The hormones
progesterone administered by injection or virginally to pregnant women, has
been helpful in reducing the chances that a woman who has had one preterm birth
will have another.
Two previous
trials have also found progesterone useful in preventing preterm births among
women with a short cervix, another known risk group. But those studies, using
the virginal form of the drug, looked only at women who had a cervical length
of less than 20 millimetres- only 2% of the population.
Scientists
have hoped the hormones would benefit even more women, making a significant
dent in the number of preterm births each year. Reports show that progesterone
in its injected form does not work for a much larger risk group: the 10% of
women with a cervix shorter than 30 millimetres. These women have about the
same risk of having a preterm birth – around 25% - as those who have already
had one.
The study emphasizes that because
progesterone works for one group at risk for preterm birth doesn’t mean that it
can automatically be extended to others, William A. Grobman, a professor of
obstetrics and gynecology at North western.
Researchers randomly assigned 657women to
a weekly injection of a form of progesterone or to a placebo shot. All were
pregnant for the first time with a single baby, and each had a cervical length
of less than 30mm at 16to22wks gestation. The women were followed through
discharge from the hospital.
The scientist was unable to find any significant
differences in birth outcomes between the two groups. Of those who took the
progesterone, 25.1% delivered prematurely (at less than 37 weeks) and so did
24.2% of those on the placebo.
The average gestational age at delivery was
the same in each group. The numbers of deliveries at less than 35wks and less
than 28wks were practically the same in those who had taken the drugs and those
who had taken the placebo.
By more than a dozen different
measures of material and fetal health, too, the researchers could find no
difference between the groups. Even the side effects – mostly pain or soreness
at the injection site- were the same.
Some researchers like Sonia S. Hassan,
the associate dean for maternal, prenatal and the child at wayne state
university in Detroit, advocate cervical length screening for all pregnant
women
If it’s found to be short, she said, they
should receive vaginal progesterone. The injectable form is commonly used for
women with a prior preterm birth. I would advise women to speak with their
physician to see if they are candidate for that.
The vaginal form of the drug has not been
tested in the larger group of women with a cervix shorter than 30mm only in the
relatively few women with a cervix shorter than 20mm.
Grobman noted that the health and economic
burden of preterm birth is enormous.
It’s incredibly important to investigate
which risk groups can benefit and whether our strategies in general can be
useful in preventing preterm birth, he said.
Approximately every 28 days, women menstruate (bleed) due to the
shedding of their uterus lining (called endometrium). This begins from
the time of first menstruation (menarche) and ends at menopause.
Hydration is the incorporation of water molecules into a complex with those of another compound. It could also refers to the process of providing an adequate amount of water to the body tissues.
The menopause marks the time in a woman's life when her menstruation
stops and she is no longer fertile (able to become pregnant).
The menopause is a normal part of like - it is a milestone, just like puberty
- it is not a disease or a condition. Even though it is the time of the
woman's last period, symptoms may begin many years earlier. Some women
may experience symptoms for months or years afterwards.
Symptoms of menopause and peri-menopause?
Experts say that technically, the menopause is confirmed when a woman
has not had a menstrual period for one year. However, the symptoms and
signs of menopause generally appear well before that one-year period is
over. They may include:
Irregular periods - this is usually the first symptom;
menstrual pattern changes. Some women may experience a period every two
to three weeks, while others will not have one for months at a time.
Lower fertility - during the peri-menopausal stage of a
woman's life, her estrogen levels will drop significantly, lowering her
chances of becoming pregnant.
Vaginal dryness - this may be accompanied by itching and/or
discomfort. It tends to happen during the peri-menopause. Some women may
experience dyspareunia (pain during sex). The term vaginal atrophy refers to an inflammation
of the vagina as a result of the thinning and shrinking of the tissues,
as well as decreased lubrication, caused by a lack of estrogen.
Approximately 30% of women experience vaginal atrophy
symptoms during the early post-menopausal period, while 47% do so
during the later post-menopausal period. There are cases of women who
experience vaginal atrophy more than a decade after their final period.
Hot flashes (UK term: hot flushes) - a sudden feeling of
heat in the upper body. It may start in the face, neck or chest, and
then spreads upwards or downwards (depending on where it started). The
skin on the face, neck or chest may redden and become patchy, and the
woman typically starts to sweat. The heart rate may suddenly increase (tachycardia),
or it may become irregular or stronger than usual (palpitations). Hot
flashes generally occur during the first year after a woman's final
period.
Night sweats - if the hot flashes happen in bed they are
called night sweats. Most women say their hot flashes do not last more
than a few minutes.
If left untreated, these symptoms will usually taper off gradually over a
period of two to five years. However, symptoms can persist for much
longer. In some cases, vaginal dryness, itching and discomfort can
become chronic, and eventually get worse if left untreated.
Causes of menopause and peri-menopause?
The hormones estrogen and progesterone regulate menstruation - more
specifically, estrogen regulates menstruation while progesterone is more
involved with preparing the body for pregnancy.
When the ovaries start producing less of these two hormones, the
peri-menopause will start. In fact, by the time a woman is in her late
30s the ovaries start producing less progesterone and estrogen. By the
time she is in her 40s, the post-ovulation spike in progesterone becomes
less emphasized. A woman's fertility starts to decline a long time
before she may notice any menopausal or peri-menopausal symptoms.
As time passes and the ovaries produce less and less estrogen and
progesterone, the ovaries eventually shut down completely and the woman
no longer has any more menstrual periods. The vast majority of females
experience a gradual change in menstrual activity, while some go on
normally until they suddenly stop.
Some women may experience premature menopause - their ovaries
fail earlier than they are supposed to (before the age of 45). Ovarian
failure can occur at any age - but very rarely - and often the doctor
and patient will never find out why. Some who experience ovarian failure
may still have periods and some degree of fertility for a while.
Premature menopause may be caused by:
A GP (general practitioner, primary care physician) should be able to
diagnose menopause or peri-menopause if he knows the age of the patient,
has information about her menstrual patterns, and receives feedback
from her on her symptoms.
Apart from a blood test which can measure levels of FSH
(follicle-stimulating hormone), there is no definitive test to diagnose
menopause or peri-menopause. FSH blood levels rise when a woman is in
the menopause. However, as FSH levels tend to fluctuate a lot during the
menopause and peri-menopause, the test may provide a little data, and
is not that helpful for a diagnosis. Under certain circumstance a doctor
may order a blood test to determine the level of estradiol
(estrogen). As hypothyroidism (underactive thyroid) can cause
menopause-like symptoms, a blood test to determine the woman's level of
thyroid-stimulating hormone may be recommended.
Treatment options for menopause or peri-menopause?
Only about 10% of women seek medical advice during the menopause. Many
women require no treatment. However, if symptoms are affecting the
woman's daily life she should see her doctor. The kind of treatment the
patient should have depends on her symptoms, her medical history, as
well as her own preferences. Available treatments include:
Hormone Replacement Therapy -this is very effective for many of the symptoms that occur during the
menopause, including vaginal dryness, vaginal itching, vaginal
discomfort, urinary problems, bone-density loss, hot flashes and night
sweats. HRT tops up the woman's levels of estrogen. However, as with many treatments, HRT has its risks and benefits:
Benefits of HRT
Effectively treats many troublesome menopausal symptoms.
Gabapentin (Neurontin) - this medication is effective in treating hot flashes. It is commonly used for treating seizures (epilepsy).
Clonidine (Catapres) - can be taken either orally as a pill
or placed on the skin as a patch. It is effective in treating hot
flashes. The drug is commonly used for treating high blood pressure (hypertension). However, unpleasant side-effects are common.
Vaginal estrogen - may be applied locally using a tablet,
ring or cream. This medication effectively treats vaginal dryness,
discomfort during intercourse, as well as some urinary problems. A small
amount of estrogen is released and absorbed by the vaginal tissue.
Hypnosis effective for the treatment of hot flashes
Researchers reported in the journal Menopause, in October 2012,
that hypnosis can reduce the symptoms of menopausal hot flashes by up to
74%. The investigators, from the school of Nursing at Indiana
University, the College of Education at the University of Texas, Austin,
and the Mind-Body Medicine Research Laboratory at Baylor University,
carried out a randomized, controlled study to determine what the effect
of hypnosis might be.
The volunteers, all with symptoms of hot flashes, were assigned to one of two groups:
After the menopause it is common for the following chronic conditions to
appear. Chronic, in medical English, means long-term, continuous (as
opposed to "acute").
Cardiovascular disease - a drop in estrogen levels often goes hand-in-hand with an increased risk of cardiovascular disease. Heart disease
is not exclusively a male problem, it is the main cause of death among
both men and women. In order to reduce the risk of developing
cardiovascular disease a woman should quit smoking,
try to keep her blood pressure within normal levels, do plenty of
regular exercise, sleep at least 7 hours each night, and eat a
well-balanced healthy diet.
Osteoporosis - a woman may lose bone density rapidly during
the first few years after menopause. The lower a person's bone density
gets the higher their risk is of developing osteoporosis. The absolute
risk of a second clinical fracture is highest in the five years after any first clinical fracture for post-menopausal women.
Urinary incontinence - the menopause causes the tissues of
the vagina and urethra to lose their elasticity, which can result in
frequent, sudden, strong urges to urinate, followed by urge incontinence (involuntary loss of urine). Stress
incontinence may also become a problem - urinating involuntarily after
coughing, sneezing, laughing, lifting something, or suddenly jerking the
body as may happen when we temporarily lose our balance.
Low libido - this is probably linked to disturbed sleep, depression symptoms, and night sweats, a study found.
Overweight/obesity - during the menopausal transition women
are much more susceptible to weight gain. Experts say women may need to
consume about 200 to 400 fewer calories each day just to prevent weight
gain - or burn of that number of calories each day with extra exercise. The chances of becoming obese rises significantly after the menopause.
Unless your symptoms are severe, you may find that some changes in your
lifestyle and diet are all you need to deal with the symptoms.
Hot flashes and night sweats
Do plenty of exercise.
Avoid wearing tight clothing.
Make sure the bedroom is not hot.
Try to reduce your levels of stress.
Remember the following commonly trigger symptoms for susceptible people: spicy food, caffeine, smoking, and alcohol.
Sleep disturbance
Exercise regularly. However, do not exercise too late during the day. Exercising too late may keep you awake longer.
Go to bed and get up at the same time each day - even during weekends.
Cut out all drinks and foods that contain caffeine.
Learn how to do deep breathing, guided imagery, and progressive muscle relaxation.
Moodiness
Make sure you do not get tired - get plenty of rest.
Do regular exercise. If you can, do strenuous exercise - check with your doctor whether this is OK for you.
Practice yoga. Make sure you have a well qualified trainer.
Vaginal discomfort and dryness
Get some OTC (over the counter) water-based vaginal lubricants or moisturizers.
Stay sexually active.
Urinary incontinence
Practice pelvic floor muscle exercises - Kegel exercises. If you
practice three or four times a day you will most probably notice a
difference after a few weeks. This review of studies explains that women suffering from urinary incontinence can benefit from pelvic floor muscle training.
The menstrual cycle is
the series of changes a woman's body goes through to prepare for a pregnancy.
About once a month, the
uterus grows a new lining to get ready
for a fertilized egg. When there is no fertilized egg to
start a pregnancy, the uterus sheds its lining. This is the monthly
menstrual bleeding that women have from their early
teen years until
menopause, around age 50.
The menstrual
cycle is from Day 1 of bleeding to Day 1 of the next time of bleeding. Although
the average cycle is 28 days, it is normal to have a cycle that is shorter or longer.
Girls usually start having menstrual periods between the ages of 11 and
14. Women usually start to have fewer periods between ages 39 and 51. Women in
their 40s and teens may have cycles that are longer or change a lot. If you are
a teen, your cycles should even out with time. If you are nearing menopause,
your cycles will probably get longer and then will stop.
Talk to
your doctor if you notice any big change in your cycle. It’s especially
important to check with your doctor if you have three or more menstrual periods that last
longer than 7 days or are very heavy. Also call if you have bleeding between
your periods or pelvic pain that is not from your period.
Controls of menstrual cycle?
Your hormones
control your menstrual cycle. During each cycle, your brain's
hypothalamus and
pituitary gland send hormone signals back and forth
with your
ovaries. These signals get the ovaries and uterus
ready for a pregnancy.
The hormones
estrogen and
progesterone play the biggest roles in how the uterus
changes during each cycle.
Estrogen builds up the lining of the
uterus.
Progesterone increases after an ovary releases an egg
(ovulation) at the middle of the cycle. This helps the
estrogen keep the lining thick and ready for a fertilized egg.
A
drop in progesterone (along with estrogen) causes the lining to break down.
This is when your period starts.
A change in hormone levels can affect your cycle or
fertility. For example, teens tend to have low or changing progesterone levels.
This is also true for women close to menopause. That is why teens and women in
their 40s may have heavy menstrual bleeding and cycles that change in
length.
Other things can change your cycle. They include birth
control pills, low body fat, losing a lot of weight, or being overweight.
Stress or very hard exercise also can change your cycle. Pregnancy is the most
common cause of a missed period.
Common symptoms to menstrual cycle?
Some women have no pain or other problems. But other women have symptoms
before and during their periods.
For about a week before a period,
many women have some
premenstrual symptoms. You may feel more tense or
angry. You may gain water weight and feel bloated. Your breasts may feel
tender. You may get acne. You also may have less energy than usual. A day or
two before your period, you may start having pain (cramps) in your belly, back,
or legs. These symptoms go away during the first days of a period.
When your ovary releases an egg in the middle of your cycle, you may have
pain in your lower belly. You also might have red spotting for less than a day.
Both are normal.
How can women take care of bleeding and symptoms?
You can use pads or tampons to manage bleeding. Whichever you use, be
sure to change the pad or tampon at least every 4 to 6 hours during the day.
Pads may be best at night.
Many women can improve their symptoms
by getting regular exercise and eating a healthy diet. It also may help to
limit alcohol and caffeine. Try to reduce stress.
A heating pad, hot water bottle, or warm bath also can help
with cramps. You can take an over-the-counter medicine such as ibuprofen or
naproxen before and during your period to reduce pain and bleeding.
A miscarriage is any pregnancy that ends spontaneously before the
fetus can survive. A miscarriage is medically referred to as a
spontaneous abortion. Miscarriage means loss of an embryo or fetus before the 20th week of pregnancy. Most miscarriages occur during the first 14 weeks of pregnancy.
A diet high in saturated and total fats has been linked to a greater risk for developing specific types of breast cancers, including the most common tumorous growths driven by estrogen.
The process of ovulation is controlled by the hypothalamus of the brain and through the release of hormones secreted in the anterior lobe of the pituitary gland, luteinizing hormone (LH) and follicle-stimulating hormone (FSH).
In the pre-ovulatory phase of theMenstruation,
the ovarian follicle will undergo a series of transformations called
cumulus expansion, which is stimulated by FSH. After this is done, a
hole called the stigma will form in the follicle,
and the ovum will leave the follicle through this hole. Ovulation is
triggered by a spike in the amount of FSH and LH released from the
pituitary gland.
During the luteal (post-ovulatory) phase, the ovum will travel through the fallopian tubes toward the uterus. If fertilized by a sperm, it may perform implantation there 6–12 days later.
Ovulation occurs when a mature egg is released from the ovary into the oviduct.
Afterwards, it will eventually become available to be fertilized.
Concomitantly, the lining of the uterus is thickened to be able to
receive a fertilized egg. If no conception occurs, the uterine lining as
well as blood will be shed in menstruation.
In humans, the few days near ovulation constitute the fertile phase. The time from the beginning of the last menstrual period (LMP) until ovulation is, on average, 14.6 days, but with substantial variation both between women and between cycles in any single woman, with an overall 95% prediction interval of 8.2 to 20.5 days.
Cycle length alone is not a reliable indicator
of the day of ovulation. While in general an earlier ovulation will
result in a shorter menstrual cycle, and vice versa, the luteal
(post-ovulatory) phase of the menstrual cycle may vary by up to a week
between women.
Details
changes around the time of ovulation, as
well as the inter-cycle and inter-woman variability in its timing.
Strictly defined, the ovulatory phase spans the period of hormonal
elevation in the menstrual cycle. The process requires a maximum of
thirty-six hours to complete, and it is arbitrarily separated into three
phases: preovulatory, ovulatory, and postovulatory.
Pre-requisite events
Through a process that takes approximately 375 days, or thirteen menstrual cycles, a large group of undeveloped primordial follicles dormant in the ovary is grown and progressively weaned into one preovulatory follicle.
Histologically, the preovulatory follicle (also called a mature Graafian follicle or mature tertiary follicle) contains an oocyte arrested in metaphase meiosis II
surrounded by a layer of corona radiata granulosa cells, a layer of
mural granulosa cells, a protective basal lamina, and a network of
blood-carrying capillary vessels sandwiched between a layer of theca
interna and theca externa cells.
A large sac of fluid called the antrum predominates in the follicle. A "bridge" of cumulus oophorus granulosa cells (or simply cumulus cells) connects the corona-ovum complex to the mural granulosa cells.
The granulosa cells engage in bidirectional messaging with the cells and the oocyte to facilitate follicular function.
By the action of luteinizing hormone (LH), the preovulatory follicle's theca cells secrete androstenedione that is aromatized by mural granulosa cells into estradiol, a type of estrogen. In contrast to the other phases of the menstrual cycle, estrogen release in late follicular phase has a stimulatory effect on hypothalamus gonadotropin-releasing hormone (GnRH) that in turn stimulates the expression of pituitary LH and follicle stimulating hormone (FSH).
The building concentrations of LH and FSH marks the beginning of the preovulatory phase.
Preovulatory phase
For ovulation to be successful, the ovum must be supported by both
the corona radiata and cumulus oophorous granulosa cells. The latter
undergo a period of proliferation and mucification known as cumulus
expansion. Mucification is the secretion of a hyaluronic acid-rich
cocktail that disperses and gathers the cumulus cell network in a
sticky matrix around the ovum. This network stays with the ovum after
ovulation and has been shown to be necessary for fertilization.
An increase in cumulus cell number causes a concomitant increase in
antrum fluid volume that can swell the follicle to over 20 mm in
diameter. It forms a pronounced bulge at the surface of the ovary called
the blister.
Ovulatory phase
Through a signal transduction cascade initiated by LH, proteolytic enzymes are secreted by the follicle that degrade the follicular tissue at the site of the blister, forming a hole called the stigma. The cumulus-oocyte complex (COC) leaves the ruptured follicle and moves out into the peritoneal cavity through the stigma, where it is caught by the fimbriae at the end of the fallopian tube (also called the oviduct). After entering the oviduct, the ovum-cumulus complex is pushed along by cilia, beginning its journey toward the uterus.
By this time, the oocyte has completed meiosis I, yielding two cells: the larger secondary oocyte that contains all of the cytoplasmic material and a smaller, inactive first polar body. Meiosis II follows at once but will be arrested in the metaphase and will so remain until fertilization. The spindle apparatus
of the second meiotic division appears at the time of ovulation. If no
fertilization occurs, the oocyte will degenerate approximately
twenty-four hours after ovulation.
The mucous membrane of the uterus, termed the functionalis, has reached its maximum size, and so have the endometrial glands, although they are still non-secretory.
Postovulatory phase
The follicle proper has met the end of its lifespan. Without the
ovum, the follicle folds inward on itself, transforming into the corpus luteum (pl. corpora lutea), a steroidogenic cluster of cells that produces estrogen and progesterone. These hormones induce the endometrial glands to begin production of the proliferative endometrium and later into secretory endometrium, the site of embryonic growth if fertilization occurs.
The action of progesterone increases basal body temperature
by one-quarter to one-half degree Celsius (one-half to one degree
Fahrenheit). The corpus luteum continues this paracrine action for the
remainder of the menstrual cycle, maintaining the endometrium, before
disintegrating into scar tissue during menses.
Ovulation is the release of a single, mature egg from a follicle that
developed in the ovary. It usually occurs regularly, around day 14 of a
28-day menstrual cycle. Once released, the egg is capable of being
fertilized for 12 to 48 hours before it begins to disintegrate. It is
the few days around ovulation that a woman is most fertile.
Clinical presentation
The start of ovulation can be detected by various signs. Because the
signs are not readily discernible by people other than the woman
herself, humans are said to have a concealed ovulation.
In many animal species there are distinctive signals indicating the
period when the female is fertile. Several explanations have been
proposed to explain concealed ovulation in humans.
Women near ovulation experience changes in the cervix, in mucus produced by the cervix, and in their basal body temperature. Furthermore, many women also experience secondary fertility signs including Mittelschmerz (pain associated with ovulation) and a heightened sense of smell.
Many women experience heightened sexual desire in the several days immediately before ovulation. One study concluded that women subtly improve their facial attractiveness during ovulation.
Symptoms related to the onset of ovulation, the moment of ovulation
and the body's process of beginning and ending the menstrual cycle vary
in intensity with each individual woman but are fundamentally the same.
The charting of such symptoms, primarily Basal Body Temperature,
Mittelschmerz and cervical position is referred to as the Sympto-Thermal
method of Fertility Awareness, which serves to allow auto diagnosis by a
woman of her state of ovulation. Once training has been given by a
suitable authority, fertility charts
can be completed on a cycle by cycle basis to chart ovulation giving
the possibility of using the data to predict fertility for both natural
contraception and pregnancy planning.
The moment of ovulation has been photographed.
Follicular waves
Research spearheaded by Baerwald et al. suggests that the
menstrual cycle may not regulate follicular growth as strictly as
previously thought. In particular, the majority of women during an
average twenty-eight day cycle experience two or three "waves" of
follicular development, with only the final wave being ovulatory. The
remainder of the waves are anovulatory,
characterized by the developed preovulatory follicle falling into
atresia (a major anovulatory cycle) or no preovulatory follicle being
chosen at all (a minor anovulatory cycle).
The phenomenon is similar to the follicular waves seen in cows and horses.
In these animals, a large cohort of early tertiary follicles develop
consistently during the follicular phase of the menstrual cycle,
suggesting that the endocrine system does not regulate folliculogenesis
stringently.
Researchers of fertility awareness or natural family planning methods discovered follicular waves in the 1950s.
These methods of family planning have always taken multiple follicular
waves into account, and this research does not challenge their
effectiveness.
The gene Lrh1 appears to be essential in regulating ovulation.
Disorders
Disorders of ovulation are classified asmenstrual disorders, and include oligoovulation and anovulation:
Oligoovulation is infrequent or irregular ovulation
Anovulation is absence of ovulation when it would be normally expected. An ovulation usually manifests itself as
irregularity of menstrual periods, that is, unpredictable variability of
intervals, duration, or bleeding. An ovulation can also cause cessation
of periods (secondary amenorrhea) or excessive bleeding (dysfunctional uterine bleeding).
Induction and suppression
Induced ovulation
Ovulation induction is a promising assisted reproductive technology for patients with conditions such as polycystic ovary syndrome (PCOS) and oligomenorrhea. It is also used in in vitro fertilization to make the follicles mature prior to egg retrieval. Usually, ovarian stimulation is used in conjunction with ovulation induction to stimulate the formation of multiple oocytes. Some sources include ovulation induction in the definition of ovarian stimulation.
A low dose of human chorionic gonadotropin (HCG) may be injected after completed ovarian stimulation. Ovulation will occur between 24–36 hours after the HCG injection.
Suppressed ovulation
Contraception can be achieved by suppressing the ovulation.
The majority of hormonal contraceptives
and conception boosters focus on the ovulatory phase of the menstrual
cycle because it is the most important determinant of fertility.
Hormone
therapy can positively or negatively interfere with ovulation and can
give a sense of cycle control to the woman.
Estradiol and progesterone, taken in various forms including combined oral contraceptive pills, mimics the hormonal levels of the menstrual cycle and engage in negative feedback of folliculogenesis and ovulation.
Hirsutism (or hirsutes) is the term used for increased hair growth in
women. It refers to a male pattern of hair, i.e. in the moustache and
beard areas (chin), or occurring more thickly than usual on the limbs.
Hirsutism is very common.
Premature birth is defined either as the same as preterm
birth, or the birth of a baby before the developing organs are mature
enough to allow normal postnatal survival.
Premature infants are at
greater risk for short and long term complications, including
disabilities and impediments in growth and mental development.
Significant progress has been made in the care of premature infants, but
not in reducing the prevalence of preterm birth.
Recent study suggests that certain vegetables such as carrots,
lettuce, spinach and tomatoes could help improve sperm quality; sperm
motility – how quickly a sperm can swim towards an egg and sperm
morphology – the size and shape of a sperm (for the best chance of
successfully conceiving, a sperm should have an oval head and a long
tail).
Recent study suggests that certain vegetables such as carrots,
lettuce, spinach and tomatoes could help improve sperm quality; sperm
motility – how quickly a sperm can swim towards an egg and sperm
morphology – the size and shape of a sperm (for the best chance of
successfully conceiving, a sperm should have an oval head and a long
tail).
In mammals, an abortion is when a pregnancy ends early without the birth of babies. Abortions can occur naturally, usually because something went wrong with the pregnancy.
When this happens, it is called a miscarriage. Humans
can also end the pregnancy on purpose before birth takes place. This is
called an induced abortion. Its legality can depend on specific
conditions such as incest, rape, severe fetal defects or the mother's
health being at risk, although it depends on where the laws are.
Difference between an embryo and a foetus
A developing human takes about thirty-eight weeks to grow and be
born. Normally, this occurs about forty weeks after the mother's last menstrual period. This developing human is called embryo for the first eight weeks of the pregnancy, and foetus for the remaining thirty-two.
Types of abortions
There are two kinds (or types) of abortion. Sometimes, things go
wrong during a pregnancy. These things may lead to the death of the
embryo or fetus. Depending on what time in pregnancy they happen in,
such abortions are called miscarriage or stillbirth.
In some cases finishing the pregnancy might be very dangerous for the
pregnant woman. Giving birth might also be very difficult for her, she
may have many worries,
or she might not want to have a baby at all. In such cases, things can
be done to end the pregnancy on purpose. This is called an induced abortion.
In both types of abortion, the embryo or fetus usually comes out of the womb. This is called a complete abortion. In some cases, the embryo or fetus remains inside the womb. This is called a missed abortion. Surgery is needed to remove the embryo or fetus from the womb so the woman does not get an infection.
Spontaneous abortions
People speak of spontaneous abortion or miscarriage
when the embryo or fetus is lost due to natural causes before the 20th
week of pregnancy.
A pregnancy that ends this way, but that is between
20 and 37 weeks old is known as "premature birth" if the baby is born alive.
If the fetus dies in the womb after 20 weeks, or while it is born, this is known as "stillbirth". Premature births and stillbirths are generally not considered to be miscarriages.
How common they are
Spontaneous abortions (miscarriages) are common. About fifteen
percent of pregnancies end in spontaneous abortion. In many cases, the
woman is not even aware she was pregnant.
The pregnancy is only a few
days or weeks old and the woman believes the miscarriage is just her menses. About twenty-five percent of all women will have a spontaneous abortion during their lives.
Most miscarriages occur very early. Between ten and fifty percent of
pregnancies end with a miscarriage, where the mother or the doctors are
aware of it. These figures depend on the age and health of the pregnant
woman.
Most spontaneous abortions occur so early in the pregnancy that the
woman is not even aware that she was pregnant. One particular study
showed a rate of pregnancy in exposed ovulatory cycles of 59.6%; with
61.9% of conceptuses lost before twelve weeks. 91.7% of these occuried
subclinically, without the knowledge of the mother.
The risk of spontaneous abortion decreases sharply after the 10th week of pregnancy,
with a loss rate between 8.5 weeks LMP and birth of about two percent;
pregnancy loss is “virtually complete by the end of the embryonic
period."
Some people are more likely to have a spontaneous abortion
Those people who have already had several spontaneous or induced
abortions run a greater risk of having a spontaneous one.
Those with
certain diseases, and those over the age 35 also run a greater risk.
Other causes for abortions can be the infection of either the woman or
embryo/fetus, or their immune response.
Certain diseases or an
accidental trauma
can also cause a spontaneous abortion. Putting the woman under trauma
or stress to cause miscarriage is considered induced abortion. Some
countries call this feticide.
Cause of spontaneous abortions
Most miscarriages are due to problems with the copying of chromosomes, but some are caused by environmental factors. When a human is conceived,
it gets 23 chromosomes from its mother and 23 from its father.
If it
does not get the right number its development happens wrong (it does not
grow right.) It may have many bad birth defects.
Most embryos and fetuses with chromosome problems will not live for a
long time. They die very early. There are a few chromosome problems
that babies can sometimes be born with. For example, Down Syndrome happens when there are three copies of chromosome #21. (Usually people have 2 of every chromosome.) This is called trisomy 21 (tri- means 3.)
Symptoms of spontaneous abortions
The most common symptom is bleeding from the vagina. This can be very little blood (less blood than a normal menses.)
It can be very much blood (much more than a normal menses.) Some women
have bad pains in their low abdomen when they have a miscarriage. This
is sometimes like the pain of menses. It can be much worse.
Or a woman
may have no pain at all. If the pregnancy is many weeks old, the woman
may see the embryo or fetus when it comes out. But if it is less than 12
weeks old a woman may not see anything but blood.
Treatment of spontaneous abortions
Sometimes no treatment is needed. Sometimes doctors do a surgical
abortion. This is the same kind of surgery that is done for induced
abortions. Sometimes doctors give women medicines to help the
miscarriage finish without needing surgery.
Induced abortions
An induced abortion is when things are done to end the pregnancy on
purpose. These things are normally done by doctors. In countries where
abortion can be done legally, it is often done by specialists who know a
lot about women's bodies (gynecologists).
Abortions done illegally are often performed by people without this
special knowledge. This makes them more dangerous. Such abortions are
usually called unsafe abortions, back-alley abortions or DIY
abortions, mainly because the risk to the health of the mother is much
higher than with abortions carried out by skilled doctors.
Medical reasons for an abortion
There can be medical reasons, why an abortion is performed. These include:
saving the life of the pregnant woman
preserving the woman's physical or mental health
ending a pregnancy that would result in a child being born with severe birth defects, which would be fatal, or which would increase the risk of the child dying at an early age.
reducing the number of fetuses to lower the health risks associated with a multiple pregnancy (like twins)
Kinds of induced abortions
There are two different kinds of induced abortions. The type of
abortion that is done depends on a few different things, like what the
woman wants, what her doctor thinks is best, and how far along a woman
is in her pregnancy (how long she has been pregnant).
One type of induced abortion is called a "medical abortion" or a
"medication abortion". In this type of abortion, a doctor gives the
woman one or two medications that will end her pregnancy. A medication
abortion can only be done early on in the pregnancy.
This is because the
medications that are used work best when they are started as early as
possible, and after a woman has been pregnant for about two months, the
medications usually do not work very well. Because of this, medication
abortion usually is not used after a woman has been pregnant for 9
weeks.
Some of the benefits (or reasons why some women choose this type of
abortion) are that it can be started as soon as a woman realizes she is
pregnant; it does not require anesthesia;
and the woman does not have to have a procedure in a hospital or clinic
to have the fetus removed, like with the other kind of abortion that is
done.
After a woman is given the medication or medications that end her
pregnancy, the abortion happens like a "spontaneous" abortion or a miscarriage. (The woman passes the fetus, along with the blood and tissue that have built up in the uterus, from her vagina.)
The most common medications that are used for medication abortions are mifepristone and misoprostol.
First, a doctor gives the woman mifepristone, which is sometimes also
called "RU-468" or "the abortion pill". This drug blocks the hormone progesterone
in the body.
Without progesterone, the embryo cannot survive. The
lining of the uterus becomes thinner, and the embryo cannot grow or stay
attached to the lining of the uterus. After a few days, a doctor gives
the woman misoprostol.
This makes the uterus contract (or get smaller)
and the embryo is expelled from (or pushed out of) the uterus through
the woman's vagina.
Sometimes, another medication, called methotrexate,
is used along with misoprostol in medication abortions.
A woman is
given methotrexate, usually as a shot in a doctor's office, and the drug
stops the embryo from staying attached to the lining of the uterus.
Then misoprostol is given a few days later.
With the second type of abortion - called "surgical abortion" or
"in-office abortion" - a doctor does a procedure that removes an embryo
or fetus from the woman's uterus.
This kind of abortion can be done in
different ways, depending on how long the woman has been pregnant.
Surgical abortion is simpler, and there are less problems that can
happen, if it is done earlier on in the pregnancy. The most common form
is called an "aspiration abortion" or a "suction curettage."
This can be done in a doctor's office or clinic. First the woman's
cervix (the top part of the uterus) is dilated (or made bigger). A
medical tool is used to suction out everything inside the woman's
uterus, including the fetus.
If the woman has been pregnant for more
than 12 weeks, the doctor first has to dilate the cervix (or make the
cervix bigger), usually by putting small sticks into the cervix to help
it open up. If another tool, called a curette, has to be used to scrape
out tissue that is still inside the uterus, then this form of abortion
is sometimes called a "dilation and curettage" (or "D&C").
Risks and complications
A pregnancy that ends without a child being born also may cause some
problems to the woman this happens to. There are two broad groups of
things that can happen:
Things that affect the mental health of the woman: Some women need counseling and therapy after an abortion.
Things that happen to the body of the woman.
Physical problems
Abortion is safer than childbirth if it is done before the 16th week of pregnancy and it is done by a professional.
Certain methods of abortion are pretty safe, and complications are rare. Generally, stopping a pregnancy that has gone on longer is riskier.
Women usually feel a small amount of pain during first-trimester
abortion. In a 1979 study of 2,299 patients, 97% reported having some
amount of pain. Patients rated the pain as being less than earache or
toothache, but more than headache or backache.
Local and general anesthesias are used during the abortion.
Psychological problems
Few studies have been done to see if an abortion affects the woman
psychologically, or mentally. Those that have been done give
contradictory results.
One study looked at 13.000 women who had become
pregnant even though they did not want to. The study found that having
an induced abortion does not increase the risk of getting mental health
problems; the group that was compared were women who also did not want
to have a baby, but who did not have an abortion.
Other studies
showed similar results: women who had an abortion did better in school
or at work after the abortion. Another study showed that women who had
an abortion had a higher self-esteem and felt better than those who did
not.
Many women who had an abortion felt better afterwards, they also felt relieved. They would do it again in a similar situation.
A study done in New Zealand in 2006 showed that many women who had an abortion developed severe depressions up to 4 years after they had the abortion. They were also more likely have problems with alcohol and illegal drugs
than those women who did not have an abortion.
The person who oversaw
the study later told media that given these results it would be very
hard to say that having an abortion has no psychological effects on the
womam who has is. He called the abortion "a traumatic experience".
Other problems
Both spontaneous and induced abortions have some risk for the woman.
If a bad thing happens because of a surgery or medicine that a doctor gives, or because of a miscarriage, it is called a complication.
Complications of abortions can be infection,
bleeding, pain. There may or may not be problems getting pregnant
again; this is still being researched.
In places where induced abortions
are legal
less than 1% of induced abortions have a bad complication. If doctors
do induced abortions, the risk to the woman is less than the risk of
complications of childbirth (giving birth to a baby).
In places where
induced abortions are legal, less women have complications of induced
abortion than in places where induced abortion is illegal.
This is
because induced abortions that are not done by doctors
have much more risks. For example, after induced abortions became legal
in the United States in 1973, less women died from having abortions.
In
the United States in 2000, 11 women died from the complications of
legal abortion. The risk of death from a legal abortion is 1/100 of the risk of an appendectomy.
The risk of death from an injection (shot) of penicillin (an antibiotic) is bigger than the risk of death from a legal abortion.
There can be emotional problems for the woman after a spontaneous or
induced abortion. She may feel sad, angry, or guilty that she had a
miscarriage or asked for an abortion. She may think she has done
something that made the miscarriage happen, or that having an abortion
was the wrong thing to do, and because of this she may feel intense grief. There are many places where women can get help dealing with these feelings.
Some women who have induced abortions may get criticism from friends or family who have different beliefs. When scientists look at this in research studies, however, they do not usually see that women have emotional problems after induced abortions.
Numbers and reasons for induced abortions
The number of induced abortions done are different for different
parts of the world. This is also true for the reasons why women decide
to have an abortion. Estimates are that about 46 million induced
abortions are done worldwide, every year. 26 million of them occur in
places where abortion is legal, 20 million happen in countries where it
is illegal to have an abortion.
Some countries, like Belgium (11.2 per
100 known pregnancies) and the Netherlands (10.6 per 100) have a low
rate of induced abortion. Others, like Russia (62.6 per 100) and Vietnam (43.7 per 100) have a comparatively high rate. Overall, there are 26 induced abortions per 100 known pregnancies.
Methods used for abortions; times when abortions are done
Abortion rates vary. The length the pregnancy has gone on, and the
method used to do the abortion influence these rates. According to data
collected in the United States, 88.2% of abortions were done in the
first twelve weeks of pregnancy, 10.4% between week 13 and week 20 of
the pregnancy. The remaining 1.4% were done in week 21 or later.
The Guttmacher Institute estimated there were 2,200 intact dilation and extraction procedures in the U.S. during 2000 - 0.17% of the total number of abortions performed that year.
Similarly, in England and Wales in 2006, 89% of terminations occurred
at or under 12 weeks, 9% between 13 and 19 weeks, and 1.5% at or over 20
weeks. 64% of those reported were by vacuum aspiration, 6% by D&E,
and 30% were medical.
In 1998, a study was done in 27 countries. This study wanted to find
the reasons, why women wanted to end their pregnancy. It found that
women often gave one of the following reasons:
Worries about their work or their education.
Not sure about how to pay for the child they were going to have.
Worries about the stability of the relationship with their partner.
Feeling that they were not yet mature enough to have a child.
A different study, done in the United States in 2004 came to similar conclusions.
Women who had an abortion in Finland and the United States usually
did not state that the pregnancy posed a risk to their health.
In Bangladesh, India and Kenya, however, more such women thought the pregnancy was a risk to their health. 1% of women in the 2004 survey-based U.S. study became pregnant as a result of rape and 0.5% as a result of incest.
Another American study in 2002 concluded that 54% of women who had an abortion were using a form of contraception at the time of becoming pregnant.
Inconsistent use was reported by 49% of those using condoms and 76% of those using the combined oral contraceptive pill; 42% of those using condoms reported failure through slipping or breakage.
The Guttmacher Institute estimated that "most abortions in the United
States are obtained by minority women" because minority women "have much
higher rates of unintended pregnancy."
Some women have an abortion because the society they live in pressures them to.
In certain parts of the world, disabled people have problems to fit into society.
The sex of the child might influence the status of the mother;
often, mothers who bear boys have a higher social status than those who
bear girls.
In many parts of the world, raising a child is a very difficult task for a single (unmarried) mother.
Certain countries, like China have measures to control their population growth.
Any of these factors might force a pregnant woman to have an abortion.
Abortion and the law
Induced abortion is not legal in every place. In some countries, a doctor who does an induced abortion is committing a crime. In the United States, Canada, and many countries in Europe abortion is legal (not a crime).
In some countries like Ireland and Somalia it is legal only to save the life of the woman. If a woman is raped in Ireland and becomes pregnant, she cannot get an induced abortion. In some countries like Chile and El Salvador, abortion is never legal, including in cases where the woman risks dying from continuing the pregnancy.
In countries where induced abortion is not legal many more women die
from abortion. Women still get induced abortions, but they cannot get
them in safe hospitals and clinics. These induced abortions have more complications than abortions done by doctors.
Women who live in places where abortion is illegal, or heavily
frowned upon sometimes travel to other places where an abortion can be
done legally, so they can have an abortion. This is a form of medical tourism.
Opinions about induced abortions
Induced abortion is a subject that is controversial. Each person has a system of moral values. Based on their system of morals, people have different opinions about it. Religion can also influence this opinion.
Different opinions around the world
A number of opinion polls
have been carried out around the world. They have tried to find out
what people think about abortion. Results were different for different
countries, but also varied with the questions that were asked.
In May 2005, a survey
was done in ten European countries. The people were asked, if they
could agree with the statement:
"If a woman does not want children, she
should be allowed to have an abortion". The highest level of approval
was 81% in the Czech Republic; the lowest was 47% in Poland.
A poll was done in November 2001. The poll asked people in Canada in
what circumstances they believed an abortion should be permitted.
32%
responded that they believe abortion should be legal in all
circumstances, 52% that it should be legal in certain circumstances, and
14% that it should never be legal.
A similar poll in April 2009
surveyed people in the United States about abortion; 18% said that
abortion should be "legal in all cases", 28% said that abortion should
be "legal in most cases", 28% said abortion should be "illegal in most
cases" and 16% said abortion should be "illegal in all cases".
In a Gallup poll taken in July of 2011, however, 47% of Americans
identified themselves as pro-life and the same percentage of Americans
identified themselves as pro-choice. A November 2005 poll in Mexico found that 73.4% think abortion should not be legalized while 11.2% think it should.
Of attitudes in South America, a December 2003 survey found that 30% of Argentines
thought that abortion should be allowed in Argentina "regardless of
situation", 47% that it should be allowed "under some circumstances",
and 23% that it should not be allowed "regardless of situation".
A March 2007 poll about abortion in Brazil found that 65% of Brazilians
believe that it "should not be modified", 16% that it should be
expanded "to allow abortion in other cases", 10% that abortion should be
"decriminalized", and 5% were "not sure". A July 2005 poll in Colombia
found that 65.6% said they thought that abortion should remain illegal,
26.9% that it should be made legal, and 7.5% that they were unsure.
Religious views
Many religions have a view on abortion. These views span a broad spectrum from acceptance to rejection. Most religions generally oppose abortion.
Can the embryo or fetus(baby) feel pain?
It is currently unclear from what moment the embryo or fetus can feel
pain. This is also used in the debate about abortion.
Many researchers
think that a fetus is unlikely to feel pain until after the seventh
month of pregnancy. Others disagree. At about twenty-six weeks of pregnancy, certain connections are made in the thalamus of the growing fetus.
Developmental neurobiologists suspect that these connections may be critical to perception of pain by the fetus. However, legislation has been proposed by pro-life advocates requiring abortion providers to tell a woman that the embryo or fetus may feel pain during an abortion procedure.
Researchers from the University of California, San Francisco published a study in the Journal of the American Medical Association.
The study analyzed data from dozens of medical reports and other
studies.
The researchers concluded that fetuses are unlikely to feel
pain until the third trimester of pregnancy. However a number of medical critics have since disputed these conclusions.
There are certain connections in the thalamus
of the fetuse. These connections develop at about twenty-six weeks of
pregnancy. At the end of the 20th century there was an emerging
consensus among developmental neurobiologists that these connections are very important when it comes to the perception of pain in the fetus.
Other researchers such as Anand and Fisk have challenged this late date, positing that pain can be felt around twenty weeks. Pain can have many different aspects: It might be purely relying on sensory input, but it might also involve emotions and thought.
For this reason, it is perhaps impossible to know exactlly when the embryo or fetus feels pain, even if it has developed the links in the thalamus.
How I Was Raped By A Police Officer
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A Woman identified as Gladys in one of the town in Lagos state, has shared
a sad experience on how she was allegedly raped by a Nigerian security
officer...
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