Menstruation is the monthly shedding of the inner lining of a woman’s womb in response to the interactions of hormones produced by the hypothalamus, pituitary, and ovaries.
The age at which menstruation starts is referred to as MENARCHE. It’s usually between 9 – 16 years. Duration of flow is the number of days the woman bleeds in each cycle. The normal duration of menstrual flow is 2 – 8 days.
A cycle is the interval between the onset of one menses and the next. It is usually between 21 – 35 days.
Menstrual Irregularities
Any menstrual pattern that differs from the normal, may be referred to as menstrual irregularity. Irregular menstruation can have causes that are not related to underlying diseases such as family history, menopause, psychological stress, and the effects of medications.
Irregular and anovulatory cycles are common during the first few years after the start of menses and these may reflect a normal process. A cycle that is shorter than 21 days is called Polymenorrhea, and a cycle that is greater than 35 days or four to nine menstrual cycles in a year is Oligomenorrhea. The normal volume of blood loss during menses is between 30 – and 80mls.
Menopause: This is a period that marks the end of the natural reproductive life of a woman. It is characterized by the absence of menses. It often occurs from 45– 55 years (can occur earlier or later).
Common problems associated with menstruation
- Heavy flow(menorrhagia) – Blood loss greater than 80mls or use of more than 3 – 4 fully soaked pads per day
- Scanty flow (hypomenorrhea) – Duration of menstrual flow is less than 2 days or the amount of blood flow is less than 30mls throughout the number of days of menstrual flow
- Dysmenorrhea – Painful menses. May be physiological and can be relieved with mild analgesia such as paracetamol. When severe, especially when it affects normal functioning, it requires attention.
- Endometriosis is a common cause of severe painful menses.
- Intermenstrual bleeding – When bleeding occurs in between normal menstrual cycles. It requires evaluation. It may be a pointer to diseased conditions including cancer.
- Post-coital bleeding – Bleeding following sexual intercourse. It is a red flag.
- Post-menopausal bleeding – Bleeding from the vagina after menopause. It is a cause for concern.
Note: Know your menstrual cycle. An irregularity may be a red flag as stated above and it requires proper evaluation. Consult your medical personnel for early review and management. Problems with menstruation can be physiological or pathological.
Early presentation, evaluation, and appropriate management would go a long way to prevent serious complications.