What is menstruation?
This happens for a reason. Every month, a women’s body (specifically uterus, the womb) prepares itself for a prospective pregnancy. If no pregnancy occurs (which is the case mostly), the uterus sheds the cushiony lining it has prepared to welcome the baby.
Since the inner lining (endometrium) of uterus is made of blood, tissues, mucous and water, what comes out from vagina looks more like ‘bleeding’, although it is more than just blood.
Good to Remember: The menstrual cycle is a term used to describe the sequence of events or phases that occur in a woman’s body as it prepares itself for the possibility of pregnancy each month. Bleeding days or the “period” is just a part or the first phase of the whole menstrual cycle.
Periods usually start between age 11 and 14 and continue until menopause at about age 50 or so. Period flow usually last for four to six days.
What does a healthy, normal period look like?
There could be an array of menstrual disorders ranging from periods being too heavy or too light, lasting too long or occurring too often, starting too early or too late, or just being plain irregular. This can happen because of several underlying physiological and psychological reasons.
Each phase of a woman’s life observers’ different kind of menstrual abnormalities. Let’s know about them in detail below.
Menstrual Disorders in Adolescent Girls
Menarche or onset of periods is the last milestone of puberty.
In India, the average age of menarche is 11-12 years but it can be as early as 8 and as late as 16 years. This is considered a normal range. Anything before 8 or later than 16 years of age should be investigated for any underlying medical condition.
Initially, it’s not all messed up!
That’s why some young girls may have irregular periods for almost about two years once their first period arrives.
Over time, in most teenage girls the menstrual cycle settles on its own and follows a cyclic pattern.
Other than delayed and irregular periods, there are a few other disorders and conditions related with menstruation in young girls.
Today, an urban Indian girl is starting with her period at the age 11-12 and12- 13 in rural setup.
Ask your mother or grandmother at what age she got her first period or try to remember how old were you when you had yours?
Most likely the answer is going to be around 13-15 years of age.
Over the time, there has been a drastic decline in the age of menarche and the reasons are mostly indicative of unhealthy lifestyle choices.
- Being obese or overweight (this affects the production of oestrogen and progesterone hormones which are responsible for hitting the puberty early).
- Chemicals in the food (like BPA in plastic) which gets infused in our system via poor quality plastic containers we use to store food.
- Sedentary lifestyle.
- Increased intake of animal proteins (farm raised animals are usually injected with artificial hormones to reproduce and develop more flesh. Hence by consuming these animals, we indirectly consume additional hormones).
- Toxins in the environment.
- Consumption of phthalates. Phthalates are found in high fatty foods, plastics, and various cosmetics such as deodorants, talcum powder,lipsticks etc. The intake of phthalates is known to alter the hormone levels in the body.
Having early menarche – good or bad?
So, the question arises if there are any harmful effects on the body if the girl
begins with her period really early?
Well, as a matter of fact, yes.
- Some statistics say that girls who have their period early might have marginally higher risk of developing breast cancer later in life.
- Once the period starts, bones tend to become mature and cease to grow at a rapid pace. Hence most girls continue to grow taller just for another 1 to 2 years after the commencement of their period and fail to attain the height which they might have, if their periods started later.
- Girls at the age of 8 or 9, even 10 are not psychologically mature. They would need help and support from their mothers.
Can early menarche be avoided?
The answer is yes and no.
There are many factors that affect the age of the first period. Some are
non-modifiable like corelations with mother’s age of menarche and girls’
own body structure and some can be modified to a large extent.
Although it does not guarantee, but following the below may help.
Generally, it is nothing much to worry about but understand that your daughter needs your help and support physically and emotionally to handle this big change in her life. Here are a few practical tips on how to manage her.
- Talk to her about it in simple and positive language.
- If need be, some professional help of a menstrual educator or a child psychologist can be taken.
- Teach her the usage and disposal of menstrual hygiene product.
- Emphasise upon maintaining hygiene, especially during those days.
- Deal early menarche with sensitivity and understanding.
What causes precautious puberty?
Sometimes, certain conditions such as tumours in brain, spine, ovaries, adrenal or pituitary gland, brain abnormalities, brain injuries, infections, hormonal disorders, or excessive exposure to external oestrogen and progesterone or radiation may cause precocious puberty.
Puberty is the phase of life when a child begins to experience physical and hormonal changes which mark his or her transition into adulthood. The child develops secondary sexual characteristics and in case of a girl, she becomes capable of bearing a baby.
In girls, puberty begins on average between ages 8 and 13.
If and when the girl begins to show characteristics of early puberty with onset of periods before the age of 8, then it is categorised as precocious puberty.
How to identify signs of precocious puberty?
Signs and symptoms of precocious puberty include development of the
following before 8 years of age in girls –
- Growth of breasts and commencement of first period.
- Appearance of pubic or underarm hair.
- Facial acne.
- Enhanced body odour.
Precocious Puberty – Its complicated!
Precocious puberty can have some physical and psychological negative effects
on the girl. Such as,
- Growth of breasts and commencement of first period.
- Short height.
- Low self-esteem and negative body image.
- Falling prey to sexual abuse.
- Increased risk of breast cancer because of exposure to oestrogen at an earlier age.
- Stress, anxiety and depression.
Treatment – Yes, Available
In a girl, when periods do not begin by the age of 16, they fall under the category of delayed puberty.
What causes delayed puberty?
Puberty can be delayed for many medical reasons.
- Problems in the pituitary or thyroid glands. These glands make hormones important for body growth and development.
- Certain chromosol disorders.
- Eating disorders.
How delayed puberty is treated?
Menstrual Disorders in Adult Women
A normal period comes every 22- 35 day and lasts for 4 to 6 days with menstrual flow which is pretty manageable and does not hamper the day-to- day activities. Yes, there could be slight discomfort or abdominal pain in some women for initial few days but not to the extent of feeling sick for all the bleeding days.
Now, if and when, any aspect of this cycle gets disrupted and cause excessive physical discomfort, blood loss or other associated symptoms, and becomes unmanageable, it is considered a menstrual disorder.
Remember, some changes here and there in the pattern of your cycle are acceptable and considered normal but anything which defers from one’s otherwise ‘normal’ pattern for longer than three months has to be looked upon by a physician.
But if the changed pattern of her bleeding days would have continued for 3 consecutive cycles, then it was advisable for Riya to seek medical advice.
Range of Menstrual Disorders
Quantity – Too much or too little/infrequent bleeding.
Timing – Too soon or delayed bleeding.
Duration of bleeding – Lasting for just a day to extending up to 7-10 days.
Associated symptoms – Excessive pain during periods or discomforting symptoms before the beginning of period.
Let’s get into details for each one of these.
Heavy Menstrual Bleeding (Menorrhagia)
Bleeding is considered heavy when it interferes with normal, day to day activities of a women’s life.
As per gynaecologists, total blood loss during a normal period is somewhere between 40 ml to 60 ml (which is approximately 3-5 tablespoons full).
Blood loss more than 80 ml falls under the condition of menorrhagia.
Of course, there is no meter or device to measure the exact amount of lost blood during a period but it can be assessed visually.
If you have to change your pad every 2 hours for most of the bleeding days, it is indicative of menorrhagia.
Heavy menstrual bleeding or menorrhagia can be caused by hormonal imbalances, uterine fibroids, thyroid problems, liver or kidney disease, blood clotting disorders, blood cancer, complications from IUD (like Copper-T or other contraceptive devices), miscarriage, and infections.
One should not neglect if heavy bleeding is experienced in more than 2-3 cycles. Visiting a gynaecologist is recommended so that exact cause can be figured out and symptoms can be taken care of.
Infrequent Bleeding (Oligomenorrhea)
There can be several causes of this infrequent bleeding; some of which are harmless but this can also be a sign of a more serious health condition.
Hormonal issues, excessive physical activity (like in athletes), stress, sudden loss or gain of weight, being overweight, certain medication, underlying health conditions such as PCOS or thyroid issues etc can cause this condition.
Seek medical guidance if you are experiencing this condition to identity the root cause.
No Periods (Amenorrhea)
Simply put, it is absence of periods without any relevant reason.
Although it’s not a disease in itself but, you should seek medical advice about it because it might be a symptom of an underlying medical condition that needs to be treated.
Primary reasons of amenorrhea or missed period can be pregnancy, breast feeding, being on birth control pills or having an intra uterine device (copper- T).
Other than these, secondary causes of missed periods can range from excessive stress, depression, poor nutrition, certain medication (such as antidepressants, blood pressure and allergy medications), any ongoing illness, extreme weight loss, over exercising, polycystic ovarian syndrome, thyroid gland disorders, ovarian tumours and chemo and radiation treatments in cancer patients.
One must seek a doctor’s advice if there is absence of menstruation for more than 3 months in a row.
Painful Menstruation (Dysmenorrhea)
You are among the blessed lot.
Menstrual pain is a kind of throbbing or aching cramps that you get in and around your lower belly just before and during your period. Most women experience some degree of menstrual cramps and other symptoms during their period.
However, if cramps are exceedingly painful and persistent it is called dysmenorrhea.
Do you know that the menstrual cramps or pain is caused because of the contraction and relaxation of uterine muscles; an act similar to the process of labour (delivering a baby) and that’s why it is also called mini labour.
Although some degree of pain during periods is normal and happens with most women but if the pain is excruciating, it could be because of an underlying medical condition.
Endometriosis (a condition in which the tissue lining the uterus grows outside of the uterus), uterine fibroids, infections of reproductive organs, cervical scarring are some of the reasons for severe menstrual cramps.
Management of period pain range from hot fomentation in lower abdominal area to keeping physically active, performing some yogic exercises and on a doctor’s, advice consuming pain-relieving medicine.
Truth: When prescribed by a medical doctor, you can safely take a pain- relieving medicine to alleviate the pain and discomfort of period pain. There are no short or long-term harmful effects of it.
Premenstrual Syndrome (PMS)
This is PMS. And yes, its for real.
PMS includes a wide variety of physical and psychological symptoms which are associated with menstrual cycle.
Some commonly experienced PMS symptoms are bloating, headaches, breast tenderness, anger and anxiety, mood swings, unreasonable crying and depression. These symptoms generally begin about a few days before your period and disappear when the bleeding period begins or soon after.
What can you do to manage PMS?
- Do some light exercise about 30 minutes a day
- Eat whole grains, fruits, and vegetables.
- Get enough calcium from dairy products, green leafy vegetables or in form of supplements.
- Avoid salt, caffeine and alcohol (very important).
- Don’t smoke
- Try to get enough sleep and don’t stress
Abnormal Uterine Bleeding
Abnormal uterine bleeding can present as
- Heavy menstrual bleeding.
- Bleeding at unusual times (between periods or after intercourse).
- Unusually long periods (seven days or longer).
- Inconsistent/irregular menstrual cycles.
The reasons and causes of AUB can be plenty, such as hormonal imbalances,
thyroid disease, polycystic ovary syndrome (PCOS), obesity, uterine polyps or
fibroids, cancers of cervix, uterus and vagina, pelvic infections and IUDs.
Any abnormal bleeding should be reported to a gynaecologist for further
Menstrual Disorders During Menopause
What is menopause?
In India, the average age for women to attain menopause is 50.
Menopause doesn’t work like an ‘on-off’ switch; one month she had her normal period and from next cycle onwards, it is never going to come back again.
Menopause sets in gradually. Once the women reach her late 40s, her ovaries start making less oestrogen and progesterone, two hormones responsible for maturation and release of female cells (ova). Eventually the production of those female reproductive hormones completely ceases, resulting in – no periods, no babies.
Phases or Stages of Menopause
The whole transition is split into three stages.
Most women hit this stage around age 46-47. Even though there is decline in oestrogen hormone during this phase, but chances of getting pregnant still remain intact.
Perimenopause can last for as little as a just a couple of months and as long as 3-4 years.
Symptoms of perimenopause – Irregular periods, heavier or lighter than normal periods, weight gain, hair changes/thinning, heart palpitation, loss of sex drive, forgetfulness, UTIs (urinary tract infections) and fertility issues in women who are trying to conceive.
Although both are part of the same life transition, menopause and perimenopause have slightly different symptoms.
Symptoms of menopause – Night sweats, cold sweats, hot flashes, depression, mood swings, excessive anxiety or irritability, insomnia, unexplained tiredness, dry skin, vaginal dryness, increased frequency of urine.
Remember, once a woman is officially (clinically) ‘postmenopausal’, no vaginal bleeding is considered normal.
Symptoms of postmenopause – During this stage menopausal symptoms, such as hot flashes, sweating and anxiety get milder or go away. But other symptoms of depression, mood swings, insomnia, unexplained tiredness, dry skin, vaginal dryness and increased frequency of urine may continue for much longer time.
Management of Pre, Menopausal and Post-Menopausal Symptoms
Lifestyle changes – Maintaining a healthy diet and doing some light exercise regularly will help in managing the symptoms and boost overall health. This is a good time to kick any old habit of drinking and smoking.
To help with hot flashes, try to be in a ventilated room, wear light, cotton clothes and avoid too much tea or coffee and spicy foods.
Hormone Replacement Therapy – If the symptoms are unbearable, there is an option of receiving the ‘dried out’ hormones (oestrogen & progesterone) externally (HRT).
Medication – If someone doesn’t want to take external hormones, certain medications can definitely help ease out symptoms of depression, hot flashes, mood swings, vaginal dryness and sleep problems.
Word of Caution: Postmenopausal women are susceptible to osteoporosis and since osteoporosis (weak and spongy bones) often lead to fractures, even with a minor fall, menopausal women need to take care of their bone health.
They must undergo bone density test, eat a calcium-rich diet and upon consultation with the doctor, have Vitamin D3 and calcium supplements.
Your menstrual cycle tells a lot about your health status. Regular periods mean your body is functioning perfectly. Good job!
Menstrual problems like irregular or painful periods, missed periods or even delayed periods can be a sign of a serious health problem.
As your body transitions to menopause in older age, declining hormone levels may increase the risk of other acute and chronic diseases.
So, keep a watch on your period and visit a gynaecologist if you observe any drastic or long-standing changes in your menstrual cycle.
- Menstruation or periods is a normal and natural process of body.
- Regular, cyclic periods denote good health
- You can still get pregnant if you have unprotected sex during your period
- Every woman’s cycle is different; never compare
- Go for annual health check-ups along with a gynaecologic consultation.
- After the age of 40, take supplements for calcium, iron and Vitamin D.