Menarche and Menopause (Age of first and last period)
Menarche (the onset of menstruation or first period) occurs most often in girls aged from 11 to 14. First period usually occurs a year or two before the appearance of other puberty related changes, such as pubic/underarm hair growth&breast development. Various factors like genetic and social influences, as well as a girl’s size and weight, her ethnicity can influence when menarche occurs. Girls with a lower body mass index (BMI) are likely to begin getting periods later than those with higher BMI scores. Girls who are more physically active (like athletes) tend to have slightly delayed menarche.
According to research,during the last century the average age of menarche has fallen. This can be attributed to a number of factors including improved diet, better healthcare, which contributed towards higher BMI and possibly the increase in oestrogen-like substances in the environment (e.g.plastics&pesticides). Recent studies suggest that the age of menarche is often slightly reduced in girls who are subject to emotional stressors.
It is recommended that if a young woman has not had her period until she is 16, she should consult a gynecologist to ensure that she does not have a medical condition that is preventing menstruation to start.
When young women first start menstruating, they are not fertile as they are often anovulatory (not ovulating). However, it is important for sexually active young women to remember that pregnancy can occur as soon as they start menstruating. Therefore, if they wish to avoid becoming pregnant, they should use contraception.
At other life stages also,Menstruation without ovulation can occur such as before menopause. Typically Menopause, the ending of periods, occurs in women who are in their late 40s or early 50s.
In the time leading up to menopause, the menstrual cycle and/or flow may change, becoming heavier, longer or even lighter. While irregular bleeding is also common at this time, it can be a symptom of gynecological cancer so women experiencing this should consult their gynecologist to rule out any other medical issue. Even though women may be unsure as to whether they are ovulating prior to menopause, if pregnancy wants to be avoided, contraception still needs to be used.
Some women avoid sexual activity when they have their period due to various reasons that can be personal, religious or cultural. However, there are few physical reasons why sex should be avoided during menstruation. One consideration is that having unprotected sex during menstruation have higher risk of transmitting blood-borne infections such as hepatitis C and HIV. If women have unprotected sex during menstruation, possibility of pregnancy is also there.
The Pill, contains synthetic estrogen to prevent the development of an egg (and therefore, prevents ovulation), and synthetic progesterone to increase the thickness of cervical mucus (to slow the movement of sperm) and prevent the complete development of the uterine lining to prevent conception.
Women who do not ovulate do not experience ovulation pain or changes in cervical mucus. Rather than a natural menstruation their ‘period’ is actually a withdrawal bleed resulting from the stopping of the synthetic hormones (during the seven days of inactive/sugar pills).
Women taking the Pill can use it to delay or miss a withdrawal bleed. This can be convenient for women on special occasions or planning travel. Women who experience health problems such as menstrual migraine,endometriosis and heavy bleeding may use the Pill to reduce the number of withdrawal bleeds they have a year (and, therefore, the number of times they experience symptoms).
Particularly In the first few months of taking the pill, breakthrough bleeding can sometimes occur in women. A woman If she has not missed any active pills and has a breakthrough bleed. However, she should consult her gynecologist to review the choice of Pill and to ensure the bleeding is not related to another condition.
Periods doesn’t start immediately after childbirth, this is because the hormone that stimulates milk production, prolactin also inhibits ovulation and the return of menstruation. The length of time before a woman’s period returns following pregnancy largely depends on whether she is breastfeeding or not. Therefore, women who are exclusively breastfeeding may not have a period for several months after childbirth or until they finish breastfeeding. The return of menstruation in breastfeeding mothers depends upon the duration&the frequency of breastfeeds a day.
Those women who are not breastfeeding or combining breastfeeding with bottle feeding, menstruation can return as soon as five-to-six weeks after childbirth. It is important to be aware that women will ovulate, and therefore be fertile, before the return of their first period following delivery/breastfeeding. It is also important to note that even though breastfeeding can delay the return of periods, it is not a reliable form of contraception.
Menstrual problems painful periods, heavy bleeding, bleeding between periods, absence of periods and premenstrual syndrome (PMS)are common.
Except pregnancy, amenorrhea is usually due to hormonal disturbances. These disturbances can be caused by various factors including weight loss or gain (body fat percentage and body weight are directly related to menstruation), being chronically underweight , over-exercising, extreme emotion (good or bad), anxiety or stress, dietary changes, traveland medical conditions such as polycystic ovarian syndrome . Often, amenorrhea is temporary with menstrual periods returning in time. Women who are not pregnant and do not have period for longer than six months should consult their gynecologist.
While some women have only mild discomfort when they have their period, other women suffer from severe, unbearable pain. This kind of pain should not considered normal and women should consult their gynecologist if the pain they experience interferes with their ability to lead normal day to day life.
Women might get pain even a few days before their period or just during the first few days of periods. The pain can be a cramping-type pain, caused by the contraction of the uterine muscles or a heavy dragging pain in the pelvic region. Pain in the legs and back, headaches, constipation, diarrhea and nausea are also common.
Period pain can be the result of prostaglandins, the substance which causes the uterus to contract during a period. Severe period pain might also signal the presence of conditions such as endometriosis or pelvic inflammatory disease. Popular remedies for mild pain include analgesics, herbal medicines, warm baths, heat packs, gentle exercise and proper rest. In treatment for more severe period pain includes the use of antiprostaglandins and oral contraceptives is also effective. If women do not find relief with these treatments they should consult their gynecologist.
Since it is hard to measure the amount of menstrual fluid lost, it is not possible to define what constitutes heavy bleeding. However, the degree to which a woman’s period interferes with her day to day life can provide a guide (e.g., having to change a pad or tampon every hour can indicate that bleeding is heavy).
Menorrhagia can be caused by a number of factors including hormonal imbalances, fibroids, endometriosis,polyps or less commonly, bleeding disorders. Excessive blood loss through heavy periods can lead to anemia. The Pill and/or antiprostaglandins can be used to treat heavy bleeding. Other treatment options include inserting a Mirena intra-uterine device (IUD), or undergoing endometrial ablation (a procedure that causes the destruction of the uterine lining)..
Bleeding or spotting between periods can be a symptom of a number of conditions like sexually transmitted infections, endometriosis, fibroids, thyroid disorder or gynecological cancer. It can also be a side effect of medications or some contraceptives. If a woman experiences bleeding between periods she should consult her gynecologist.
Premenstrual syndrome (PMS) refers to any symptom or symptoms, women experience before every period. Physical signs of PMS include fluid retention, tender or lumpy breasts, bloating, headaches andfood cravings. Psychological signs include mood swings, feelings of anxiety, sadness and anger. Women who suffer from mild premenstrual syndrome might find exercise, dietary changes, yoga herbal remedies & relaxation techniques useful.
A small percentage of women experience a severe form of PMS called premenstrual dysphoric disorder (PMDD). Women with PMDD experience symptoms so severe that they greatly impact their day to day functioning. Treatments for PMDD include lifestyle changes, the Pill, cognitive behavioral therapy, and, if other treatments are unsuccessful, a type of antidepressant known as selective serotonin-reuptake inhibitor (SSRI) may be prescribed.
About half of all women who suffer from migraine can clearly connect at least some of their attacks to their periods. Some women have migraine attacks only due to their period, not at other times of month. The drop in estrogen that occurs just before a woman has a period, is a major factor considered to trigger migraine Women who think their migraines may be related to their menstrual cycle are recommended to keep a diary tracking their menstrual cycle and migraine attacks for three months to show to their Gynecologist to give a clear picture.
- Ojeda, L. (1983).Exclusively Female: A Nutrition Guide for Better Menstrual Health. Claremont: Hunter House, pp2-3
- Boston Women’s Health Collective. (1998).Our Bodies, Ourselves: For the New Century. New York: Touchstone, p276
- Weshler, T. (1995).Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control and Pregnancy Achievement. New York: HarperCollins, p58
- Billings, E. &Westmore, A. (1992).The Billings Method: Controlling Fertility Without Drugs or Devices. South Yarra: Ann O’Donovan, pp21-22
- Boston Women’s Health Collective., op. cit., p278
- Grimwade, J. (1995).The Body of Knowledge: Everything You Need to Know About the Female Cycle. Melbourne: William Heinemann, pp21-2
- Karapanou, O. & Papadimitriou, A. (2010). Determinants of Menarche.Reproductive Biology and Endocrinology 2010 (8): 115
- Ojeda, L., op. cit. p11-12
- Sloboda, D. M., Hart, R., Doherty, D.A., Pennell, C.E., & Hickey, M. (2007). Age at Menarche: Influences of Prenatal and Postnatal Growth.The Journal of Clinical Endocrinology and Metabolism92(1):46-50.
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