By: Dr. Sabeena Jalal
The onset of menstruation, called the menarche, usually occurs at age 12 or 13. One study, however, has indicated that girls may be starting puberty earlier than in past.
Researchers are looking for reasons for this trend toward earlier menstruation. Being overweight is a risk factor for early puberty. Some experts believe, however, that environmental estrogens found in chemicals and pesticides are major suspects.
Length Of Monthly Cycle
Periods average of 6.6 days in young girls. By the age of 21, menstrual bleeding averages six days until women approach menopause. It should be noted, however, that about 5% of healthy women menstruate less than four days and 5% menstruate more than 8 days. Thin women, particularly those who smoke, tend to have longer bleeding periods. while athletes tend to have shorter ones. Women who use oral or injected contraceptives generally have shorter periods.
Normal Absence Of Menstruation
A normal absence of periods can occur in any woman under the following circumstances.
- Menstruation stops during the duration of pregnancy. Some women continue to have irregular bleeding during the first trimester. The bleeding may indicate a threatened miscarriage and requires immediate attention from the physician.
- When women breastfeed they are unlikely to ovulate during the first eight weeks after delivery. After that time, menstruation usually resumes and they are fertile again.
- Per menopause starts when the interval between periods begins to lengthen, and it ends with menopause itself (the complete cessation of menstruation). menopause usually occurs at about age 51, although smokers often go through menopause earlier.
Common Menstrual Disorders
There are many different types of menstrual disorders with a wide variety of causes and treatment options. Some of the more common once include:
Menorrhagia( heavy menstruation)
With this disorder, the cycle interval( generally 27-32 days) is consistent from cycle to cycle. Women experiencing menorrhagia often complain of frequent pad changes.
Menstruation lasts longer than 7 days.
Menstruation interferes with a woman’s sleep pattern by forcing her to change pads or tampons in the middle of the night.
A disorder in which cycles are shorter than 25 days.
A change in menstrual flow characterized by light periods or spotting.
Spotting between periods. Women with this disorder generally have regular cycles with a predictable number of days of bleeding. However, they may experience spotting during any portion of the cycle.
Excessive menstrual cramps. With dysmenorrhea, periods may be extremely painful, causing the woman to miss days of work or confined to bed. Most women experience some cramps just prior to and during menstruation. Generally, these cramps are relieved with a heating pad or over the counter anti-inflammatory agents. Women with dysmenorrhea often experience a lifestyle change during and around the time of their menstrual flow.
Cessation of menses altogether. If a woman’s regular periods stop at any age, or a teenager fails to develop a menstrual cycle, she may have amenorrhea. The most common reason for a missed period is pregnancy, so it’s best to take a pregnancy test. Other reasons for missed periods include:
- Sudden change in weight
- Hormone irregularities
- Certain medication
- Stress or emotional trauma such as the death of a spouse or close family member.
Causes And Treatment
Menstrual flow is the result of the complex interplay of many factors that arise from the central nervous system, the pituitary gland, the ovary, the uterine muscle, and its lining. The regulation of menstrual flow is also dependent on a normally functioning clotting system. The specific evaluation of a problem for a particular woman will often depend on the duration of the problem, the age of the woman, her specific medical history, her physical exam, and her ultrasound examination. Occasionally, the cause of various menstrual abnormalities is complex. This is particularly true in the case of amenorrhea and oligomenorrhea.
Treatments of specific menstrual disorders also vary depending on a variety of factors. Oftentimes, the treatment is simple observation. Some patients require manipulation of a particular hormone or several hormones. Occasionally, surgery is necessary to remove fibroids or the uterine lining. In extreme cases, hysterectomy (removal of the uterus) may be necessary for the treatment of menorrhagia or hypermenorrhea.