Women typically stop menstruating if they conceive or if they are breastfeeding. Menstruation lasts from puberty until menopause among non-pregnant women.
Regular menstruation lasts for a few days, usually 3 to 5 days, but anywhere from 2 to 8 days is considered normal. The average menstrual cycle is 28 days long from the first day of one menstrual period to the first day of the next. A normal menstrual cycle is typically between 21 and 35 days between menstrual periods. The premenstrual time period is termed molimina and symptoms (other than bleeding) preceding menstruation are termed moliminal.
The average volume of menstrual fluid during a monthly menstrual period is 35 milliliters (2.4 tablespoons of menstrual fluid) with 10–80 milliliters (1–6 tablespoons of menstrual fluid) considered typical. Menstrual fluid is the correct name for the menstrual flow, although many people prefer to refer to it as menstrual blood. Menstrual fluid in fact contains some blood, as well as cervical mucus, vaginal secretions, and endometrial tissue. Menstrual fluid is reddish-brown, a slightly darker colour than blood.
Many women also notice blood clots or shedding of their uterus's endometrium lining during menstruation. These appear as small pieces of tissue mixed with the blood. Pieces of endometrial tissue are easy to confuse with menstrual clots and a specimen test can confirm which you have.
Sometimes menstrual clots or shed endometrial tissue is incorrectly thought to indicate an early-term miscarriage of an embryo. An enzyme called plasmin contained in the endometrium tends to inhibit the blood from clotting.
The amount of iron lost via menstrual fluid is relatively insignificant for most women. In one study, premenopausal women who exhibited symptoms of iron deficiency were given endoscopies. 86% of them actually had gastrointestinal disease and were at risk of being misdiagnosed simply because they were menstruating.
The first experience of a menstrual period during puberty is called menarche. The average age of menarche is 13, but menarche can typically occur between ages 8 and 18.Premature or delayed menarche should be investigated, ie before 10 yrs or after 16 years. Perimenopause is when fertility in a female declines, and menstruation may occur infrequently in the years leading up to menopause, when a female stops menstruating completely and is no longer fertile. Menopause typically occurs between the late 40s and 50s in Western countries.
Physical experience
In most females, various physical changes are brought about by natural fluctuations in hormone levels during the menstrual cycle, and by muscle contractions (menstrual cramping) involving the uterus that can precede or accompany menstruation. Some may notice water retention, changes in sex drive, fatigue, breast tenderness, or nausea. Breast swelling and discomfort may be caused by water retention during menstruation.Usually, such sensations are mild, and some people notice very few physical changes associated with menstruation. A healthy diet, reduced consumption of salt, caffeine and alcohol, and regular exercise are often effective in controlling these physical changes. The sensations experienced vary from person to person and from cycle to cycle.
Painful menstrual cramps
Many women experience painful uterine cramps during menstruation. The muscles of the uterus, and abdominal muscles surrounding the uterus, contract spasmodically to push the menstrual fluid out of the uterus. The contractions are produced by the tissue lining the uterus, which is believed to release an excess of fatty acids called prostaglandins that stimulate the muscles, leading to contractions. This is called primary dysmenorrhea.Primary dysmenorrhea usually begins within a year or two of menarche. It may continue until menopause, but many people find that their symptoms of dysmenorrhea gradually subside after their mid-20s. If the pain occurs between menstrual periods, or lasts longer than the first few days of the period, it is called secondary dysmenorrhea.
Symptoms of dysmenorrhea may become debilitating in some people. It is unknown why this occurs in some people and not others. Severe symptoms may include pain spreading to hips, lower back and thighs, nausea and frequent diarrhea or constipation.
Treatments target excess prostaglandin, using anti-prostaglandin medications or oral contraceptives. Nonsteroidal antiinflammatory drugs (NSAIDS), such as over-the-counter ibuprofen and naproxen, may ease symptoms.
Emotional and psychological experience
Some women experience emotional disturbances associated with their menstruation. These range from the irritability, to tiredness, or "weepiness" (i.e. easily provoked tearfulness). A similar range of emotional effects and mood swings is associated with pregnancy. The prevalence of PMS is estimated to be between 3% and 30%. More severe symptoms of anxiety or depression may be signs of Premenstrual Syndrome. Rarely, in individuals susceptible to psychotic episodes, menstruation may be a trigger (menstrual psychosis).Premenstrual Syndrome
In some cases, stronger physical and emotional or psychological sensations may become debilitating, and include significant menstrual pain (dysmenorrhea), migraine headaches, and severe depression.Dysmenorrhea, or severe uterine pain, is particularly common for adolescents and young females This phenomenon is called Premenstrual Syndrome. More severe symptoms may be classified as Premenstrual Dysphoric Disorder (PMDD).
Menstrual disorders
There is a wide spectrum of differences between how people may experience menstruation. What may indicate a more serious physical problem for one person, may be quite normal for another. There are several ways that a person's menstrual cycle can differ from the norm, any of which should be discussed with a doctor to identify the underlying cause:Dysfunctional uterine bleeding is a hormonally caused bleeding abnormality. Dysfunctional uterine bleeding typically occurs in premenopausal females who do not ovulate normally (i.e. are anovulatory). All these bleeding abnormalities need medical attention; they may indicate hormone imbalances, uterine fibroids, or other problems. As pregnant women may bleed, a pregnancy test forms part of the evaluation of abnormal bleeding.
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