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. Some illustrations 1. Gini is 16 years old and started her periods about 8 months back. She had slight bleeding to begin with and her mother assured her that it is just the first cycle and not to worry. She got her next periods after two and a half months and bled for 18 days daily soaking 2-3 pads. Her mother assured her and overtime they decided to go to the doc something came up and incidentally her bleeding stopped and she never visited the doc. After 2 months she had a heavy bout of bleeding and was found unconscious in the bathroom and was brought in hospital with heavy bleeding and shock. She was resuscitated and medications were given. Her investigations revealed that she had severe anaemia with hemoglobin of 4 g/dl. A bleeding disorder was suspected but it wasn’t there. It was concluded that she had nutritional anaemia due to poor dietary habits and the anaemia got exaggerated by long term bleeding which wasn’t corrected. Lesson learnt : seek help when irregular menstruation occurs and get it evaluated 2. Tanisha, a 27 years old had frequent menstruation every 18 – 19 days and bled for 3 to sometimes 7 days. She had started putting on weight and growing around the belly. Evaluation revealed that she had joined a new job for the past 9 months which needed her to work in the night and she had very less time for exercise. Food intake had been odd and she defended mostly on pantry snacks. She and worm infestations, anaemia and thyroid abnormality. Her care plan included treatment for anaemia and thyroid abnormality, dietary and exercise guidance and mindfulness. She is doing phenomenally well for the past three years and needed treatment for an year and is very confident and healthy. Lesson learnt : if life throws you lemons make lemon squash and enjoy 1. Seema, a 37 years old presented with heavy menstrual bleeding, leading to anaemia. She had taken treatment for 10 months with no relief. Careful internal sonography revealed a polyp inside the womb. She was treated by hysterocopic removal of the polyp which is specialised surgical procedure in which the womb is accessed by a special endoscope called the hysoeroscope and the polyp ( fleshy mass) growing inside the womb is removed under vision. followed by this a hormone impregnated special system the LNGIUS ( levonorgestrel intrauterine system ) was placed in the womb to prevent recurrence. She is now 45 and symptoms free Lesson learnt : irregular bleeding is not always cancer and can be treated by conservative surgical approach and prevented by special therapies