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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CT-scan-machine
CT – Computed Tomography Scan CT scan or computed tomography scan is an diagnostic imaging technique where cross-sectional images of body are obtained…
phenytoin test
Phenytoin test Phenytoin is a drug that is administered mainly to epilepsy patients. The phenytoin blood test measures the level…
Thyroid disorders
Thyroid Profile Thyroid profile is a panel of blood tests performed to check if an individual is suffering from any…
rosacea-treatment--before-_-after
The best and safest ways to treat rosacea Rosacea is a skin disease that is characterized by reddish hives and rashes on the face. Read more…
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…
Coconut sugar: What is it and is it healthier than table sugar? In the long list of things that the wonderful coconut gives us, coconut sugar is another remarkable addition.…
dandelion weight loss
Caralluma Fimbriata: How to eat this cactus to lose weight Caralluma fimbriata is a miracle cactus that can be safely consumed by most for losing weight and boosting…
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…
SIBO Diet: The important dos and don’ts of this gut-healing diet A SIBO diet is a diet that works by eliminating certain sugars from your diet and adding fibers…
CEA_test
Carcinoembryonic antigen (CEA) test CEA or carcinoembryonic test detects the presence of CEA antigen in your blood mainly & determines the effectiveness…
hidden causes obesity
8 hidden causes of obesity you probably didn’t know! Did you know that around 2 billion people worldwide are either overweight or obese? Are you too a…
carrageenan seaweed
Carrageenan: How a simple seaweed extract could better your gut health & immunity Eat more ice cream to prevent cold and flu? –With carrageenan you get one simple seaweed extract that…
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…
Juice Plus: Can you really replace actual fruits with pills?  Juice Plus supplements intend to fill nutritional gaps present in our daily diet. But how successful have they…
Shilajit: A miracle Himalayan herb for an active and happy life The Himalayas contain more wonders than you thought. Shilajit is a miracle herb that is widely used in…
Did you know drinking alkaline water could be the healthier choice for you? Ever wondered how safe is your drinking water in terms of pH? Recent studies have revealed that Alkaline…
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.…
LFT-test
Liver Function Test – LFT LFT or Liver Function Test is a blood test used to determine the levels of hepatic enzymes which…
shiitake mushrooms healthy
What are Shiitake Mushrooms and why should you eat them? Shiitake Mushrooms are well known for their smoky and robust taste. However, did you know they are replete…
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…
GM Diet: The fastest way to lose weight or yet another hoax diet? General Motors started this trend of extreme dieting for 7 straight days to ensure its employees were able…
CLA: A breakthrough weight loss supplement with minimal side effects Tried every weight loss supplement in the market with no substantial gain? Why not try CLA supplements, derived…
Psyllium Husk: More than just an effective natural laxative Psyllium husk, or isabgol, is a popular natural laxative . But did you in addition to regulating bowels,…
Goji berry: A traditional Chinese berry that packs the best of antioxidants Goji berry is an ancient berry that is considered to be power-packed with nutrients and antioxidants. Which means…
Tart Cherry: The healthiest excuse for taking that second serving of pie Tart cherry has been traditionally used in delectable desserts such as pies. Recent studies have revealed that its…
GERD heartburn
Heartburn: What are the exact symptoms and the best home remedies? There are easy home remedies for heartburn, which not only acts as a first aid when you experience…
amylase test
Amylase Test Amylase test is done by checking the level of this protein in the blood sample and also in…
fructosamine test
Fructosamine Test A fructosamine test measures blood sugar glucose content. Fructosamine level can indicate blood sugar level in past 2-3…
Rubella IgM test
Rubella IgM Test The Rubella IgM test is a blood test that is performed to diagnose the presence of the rubella…
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…
sodium blood test
Blood Sodium Test A blood sodium test measures the amount of sodium (an important electrolyte) in your body. It is also…
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…
blood ketone test
Blood Ketone (D3HB) Test The Blood Ketone Test measures and monitors the levels of ketone in the blood which is usually performed…
Hymenoplasty
Hymenoplasty Read on to find out all about hymenoplasty, the procedure, post-surgery care, the risks, and the benefits.
hidden benefits walking
9 benefits of walking we bet you didn’t know! Did you know walking can be the miracle pill for eternal youth? Everyone knows walking is good for…
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…
xylitol gum
Xylitol : Is this the right sugar substitute for you? Discovered during World War 2 owing to sugar shortage, xylitol has become a common name in pharamaceutical industry.…
gallbladder diet tomato
Gallbladder surgery :Tips on post-operative care and diet What to eat post a gallbladder surgery? What are the key things to avoid if you had a…
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…
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…
How to correctly perform nasal irrigation using a Neti Pot? Neti pot has been a part of Ayurveda since centuries. This ancient tool is extremely effective in treating…
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…
Quinine: How gin and tonic came to be known as a potent health elixir The discovery of quinine-containing tree bark is sometimes considered the most serendipitous medical discovery of the 17th century.
Barium-enema
Barium Enema Barium enema is also known as colon x-ray. Here, the patient is asked to consume small amount of…
GGt test
GGT – Gamma-Glutamyl Transferase Test GGT or gammaglutamyl transferase test is a liver function test that is used to detect the extent of…
Bloodtestalbumin
Albumin Test Albumin test or blood serum test is a liver function test that measures the amount of the protein…
blood elements analysis
Blood Element Analysis Test A blood element analysis is a blood test performed to measure the level of toxic elements such as…
anoscopy
Anoscopy Anoscopy is an invasive diagnostic procedure where a small device known as anoscope will be inserted in the…
Diabetes blood test
Diabetic Profile The diabetic profile is a set of tests used for testing and monitoring the various kinds of Diabetes…
oral hygiene tips
6 shocking consequences of bad oral hygiene (and how to avoid them) Did you know bad breath is not just turning off, but also harms your body in ways you…
avocado benefits
Avocado: 15 reasons why this fruit should be a staple in your diet Did you know that the word avocado literally means "testicles". Don't get grossed out as this power-packed fruit…
Cayenne: The remarkable benefits of these red hot chili peppers These may make you rush for a glass of water, but cayenne pepper is actually a healthy additive…
Kava: Is it the healthy substitute for alcohol you have been waiting for? Native to the beautiful South Pacific islands, Kava is a famous beverage rooted in the local culture. It…
How seitan proved to be a blessing in disguise for vegans worldwide Can only meat-eaters enjoy delicious juicy steaks and burgers? With seitan, the best meat substitute available today,even vegans…
How can Kegels help you overcome weak pelvic muscles & incontinence? Kegel exercises are pelvic floor strengthening exercises that can help you overcome incontinence issues that rise out of…
Mood swings
The real reasons for your mood swings and how to overcome them Are you prone to heated moods frequently? Do you also feel bouts of depressive feeling creeping up on…
Urologist: When should you visit one and why? A urologist can treat not only genitourinary problems of both men and women but also can treat various…
glucose-tolerance
Oral Glucose Tolerance Test – GTT Glucose tolerance test (or Oral GTT) is used to detect the onset of diabetes or prediabetes conditions. It…
ASTtest-liver
AST- Aspartate Aminotransferase Test AST test is a blood test that is used to measure the level of a particular liver enzyme…
ANTIPHOSPHOLIPIDANTIBODY(APL)_IgG
Antiphospholipid (APL) antibody-IgG The Antiphospholipid Antibody testing is a blood test used to determine an autoimmune disorder called Antiphospholipid syndrome linked…
Strep throat pain
Anti-Streptolysin-O Test The ASO or Anti-Streptolysin-O is a blood test designed to check for the presence of streptococcus bacterial infection…
vdrl test syphilis
VDRL Test The VDRL test is a blood test that is used to diagnose sexually transmitted or venereal diseases, primarily…
malarial antigen test
Malaria Antigen Test A malaria antigen test is a rapid diagnostic test (RDT) that can detect malarial antigens (proteins) in your…
iron deficiency profile
Iron Deficiency Profile An iron deficiency profile is a battery of blood tests which are performed in order to determine the…
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),…
stress depressed anxiety
Are you depressed or just stressed? Know when to see a doctor Why are some people more anxious than others? Is being depressed the same as feeling sad? Have you…
sugar toxic health
Sugar: 7 new shocking truths revealed about the sweet poison Can drinking soda bring you closer to death? Is sugar slowly poisoning you and your family? You would…
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…
High Fiber Diet – Fire up your fiber intake for these health benefits! Regular bowels, healthy detox, higher immunity, and guaranteed weight loss - a high fiber diet can bring all…
Agave nectar: The bitter truth about this sweetener revealed Agave nectar is considered to be sweeter than the normal table sugar and even contains higher amounts of…
gout diet purines
Gout Diet : Get relief from painful joints by eating these foods Are you a victim of this painful condition? Are medications providing only short relief? Find a list of…
DHEA wrinkles
DHEA: Now get unbelievable age defiance with this wonder hormone! DHEA is known popularly as the age-defying hormone. This supplement is widely used to slow down aging and…
Oil of Oregano: The one-stop essential oil you’ve been looking for Are you plagued by a weak immune system? High body inflammation accompanied by pain and infections? Why not…
Pescatarian Diet 101: What are the inherent health advantages of this diet? People opt to become a pescatarian in order to enrich their bodies with the essential health benefits that…
What is the right way to take a pregnancy test? A pregnancy test is undertaken to determine if you have conceived. A home pregnancy test is the most…
Inhale oxygen, exhale worries: The top breathing exercises and how to perform them Performing the breathing exercise is like becoming mindful of how you breathe.  Here is a list of breathing…
hemoglobin variant analysis
Hemoglobin Variant Analysis Hemoglobin variant analysis is a blood test that is used to detect the presence of hemoglobin variants which…
cystatin C
Cystatin C Test Cystatin C is a specific single-chain protein that is found in body fluids and is a biomarker for…
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
liver detox facts
7 liver detox facts and why ignoring these could kill you! Are you taking care of this organ that handles over 500 different vital functions in your body? Your…

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