Written by :
Indraprastha Apollo Hospital, New Delhi
What are menstrual problems?
Menstruation is a normal part of a woman’s reproductive cycle. The ovary periodically releases an egg. It also releases a hormone called oestrogen, which stimulates the lining of the uterus to grow and get prepared to receive the fertilized egg. If, however, the egg does not get fertilized, the uterus sheds its lining resulting in menstrual flow. This flow repeats itself in a cycle of approximately 28 days until a woman gets pregnant or has approached menopause.
A slight discomfort or pain associated with menstruation is quite normal but if it becomes severe, a doctor should be consulted for problems that may not be really visible. The three main problems associated with menstruation are:
- Lack of periods- amenorrhoea
- Painful periods- dysmenorrhoea
- Heavy periods- menorrhagia
- Premenstrual Syndrome (PMS or PMT)
Amenorrhoea is the absence or abnormal stoppage of menstruation. It can be of a primary or secondary nature. It can be due to normal physiological reasons like pregnancy, breast feeding or menopause. Infact, the commonest cause of physiological amenorrhoea is pregnancy. The abnormal (pathological) causes are:
Girls who have attained the age of 16 years and still not started getting their periods are said to have primary amenorrhoea. Secondary amenorrhoea occurs when a woman who was having normal periods suddenly stops menstruating for more than 6 months.
It can be due to a hormonal imbalance or a developmental problem. Stress, severe dieting, increased levels of exercise or chronic illness could also add to the problem. Most often women do not give importance to this but it needs to be dealt with more cautiously as it may be a sign of an underlying problem- imbalance in the production of reproductive hormones or even uterine cancers.
Dysmenorrhoea or pain during the periods may be quite normal in most of the cases. Primary dysmenorrhoea is more common in teens and is not caused by a disease. It is because of the production of a hormone called prostaglandins in large quantities leading to nausea, headaches, diarrhoea and severe cramps. These symptoms last only for a day or two.
Secondary dysmenorrhoea is pain caused by some physical condition like fibroids in the uterus, infections in the pelvic region or growth of tissues normally found only in the uterus outside the uterus-the ovaries, fallopian tubes or other parts of the pelvic cavity, a condition called endometriosis.
A heavy period is one that lasts longer than eight days, saturates napkins within an hour or includes large clots of blood in the menstrual flow. It is very common in adolescents because of slight hormonal imbalances at their age. An imbalance in the levels of oestrogen and progesterone hormones allows the uterine wall to keep building up resulting in bleeding that is very heavy. In some cases it can also be due to fibroids, vaginal infections or thyroid problems.
PMS refers to a combination of physical and emotional symptoms experienced by all women during the menstrual cycle, usually just before menstrual bleeding begins. The intensity and range of symptoms vary from person to person. These include:
PMS is usually at its worst 7 days before the period starts and disappears before it begins. Diet that is low in sodium and salt, increased fluids, high fibre, high complex carbohydrates, low fat and low sugar may be taken. Exercise, massage, relaxation techniques may help in relieving the symptoms.
- Temporary weight gain, due to accumulation of water in the body.
- Headaches and cramps.
- Painful breasts.
- Tension and depression, irritability and stress.
What to do if the problem is suspected?
A visit to the doctor becomes important
- if a girl has not started her periods till the age of 16 or is having irregular periods. The most likely cause could be a hormonal imbalance. Unhealthy eating habits can also lead to the same.
- if she stops getting her periods or it becomes irregular after being regular for 6 months or longer. Severe dieting can cause this problem.
- if she has extremely heavy or long periods that are painful and associated with anaemia. This could be a sign of growth in the uterus, thyroid condition or some kind of infection.
How can a doctor help?
To diagnose the problem:
- the doctor will do a thorough pelvic examination.
- blood tests(to check hormone levels).
- sometimes even urine and stool tests.
- an ultrasound or CAT scan may be performed with the tests to arrive at a correct diagnosis.
If a fibroid or other such growths is identified medicines or surgery as suggested by the doctor would be required. Hormone therapy to rectify the imbalance in the production of hormones can also be suggested. Severe menstrual pain with no underlying medical cause can be treated by medicines like ibuprofen or acetaminophen.
Does self management work?
Several things that can be done on a self help basis to combat the problem. These include:
- A balanced diet with lots of fresh fruits and vegetables.
- Cutting down on salty processed foods to check water retention.
- Reducing caffeine intake to maintain emotional calm.
- According to a recent study, increasing the amount of calcium in the diet reduces the severity of PMS symptoms.
- Above all a brisk walk that helps in the release of endorphins (chemicals in the body that make one feel good) or a warm bath are suggested to keep fresh and relieved.