Dr.D.Senthil Kumar.,

Dr.D.Senthil Kumar.,
Consulting Physician & Psycologist

Menstrual Disorder: -


Menstrual Disorder: -

Oligomenorrhoea/ Menorrhagia/ Metrorrhagia/Amenorrhoea:
Irregular, excessive, absent or infrequent menses periods
Oligomenorrhoea:
  • Periods occurring infrequently, with time between periods varying from 35 days to 6 months.
  • It's common for periods to be light and widely spaced when you first start having periods.
  • Periods also become more irregular as you get older and near the menopause.

What if it isn't down to puberty or menopause?
Many women experience widely spaced periods, typically having one or two periods every six months. This may concern you, but it is very unlikely that there is a serious underlying cause.

If you are worried about the frequency of your periods, you should consult via sending mail to consult.ur.dr@gmail.com .

What else can cause irregular periods?
  • The commonest cause of infrequent periods is a condition called polycystic ovaries (PCOS).
  • Women with PCOS have a large number of very small (less than 1cm) cysts on their ovaries and a hormone imbalance. The cysts interfere with regular ovulation and so periods are infrequent.
  • PCOS is a common condition that affects as many as 10 per cent of women.

Menorrhagia:

Definition
At some time in your reproductive life, you've probably experienced heavy bleeding during your menstrual period. If you're like some women, you have heavy periods almost every cycle. Menorrhagia is the medical term for excessive or prolonged menstrual bleeding — and for periods that are both heavy and prolonged. The condition is also known as hypermenorrhea.

The menstrual cycle isn't the same for every woman. Normal menstrual flow occurs every 21 to 35 days lasts four to five days and produces a total blood loss of 30 to 40 mille litters (about 2 to 3 tablespoons). Your period may be regular or irregular, light or heavy, painful or pain-free, long or short and still be considered normal. Menorrhagia refers to losing 80 mille litters or more of blood during your menstrual cycle.

Although heavy menstrual bleeding is a common concern among pre menopausal women, few women experience blood loss severe enough to be defined as Menorrhagia. Treatments and self-care steps may help you.

Symptoms
  • The signs and symptoms of Menorrhagia may include:
  • Menstrual flow that soaks through one or more sanitary pads or tampons every hour for several consecutive hours
  • The need to use double sanitary protection to control your menstrual flow
  • The need to change sanitary protection during the night
  • Menstrual periods lasting longer than seven days
  • Menstrual flow that includes large blood clots
  • Heavy menstrual flow that interferes with your regular lifestyle
  • Constant pain in your lower abdomen during menstrual periods
  • Tiredness, fatigue or shortness of breath (symptoms of anemia)

  • Metrorrhagia: (Bleeding Between Menstrual Periods)
    Bleeding from the uterus between menstrual periods is called metrorrhagia. This is a common problem, especially for teenagers and women nearing menopause.

    Definition:
    If by the age of 16 years menses do not begin than we call it a case of Primary Amenorrhoea and a gynaecologist needs to be consulted.

    Common Causes:
  • Delayed Puberty: Some girls just take little more time to mature and get delayed onset of menses. It may be considered normal if the menses start Upto 18years. Otherwise the body changes start appearing like growth spurt, breast development and genital hair.
  • Sometime very low weight or dietary deficiencies are also responsible for such delay. Just waiting and improvement in general health status helps in starting the menstruation.

  • Amenorrhoea:
  • Amenorrhoea is the absence of a menstrual period.
  • Primary amenorrhoea is when a young woman has not yet had a period by age 16.
  • Secondary amenorrhoea describes someone who used to have a regular period but then it stopped for at least three months (this can include pregnancy).

  • What are the signs of amenorrhoea?
  • The main sign of amenorrhoea is missing a menstrual period.
  • Regular periods are a sign of overall good health. Missing a period may mean that you are pregnant or that something is going wrong. It’s important to tell your health care provider if you miss a period so he or she can begin to find out what is happening in your body.
  • Amenorrhoea itself is not a disease, but is usually a symptom of another condition. Depending on that condition, a woman might experience other symptoms, such as headache, vision changes, hair loss, or excess facial hair.

  • Treatment for amenorrhoea
    For amenorrhoea depends on the underlying cause. Sometimes lifestyle changes can help if weight, stress, or physical activity is causing the amenorrhoea. Other times medications and oral contraceptives can help the problem. For more information, send mail to consult.ur.dr@gmail.com

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    Friday, May 6, 2011

    THE PROCESS OF MENSTRUATION







    THE PROCESS OF MENSTRUATION

    What is Menstruation?
    Also commonly known as the menstrual period or monthly 'period', it is a normal biological and physiological function of the female body. In essence, it is the discharge of blood and tissue from the vagina at monthly intervals. Typically the cycle lasts 28 days, but cycles varying from 24 days to 35 days are not uncommon. In the first year or so the cycles can be quite irregular. There can be no fixed pattern to it and a few months may pass between the first few periods. But there is no need for alarm. This is a common occurrence.

    When does it start?
    The beginning of menstruation, known as menarche may occur sometime between the ages of 10 years - 16 years. Just as no two individuals are alike, neither are the menstrual patterns of any two girls. Each body is different with different patterns and rhythm, so some may start as early as 9 years while others as late as 16 years. Menarche is a major milestone in a young girl's life, indicating the onset of the reproductive cycle in females. However, while a girl can technically bear children after achieving menarche, for all practical purposes she is underdeveloped and immature for the role of motherhood both, physically as well as psychologically. The menstrual cycle continues uninterruptedly month after month, except during pregnancies or for specific health reasons, until menopause. Menopause occurs when a woman is in her 40s to 50s and it is when the monthly cycles cease to occur.

    What really happens?
    While a lot of changes are happening at menarche in your daughter, a number of internal changes also occur. Her reproductive system has been developing in the lower abdomen and it is not something your daughter is aware of. A pear shaped organ called the uterus also known as the womb. It has a cavity where the babies grow before they are born.

    The uterus is connected on either side by the fallopian tubes to two small glands called the ovaries, which has two functions:
    • To produce the female hormone oestrogen.
    • To produce the female egg cells, called Ova.

    In the fallopian tube the female egg cell and male egg cell unite to form the embryo, which then travels through the fallopian tubes to the uterus, to get its nourishment.

    The process of Menstruation
    A small gland located in the base of the brain, called the pituitary gland, which causes a play of various hormones triggering menstruation. The pituitary gland produces chemicals that act like messengers, travelling in the blood to the ovaries. Inside the body, the reproductive system begins to function. During each monthly cycle, one of the ovaries releases an egg cell. It enters the nearby fallopian tube and travels towards the uterus. Meanwhile the hormone

    Oestrogen has been busy preparing the uterus to receive the embryo, by developing a thick lining of blood and nutrient filled tissue called the endometrium, which provides the embryo with immediate nutrition required for its survival and growth. However, if the egg cell is not fertilized and the embryo is not formed then the lining of the uterus is not needed to develop, so the lining of the uterus will disintegrate causing bleeding and this sheds from the uterus through the vagina and out of the vaginal opening as menstrual blood. This is called Menstruation. The time between the beginning and end of the menstrual flow is called as the menstrual period. The length of each menstrual period varies from person to person, as does the amount of menstrual flow. Usually a period lasts from three to five days, though variations from two to eight days are also common.

    Each time a girl gets her period, a new cycle begins. The cycle usually lasts about 28 days, but the length of the cycle may also vary. Each girl's menstrual cycle can be different, with cycles as short as 24 days to as long as 35 days. This cycle repeats month after month. Generally a woman keeps to her individual established pattern, although stress, illness or strenuous exercises may alter her personal cycle.

    How to calculate the Monthly Menstrual Cycle?
    Mark with an 'X' or a red dot, the first day of the current menstrual cycle.

    • The next month, circle the first day of the new period.
    • Count the days between the first day of the last period and the first day of the next one. The number of days between the two dates will be the menstrual cycle duration. If the number is 28 days, the next period will probably follow after 28 days - so if the first day of the last cycle was 5th of April, the next period can start on 2nd or 3rd of May.

    Irregularities that can occur during Menstruation
    As mentioned earlier, the menstrual cycle will typically be between 28 to 30 days. In the first year or two following menarche, your daughter may have her period at irregular intervals, but that's nothing to worry about as it usually settles down. She however may need frequent assurance, since young girls are often concerned about having irregular cycles. They need to understand that the body needs time to develop a regular pattern. A change in environment or routine or any emotional stress or illness may upset the cycle, causing the period to begin later or earlier than expected. Apprehension about a forthcoming exam, excitement about a family wedding, a crash diet all these situations can disturb an established pattern. However, if the periods continue to be irregular even otherwise, you should consult a gynecologist. Some conditions like those described below, may indicate that a problem with menstruation exists and should be referred to gynecologists.

    • Menstruation has not begun by age 17 - Primary Amenorrhea
    • Menstruation has occurred and stopped briefly like in pregnancy or in
    • some illnesses or conditions of stress - Secondary Amenorrhea
    • Abnormal heavy flow - Menorrhagia
    • Scanty flow - Oligomenorrhea
    • Consistently irregular menstrual periods - Metroragia
    • Painful menstruation - Dysmenorrhea

    Graphical explanation of Menstration

    The endometrium immediately after the menstrual bleeding stopped. It is very thin compared to its thickness later in the cycle.
    (Explaining this and the following drawings: The brown outer layer represents the womb's muscle. The red lines represents blood vessels. The purple inner line represents the cells covering the endometrium.)





    The endometrium about one week later (12-14 days since the onset of menstruation). This is just before ovulation. (Ovulation = the release of an egg cell by the ovaries) The endometrium is now much thicker (usually more than 6mm).
    The blood vessels are still represented by red lines. This thickening is caused by estrogen.(a hormone released by the ovarie
    s)

    .
    The endometrium a few days after ovulation. Glands develop and the blood vessels become more prominent. The protein content ( purple blotches) in the endometrium increases. The increased gland activity is responsible for the production of these proteins. The proteins are important nutrients for` the embryo following implantation.
    The changes now seen in the endometrium are caused by a hormone called progesterone. (a hormone also secreted by the ovaries, but only if ovulation occurred and only for ten days.
    The endometrium immediately before the onset of menstruation.
    The inner part of the all the arteries have a curly (spiral) appearance and are called spiral arteries. The protein content in the endometrium has also increased. All these changes ( increased protein and spiral arteries) are the result of progesterone activity. 
    The endometrium is now ready for implantation.


    Menstruation starts. Pregnancy did not occur and the coronal levels dropped. (The ovary temporary stopped producing the hormones estrogen and progesterone.) This lack of estrogen and progesterone causes menstruation to start. Blood starts leaking out at the bases of the spiral arteries and the inner two thirds of the endometrium is discarded 


    .
    The upper two thirds of the endometrium is discarded. The arteries are exposed (not covered by mucus membranes) and are bleeding freely. Special anti clotting substances are also released to prevent the menstrual blood from clotting.



    The purple line represents a new endometrial cover. The ovaries start producing estrogen again and estrogen 
    causes the new lining to develop


    .

    The purple line represents the endometrial cover. It covers the endometrium and blood vessels completely. 
    The bleeding stops and a new cycle begins


    .

    The bleeding has stopped completely and the cycle starts again.

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