Hormonal Imbalance series: Understanding Menstrual Cycle & Sex Hormones Function

1.      Understanding Menstrual Cycle and Sex Hormones Function

The Myths and The Facts About Menstruation

Menstruation is also known by the terms menses, menstrual period or period.  Menstruation is the monthly shedding of the lining of a women’s uterus (more commonly known as the womb). The menstrual blood—which is partly blood and partly tissue from the inside of the uterus—flows from the uterus through the cervix and out of the body through the vagina.

Some people refer menses as a women’s good friend as it is expected to revisit monthly without fail.  It is also regarded as a symbol of ‘womenness” and reproduction, without it women become less of a woman and incapable of childbearing which to some extent from a scientific point of view, it is a fact. Interestingly, many women regardless of their cultural and education background believe that menstrual period is a way that body eliminates dirty blood or bad element in their body monthly. Failing to have their monthly menstrual bleeding, it will make them unwell.  For Muslim women and the Jews , having menstrual period means a holiday from all religious rituals and sexual intercourse as women during this period are regarded as in the state of ‘spiritually unclean’.

Many women do not know when it is considered normal menstrual blood loss and when it is not. Some women believe that heavier menstrual blood loss and longer days is better than less as dirtier element or blood is flushed out from the body. There are a number of women who are concern about the color and thickness of the menstrual blood as they fear it may be associated with some disease.

Phases of a normal menstrual cycle and it significance

Girls starting menstruation simply mean they are entering into the reproductive phase of life where their reproductive system is now begin to function preparing their body for a possibility of pregnancy each month. Most girls start menstruating at the age of 12, however, girls can begin menstruating as early as 8 years of age or as late as 16 years of age. The menstrual cycle is controlled by the rise and fall of hormones, namely oestrogen, progesterone from the ovaries, and hormones from the hypothalamus and the pituitary in the brain.  A normal menstrual cycle has 4 phases.

The menses phase —the bleeding phase, which typically lasts from day 1 to day 5, is the time when the lining of the uterus is actually shed out through the vagina if pregnancy has not occurred. Most women bleed for 3 to 5 days, but a period lasting only 2 days to as many as 7 days is still considered normal. Menstrual blood loss more than 80 mls percycle is considered excessive and abnormal.

The follicular phase —this phase typically takes place from days 6 to 14. During this time, the level of the hormone estrogen rises, which causes the lining of the uterus (called the endometrium) to grow and thicken. In addition, another hormone—follicle-stimulating hormone—causes follicles in the ovaries to grow. During days 10 to 14, only one of the developing follicles will form a fully mature egg (ovum).

Ovulation —the fertile phase - this phase occurs roughly at about day 14 in a 28-day menstrual cycle. A sudden increase in another hormone—luteinizing hormone—causes the ovary to release its egg. This event is called ovulation. Some women may experience a sharp pain during mid-cycle due to ovulation.

The luteal phase —this phase lasts from about day 15 to day 28. After the egg is released from the ovary it begins to travel through the fallopian tubes to the uterus. The level of the hormone progesterone rises to help prepare the uterine lining for pregnancy. If the egg becomes fertilized by a sperm and attaches itself to the uterine wall, the woman becomes pregnant. If pregnancy does not occur, estrogen and progesterone levels drop and the thickened lining of the uterus is shed during the menstrual period.

A menstrual cycle calendar is considered to begin on the first day of a period. The average cycle is 28 days long; however, a cycle can range in length from 21 days to about 35 days. Women stop menstruating at menopause, which occurs at about the age of 50. At menopause, a woman stops producing eggs (stops ovulating) and can no longer become pregnant, the body stops preparing the uterus for a possibly pregnancy, and the monthly menses stops.

What is pre-menstrual syndrome?

Due to the changes in the level of sex hormones particularly progesterone level, it is common that women experience the following symptoms:

• Moodiness
• Trouble sleeping
• Food cravings
• Development of cramps
• Bloating
• Tenderness in the breasts
• Light headaches

What is Abnormal Menstruation and Terms used?

Abnormal menstruation is simply means the menstruation that does not follow the order or normal menstrual cycle and may spell a symptom of disease affecting women’s reproductive system.  There are many conditions of abnormal menstruation and it is often referred to using specific medical term as the following:

Menorrhagia ─ heavy menstrual bleeding every month of more than 80 mls per cycle.  If it is not corrected it commonly cause chronic iron deficiency anaemia in women

Dysmenorrhoea ─ severe menstrual pain just before the menstrual begin and usually subsided one or two days after.  Most of the time it is physiological but it is often associated with endometriosis and other uterine pathology

Polymenorrhoea─ frequent period of more than once a month.

Oligomenorrhoea─scanty period or infrequent period of less than 6 times per year.  This is one of the common symptom of polycystic ovarian syndrome in women.

Menometorrhagia haemorhagica─erratic menstrual bleeding and usually very heavy with blood clots and flooding.

Menstrual Calender

It is indeed a good habit to keep record on detail of your period every month on a calendar. Pay attention on the date when the period starts, the pain ─ how severe and how long it last, and the menstrual flow─how heavy it is. Keeping menstrual calendar helps early detection of menstrual abnormality and helps you with pregnancy planning.

When do you need to contact your gynae doctor?

Contact your doctor if:

·         You have not started menstruating by the age of 16

·         You are bleeding between period

·         You are bleeding for more days than usual

·         You are bleeding more heavily than usual

·         You have severe pain during your period

·         You have bleeding after sex

·         You are bleeding after menopause

·         Your period interval is more than 35 days or shorter than 21 days

·         You think you might be pregnant