This is a question that lingers in every woman’s mind at least once in her life. If you are wondering if your periods are normal, it is a sign that you are in fact concerned with something related to it. Therefore, regardless of the medical definition of a “normal” period, your concern should be assessed in addition to being appropriately counselled and educated. In matters of Periods and Menstruation, the most accurate and effective means to make a diagnosis is by listening. Listening is an active process performed with empathy and discernment. As physicians, we are all taught that the medical history is more accurate than physical examination and lab data in determining the cause.
Consider a 36-year-old woman who normally has regular periods monthly lasting 2-3 days with only 2-3 pads a day. She states that for the past 6 months, she now has periods that are regular monthly, but now last 7 days with flow that requires 8 pads per day with clots. As a gynaecologist for over 30 years, I can confidently say that there are many women who accept the latter menstrual cycle as normal because they have lived with that pattern for years. Many physicians would agree with such a patient. However, it is completely understandable that this patient feels that her periods are much worse. Not only is she concerned about why her period has changed, but she may also get concerned on how they can be improved, or returned to her former pattern.
Fortunately, medical science has advanced significantly in helping us to understand the source of most menstrual changes and to offer more and better options for improving the menstrual period. Whether the patient is missing periods, having heavy periods, irregular periods, painful periods, or painful sex the diagnosis of most problems can be completed in just a few office visits and the vast majority of treatments can be successfully treated with medication or office procedures alone.
With this background, let’s return to the question at hand: “Are my periods normal?” As a physician, I suggest looking at the question from another angle: “Do your periods bother you?” If the answer is yes, then the answer to the first question becomes: “No, they are not normal.” A professional athlete, a ballerina or an executive may find that any bleeding, though normal, is disruptive to their professional or personal lives. These women can be offered ways to manage their periods thereby improving their performance in these areas of their life. In another case, a woman whose husband serves in the Navy and is coming home after many months, may find even a normal period during his time off rather bothersome.
It is rather incredible that after millennia of the social stigmatization and isolation associated with the menstrual cycle, as well as the pain and bleeding associated with it, that women are now able to actually control their cycle. Almost any woman can now improve her period and in doing so, more effectively improve her life.
Menstrual pain is common for many women every menstrual cycle. Many women are able to manage their pain with little interference with normal work or social activities using over-the-counter medication.
However, for over 60% of women, the pain of a menstrual cycle can be severe or moderately severe, interfering with normal social or work activities. For these women, the prospect of another menstrual period with its pain can provoke anxiety.
Many women accept the pain of menstrual periods, and the misery associated with it, as an unfortunate consequence of a normal physical process. After all, menstrual periods are normal aren’t they? Oftentimes, a woman with this pain may have seen a doctor with a normal exam and even a normal ultrasound. Medication is prescribed, but for some women, it just does not help. As a result, some women will take high doses of these drugs in a futile attempt to improve their pain, risking stomach or kidney damage.
At AMCC our staff takes the time to listen, takes the time to care, takes the time to evaluate your pain, and then takes the time to implement a comprehensive plan to help improve your pain. For many of our patients with severe menstrual pain, this focused and comprehensive approach leads to significant improvements in the quality of life.
For some people, the period is never over.
If you are still having periods in your 50s, your periods may not be normal,
AMCC is one of the few Centres in the country offering proper assessment and treatment of abnormal vaginal bleeding, including bleeding after Menopause. Bleeding after the change of life, may be caused by polyps, pre-cancer or cancer.
As a result, any bleeding after the change of life should be evaluated as soon as possible. Up to 15% of women who have bleeding after the change of life (postmenopausal bleeding) have cancer of the lining of the womb. If you have bleeding after the menopause, seek care from a Gynaecology specialist. The staffs at AMCC are specialists in postmenopausal bleeding.
Evaluation for postmenopausal bleeding may include:
Hysteroscopy. Hysteroscopy is a slender telescope, only 1/8 to 1/5 of an inch in diameter to look into the uterus.
Menstrual bleeding disorders are a common problem that can affect as many as 30% of women at any point in their life. From the onset of the menstrual cycle, to after the menopause, menstrual bleeding disorders are common and can be socially embarrassing and physically debilitating.
Menstrual bleeding disorders have many potential causes, including the following problems common to many women:
In the care of young ladies and women with menstrual bleeding disorders, AMCC is one of the first centres to specialize in the unique needs of women with menstrual bleeding problems such as
AMCC provides comprehensive GYN women’s care with specialization in treatment of menstrual bleeding disorders, including heavy menstrual bleeding (HMB), abnormal uterine bleeding (AUB), postmenopausal bleeding (PMB), fibroids, polyps, endometriosis, pelvic pain and painful periods.
AMCC provides a unique combination of experience, expertise, specialized equipment, staff training and a commitment to providing patient care with “compassion, expertise and service”.
What is adolescence and puberty?
Adolescence refers to that transitional phase between childhood and adulthood in a person’s life. This period is characterized by a plethora of physical, psychological and emotional changes.
A combination of physical changes such as height and weight gain, development of sexual organs and characteristics that ensure the maturation of a child into an adult is termed as puberty. It is during this period that adolescents reach sexual maturity and become capable of procreating.
What is menarche?
At the onset of puberty, girls usually have their first vaginal bleeding, which over time becomes a regular occurrence. The onset of this regular cycle is termed as menarche. Girls start menstruating somewhere between the ages of 9 and 16 and continue to do so till their early 50’s.
Why do females menstruate?
Women have hundreds of eggs in their ovaries at any given time. Every month, in response to reproductive hormones – mainly oestrogen and progesterone – a woman’s womb gets ready for pregnancy
Once every 21-40 days, an egg is released by the ovary, travels through the fallopian tubes and reaches the uterus. The inner lining of the uterus, called the endometrium forms a soft, cushiony layer made up of several minute blood vessels in anticipation of an embryo in case the egg is fertilized by a sperm.
If fertilization does not occur, there is no need to retain the uterine cushion as there is no embryo to nourish and protect. Dropping progesterone levels serve as a cue and the uterus sheds the cushiony blood vessel lining which flows out of the vagina as the menstrual flow.
What is a menstrual cycle?
The time between the first day of a menstrual period and the beginning of the next one is referred to as a menstrual cycle. Usually a typical cycle lasts for 28 days. However, this differs from person to person and can last anywhere between 22 and 45 days.
How long does a period usually last?
On average, a menstrual period lasts somewhere between 3 and 7 days. This varies from person to person.
How much blood does a woman lose during every menstrual cycle?
Scientific studies reveal that on an average, a woman can lose anywhere between 30 and 90 ml of fluid which constitutes both of blood and mucosal tissue over 3-7 days of menstruation.
Are periods painful?
Slight abdominal pain and cramping during periods is normal. The intensity and duration varies from person to person. This is due to the release of hormone-like compounds called prostaglandins which stimulate contractions of smooth muscles of which the uterus is one
Unless the pain is completely debilitating, in which case visiting a doctor would be recommended, most symptoms can be cured using home-made remedies such as hot water compresses and abdominal massage.
What is PMS?
Women usually experience one or a combination of physical and emotional symptoms just before they start their monthly periods. Some of the symptoms include temporary weight gain or feelings of heaviness, tenderness of the breasts, headaches, cramps and general irritability. All these together constitute what is known as Pre-Menstrual Syndrome (PMS).
PMS usually sets in a week or so before menses starts and goes away before the bleeding starts.
Popular myths and existing realities
The topic of menstruation is shrouded by a heavy veil of taboo. For centuries, communities across the world have associated menstruation with all things dark and evil. Menstrual blood is considered impure and menstruating women are often forbidden from entering places of worship, kitchens and farmlands due to fear of ‘polluting’ these spaces.
Over the years, these perceptions have been proven wrong and science has helped confirm that menstruation is a perfectly normal, healthy, biological function.
Click here for interesting facts about the history of menstrual taboo.
Why is menstrual hygiene important?
Majority of females have very limited or no knowledge about menstruation and the importance of personal hygiene while menstruating. Maintaining adequate hygiene during menses is necessary to stay away from infections as well as for general comfort and easy mobility.
Due to this lack of knowledge, many women follow very unsafe practices such as using coir and unsanitary cloth pads during their menses.
What are the sanitary products available for menstruating females?
It is important to use an absorbent material to soak up menstrual blood in order to prevent bacterial and fungal infections. It is a known fact that many women use traditional cloth napkins during their period. While this may not be totally sanitary, it is not completely unsanitary either. If cleansed well and dried properly under the sun, these pads can be re-used a few times. But in most cases, this does not happen. In order to avoid the ‘shameful’ exhibition of these cloth napkins, women hide them in nooks and reuse the unsterile pads leading to infections and complications.
Sanitary napkin – The most widely used sanitary product is the disposable ‘sanitary napkin’. Most napkins have an absorbent core and a leak-proof barrier that holds the napkin together. These use and throw napkins are available in a variety of sizes and are by far the most popular female hygiene product in India.
Tampons – Unlike the sanitary napkin which is placed outside the vulva, tampons are miniature cylinders of absorbent material that can be inserted into the vagina.
Menstrual cups – These silicone cups can be placed inside the vagina to collect the menstrual flow. Unlike the sanitary pad or the tampon, menstrual cups can be sterilized and re-used.
How to dispose of these sanitary products?
One time use sanitary products should be disposed of with care. Sanitary pads should not be thrown out in the open as it may turn into a breeding ground for bacteria. They should not be flushed down the toilets either as the plastic can choke up drains.
They should be wrapped in newspaper and thrown out along with the garbage. If your village or town does not have daily garbage collection facility, it is better to burn them instead of letting them lie around. Technically speaking, a used napkin should be incinerated for the benefit of the environment
What to do in case a sanitary pad is not available?
While opting for a sanitary solution is best, in case a sanitary napkin is not available, a clean cotton cloth can be used to soak up the menstrual flow. The cloth should be changed periodically depending on the flow.
In case you plan to use the same piece of cloth again, make sure it is washed thoroughly, dried under the sun and stored in a clean and dry place.
(Credits: ASHA – Accredited Social Health Activist, Ministry of Health and Family Welfare)