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Menstrual Miseries
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Dr. Aniruddha Malpani
Renowned infertility specialist. He runs an infertility clinic in Mumbai and has written many books.
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Menstrual problems are the commonest reason for which women seek medical attention. In order to understand the reasons for abnormal menstrual cycles, it is necessary to first understand what happens to a woman during a normal menstrual cycle.
The menstrual cycle is the time from the beginning of one period to the beginning of the next one. Usually menstrual cycles last about 28- 35 days, though anywhere from 3 to 6 weeks is considered normal.
During the menstrual cycle, the uterus gets ready for pregnancy. Under the influence of the hormones estrogen and progesterone, its lining grows rich and thick to prepare for the fertilized egg. If pregnancy doesn't occur, the uterus must get rid of this lining so that it can grow a new one in the next cycle. The old lining passes out of the uterus through the vagina as the menstrual flow.
The menstrual flow thus consists of:
- The shed uterine lining;
- Blood (this comes from the blood vessels, which are torn when the lining is shed);
- The degenerated unfertilised egg
The menstrual cycle is regulated by the female hormones, which are chemicals the body makes to carry messages from one part of the body to another. There are two major female hormones - estrogen and progesterone, which are produced by the ovaries. Reproduction is like an orchestra - and the reproductive organs need to be synchronised to perform at just the right time for them to work properly. It is the fertility hormones, which play the conductor's role.
The commonest menstrual problems women experience are: irregular cycles, heavy periods, premenstrual syndrome (PMS) and painful periods (dysmenorrhea).
This article focuses on the problem of irregular cycles.
When a woman is ovulating normally, she has normal regular menstrual cycles. When a woman does not ovulate normally or does not ovulate at all, her menstrual cycles become irregular. The reason for the anovulation can lie either within the ovary, within the hypothalamic pituitary system, or because of some other illness or hormonal disturbance.
The age of the woman is also a major clue as to what may be the cause of her irregular bleeding pattern. A teenage girl whose endocrine system has not yet fully matured will have totally irregular bleeding with either very infrequent periods or very heavy irregular periods, simply because she has not yet established a normal ovulatory menstrual cycle.
For women in their twenties and thirties, organic causes of the irregular bleeding are the more likely source of the problem and complications related to a pregnancy are very common.
For a woman in her late thirties and forties, organic disease of the ovary, such as ovarian cysts need to be considered. As a woman ages and nears the menopause, the ovulatory process begins to breakdown and failure to ovulate normally, or failure to ovulate at all, again becomes a common reason for irregular bleeding, just as it was in the teenage girl.
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