01 Jan 2012
By: RACHEL CHAN
It was once believed that the presence of menstruating women can spoil milk and meat, and should not be allowed in the kitchen. More extreme is the belief that menstruating women are unclean and should be banished from the home during that time. While few cultures now consider menstruation as something impure, the monthly bleeding - a result of the lining of the womb breaking down after pregnancy fails to occur - remains a curse for many modern women.
Heavy menstrual flow is a typical complaint, although some women can suffer from prolonged, irregular, infrequent or erratic periods. For many women, having the period can also be accompanied by mood swings, vomiting, diarrhoea, stomach cramps or pain, lethargy, bloating, weight gain or even food cravings.
"Period problems typically occur in the very young or old," said Dr Yong Tze Tein, Senior Consultant, Department of Obstetrics and Gynaecology, Singapore General Hospital (SGH).
"For girls who have begun menstruating, it's almost like a new factory starting to get into production. They may initially have irregular cycles that usually improve when the 'factory' gets more efficient. Sometimes, they may get period pain which lessens as they grow older."
Women in their late 40s or early 50s often experience irregular, heavy or prolonged periods, or spotting in between periods, as a result of hormonal changes brought about by impending menopause.
When they reach their late 30s, women become more prone to growths in the womb and/or the ovaries. They may develop fibroids, which are solid benign tumours that grow from the muscle of the womb; or adenomyosis which occurs when the lining of the womb infiltrates its muscular wall. Endometriotic cysts, or blood cysts, are thought to result from the reversed flow of the menstrual blood through the fallopian tube into the pelvic cavity and ovaries. Fibroids are more common, with one in five women likely to have it at some point, said Dr Yong.
Some women may lose so much blood that they become anaemic. "They are usually in their 40s, but don't think about seeing a doctor. Instead, they may wear two or more (sanitary) pads or even disposable baby diapers, and use a plastic sheet on their bed to avoid staining. But they may lose so much blood that they end up needing a blood transfusion," said Dr Yong.
Doctors usually prescribe drugs to reduce the blood flow, or painkillers for pain if sufferers are found to have little or no problem. But if they are found to have fibroids or cysts, an operation to remove them is likely to be an option.
The average uterus has a diameter of about 60mm - about the size of an egg - but it can become enlarged by fibroids or cysts. One patient, said Dr Yong, had a womb that was as large as that of a five-month-pregnant woman. The condition, unusual for someone so young, caused the woman who was in her early 20s to have very heavy periods. On an overseas trip, she was so desperate to stop the blood flow that she combined two types of medicine, including one that promoted clotting.
But she developed a blood clot in the leg, a potentially fatal condition known as deep vein thrombosis. To dissolve the clot, doctors gave her blood-thinning medication, but the treatment took her back to square one - heavy menstrual bleeding. Eventually, doctors had to resort to blocking the blood vessels that supple her womb, a procedure known as embolisation. This caused the bleeding to stop and her womb to shrink, but she eventually had to have her womb removed.
Removal of the womb or hysterectomy is now much less common than before, both in Singapore and worldwide. This is because there are more options to manage heavy periods. Mirena - an intra-uterine contraceptive device that releases progestogen, a hormone that makes the lining of the womb thinner and bleeding lighter - is an alternative. Mirena has FDA approval and is the first line of treatment for heavy periods, said Dr Yong.
"Adenomyosis and fibroids are benign conditions. If you have an enlarged uterus but a normal period, there is no need to have any treatment," Dr Yong said. "But we don't believe women should suffer from their periods. If they have heavy or painful periods, they should seek treatment," she added.
Fertility rites
Designed purely for the purpose of getting her pregnant, a woman's reproductive system goes through a 28-day menstrual cycle every month, although it can also vary from 21 to 45 days.
AT the end of the cycle, the bleeding stops when the lining of her womb is shed and becomes very thin. The cycle starts when signals from the brain to the ovaries prompt the eggs in the ovary to grow in a bid to achieve ovulation. Many will start in this race, but only one will emerge dominant. During this time, the ovaries produce estrogen, a hormone that causes the lining of the womb to thicken.
When the amount of estrogen reaches a certain level, a signal is sent to the brain to release another hormone - that causes final maturation of the egg and ovulation occurs. The corpus luteum which is left behind produces a second hormone, progesterone, which changes the lining of the womb to become very "nutritious", setting the stage for an embryo to be implanted. If pregnancy doesn't occur, the corpus luteum degenerates and the estrogen and progesterone levels will fall. Without suppoer from the hormones, the lining breaks down and is expelled from the body as "menses".
Menstruation lasts for three to 10 days.
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