Menstruation

mensturation woman

Last Updated December 20th, 2021

Overview of menstruation

Hormonal changes occur within the female body from the beginning of puberty. It leads to associated physiological and psychological changes as well as few complications within the female body. One significant phenomenon that is observed in females (after 10 years of age) is “menstruation”.  Before proceeding to a detailed discussion on the topic, it has the to be made clear that menstruation is not some kind of disease. It is an absolutely natural and healthy phenomenon which takes place within the female body due to certain biological factors. The absence of menstruation even after a certain age (15 years) is an indication of some major health problem and calls for immediate medical attention. At present, many women belonging to undeveloped countries suffer from menstrual disorders due to lack of proper hygiene and health conditions, inadequate knowledge and the social stigma attached to menstruation.

 

What is menstruation?

Mensturation padsMenstruation or menstrual cycle is defined as the monthly loss of blood through the vagina due to the breakdown of the uterine wall lining due to the absence of fertilized ovum within the uterus.

It is characterized by the loss of tissues and blood from the inner lining of the womb. The menstrual blood flows from the uterus to the mouth of the cervix and then gets discharged through the vagina.

The onset of menstruation in young females is known as “menarche” and this cycle continues on a monthly basis and stops only after menopause (cessation of menstruation after a certain age) or during pregnancy.

The amount of blood lost via menstruation is about 25 mL per day and continues for 4-5 days per month. Interval between consecutive menstrual cycles is about 21-35 days. Each menstruation cycle basically prepares the body for pregnancy every month. A normal and healthy menstrual cycle is an indication that the body parts are functioning normally and the hormonal activities are normal.

 

What are the phases of menstruation?

The menstruation cycle is divided into few phases, each of which is marked by hormonal fluctuations and other physiological changes. The different stages of physiological changes during menstruation are described below-

Ovarian cycle: It lasts for 28 days and is stopped only during pregnancy (temporarily) and during menopause (permanently). It consists of three distinct phases-

  • Follicular phase: It occupies the first half of the ovarian cycle (~14 days) and is marked by the presence of mature follicles. Increased secretion of Follicle Stimulating Hormone (FSH) and oestrogen occurs in this phase.
  • Ovulation: It is characterized by rupture of the wall of the Graffian follicle and a significant increase in the secretion of the Luteinizing hormones (LH). This phase is clubbed with the follicular phase in most cases.
  • Luteal phase: It occupies the second half of the ovarian cycle. The existing follicular cells undergo transformation and eventually form the corpus luteum. If the released ovum is not fertilized and does not plant itself on the wall of the uterus, the corpus luteum degrades within 14 days. All activities in this phase are regulated by the LH hormones.

Mensturation uterusUterine cycle: It is marked by major hormonal changes and lasts for 28 days on an average. It is further subdivided into three distinct phases –

  • Menstrual phase: It is characterized by reduced levels of oestrogen and progesterone (during degeneration of the Corpus Luteum). Secretion of uterine prostaglandin occurs in this phase which leads to vasoconstriction of endometrial vessels (causes degeneration of endometrium) and constriction of the uterine myometrium (discharges the menstrual flow). The uterine lining and endometrial debris are released via blood through the vagina. This phase lasts for 5-7 days (coincides with the end of luteal phase and beginning of follicular phase).
  • Proliferative phase: It starts at the end of the follicular phase. Gradual repairing of the endometrium occurs (mediated by oestrogen). It extends from the end of menstruation to the beginning of ovulation. Increased secretion of LH hormones is triggered by the increased oestrogen level.
  • Secretory or progestational phase: In this stage, the endometrial wall is ready for implantation of a fertilized ovum. The blood supply is increased to a certain extent and a large amount of oestrogen and progesterone is secreted by the Corpus Luteum, and glycogen is secreted by the endometrial glands. When fertilization does not occur, the Corpus Luteum degrades and the follicular and menstrual phases start again.

 

Symptoms of menstruation

The symptoms of menstruation include the array of symptoms in the pre-menstrual, menstrual and post-menstrual phases. These are described below-

  • Sudden rush of blood through the vagina at any time of the day (flow increases during heavy activities)
  • Presence of blood in the urine (not to be confused with hematuria)
  • Presence of clots in the expelled blood
  • Pain in the lower abdomen which starts before menstruation and continues during the entire menstrual period.
  • Abdominal cramps or menstrual cramps (dysmenorrhea) which may occur due to the presence of uterine fibroids (endometriosis)
  • Pain and cramps in legs
  • Sleep disturbance (occurs 3-6 days before menstruation)
  • Headache (might reach the proportion of migraines)
  • Nausea and fatigue
  • General feeling of weakness
  • Change in weight (gain or loss)
  • Eruptions on skin (acne)
  • Disturbed mental state
  • Gastrointestinal disorders
  • Increased tenderness of breasts
  • Reduced sexual urges (during menstruation period)
  • Abdominal bloating
  • Loss of appetite
  • Increased perspiration
  • Seizures (58% of cases during pre-menstrual phase and 9% cases during menstruation period) in epileptic women
  • Worsened allergies and asthmatic conditions (in the premenstrual phase)
  • Abnormal drying up of skin (eczema)

 

Types of problems related to menstruation

There are several complications associated with menstruation which are indicators of some major health or hormonal problems within a woman’s body. These are discussed below-

Amenorrhea: It is medically defined as the absence of menstruation even during the relevant time of the month or after a certain age. It is characterized by the following symptoms-

  • Headache (an acute migraine in few cases)
  • Galactorrhea (production of milk by the breasts even when the woman is not pregnant or breast-feeding a baby)
  • Temporary or permanent vision impairment (due to the presence of pituitary gland tumour)
  • Abnormal weight gain or loss
  • Acne and pimples on the face
  • Extremely dried up vagina
  • Excessive hair growth (hirsutism)
  • Noticeable changes in voice
  • Changes in breast size and shape
  • Cyclic pain with the absence of bleeding

Amenorrhea is of two types –

Primary Amenorrhea: It is characterized by the absence of menstruation even by the age of 16. It is mainly caused by some major defects of the reproductive system and/or pituitary gland.

Secondary Amenorrhea: In this condition, menstruation begins at the proper age but later on stops for more than 3 cycles or 6 months. The main causes of secondary amenorrhea are as follows-

  • Abnormal weight loss
  • Eating disorders
  • Hormonal changes during pregnancy
  • Disturbed mental state such as stress, anxiety, and depression
  • Obesity
  • Polycystic ovary conditions (causes hormonal imbalance)
  • Endocrine disorders such as thyroid diseases and diseases of the pituitary gland (a tumour)
  • Excessive and rigorous physical exercise
  • Menopause
  • Excessive use of birth control pills and contraceptives
  • Presence of scars or ulcers in the uterus

Menorrhagia: Menorrhagia is exactly the opposite condition of Amenorrhea. It is characterized by abnormally heavy bleeding. It is very common in pre-menopausal women. Excessive blood loss in each menstruation period causes weakness and cramps.

mensturation womanDysmenorrhea: Dysmenorrhea is the medical term for menstrual periods with cramps and extreme pain. These cramps are caused by secretion of excessive uterine prostaglandin. In elderly women, certain other conditions like Endometriosis (presence of uterine fibroids) can also cause abdominal cramps.

Premenstrual Syndrome (PMS): Premenstrual syndrome refers to the series of behavioral, physiological and hormonal changes within a woman’s body before the beginning of the menstrual bleeding. It is characterized by weight changes, mood swings and muscle cramps.

Premenstrual Dysphoric Disorder (PMDD): It is characterized mainly by abnormal psychological changes and is observed in 3-8% menstruating women. The main symptoms are disturbed mental state, extreme irritability, frequent mood swings, depression, anxiety and nervousness, panic attacks, extreme fatigue and lack of interest in daily activities. Few physical symptoms such as tenderness of breasts, abdominal bloating, headaches, muscle and joint pain are also present.

Anovulatory androgen excess (AAE): This condition is observed in 4-10% of women. It is medically defined as the presence of excess male hormones (testosterone) during the menstruation phase that is manifested as excess facial hair, oily skin with acne, oily hair, abnormalities in regular egg release, hair loss, increases insulin resistance, Diabetes, fertility problems, depression, and obesity.

 

Causes of menstruation disorders

The menstruation related complications discussed in the above section are triggered by certain physiological, psychological or environmental factors. All these causes are discussed below in details-

  • Pregnancy: It causes a delayed or missed period (Secondary Amenorrhea). A few conditions associated with pregnancy such as improper abortion, ectopic pregnancy, and trophoblastic diseases can also contribute to abnormalities in menstruation at some later point of time.
  • Breastfeeding: Restoration of normal menstruation conditions might be delayed to a certain extent after completion of the breast-feeding period.
  • Eating disorders: Anorexia nervosa, Binge eating disorder, and bulimia can cuased missed or irregular periods.
  • Rigorous physical exercise: It can interfere with the menstruation process, especially if physical exercises are carried out during the time of menstruation.
  • Weight changes: Abnormal weight loss and obesity are equally responsible for impairments in the menstrual cycle.
  • Polycystic Ovary Syndrome (POCS): It can cause hormonal imbalance which may lead to irregular periods.
  • Ovarian failure: Premature ovarian failure (before the age of 40) occurs in many women causing significant loss of ovarian hormone secretion that leads to an irregular menstrual cycle.
  • Pelvic Inflammatory Diseases (PID): In these conditions, acute inflammation of the reproductive organs occur causing abnormalities in menstrual bleeding.
  • Endometriosis: It is characterized by the presence of uterine fibroids and endometrial polyps, which is manifested as heavy menstrual bleeding, cramps, pain, and bleeding between consecutive menstruation periods.
  • Blood coagulation failure: Certain existing diseases like Leukaemia, Prothrombin deficiency, Thrombocytopenia and Hypersplenism cause loss of blood coagulation and thereby result in excessive menstrual bleeding.
  • Endocrine disorders: Hypothyroidism or pituitary gland tumours can cause heavy bleeding (Menorrhagia) or bleeding between menstrual periods (Intermenstrual bleeding).
  • Cirrhosis: It is often accompanied by Hypoprothrombinaemia and impede the oestrogen metabolism capacity of the liver.
  • Malignancies: Different malignancy conditions such as endometrial and cervical carcinoma or ovarian carcinoma can be leading causes of the disturbed menstrual cycle.
  • Genetic disorders: Certain genetic disorders such as Turner syndrome, accompanied by gonadal anomalies can account for menstrual disorders.
  • Medications: Certain hormonal drugs used for contraception such as Combined Oral Contraceptive Pill (COCP) or Progesteron-only Contraceptive Pill (POCP) or Hormone Replacement Therapy (HRT) can interfere with healthy menstruation process. Few cytotoxic and psychotropic drugs like risperidone also belong to this category. 

 

Diagnosis of menstrual problems

Menstrual problems need to be diagnosed in the early stages, failure to do which can cause problems in pregnancy and can give rise to associated clinical complications. The following diagnostic tests are normally recommended-

  • Progestin withdrawal
  • Prolactin level determination
  • Blood tests (to determine levels of testosterone and estradiol hormones)
  • Thyroid function studies (to rule out menstrual problems due to Hypothyroidism)
  • Follicle Stimulating Hormone (FSH) test
  • Luteinizing Hormone (LH) test
  • Pelvic ultrasound or hysterosonogram
  • Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scan of the head to detect the presence of pituitary tumours that might lead to menstrual abnormalities 

 

Treatment and Prevention of menstrual disorders

Treatment of menstrual-related disorders often includes:

  • Oral contraceptive pills
  • Cyclic progestin supplements
  • Nutritional/ dietary therapy to correct the underlying cause of the menstrual disorders.
  • In case the reason for irregular menses is a structural defect such as fibroids or polyps, surgery might be prescribed.
  • In extreme cases, a hysterectomy (removal of the uterus) might be performed.

Menstrual problems can be prevented by following these guidelines:

  • Consuming a healthy diet rich in fresh fruits and vegetables.
  • The diet should be low in sugar, cholesterol, and added preservatives.
  • Regular physical activities and getting adequate sleep is important.
  • Use hygienic sanitary products. Avoid using super-absorbent tampons.
  • Limit alcohol, tobacco, and caffeine consumption.

 

 

Dos and Don'ts

Dos
  • Eat a healthy diet that will keep your energy levels up during the cycles.
  • Drink adequate amount of water to avoid getting dehydrated.
  • Maintain complete hygiene while using and changing your sanitary pads/tampons/menstrual cup. Change it every 4-8 hours before it gets completely soaked.
Don'ts
  • Consume a diet high in sugar and salt. Limit the consumption of processed foods.
  • Combine intense physical workout with a low-calorie diet.
  • Wear soiled underpants for a longer time as it could become a breeding ground for microbes.

 

 

 

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Prolactin Test (PRL) Prolactin or PRL is a lactogenic hormone produced to induce milk production in lactating mothers. PRL test measures…
biotin for hair
Biotin: One-stop-shop for shiny hair and an active body! What is common to bananas, eggs, sweet potatoes, and liver? These are delicious and rich in biotin ;…
Love tea, hate tannins? Rooibos tea is just what you need The market is brimming with a multitude of herbal teas. But what makes rooibos tea (or red bush)…
anti ds dna test
Anti Ds-DNA antibody Test The  Anti Ds-DNA antibody test is used to diagnose the disease called lupus or more aptly the SLE(Systematic…
arterial-blood-gas
Arterial Blood Gas Analysis Arterial blood gas analysis is a diagnostic procedure used to determine the volume of oxygen and carbon dioxide…
nature health benefits
Green Healing: The amazing health benefits of being in nature You have no idea what sitting in a closed room does to your body and mind.Can a stroll…
free thyroxine ft4
Free thyroxine test (FT4) The FT4 or free thyroxine test is used to detect the level of free thyroxine of FT4 thyroid…
diverticulitis diet
Diverticulitis diet: The right way to eat if you suffer from the disease Are you suffering from diverticultis but clueless about your diet ? Read this complete plan for diverticulitis diet…
These are the top foods to increase your hemoglobin count It is important to add iron-rich foods into your diet in order to increase hemoglobin. Deficiency of hemoglobin could…
piles fissure fistula
Allopathy vs homeopathy vs ayurveda treatment for piles, fissures, and fistula Read to know the best form of treatment among allopathy, homeopathy,or ayurveda for piles, fissures, and fistula
Isagenix diet weight loss
How are BMI and BMR different and what do these numbers mean? BMI and BMR are two important metrics that provide a clear picture of your body's metabolism and also…
sodium blood test
Blood Sodium Test A blood sodium test measures the amount of sodium (an important electrolyte) in your body. It is also…
iron deficiency profile
Iron Deficiency Profile An iron deficiency profile is a battery of blood tests which are performed in order to determine the…
woman with abdominal pain holding ovulation calendar
Ovulation – facts to know about ovulation Learn how and when ovulation occurs, demystify common misconceptions, identify symptoms, methods of detection and right period for…
Pumpkin Seeds: Why pumpkins are more than just for pies! Pumpkins have been long associated with Halloween carvings and delicious pies. But did you know that pumpkin seeds…
Is bronchitis contagious? And how to prevent this infection? It is acute bronchitis that is contagious which means you can contract it from another person or you…
vdrl test syphilis
VDRL Test The VDRL test is a blood test that is used to diagnose sexually transmitted or venereal diseases, primarily…
colposcopy
Colposcopy Colposcopy is a simple, quick and non- invasive diagnostic tool to look closely inside the vulva, vagina, and…
L-theanine attention
L-Theanine: Better sleep, higher focus, and many other benefits Did you know that L-theanine found in green tea can make you sleep better and be focused at…
leptospira Igm test
Leptospira-IgM Test A Leptospira-IgM test is a blood test which is carried out to detect anti-Leptospira IgM antibody. Leptospirosis is…
Inversion Therapy: The anti-gravity way of healing chronic back pain Inversion therapy involves suspending a person upside dow using different types of equipment. This works by taking the…
50 common health conditions
What are the top 50 deadly and widespread diseases? A complete list of the top 50 most common and deadly diseases that plague humanity. Which disease is…
Threatened abortion
A few facts about threatened abortion A threatened miscarriage indicates an early pregnancy loss. Look out for symptoms like bleeding, vaginal discharge, and pain.
cytomegalovirus iGG
Cytomegalovirus (CMV)- IgG Test The cytomegalovirus IgG is the immunoglobulin protein produced by our immune system when the body is infected by…
How can berberine supplements help you live longer and healthier? Berberine is a turmeric look-alike herbal extract that is credited with numerous health benefits ranging from diabetes cure…
sleep deprivation
Don’t let your sleep deficit grow into memory loss or heart attack Why is sleep important for us? How could sleep deprivation harm you? We bet you didn't know about…
myelogram
Myelography Myelography is an important diagnostic tool that is used to investigate and identify abnormalities in the spine and…
kidney stones
Kidney stones Kidney stones are solid substances made up of crystals. They can be of various sizes. Treatment depend on…
Bubble Tea: Bubbling with nutrition or a hidden sugar mine? The tapioca pearls present in the tea looks like bubbles and hence the name bubble tea became popular.…
black seed oil benefits
Black Seed Oil: What secret benefits could it bestow on your health? Black seeds or nigella seeds are tiny packets of health brimming with amazing benefits. Find out why should…
Tissue Transglutaminase Antibody (tTG) Test Transglutaminase is an enzyme present in our body and is involved in protein metabolism. A tTg test is…
The Cabbage Soup Diet: The healthiest way to instant weight loss Cabbage soup diet rapid weight loss diet for those who want to shed those extra pounds in less…
The Shepherd's diet
Facts about the Shepherd’s diet Kristina Wilds promoted Shepherd's diet, a Christian-based diet that highlights Jesus Christ's diet as mentioned in the Bible.
Jack in the box fast food
Jack In the Box : The perils of surging fast food culture in the USA Jack in the Box - How a culture of fast-food can clog your arteries, weaken your heart, fatten…
Optavia diet
The features of an Optavia diet The Optavia diet endorses pre-packaged meals and snacks called "fuelings" that are tasty, low in calorie, and incorporates…
antiHEV IgM test
Anti hepatitis E virus (Anti HEV) IgM Test Anti HEV IgM test determines the level of the IgM antibodies in the blood, The disease is often…
Bloodtestalbumin
Albumin Test Albumin test or blood serum test is a liver function test that measures the amount of the protein…
Dragon Fruit – Blessing from Nature’s Basket Dragon fruit is packed with nutrients but low on calories. It is the dream food that can help…
Hepatitis A virus infected liver
Hepatitis A Virus (HAV) Total Blood test to look for IgM antibodies to know if you are infected with Hepatitis A virus (HAV),…
Exercises or diet? Find out the healthiest way to gain weight Tired of being called skinny all the time? Looking for healthy ways to beef up? Why not try…
dance health benefits
5 unbelievable effects of dance on your overall health! You enjoy dancing, but did you know what else it does to your body? Dancing is not only…
Experts reveal the safest ways to perform an enema at home The idea of pushing some up your rectal area might make you queasy but an enema could actually…

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