Demystifying menstrual health
In this week’s Myanmar Times Zon Pann Pwint writes about Pan Ka Lay, a new initiative aiming to break the taboo around discussing menstruation or menstrual health which is common in many societies. Avoiding the topic of menstruation may save embarrassment but can lead to negative health impacts. In today’scolumn we cover normal and abnormal menstrual health, flagging those signs which should prompt a visit to the doctor.
So what is the menstrual cycle, how long is it and is it always painful?
The menstrual cycle is the body’s way of preparing for the possibility of pregnancy. One cycle lasts 4 weeks on average but there is a lot of variation with some women having a 3 week cycle, some 6 weeks, and some women having irregular cycles.The menstrual cycle is governed by hormonal changes. These hormones are produced by glands in the brain and by the ovaries.
Each cycle is divided into four phases:
Phase 1- Bleeding. The first day of bleeding (menstruation or ‘period’) marks the first day of the menstrual cycle. The bleeding is the result of shedding of the lining of the womb (uterus). Some girls and women experience abdominal cramps but this is variable. Bleeding lasts for about 3 to 7 days.
Phase 2- Preparing for ovulation. The ovaries are stimulated to develop eggs, of which only one will mature fully. The lining of the uterus becomes thicker ready for a fertilized egg to implant itself in the uterus wall if needed.
Phase 3- Ovulation. This describes the release of the mature egg by one ovary and takes place 12-16 days before the next period. The egg only survives 6-24 hours if fertilization does not take place.
Phase 4-End of the menstrual cycle. The lining of the uterus continues to thicken for a while but if fertilization does not take place it starts to break down again, when a new cycle begins. During this last phase before the next menstruation some women notice physical changes such as breast enlargement and tenderness, fluid retention or find they are more hungry than usual. They may also experience emotional changes such as low mood, irritability and anxiety. These symptoms are labelled as the ‘pre-menstrual syndrome’. Studies have shown that pre-menstrual symptoms are very similar in women in different countries around the world.
It is a myth that it is possible to avoid getting pregnant reliably by only having sex during certain parts of the menstrual cycle and use of contraception is advisable throughout to avoid unplanned pregnancy.
Girls usually start menstruation between the age of 9 and 16 years and reach the menopause (when periods end permanently) between 45 and 55 years of age.
Menstrual health: differentiating normal from abnormal
The wide variation in menstrual cycles between different women can make it difficult to distinguish normal from abnormal. Here are some signs to look out for when it is advisable to consult a doctor.
Pre-menstrual syndrome (PMS). Many women are aware of changes in their body or emotional state before their period but these changes do not have a major impact on their day-to-day life. For moderate symptoms, simple measures such as exercise and vitamin B6 supplements may help. A few women with severe PMS may benefit from hormonal treatments, anti-depressants and even surgery in exceptional cases. Specialist advice should be sought.
Painful periods. Some discomfort or abdominal cramps during menstruation is very common, but for some women and girls this can be so severe it prevents them from going about their normal activities. If simple pain relief such asparacetamol does not help a doctor can prescribe some different pain-killers which target period pain, orin some cases the combined oral contraceptive pill will ease symptoms.
Heavy periods. What’s normal in terms of the amount of blood loss during menstruation also varies but some women experience very heavy periods which can make leaving homefor any length of time impossible. Some medical investigations may be needed to look into the cause and there are different treatment options available, including the contraceptive pill or intrauterine contraceptive device. There is a belief in Myanmar that heavier bleeding is better for health and some women take traditional medicine with the aim of promoting blood loss. There is no scientific evidence to support this practice.
Missed periods. Amissed period may be the first sign of pregnancy but there may be an alternative explanation such as dieting or weight loss, or emotional stress. Being overweight can also lead to irregular or missed periods.
Bleeding between periods. This can be a side-effect of some types of contraceptive pills or injections, but it may indicate a serious medical condition such as an infection or even cancer, and so should prompt a visit to the clinic.
Post-menopausal bleeding. Menstruation may become irregular and unpredictable around the time of the menopause and the time between periods may get longer before they finally stop completely. Any bleeding after the menopause should be investigated promptly because in around 10% of women this symptom this is linked to cancer of the womb or cervix.
Menstruation is a normal, although at times inconvenient, part of life for half of the population. Demystifying it by educating girls and boys early can break some of society’s most enduring taboos and help girls and women to lead healthier and happier lives.
Dr Elizabeth Ashley is a physician and Researcher at Myanmar Oxford Clinical Research Unit, Yangon.
Each cycle is divided into four phases:
Phase 1- Bleeding. The first day of bleeding (menstruation or ‘period’) marks the first day of the menstrual cycle. The bleeding is the result of shedding of the lining of the womb (uterus). Some girls and women experience abdominal cramps but this is variable. Bleeding lasts for about 3 to 7 days.
Phase 2- Preparing for ovulation. The ovaries are stimulated to develop eggs, of which only one will mature fully. The lining of the uterus becomes thicker ready for a fertilized egg to implant itself in the uterus wall if needed.
Phase 3- Ovulation. This describes the release of the mature egg by one ovary and takes place 12-16 days before the next period. The egg only survives 6-24 hours if fertilization does not take place.
Phase 4-End of the menstrual cycle. The lining of the uterus continues to thicken for a while but if fertilization does not take place it starts to break down again, when a new cycle begins. During this last phase before the next menstruation some women notice physical changes such as breast enlargement and tenderness, fluid retention or find they are more hungry than usual. They may also experience emotional changes such as low mood, irritability and anxiety. These symptoms are labelled as the ‘pre-menstrual syndrome’. Studies have shown that pre-menstrual symptoms are very similar in women in different countries around the world.
It is a myth that it is possible to avoid getting pregnant reliably by only having sex during certain parts of the menstrual cycle and use of contraception is advisable throughout to avoid unplanned pregnancy.
Girls usually start menstruation between the age of 9 and 16 years and reach the menopause (when periods end permanently) between 45 and 55 years of age.
Menstrual health: differentiating normal from abnormal
The wide variation in menstrual cycles between different women can make it difficult to distinguish normal from abnormal. Here are some signs to look out for when it is advisable to consult a doctor.
Pre-menstrual syndrome (PMS). Many women are aware of changes in their body or emotional state before their period but these changes do not have a major impact on their day-to-day life. For moderate symptoms, simple measures such as exercise and vitamin B6 supplements may help. A few women with severe PMS may benefit from hormonal treatments, anti-depressants and even surgery in exceptional cases. Specialist advice should be sought.
Painful periods. Some discomfort or abdominal cramps during menstruation is very common, but for some women and girls this can be so severe it prevents them from going about their normal activities. If simple pain relief such asparacetamol does not help a doctor can prescribe some different pain-killers which target period pain, orin some cases the combined oral contraceptive pill will ease symptoms.
Heavy periods. What’s normal in terms of the amount of blood loss during menstruation also varies but some women experience very heavy periods which can make leaving homefor any length of time impossible. Some medical investigations may be needed to look into the cause and there are different treatment options available, including the contraceptive pill or intrauterine contraceptive device. There is a belief in Myanmar that heavier bleeding is better for health and some women take traditional medicine with the aim of promoting blood loss. There is no scientific evidence to support this practice.
Missed periods. Amissed period may be the first sign of pregnancy but there may be an alternative explanation such as dieting or weight loss, or emotional stress. Being overweight can also lead to irregular or missed periods.
Bleeding between periods. This can be a side-effect of some types of contraceptive pills or injections, but it may indicate a serious medical condition such as an infection or even cancer, and so should prompt a visit to the clinic.
Post-menopausal bleeding. Menstruation may become irregular and unpredictable around the time of the menopause and the time between periods may get longer before they finally stop completely. Any bleeding after the menopause should be investigated promptly because in around 10% of women this symptom this is linked to cancer of the womb or cervix.
Menstruation is a normal, although at times inconvenient, part of life for half of the population. Demystifying it by educating girls and boys early can break some of society’s most enduring taboos and help girls and women to lead healthier and happier lives.
Dr Elizabeth Ashley is a physician and Researcher at Myanmar Oxford Clinical Research Unit, Yangon.
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