Women's Health
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The ABC of menstruation
Changes and variations
There are several variations, changes and abnormalities of the 'normal' menstrual cycle that can have varying effects and influences on a woman's life - especially as far as her fertility is concerned:
- 1. Amenorrhoea: the absence of the monthly menstrual cycle can be either primary or secondary. A significant delay in the time of the start of the first menstrual cycle is primary amenorrhoea. Delayed puberty is the commonest reason.
Secondary amenorrhoea implies an absence of, or delay in, menstruation in a previously normal female and is most commonly due to pregnancy and breastfeeding. Menstruation re-appears after delivery or breastfeeding stops. Other causes are:
- Severe weight loss (30 per cent)
- Polycystic ovary disease (25 per cent)
- Pituitary gland/hormone changes (30 per cent), most commonly as a result of a post-pill (oral contraceptives) effect.
- Stress
- Intensive exercise
- Psychological factors - anxiety, depression or pseudocyesis (false sense of being pregnant).
- Serious illness
- Acute changes in the weather have also been reported as causing delay in the menstrual flow.
Natural menopause is said to be established, in retrospect, after there has been 12 months of amenorrhoea, in a non-pregnant woman over 35.
- 2. Oligomenorrhoea is defined as sparse or infrequent menstruation, usually every three to six months. They can be long and irregular. Some of the above conditions can cause this, particularly polycystic ovary disease.
- 3. Menorrhagia - excessively heavy, regular periods - may involve an excessive amount of blood loss, or normal blood loss with increased loss of tissue fluids. It may be associated with some form of organic disease in the uterus, or there may be menorrhagia in the absence of any detectable uterine abnormality, which is described as dysfunctional uterine bleeding (DUB).
Few women talk in detail about their periods, so it is very difficult for them to know how the heaviness compares with anyone else. If a woman becomes anaemic and no other cause can be found, this may indicate that the periods are excessive. The other markers are whether there are clots forming and whether the woman experiences flooding. Other indications are tampons having to be changed every one to two hours, or double pads being used.
- 4. Polymenorrhagia - frequent, heavy periods.
- 5. Hypomenorrhoea - excessively light periods - but this is not a usual complaint.
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