For better or worse, menstruation is a woman’s constant companion.
Menstruation marks the beginning of a menstrual cycle. It is part of the womb’s constant renewal process that prepares a woman for pregnancy. By shedding an unfertilized egg (ovum), blood, secretions, and tissue debris, the womb is rejuvenated. Subsequently, a new menstrual cycle begins – the uterus wall is rebuilt, a new network of blood vessels is established and a new ovum is released.
The normal menstrual cycle averages 28 days and menstruation lasts for 4 to 6 days with a total blood loss of about 30 to 40ml. Ladies may experience varying degrees of discomfort or problems during this process.
Some common problems associated with menstruation and menstrual cycles are amenorrhea, irregular menses, menorrhagia, dysmenorrhea, and premenstrual syndrome (PMS).
Amenorrhea
Amenorrhea takes place when there is no menstruation or when menses suddenly stops. It may be classified as primary or secondary amenorrhea. Primary amenorrhea refers to no periods or never having a period. Secondary amenorrhea refers to interrupted periods or periods that suddenly stop after previously being regular.
Causes:
Primary amenorrhea
- Genetic or hormonal disorders
- Lack of reproductive organs (e.g. no uterus at birth)
Secondary amenorrhea
- Pregnancy
- Stopping oral contraceptives
- Breastfeeding
- Emotional stress
- Certain medications (e.g. antidepressants, antipsychotics)
- Diseases (e.g. diabetes)
- Hormonal disorders
- Sudden weight gain or loss
- Excessive exercise
- Tumours
- Premature menopause
How to deal with it:
Treatment may include eating healthy, exercising, reducing stress, or taking oral contraceptives or thyroid medication.
Irregular Menses
Irregular menses is defined as having irregular or unexpected periods. For example, there is frequent bleeding, irregular bleeding (sometimes heavy, sometimes light), bleeding in between periods, or bleeding after menopause.
Causes:
- Hormone disorders
- Stress
- Cancer
- Pelvic infections
- Certain medication
- Miscarriage
- Ectopic pregnancy (pregnancy that develops outside the uterus e.g. in a fallopian tube)
How to deal with it:
Treatment may include taking oral contraceptives correctly to regulate hormones, reducing stress or surgically removing polyps to correct irregular bleeding.
Menorrhagia
Menorrhagia takes place when there is an excessive loss of blood during menstruation (i.e. more than 80ml blood loss per cycle). Symptoms include abnormally heavy blood loss, large blood clots in the discharge, prolonged menstrual bleeding, constant lower abdominal pain, dizziness, or fatigue. Anaemia is a common complication.
Causes:
- Hormone disorders
- Stress
- Cancer
- Pelvic infection
- Liver disease
- Fibroids (benign tumours in the uterus)
- Polyps (growths in the lining of the cervix)
- Oral contraceptives
- Certain medication
- Miscarriage
- Ectopic pregnancy
How to deal with it:
Taking iron supplements or eating foods rich in iron, taking nonsteroidal anti-inflammatory drugs (NSAIDs/except aspirin which can thin the blood) (a group of pain relievers e.g. aspirin, ibuprofen, or naproxen), oral contraceptives, or progesterone (a type of female hormone), and rest can help in relieving symptoms.
Dysmenorrhea
Dysmenorrhea refers to painful periods or menstrual cramps. Symptoms may include mild to severe lower abdominal cramps which may come and go in waves (caused by uterus contractions), dull ache in the lower back, nausea, vomiting, diarrhoea, sweating, headache, dizziness, and fainting.
Causes:
Primary dysmenorrhea:
- Excessive production of prostaglandins (the chemicals that cause the uterus to contract and cause pain and inflammation).
Secondary dysmenorrhea:
- Endometriosis
- Pelvic infection
- Intrauterine contraceptive device (IUD)
- Fibroids or polyps because the uterus may try to expel any foreign objects
How to deal with it:
For primary dysmenorrhea, NSAIDs, antispasmodics, oral contraceptives, hot baths or heating pads, exercise, rest and fluids, reducing stress, massage, yoga, meditation, or acupuncture can provide some relief from the pain.
Secondary dysmenorrhea usually involves treating the underlying cause.
Premenstrual Syndrome (PMS)
Premenstrual syndrome is a combination of physical and emotional (mood) changes that normally occurs 7 to 14 days before menses.
Some emotional and behavioural symptoms that may be seen in PMS are tension or anxiety, depression, crying spells, mood swings, irritability, anger, appetite changes, food cravings, insomnia, fatigue, and/or poor concentration.
Some physical signs and symptoms include joint or muscle pain, headache, fatigue, weight gain, fluid retention, abdominal bloating, breast tenderness, acne, constipation or diarrhoea.
Causes:
Hormone changes, or hormonal imbalance aggravated by…
- Smoking
- Stress
- Vitamins and minerals deficiency
- Salt, sugar, alcohol, caffeine
- Oral contraceptives
How to deal with it:
Treatment measures include taking antidepressants, NSAIDs, diuretics (medication to treat water retention and increase urination), oral contraceptives.
Maintaining a healthy diet, taking multivitamins, consuming evening primrose oil, avoiding caffeine, alcohol, and salt, quitting smoking, exercising, reducing stress, resting, yoga, or massage may also help treat PMS.
Normal menstruation symptoms are entirely manageable.
However, a visit to a doctor is highly recommended if
- there is no menses after the age of 16,
- if periods suddenly stop for no reason,
- if bleeding occurs after menopause
- if more severe symptoms of menorrhagia, dysmenorrhea and PMS are present,
Lastly, taking active steps to know more about menstrual problems minimises their effects and helps you celebrate life as a woman!
