Menstruation
2 Case Studies
1 Member Stories
11 Research

What is Menstruation?

Menstruation describes the monthly discharge through the vagina of the blood and cells which were laid down in the uterus in preparation for pregnancy.


The menstrual cycle, which is counted from the first day of one period to the first day of the next, is not the same for every girl. Menstrual flow may occur every 21 to 35 days and last two to seven days. For the first few years after menstruation starts, long cycles are typical. But, menstrual cycles tend to shorten and become routine as you get older.


Your menstrual cycle might be routine - roughly the same length every month -- or somewhat irregular, and your period may be light or heavy, painful or pain-free, short or long, and still be considered normal. But in general, "normal" is whatever is normal for you.


Remember that use of certain kinds of contraception, such as extended-cycle birth control pills and intrauterine devices (IUDs), will change your menstrual cycle. Speak with your medical care provider about what to expect.

When you get near menopause, your cycle could become irregular. Since the risk of esophageal cancer increases as you get older, discuss any irregular bleeding about menopause with your health expert.

What is the menstrual cycle?

The menstrual cycle is the monthly series of changes a woman's body goes through in preparation for the possibility of pregnancy. Monthly, one of the ovaries releases an egg - a process called ovulation. At exactly the exact same time, hormonal changes prepare the uterus for pregnancy. If ovulation takes place and the egg is not fertilized, the lining of the uterus sheds through the vagina. This is known as a menstrual period.

Menstrual irregularities

Women may experience menstrual cycles which fall out the standard as described above. Menstrual problems include missing a period of time, change in the period of the cycle, changes in the flow, color, or consequences of menstrual blood, and intense pain or other menstrual disorders. Women may also experience psychological distress or broad mood swings throughout the luteal phase of the menstrual cycle. There's evidence that a substantial proportion of premenopausal women suffer psychological distress or impairment in job functioning in the week prior to their menstrual period. 


Menstruation isn't an illness, but a normal part of the menstrual cycle. But, menstrual problems do happen, and are due to varying causes.


a. Amenorrhea

Amenorrhea is the absence of menstruation, and may be either primary or secondary. Primary amenorrhea is failure to menstruate by age 16 years in women who have normal puberty, by age 14 years in those with delayed puberty, or 2 years after sexual maturation has occurred. Primary amenorrhea may be caused by genetic disorders, hormonal imbalance, brain defects, or physical abnormality of the reproductive organs. In 2003, a group of investigators reported on a new genetic mutation associated with primary amenorrhea. Moreover, certain systemic diseases may delay puberty and menstruation. Delayed menstruation may occur in athletes, particularly gymnasts, ballerinas, and long tail runners due to insufficient body fat. Amenorrhea associated with athletic training and specialist dance is a growing health concern, though, since it frequently occurs together with eating disorders and a reduction of bone mass that may result in early osteoporosis.

Secondary amenorrhea refers to the lack of menstruation after a period of regular menstruation. It's recognized as not menstruating for three months in females with irregular menstrual cycles, six months in females with regular menstrual cycles, and 18 weeks in females that had only started menstruating. Secondary amenorrhea can result from pregnancy, weight loss, excessive exercise, breast feeding, disease, or melancholy. Menopause takes place once the ovaries stop producing estrogen, causing periods to become irregular and then stop. It generally happens when a woman is between 48 and 52 years old.


b. Dysfunctional and abnormal uterine bleeding

Dysfunctional uterine bleeding is irregular or excessive bleeding in the uterus. It's due to uncontrolled estrogen production that contributes to excessive build up of the endometrium.

Abnormal uterine bleeding is excessive bleeding during menstruation, regular urination, and/or irregular bleeding. Abnormal bleeding may be caused by fibroids (noncancerous uterine growths), endometriosis (if endometrium spreads out the uterus), uterine infections, hypothyroidism, clotting problems, intrauterine devices (IUD), or cancer.


c. Dysmenorrhea

Dysmenorrhea is painful and difficult menstruation. Studies have found that 60-92 percent of teens suffer from dysmenorrhea. It normally starts six to 12 months after menarche. Symptoms may be severe enough to miss school or work, and protect against participation in regular activities. Risk factors for developing dysmenorrhea may include long menstrual periods, obesity, early age at menarche, smoking, and alcohol use.

Primary dysmenorrhea is thought to be due to high levels of prostaglandins (fatty acids that stimulate muscle contractions, among other actions ) which cause painful uterine muscle spasms. Signs of primary dysmenorrhea happen when bleeding begins and might include mild to severe menstrual pain (crampy, spasmodic, and labor-like or a dull ache), nausea, vomiting, headache, fatigue, low back pain, thigh pain, and nausea.

Secondary dysmenorrhea is caused by conditions such as endometriosis, abnormalities of the pelvic organs, pelvic inflammatory disease, fibroids, ovarian cysts, tumors, inflammatory bowel disease, and salpingitis (inflammation of the fallopian tube). Signs of secondary dysmenorrhea usually occur a few days before bleeding begins. The symptoms depend upon the particular cause of dysmenorrhea, but pain is the hallmark symptom.


d. Heavy periods

Many women experience heavy menstrual bleeding during their periods, known as menorrhagia. Heavy periods cause more blood loss than ordinary periods or may last more than seven days. Women experiencing menorrhagia may lose up to 92 percent of the overall tissue and fluid in the first 3 days of the cycle. Heavy menstruation is not uncommon in young women who have started their periods.

Menorrhagia is frequently brought on by a failure to ovulate, which contributes to a lack of progesterone. Without progesterone, the uterine lining becomes unstable and intervals are normally longer and unpredictable. Toxins in the bloodstream have a tendency to settle in the endrometrial tissue. If this tissue is shed each month, are the toxins. Heavy periods might be a toxin-excretion technique.


e. Premenstrual syndrome

Premenstrual syndrome (PMS) is a condition that occurs during the premenstrual phase of the menstrual cycle. The reason is unclear but concepts include: abnormal hormone levels, other biochemical abnormalities, improper diet, nutrient deficiencies, emotional factors, or a combination of several elements.

Emotional and psychological symptoms include fatigue, mood swings, irritability, anxiety, confusion, depression, tearfulness, and nervousness. Physical symptoms are bloating, discomfort, breast tenderness, cravings, weight gain, acne, change in bowel movements, joint pains, and nausea.


f. Other menstrual Issues

- A missed period may result from pregnancy, anxiety, increased exercise, emotions, despair, and illness, amongst others.

- Metrorrhagia is bleeding in between ordinary episodes of menstruation. It might be due to ovulation, hormonal factors, cervical lesions, or esophageal cancer.

- Polymenorrhoea is bleeding associated with menstrual cycles that are shorter than 21 days. It might result from hormonal or ovulatory issues.

- Oligomenorrhea is rare menstruation with 35 days to six months between menstrual cycles. Scientists have found that women with a menstrual cycle of 40 days or more are twice as likely as women with average-length cycles to develop type II (adult-onset) diabetes mellitus. It's believed that long or highly irregular menstrual cycles may be related to insulin resistance.

What causes menstrual cycle irregularities?

Menstrual cycle risks can have many different causes, such as:

· Pregnancy or breast-feeding. A missed period may be an early indication of pregnancy. Breast-feeding typically delays the return of menstruation after pregnancy.

· Eating disorders, extreme weight loss or excessive exercising. Eating disorders - such as anorexia nervosa - extreme weight loss and increased physical activity can interrupt menstruation.

· Polycystic ovary syndrome (PCOS). Women with this frequent endocrine system disease may have irregular periods in addition to enlarged ovaries that contain small collections of fluid - known as follicles - found in each gut as seen through an ultrasound test.

· Premature ovarian failure. Premature ovarian failure refers to the reduction of normal ovarian function before age 40. Women who have premature ovarian failure - also called primary ovarian insufficiency - may have irregular or intermittent periods for ages.

· Pelvic inflammatory disease (PID). This disease of the reproductive organs may cause irregular menstrual bleeding.

· Uterine fibroids. Uterine fibroids are noncancerous growths of the uterus. They can cause heavy menstrual periods and prolonged menstrual periods.

Diagnosis of menstrual problems

Menstrual problems can be diagnosed and treated by gynecologists. Most menstrual issues are diagnosed by performing a detailed medical history (with a focus on menstrual history) and a physical examination, which would include a rectal examination. Pelvic exams have two elements: the manual examination and the speculum examination. During the manual examination, the doctor inserts one or two fingers into the vagina and presses their other hand on the lower abdomen to feel the uterus and ovaries. A speculum exam involves inserting a speculum (a plastic or metal instrument for opening the vagina) to allow screening of the vagina and cervix, and to get smears for Pap testing (sampling of cervical cells) or civilization if an infection is suspected.

Ultrasound exam, in which internal organs are visualized using sound waves, may be carried out. Abnormal findings in the examination and lab tests may warrant laparoscopy where a thin, wand like instrument is inserted into an incision in the belly button to imagine abdominal organs.

Urine tests may be performed to diagnose pregnancy or disease. Blood tests to determine hormone levels, in addition to other blood parameters, could be carried out. Patient history and physical examination findings may suggest certain illnesses that would require further lab testing.

The individual may be asked to complete a journal where daily menstrual disorders are recorded over a span of three to six months. Sometimes, the individual may be referred to a psychologist for evaluation for PMDD.

Natural treatments for PMS cramps & pain

There are lots of alternative treatments for menstrual issues. Because menstrual difficulties could be due to a severe illness, patients should consult a physician prior to self-treating or using natural remedies.

a) Diet

Phytoestrogens are estrogen-like compounds produced by certain plants. Food sources of phytoestrogens include soy products, flaxseeds, chick peas, pinto beans, french beans, lima beans, and pomegranates. Phytoestrogens can lighten menstruation and lengthen menstrual cycles. On the other hand, scientists have found that women who were fed soy-based formulas in infancy rather than cow's milk are more likely to report heavy menstrual bleeding and painful periods in adult life.

PMS symptoms can be relieved by avoiding caffeine, salt, sugar, white flour, red meat, milk, butter, monosodium glutamate (MSG), fried foods, and processed foods throughout the 2 weeks before menstruation. Food that help to combat PMS include steamed green vegetables, salad, beans, grains, and fruit. To acquire essential fatty acids (omega-3 and omega-6) women can eat flaxseeds, sesame seeds, pumpkin seeds, salmon, mackerel, and tuna.


b) Ayurveda and Chinese medicine herbal remedies 

A selection of herbal remedies can alleviate symptoms related to menstrual issues. These include:

- black cohosh (Cimicifuga racemosa): mood swings, tension, establishing ovulation (an important source of phytoestrogens). 

- black haw (Viburnum prunifolium): cramps

- chamomile (Matricaria recutita): mood swings, tension, and cramps

- cramp bark (Viburnum opulus): cramps

- dandelion (Taraxacum dang gui): fluid retention and bloating

- dong quai (Benincasa cerifera): PMS symptoms, cramps, irregular cycles, heavy bleeding, or bleeding in between cycles

- fenugreek (Trigonella foenumgraecum): irregular bowel movements

- feverfew (Chrysanthemum parthenium): headaches and PMS symptoms

- ginger (Zingiber officinale): cramps, irregular cycles, heavy bleeding, or bleeding in between cycles

- goldenseal (Hydrastis canadensis): heavy bleeding

- horsetail (Equisetum arvense ): heavy bleeding

- licorice: PMS symptoms

- milk thistle (Silybum marianum) extract: heavy bleeding

- nettle (Urtica dioica) extract: heavy bleeding

- peppermint (Mentha piperita): mood swings and tension

- raspberry tea: cramps, irregular cycles, heavy bleeding, or bleeding in between cycles

- red clover (Trifolium pratense): phytoestrogen Resource

- rosemary (Rosmarinus officinalis): cramps

- shepherd's purse (Capsella bursa-pastoris): heavy bleeding

- St. John's wort (Hypericum perforatum): depression associated with PMS

- valerian (Valeriana officinales): mood swings and tension

- vitex: PMS symptoms

- wild yam: phytoestrogen Resource

- yarrow (Achillea millefolium): cramps


c) Supplements

These supplements can treat menstrual problems:

- Calcium deficiency may be associated with PMS

- Iron supplementation may treat anemia

- Magnesium pidolate supplementation decreased dysmenorrhea symptoms by up to 84%, particularly on days two and three

- Niacin may help to alleviate cramps

- Omega-3 fatty acids deficiency is associated with dysmenorrhea pain (in a small study, patients taking omega-3 fatty acids had lower pain scores)

- Thiamine (vitamin B1) cured dysmenorrhea at 87 percent of the patients for up to two weeks following therapy

- Vitamin A may be useful to treat heavy bleeding in women who have vitamin A deficiencies

- Vitamin B complex may assist hormonal function, prevent anemia, decrease water retention, and relieve stress

- Vitamin E can reduce mood swings and menstrual cramps


d) Acupressure. Acupressure can alleviate pain, reduce anxiety, and enhance circulation.


e) Acupuncture. Treatment is related to improvement or treatment of dysmenorrhea and PMS and decreased use of pain medicines. A National Institutes of Health (NIH) panel concluded that acupuncture might be a helpful remedy for menstrual cramps.


f) Aromatherapy. Massage with the essential oils rose, Ylang-ylang, bergamot, or geranium oils for mood swings; lavender, sandalwood, and clary sage oils for menstrual cramps; and chamomile, cypress, melissa, lavender, and jasmine oils for irregular menstruation or amenorrhea.


g) Biofeedback. Weekly biofeedback treatment for 12 weeks resulted in significant decrease in PMS symptoms.


h) Chiropractic. Spinal manipulation can help ease cramps.


i) Exercise. Regular, moderate aerobic exercise reduces or eliminates menstrual pain, improves PMS, reduces the amount of menstrual bleeding, reduces the danger of endometriosis, and reduces cyclic breast pain and cysts. Yoga stretching can alleviate back and thigh pain.


j) Homeopathy. Homeopathic remedies include: lachesis or sepia for PMS, cimicifuga, colocynthis, or magnesia phosphorica for cramps, and pulsatilla or aconitum for irregular menstruation or amenorrhea.


k) Hydrotherapy. Soaking in a hot tub or with a moist heating pad relaxes uterine muscles that relieves cramping.

Reflexology. Ear, hand, and foot reflexology resulted in a substantial reduction in PMS symptoms that lasted for many months following treatment.


Can menstrual irregularities be prevented?

Most menstrual problems can be successfully treated using traditional or alternative treatments.


Avoiding sodium and caffeine may decrease some menstrual symptoms. Regular moderate aerobic exercise or yoga can be beneficial for menstruation difficulties. Getting annual pelvic exams and Pap smears will help identify issues until they become advanced.


For many women, use of birth control pills can help regulate menstrual cycles. Treatment for any underlying issues, like an eating disorder, also might help. But some menstrual irregularities cannot be prevented.

References


Mayo Clinic https://www.mayoclinic.org/diseases-conditions/menstrual-cramps/symptoms-causes/syc-20374938

Gayle Encyclopedia of Alternative Medicine 

Pan JC, Tsai YT, Lai JN, Fang RC, Yeh CH. The Traditional Chinese Medicine Prescription Pattern of Patients With Primary Dysmenorrhea in Taiwan: A Large-Scale Cross-Sectional Survey. J Ethnopharmacol. 2014 Mar 14;152(2):314-9. doi: 10.1016/j.jep.2014.01.002. Epub 2014 Jan 10.

Suzuki N, Uebaba K, Kohama T, Moniwa N, Kanayama N, Koike K. French Maritime Pine Bark Extract Significantly Lowers the Requirement for Analgesic Medication in Dysmenorrhea: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Study. Journal of Reproductive Medicine 2008 53(5):338-46.

Pattanittum P, Kunyanone N, Brown J, et al. Dietary supplements for dysmenorrhoea. Cochrane Database of Systematic Reviews. 2016. doi:10.1002/14651858.cd002124.pub2.

Zhu X, Proctor M, Bensoussan A, Wu E, Smith CA. Chinese herbal medicine for primary dysmenorrhoea. Cochrane Database of Systematic Reviews. 2008. doi:10.1002/14651858.cd005288.pub3

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