and is characterized by disturbances in woman's emotions, behaviour and physical health during certain days of the menstrual cycle. It is very common and may occur as early as 2 weeks before the menstrual period or just before the menses.

    Premenstrual Syndrome (PMS) symptoms in a woman: 

    • Irritability
    • Food cravings
    • Mood swings
    • Tender breasts
    • Fatigue
    • Depression (also termed as PMS depression) etc. 


    PCOS or Polycystic ovarian syndrome is a condition in which numerous small, fluid-filled sacs known as cysts develop in the ovaries. PCOD problem affects the levels of the hormones. It is a situation when woman produce higher than normal amount of male hormones (androgens). This may also hamper the process of ovulation. PCOS symptoms include the following: 

    • Irregular or no periods
    • Obesity
    • Acne
    • Excess hair growth on the face, chest, back, etc. 
    • Harder to get pregnant

    If you are experiencing any of these symptoms, consult to your doctor and get evaluated and treated for polycystic ovarian syndrome. 


    Health Hygiene during Menstruation

    Hygiene during menstruation is very important and every woman should take care of it to prevent unwanted diseases as women are most susceptible to infection during this period. Here are a few tips that can help you deal with those difficult days of the month: 

    • Bath daily
    • Use good sanitary pads
    • Change your sanitary napkin every 4-6 hours irrespective of less bleeding
    • Wash your vagina regularly using your hands in motion from the vagina to the anus, not vice-versa.  
    • Use clean underwear and change it every day
    • Use lukewarm water to clean the vagina
    • Don't use soaps or vagina hygiene products during menstruation
    • Always pat the vaginal area dry after every wash to avoid irritation
    • Wash your hands with warm water and soap after every toilet use
    • Dispose of your tampons and sanitary napkins properly


    Reference:-


    https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Adolescent-Health-Care/Menstruation-in-Girls-and-Adolescents-Using-the-Menstrual-Cycle-as-a-Vital-Sign?IsMobileSet=false


    https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome

    Frequently Asked Questions

    Although many women complaint of heavy bleeding, it is only a cause of concern if the bleeding is so heavy that it affects normal activities when you have your period. If this is the case of your daughter, talk with your doctor and know the real cause of excessive bleeding and get her treated.

    Though PMS is a condition that affects almost 90% of menstruating women every month if it affects you badly, then you can visit a specialist for better management.

    It is very important for you to share this news with your mother as she can guide you with her experience. Just sit calmly, tell her and discuss all your concerns. It is a very natural process and is not at all a thing to hide.  

    Most women experience blood clots in their menstrual flow and it is somewhat normal too. But if you pass many large and thick clots with regularly very heavy bleeding (need to change your pad or tampon every hour) then it is advised to visit a specialist.  

    Menstrual irregularity can be because of so many reasons as discussed above. And most importantly persistent irregular cycles can be a sign of an underlying disorder that should be diagnosed and treated. It may cause difficulty in pregnancy and it is highly recommended to get the consultation of a specialist 

    No, soaps should not be used for vaginal hygiene during menstruation. Vagina has its own cleaning mechanism and soap can hamper the natural process leading to infections and growth of bacteria. 

    You need to first calculate your cycle days. The first day of the cycle is the day when bleeding starts. So to count a cycle, starting from the day of bleeding and count till the next bleeding appears. This is one menstrual cycle and at the end of each cycle, another cycle starts. Every month there can be 2-3 days variation in the number of days of the cycle. As normal menstrual cycle lasts for about 21-35 days, so if your cycle continues after approximately the same number of days all around the year, your periods are regular and there is no need to worry. But if this is not the case, then you must 

    consult a specialist.


    PCOS seems to run in families too, so it may affect you if someone in your family has it. But there is just a possibility, it is not sure that you will definitely have PCOS. Stay active and maintain a healthy lifestyle to prevent yourself.  

    Though cramps during periods are mainly because of natural menstruation process, it can also be due to causes like PCOD, endometriosis, fibroid, etc. If the cramps affect your daily activities during menstruation, it is advised to consult a specialist.  

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