Period problemshttp://www.telegraphindia.com/1150119/jsp/knowhow/story_9008.jsp
Your Health - Dr. Gita Mathai
What is the actual difference between men and women? Women can produce babies while men cannot. For this, women have a uterus and two ovaries. Although these are present from birth, they start to function at a certain age called "menarche," when menstrual bleeding or the periodic shedding of the lining of the uterus sets in.
The age of menarche varies from nine to 15 years. It depends on genetics, nutrition, environment, physical activity and body weight. Usually the BMI needs to be above 18.5, with around 15-20 per cent body fat, for menarche to occur. It is brought about by the shedding of the thickened uterine lining in response to fluctuation in levels of oestrogen and progesterone hormones. Delayed menarche may occur in families where many members mature late. Investigations may be needed if menarche does not occur after 15-16 years.
The menstrual cycle can vary in length from 21 to 35 days. The cycles may be irregular in the first year after menarche and one or two years before menopause. The bleeding usually last 3-7 days. Total blood lost is 50-60ml and requires the use of one or one and a half packets of sanitary napkins.
At any age, the commonest reason for a missed period is pregnancy. It can occur soon after childbirth and also while breast feeding without menstruation having occurred. Childbirth and breast feeding can delay periods and make them irregular.
PCOS (polycystic ovarian syndrome) occurs in almost 60 per cent women of childbearing age. Cycles are unpredictable. The periods do not appear for months on end unless medication is taken. Once bleeding sets in, it does not stop without treatment.
Athletes, women who exercise rigorously (6-7 hours a day), diet excessively and achieve extreme weight loss can have scanty, infrequent periods. The ovaries can fail gradually at a young age. Periods become scanty and may suddenly stop before the age of 40. Usually no reason can be found and this is termed "primary ovarian failure."
Uterine fibroids, ovarian cysts, endometriosis, pelvic inflammation or cancer can cause irregular, excessive bleeding.
If there has been no menstruation for three months and the pregnancy test is negative, if the flow is excessive, if there is abdominal pain, or it is associated with fever, consult a gynaecologist.
A pelvic examination and an ultrasound scan helps to make a diagnosis. Menstrual irregularities can be a reflection of a problem elsewhere in the body; thyroid function tests may be required and pituitary hormone levels may need to be estimated.
OCP (oral contraceptive pills) or progesterone only pills are usually prescribed to regularise the cycle and reduce bleeding. Correction of any underlying disease with appropriate therapy may control the problem. Surgery may be required for cysts, fibroids and other tumours.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
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