Of the many physiological changes that take place in a girl’s body while growing up is the attainment of menarche. In simple terms menarche means having periods. As the girl attains womanhood, every month the body or uterus prepares itself for a possible pregnancy by shedding old inner lining of the uterus or the endometrium. Regular cyclic menstruation results from a relationship between the endometrium and its regulating hormones.
Normally this cyclical flow of blood from the female’s body usually occurs at an interval of 28 days and usually lasts for around four to seven days. As the uterus is getting rid of the old endometrial layer, i.e when a girl is having her periods, of the two ovaries, one ovary starts recruiting follicles out of which one will grow to form the mature follicle which will then release the egg. This release of the egg usually takes place on day 14 of the cycle. Simultaneously, the endometrium grows and thickens under the influence of the hormones produced by the follicles to support the pregnancy in case the released mature egg meets the sperm to form the future fetus.
The leftover part of the mature follicle from which the egg was released is now called as the Corpus Luteum. This Corpus Luteum produces the hormone progesterone under the influence of which the endometrial glands become mature and the endometrial lining further thickens. In case if there is no fusion of the egg and the sperm, this mature inner lining of the uterus is lost after 14 days of the release of the mature egg. The body loses this mature endometrial lining in form of periods.
Normal menstrual cycle can range from 21 to 35 days. Any deviation from the this is termed as Abnormal Uterine Bleeding (AUB).
Common menstrual problems
- Menorrhagia is defined as prolonged or heavy cyclical blood loss of more than 7 days in duration or more than 80 ml blood loss.
- Metrorrhagia is bleeding in between periods. Usually this occurs due to hormonal imbalance in the body and commonly a female suffers from menometrorrhagia.
- Hypomenorrhea is diminished blood flow during periods.
- Oligomenorrhoea periods usually occurring at an interval of more than 35 days.
- Withdrawal bleeding refers to the predictable bleeding that often results from abrupt progestin cessation.
What causes abnormal uterine bleeding
Abnormal uterine bleeding (AUB) occurs in 10 to 30% of women in the age group of 15 to 45 years and approximately 50% of perimenopausal women. There are many reasons that can lead to AUB, the common ones are as follows:
- Stress and lifestyle factors: gaining or losing a considerable amount of weight can alter the menstrual cycle of female. Sudden weight gain has been associated with polycystic ovarian syndrome which is one of the most common cause of heavy and prolonged periods in a younger population.
- Pregnancy: implantation bleeding and low lying placenta are other causes of abnormal uterine bleeding in younger population.. Likewise, missed abortions or threatened abortions can lead to AUB.
- Fibroids and polyps. Uterine fibroids are polyps are non cancerous growth seen within the uterus. There may be one or more such growth seen and are common causes of inetrmenstrual bleeding seen in reproductive age group.
- Endometriosis: of the many hypothesis of the pathogenesis of endometriosis is the backward flow of the menstrual blood from the uterus to the fallopian tubes. The endometrial tissue in the menstrual blood can get attached to the ovaries and other parts of the body leading to abnormal uterine bleeding, painful periods and pain during intercourse.
- Pelvic Inflammatory disease(PID): PID is very commonly seen in the reproductive age females. It is generally caused by bacteria which enter the pelvic cavity by sexual contact and then spreads to the uterus and other genital tract. Bacteria may even enter through childbirths or abortion. The symptoms include foul smelling vaginal discharge, lower abdominal pain and heavy blood flow during periods.
- Cancers: gynaecological cancers including ovarian, uterine or cervical can lead to AUB generally seen in menopausal group females.
- Medical conditions such as thyoid problems, pituitary disorders that can lead to hormona imbalance in the body and chronic conditions such as tuberculosis, bleeding disorders can also lead to abnormal uterine bleeding.
- Medications such as oral contraceptive pills or emergency pills can sometimes lead to intermenstrual bleeding. Also, drugs like blood thinners can lead to abnormal intermenstrual bleeding.
When should you seek medical attention for abnormal periods
One needs medical attention in case of the following symptoms:
- Severe pain during periods or between periods
- Frequent changing of sanitary pads due to excessive soaking or passing large clots
- A period lasting for more than seven days.
- Symptoms of toxic shock syndrome i.e high grade fever of over 102 degree.
- Nausea and vomiting.
- If there is bleeding in between periods.
Have you experienced any of the above? Did you visit your doctor? Let us know in the comments.