MENSTRUAL IRREGULARITIES AND PAINS - clearly explained.

INTRODUCTION- It is a common complaint in the gynaecological clinics with lots of misconceptions which has generated worries in females experiencing any form of it. This post is crafted in a way to allay anxieties and dispel such misconceptions while letting you know the doctor's mind as regard the regular menstruation and the menstrual irregularities.


THE MISCONCEPTIONS- The common worrisome misconceptions includes;

1.  I don't see my menses every 4 weeks unlike my friends.
2.  I don't menstruate for 5 days unlike my friends.
3.  I use 7 sanitary pads every month unlike my friends. 

THE FACT- Doctors considers you normal if;

1.  Your mentrual cycle length is between 3weeks (i.e 21days) to 5weeks( i.e 35days). Your menstrual cycle starts the first day of menstrual blood flow and ends on the first day of the next menstrual blood flow (which marks the beginning of the next menstrual cycle). The days that span this period is what the doctors refer to as the length of your menstrual cycle and doctors consider it normal if it is between 3 weeks (21days) to 5weeks (35days).
2.  You menstruate for 3 to 7 days.
3. You lose between 25ml to 80ml of blood during your menstrual flow. You can estimate your blood loss by counting the number of sanitary pads you have used in each menstrual cycle flow period. Knowing well that a regular-absorbency sanitary pad could soak about 5ml of blood. Doctors consider it abnormal when you change sanitary pad every 4 hours or less. By simple arithmetic, there are 24hrs in a day, changing sanitary pad every 4 hours in a day implies that you would have used 6 pads in 1 day (24hrs÷4=6). If a pad soaks 5ml of blood it implies that you would have lost 30ml of blood in one day [ 5ml×6 (soaked pads) = 30ml/day]. Now assuming you menstruate for 3 days (the accepted minimum days), it in all implies that you have lost a total estimate of 90ml of blood during the flow phase of your menstrual cycle as against the maximum 80ml accepted (30×3=90).  THIS IS ABNORMAL. 

THE NORMAL MENSTRUAL CYCLE AND ITS IMPORTANCE

Your menstrual cycle starts on the first day you see your menses. your menses is expected to flow for 3-7 days. After the last day of menses, you are not expected to see any menses again till your NEXT MENSTRUAL CYCLE. However, some changes goes on both in your ovaries and your womb(uterus) that you are not aware of but i will tell you.

In your ovaries, there are eggs and nature has designed it in a way that only one is released during every menstrual cycle . so after menses, in the ovary the eggs starts to develop but oops! only one lucky egg gets to mature. What makes your menstrual cycle length differ from that of your friends lies in this developmental phase. Due to variation in our body hormonal system, in some females, the egg tends to mature faster and this shortens their menstrual cycle to 3-4 weeks. In other females in which the egg matured much later may have their menstrual cycle lengthen to 4-5 weeks. both scenarios are still normal.
In your womb, the walls becomes thickened as they develop new cell layers in preparation for implantation(pregnancy) should the released egg get fertilized and new blood vessels grows into it in bid to supply the newly formed cells the required nutrient and to nourish the embryo should fertilization occur.
Now the release of the lucky matured egg is what the doctors call ovulation and it is at this time that you get the first hint that something is actually going on inside of you. This hint may be in form of sudden acne, mood swing, high temperature etc. When you see these, you best be ready for another menstrual flow in the next 14 days. It is a constant factor to doctors that the menstrual cycle ends 14 days after ovulation.

If the released egg is fertilized by a sperm, it would be implanted into the newly formed layers of cells in the wall of the womb and receives its nutrient from the newly formed blood vessel. The implication of this is that there would be no more menses for the next 9 month, meaning that you're pregnant.

However if not fertilized, it would disintegrate after 24 hours and after 14 days of its release, the disintegrated ovum, the newly formed cell layers, the newly formed blood vessels with its blood would be expelled from the womb through the vagina and all these are what constitute the content of a normal menses. The first day you see this marks the end of that menstrual cycle and the beginning of the next.

NOW TO THE FREQUENTLY ASKED QUESTION

1. WHY IS MY CYCLE LESS THAN 21 DAYS?, WHY IS MY CYCLE MORE THAN 35 DAYS?, AND WHY DO I BLEED IN BETWEEN MY CYCLE?.

Doctors calls these polymenorrhea, oligomenorrhea, and metrorrhagia respectively. they've been shown to have sourced from common aetiologies(i.e causes) which can be categorized into 2 classes;

1. Behavioural/lifestyle changes; engaging in rigorous exercises or sporting activities as seen in female athletes, dancers, swimmers. dieting, excessive weight loss, excessive weight gain.
2. Organic disease; like disease of the thyroid gland (graves disease)*, when the ovary has multiple cysts (polycystic ovarian syndrome)*, due to hormonal imbalance at around menopause or menarche (dysfunctional uterine bleeding)*, fibroid( benign leomyoma)*, malignant neoplasm(ca cervix, endometrial ca)*.

WHAT TO DO

1. Lifestyle modification; maintaining the normal body mass index BMI (18.5-24.9), limiting rigorous exercises.
2. But if you experience symptoms like excessive hair growth, acne, or became intolerant to heat, you are likely to have an underlying organic disease. Report to your doctor or to a hospital as soon as possible for proper evaluation and satisfactory management. DO NOT ATTEMPT TO SELF MEDICATE ANY OF THESE ORGANIC DISEASES. I BELIEVE THEIR NAMES SHOULD SCARE YOU.

2. WHY DO I MENSTRUATE FOR MORE THAN 7 DAYS OR WHY DO I USE MORE THAN 16 SANITARY PADS EVERY CYCLE?

Doctors calls this menorrhagia. The aetiology(cause) is similar to the above, and it can be severe enough to restrict normal daily activity. Most people would complain of menstruating clotted blood while some would experience dizziness and even faint at times.

WHAT TO DO

• Present to a hospital where you will be investigated for some of the above organic causes and also for blood coagulation disorder like hemophilia and the underlying cause would be appropriately treated.

3.WHY DO I EXPERIENCE PAIN DURING MENSTRUATION

The muscle of the womb(uterus) usually contract to expel the menses out of the uterus, which may be associated with pain and inflammation. This pain has be shown to be intense in woman with a family history of menstrual pains, in a female under 20 yrs of age, in women who has not given birth, in women who attain puberty early and in women that smokes.

WHAT TO DO

1. Having a light but regular exercises.
2. Having a warm bath.
3. Massaging the abdomen.
4. Relaxation techniques like yoga.
5. Eating adequate diet.

If the pain is severe enough to disturb your normal daily activity, see your doctor. Do not self prescribe anti inflammatory drugs or abuse alcohol as these may predispose you to developing ulcers in  your stomach at wrong doses. Your doctor would prescribe the appropriate medication with the right dose for you and also discuss other management options with you.

CONCLUSION

Menstrual irregularities is a spectrum of menstrual disorders in which more than one of these disorders can be caused by the same factor which can appropriately be figured out and promptly treated by a doctor. The onus is unto us to present at the hospital for proper evaluation and management.