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Live Q&A on Irregular Periods

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On 26th October 2018, Cloudnine launched a Facebook Live on Irregular Periods on its Facebook page @CloudnineCare. It was led by Dr. Manjula Deepak, Obstetrician & Gynaecologist at Cloudnine Hospital, HRBR Layout, Bangalore, and Swathi Kulkarni, Co-founder, Nua. The forum, conducted in a question-and-answer format, cast a spotlight on various aspects of irregular menstruation. Excerpts are included below.

Specialist Details: Dr. Manjula Deepak

Specialty: Obstetrics & Gynaecology

Clinical Focus and Expertise: Infertility evaluation, infertility treatment, high-risk pregnancy care, breast care, hysterectomy, laparoscopy, sexual health, reproductive medicine

Live Introduction

Periods are often considered a pain point, and irregular periods, even more so. Traumatising as they are, irregular periods are very common – and can start at any age, from puberty through to menopause. Menstruation is not just governed by the uterus. It is achieved via a synchrony of 5 different organs, from the brain to the vagina. When all of these work in harmony, menstruation occurs in a normal manner. However, factors like stress and cancer can hamper this process.

Menstruation should not be perceived as an inconvenience, but rather as a gift of nature that enables the circle of life.

A normal menstrual cycle is approximately 28 days, plus or minus 7 days, and bleeding usually lasts between 2 to 7 days. The amount of blood lost varies from woman to woman. Losing up to 80 ml of blood is considered normal, as is the appearance of blood clots on the first day.

Live Questions & Answers

Q1. Is it normal to have a 1.5-month period cycle?

The length of a period cycle typically hinges on age. It is perfectly normal for a young girl who has just attained puberty to observe abnormal cycles for the first 2 years. This is because hormonal glands still need time to attain maturity. In such cases, where the hormonal equilibrium isn’t yet formed, bleeding can occur once every 2-3 months, and can be very heavy. If you identify with this, observe your menstrual cycle for 2 years. If you have 3 consecutive 60-day cycles, consult a doctor.

Q2. Some period cycles are heavy, while others are light. Is this normal?

Periods are dependent on a range of environmental, emotional and physical factors. So, some months, you may observe prolonged bleeding, especially when you’ve had a delayed menstrual cycle. If you see prolonged bleeding for more than 14 days straight, please see a doctor.

Q3. Is leg pain before periods normal?

Yes, it is. Each woman has a different threshold for pain. While some women are able to handle it well, others throw up, have weakness or feel tired. Leg pain usually manifests as pain in the calf muscles, or a persistent pain from the hip to the toe. Leg pain is mainly caused by a deficiency of vitamin D3 and can be corrected through the right supplements.

Q4. I have polycystic ovarian syndrome (PCOS) and have noticed clots in my periods. What should I do?

In PCOS, high oestrogen levels impede ovulation, leading to anovulatory cycles. Generally when you ovulate, your uterus receives a signal on when to bleed. However, in anovulatory cycles, the uterus fails to receive these signals and continues to collect blood, in turn, developing a very thick lining. When you do eventually menstruate, the endometrial walls shed so much that sometimes, flesh comes out along with the blood, causing a significant amount of pain. Treatment for PCOS typically entails lifestyle modifications. Consult a doctor for guidance.

Q5. Does the term ‘irregular periods’ refer only to absent periods, or also to the reduced flow or duration of one’s monthly bleeding?

There are 8 types of irregular periods, all of which require medical intervention:

  • Amenorrhoea: Delayed puberty or when a woman has not bled for a period of six months after her first menstrual cycle
  • Menorrhagia:  Abnormally heavy periods  
  • Hypomenorrhoea: Bleeding of only one day in every menstrual cycle
  • Polymenorrhoea: Heavy menstrual cycles spaced less than 21 days apart
  • Intermenstrual bleeding: Bleeding or spotting between periods
  • Postcoital bleeding: Bleeding post-sexual activity
  • Postmenopausal bleeding: Bleeding after menopause

Q6. Will conception be an issue with irregular periods?

Regular periods are not a barometer of fertility. Infertility can occur even if both the man and the woman are perfectly healthy. Likewise, irregular periods need not mean that you are unfit for pregnancy. Having irregular periods is fine, but noting how irregular the periods are is very important.

Q7. I have had 2 C-section surgeries, and have also had to get one fallopian tube surgically removed – all this, despite having had regular periods my entire life. I have also observed that my periods become irregular if I have not been eating healthy or exercising regularly. Is this normal?

Between puberty and menopause, our bodies are governed by a reproductive graph. During this time, factors like childbirth and breastfeeding cause large shifts in hormone levels. Pregnancy, for instance, causes the pituitary glands to work harder than normal and also elevates endorphin levels. All these factors have an impact on the uterus, leading to irregular periods.

Q8. Are mood swings during premenstrual syndrome (PMS) normal?

Mood swings are very common during PMS, especially in the age band of 30 to 40. PMS is primarily triggered by mental stress, which causes a hormonal imbalance. In rare cases, it could lead to depression.

Q9. How do ovarian cysts affect periods?

Polycystic ovaries impede ovulation due to significantly low amounts of oestrogen in the body. This in turn, leads to irregular periods and often, infertility. Breaking this cycle is very important.

Q10. Can fibroids cause irregular periods?

Fibroids are muscular bumps or eruptions that sometimes appear inside the uterus. Women between 30 and 40 years of age are most susceptible to them. There are 3 types of fibroids. Depending on where they are and how they are, the symptoms vary. Small fibroids can be especially dangerous, and cause significant bleeding. They can grow up to 12 cm in length. Fibroids can be detected via an ultrasound scan, and can be removed.

Q11. My sister-in-law is on thyroid medication and is experiencing irregular periods. Is there a correlation?

Thyroid disorder can affect the pituitary gland, and consequently derail periods. The thyroid gland secretes a hormone called thyroid stimulating hormone, or TSH. When you have hyper or hypothyroid issues, the hormones responsible for the ovulatory mechanism are disturbed. So, if you treat your thyroid levels, you can also treat your ovaries, and hence start ovulating regularly again.

Q12. How do I know if I have a uterine fibroid?

Irregular periods are a symptom of uterine fibroids. An ultrasound scan is the only way to definitively detect a fibroid.

Q13. I was 9 when I got my first period. I am now 23 and suffer from a lot of period pain. I take at least 2-3 tablets a day. Will this affect my future pregnancies? How long do I have to go through this?

The attainment of menopause depends on your genetics. If you have attained early puberty, you most likely will attain early menopause as well. Hormonal and uterine changes can cause painful menstrual cycles. Take heart in knowing that pain-relief tablets will not have any effect on future pregnancies.

Q14. I have regular periods but a light flow. Is this normal?

This is totally normal, as long as you get your periods every 21-35 days.

Q15. What are the factors one should consider when purchasing menstrual products?

Pick products that are chemical-free. Also, make sure the surface of the product is soft and smooth, has no perfume, and is clean. Bigger pads are ideal for a heavy flow and medium-sized ones, for a lighter flow.

Q16. How often should one change a pad?

About every 6-8 hours. Menstrual hygiene is very important because any rough or toxic products can lead to rashes. They can also cause a lot of discomfort. Changing pads once every 6 hours is a hygienic practice, unless you experience a very heavy flow, in which case you may want to wind down this window.

Q17. Do birth control pills impact periods? Are they more effective than condoms and copper-Ts?

Oral contraceptive pills can affect period regularity, and give rise to anovulation. You may also notice the duration and flow of your period reducing. However, contraceptive pills are also advantageous because they reduce the occurrence of breast and ovarian cysts. Copper-Ts are excellent contraceptive devices. However, the body recognises a copper-T as a foreign body and in turn, compromises hormone production. It is not uncommon for you to experience irregular or heavy cycles in the first 3-6 months of having one inserted.

Q18. How soon can one start trying to conceive after an abortion or miscarriage?

In post-abortion cases, it is advisable to wait for at least 3 months before trying to conceive again.

Q19. Can excessive exercise reduce period flow?

When you over exercise and lose an inordinate amount of weight, you lose a lot of oestrogen. This can reduce your period flow.

Q20. Can iPill be used as a contraceptive?

iPill should never be used as a contraceptive. There are many alternative tablets you can take as contraceptives.

Q21. How does one know if she is ovulating?

Follicular scans can shed light on whether you are ovulating.

Q22. What tablet should one take for painful periods?

Brufen (we start this as a non-steroidal drug), Meftal Spas, Drotin-M and Cyclopam are some options.

Q23. I have regular periods, but I have 40-day cycles. Is this a cause for concern?

You have nothing to worry about. Regular cycles of 40-45 days is normal.

Q24. How can one make periods less stressful?

Try to stay calm, take things easy, don’t burden yourself with stress over periods. Share your pain with your near and dear ones and stay positive. Eat well and exercise well. Pain is usually caused by cervical expansions. A happy and healthy life with plenty of exercise and outdoor activity is a proven formula for reduced pain.

Q25. Can I exercise during my periods?

Yes! You can exercise during your periods, but it’s best to avoid sexual activity in the first 3 days. This is because sexual activity can push menstrual fluid back inside the uterus, causing a retrograde menstrual flow into the endometrial cavity. This can lead to endometriotic cysts. Other than this, no other normal activity will affect your cycle.

If you found this article interesting and would like to know more, talk to a Cloudnine expert today!

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