Menstrual cycle gives information about the overall health state of an adolescent and adult female. Menstrual issues are the largest component of health disorders faced by women.

Menstruation is the shedding of the uterine lining.  It starts at the onset of puberty (around 12 – 13 years of age) and ends at menopause (47 – 52 years). It usually occurs once every 21-40 days and lasts for about 2 to 7 days.

Changes occurring at puberty

  1. Increase in height, about 25 to 30 cm, in 2 to 5 yrs. The growth spurt includes growth of legs, chest, abdomen, and growth of the bony pelvis.
  2. Increase in weight 15 to 20 kg, in 2 to 5 years.
  3. Changes in body contour.
  4. Growth and development of sex organs.
  5. Appearance of secondary sexual characters such as development of breast bud and growth of pubic hair.
  6. First menstrual period => menarche.

Terms related to menstrual flow

Menorrhagia => Excessive bleeding lasting for more than 7 days, requiring to change pads every 2 to 3 hrs, and blood loss more than 80ml

Polymenorrhagia => Frequent menstruation and increased bleeding, earlier than 20 days

Oligomenorrhea => Infrequent menstrual periods

Menometrorrhagia => Prolonged and excessive bleeding, occurring irregularly and more frequently.

When do u need to consult a Gynecologist?

If, you

  • haven’t started menstruating by 16 yrs
  • experience sudden stoppage of “periods”
  • bleed excessively, or for more days than usual
  • suddenly feel sick after using tampons
  • bleed between periods
  • have severe pain during your “periods”

Common problems of menstruation

  1. Painful menstruation or dysmenorrhea
    Most common complaint in the OPD, typically pain in the lower abdomen. Starts with the onset of flow, lasting for 1 to 2 days, it is due to uterine contractions.  It is usually associated with lower backache and pain in the inner thighs. Some women may also occasionally have associated nausea, vomiting, bloating, fluid retention, headache, diarrhea and fainting episodes.Treatment

    • Take adequate rest
    • Avoid coffee, tea
    • Drink plenty of liquids
    • Apply heat to aching site to get relief
    • Yoga and stretching exercises
    • If severe pain – pain killers under medical advice
  2. Irregular periods
    Common in the first 1 to 2 yrs after menarche and is usually anovulatory. It also occurs in 30% of women in the reproductive age group. Occurs mostly as a result of hormonal signals that have been thrown out of sync.Causes

    • Polycystic ovarian syndrome (PCOS)
    • Severe physical exertion as in athletes
    • In extreme weight loss
    • Thyroid abnormalities


    • Reduce your stress levels
    • Take time to meditate, relax, or just hang out
    • Don’t over exercise
    • Correct your eating disorder
    • Hormone supplements, in consultation with a gynecologist
  3. Menorrhagia
    Abnormally heavy and prolonged menstrual period, with blood loss greater than 80 ml or lasting longer than 7 days. It is estimated by number of tampons or pads, changed in a day. A fully soaked tampon or pad can hold about 5ml of blood.Causes

    • Pregnancy related
    • Disorders of coagulation
    • Excessive build up in endometrial lining, due to hormonal imbalance
    • Fibroids of uterus
    • Pelvic infection
    • Adenomyosis
    • Others – Obesity, Anovulation, Irregular hormone treatment


    • Consult your doctor at the earliest
    • Reduce weight
    • Lifestyle modifications
    • Treat anaemia
    • Medication with doctor’s prescription
  4. Premenstrual syndrome
    It is due to extra water content in the body. It can cause physical and behavioral changes, which starts 1 week prior to the onset of periods. Physical symptoms are headache, lethargy, tiredness, swelling or pain of the breasts, abdomen, appetite changes and frequency of urination. Behavioural symptoms like sudden mood changes; irritability, depression, hostility and anxiety can also be seen.Treatment

    • No medication is necessary, needs healthy lifestyle modification
    • Avoid salty food
    • Exercise regularly
    • Balanced diet
  5. Abnormal vaginal discharge
    Some pearly white discharge during the period of ovulation and prior to having menses is quite normal.Treatment

    • Consult a doctor if discharge is smelly, greenish or yellow colored. Also if profuse, produces itching in the genital area, and causes pain and burning while passing urine.
    • Rule out diabetes, anaemia and other sexually transmitted diseases.
  6. Urinary infection
    Frequent urination, burning sensation, itching, fever and chills are the presenting symptoms.Drink at least 8 glasses of water. Wash with water from front to back after urinating or defecating and do not hold back the urge to urinate. It is advisable to use clean cotton underwear and importantly maintain proper menstrual hygiene.

Menstrual hygiene and preventive measures

  • Goals
    • To improve the reproductive health of girls and women by increasing the accessibility, availability, affordability and acceptability of sanitary napkins and other protection materials for menstrual hygiene
  • Good hygiene is very important during menses. It helps in preventing infection, itching and bad odour
  • Take bath twice daily
  • Wear well fitting cotton panties
  • Wash hands with soap and water after using toilet
  • Wash genitalia with water after urination
  • Wash the inner sides of the thighs and the skin folds well with soap and water while bathing
  • Dry these regions well
  • Change the napkin at least 2 or 3 times a day, at every 4-6 hour interval

Pads have replaced the clothes, for good hygiene and infection free periods. Tampons and Menstrual cups are also used. Tampons have to be inserted in the vagina, but take care to change them more frequently to avoid any toxic shock syndromes. Menstrual cups are small cups which are inserted into the vagina and the blood is collected in it. They have to be emptied and washed and can be reused.

How to dispose a napkin

  • It can be disposed by burning with kerosene/spirit or discarded in the dustbin after wrapping in paper
  • They can also be disposed off in incinerators specially made for them

Apollo hospital corporate responsibility

  • Helping in manufacturing of low cost sanitary napkins through inmates of the prison.
  • By training them, good quality low cost sanitary napkins can be produced.
  • This will be a source of income to these inmates after their release from the prison.
  • This is planned and executed by Apollo Hospitals Educational and Research Foundation.

If you experience any such discomfort, get expert advice from some of the best Obstetrician & Gynecologists in India at Ask Apollo.

Contributed By:

Dr. V. Senthamil Senthil, MBBS, DNB (OBGYN)
Consultant Obstetrician & Gynaecologist
Apollo Hospitals, Greams Road, Chennai

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