( By Dr. Vithal Prabhu )

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A cyclical bleeding through the vagina in a woman is called “menstruation.” This occurs between of the age 13 and 45 years. The beginning of the first menstruation is called “menarche” and the stopping of it is called “menopause.” Menarche could be little earlier or little later than 13 years. If it occurs between the age of 10 to 16 years, it is taken as normal.

The age of menopause also varies. It could be somewhere between the ages of 40 and 50 years, though the average age of menopause is 45 years when the menstruation stops permanantly. During the period from menarche to menopause, a woman can become pregnant and produce children and hence this period is called as “reproductive period.” Menstrustion is called “cyclical” because it recurs every month. To be exact, it occurs after every 28 days. However, there is a range of variation.

The normal range is between 21 and 35 days. During the reproductive period, the menstruation may be at a regular interval, but at menarche and menopause, the menstruation is irregular. This should not cause anxiety. It may take 2 to 3 years for the cycles to become regular after menarche. Menstruation is also known as ‘period’, ‘M.C.’, ‘Chum’, ‘Menses’ etc. The duration of bleeding during the menstruation is for two to seven days, the average being for four days. The flow is about 60 ml. in volume containing blood and mucus. It may vary from woman to woman and from time to time. During menarche and menopause, it could be profuse or scanty. This too should not cause worry.

Menstrual frequency and flow also depend upon psychological state, general health, nutrition, social status and genetics. Tension, disease or poor diet may delay the menstruation. During the reproductive period, every month the nature prepares a woman for motherhood.

Every month one single Graffian follicle (the shell that contains the ovum or egg) in the ovary becomes mature. It breaks and releases an ovum and also produces hormone called “Estrogen.” The empty shell of the follicle produces the hormone “Progesterone.” The release of the egg is called “ovulation.” The ovum is attracted in the Fallopian tube by the finger like processes called “Fimbria.” Ovulation takes place on the 14th day, counted from the first day of the last menstruation.

The hormones estrogen and progesterone are thrown into the blood circulation, reach the uterus and prepares a bed on its inner lining, called “Endometrium” for the reception and growth of the fertilized ovum. By then, if sperms enter through the vagina, they surround the ovum in the Fallopian tube. Only one sperm enters and fuses with the ovum and pregnancy occurs. This is called “Fertilization.” The fertilized ovum divides repeatedly and simultaneously travels towards the uterus, gets embeded in the bed already prepared inside the uterus and grows there. In that case the woman stops menstruating till the child is delivered.

In case the ovum is not fertilized, the preparation made in the uterus for its reception goes in vain. The blood levels of both the hormones fall down and the bed or the inner lining of the uterus, formed of blood and mucous glands tries to disintegrate. This happens because it has no function to do. This disintegrated layer of endometrium is thrown out through the vagina on 14th day after the ovulation. Though it is called vaginal bleeding, its source is uterus.

This cycle repeats every month. A new lining will be deveoped during the next menstrual cycle to receive the ovum from the next ovulation. Many girls are unaware of the menstruation and get shocked when they see the bleeding unexpectedly. Therefore, they should be given sufficient information prior to the first menstruation (menarche) and should be taught about how to use a sanitary pad. Menarche should be expected when the girls start developing breasts, hair in the armpits and on pubis, and get vaginal discharge.

Menstruation is the preparation of a woman by the nature for motherhood. How is it that the girls do not menstruate since birth? The nature does not want the babies to have babies. Therefore, the nature has designated a limited reproductive period that begins at a particular age when the girl approaches near her physical maturity. The function of the menstruation is in reality regulated by the brain, mediated through the hormones. The part at the base of the brain called hypothalamus sends messages to a pea sized gland called pituitary to release hormones (Follicle Stimulating Hormone and Luteinising Hormone) that affect the ovary to mature the Graffian follicle and undertake the process as mentioned earlier. Since this activity in the hypothalamus does not begin till the age of puberty, the girls do not have menstruation.

Why the boys do not menstruate?
They do not have a uterus. They have been given a different role to play, i.e., production and release of the male gamates, the sperms. If the menstruation begins prior to the age of 10 years or does not begin till the age of 16 years, the girl should consult the doctor. Hormonal imbalance, genetic defect, ill health, anaemia, poor nutrition or anatomical abnormality of the sex organs (small uterus, imperforate hymen) could be the cause for the delay. Some girls complain of white discharge before the commencement of the menstruation. This is normal as long as the discharge is not offensive. Menstruation is associated with pain in its initial years. This is normal.

Pain may be in the lower abdomen or in the back. It is supposed to be due to the cramps of the uterus or due to passing of blood clots through a tight cervix. If the pain is mild, the girl should involve her mind in her normal activities so as to deviate her mind. If the pain is severe, she should take rest in the bed and use a hot water bottle for fomentation. She may need for the relief of pain a tablet like Paracetamol, Mefenamic Acid, Codein; or a spasm-relieving drug like Dicyclomine. She should take the drug only as per the advice of her doctor since every drug is a double edged weapon. Some girls get nausea, feel tired or irritated just four days prior to menstruation. Some may complain of painful breasts. These complaints disappear after the onset of menstruation. No treatment is required since this is normal. Menstruation is supposed to be a curse and menstrual flow is supposed to be “bad” or “poisonous” blood. There is a myth that the shadow of a menstruating woman may dry the flowers and vitiate the food. A menstruating woman is considered to be “impure” and is supposed to stay away from religious places and religious functions. All this is far from the truth and is absolutely unscientific.

In reality, Menstruation is a boon granted by the nature only to women, for the purpose of motherhood. A woman who does not mestruate, can never become a mother. If the fertilized ovum is lodged in the endometrium, it would not have disintegrated into menstrual fluid; instead, it would have nourished the fertilized ovum. It is not “bad” blood. Every human being on the earth has grown initially on the same fluid when in mother’s womb. The fluid is as important for the human being as the soil for the seed.

There is no harm in taking bath, washing hair, or taking part in sports during menstruation. Women visit their doctor to get prescription to postpone their menstruation to enable them to attend a religious function. The doctor may prescribe progesterone (e.g., Primolut-N) which when taken twice a day, four days prior to menstruation, withholds the inner lining of the uterus (endometrium) from disintegration. Thus the menstruation can be postponed as long as the tablets are continued. This is for self satisfaction.

Whether the lining lies inside the body or is thrown out, should have no relation with the religious function. It is necessary that a rational and scientific attitude is developed towards the menstruation and a feeling of self impurity is discarded. Is it alright to have sex during the menstruation? Yes and No! If man and woman both like to have sex during menstruation, there is no harm in doing so. If any one of them feels uncomfortable and deslikes it, then it is better to avoid it.

Does orgasm in a woman release an ovum?

No. Ovulation is a cyclical process and depends upon hormonal levels, while the release of sperms by ejaculation depends upon sexual stimulation and not on hormonal levels.

Care during Menstruation:
The sanitary pads (napkins) are used inside the underwear to absorb the menstrual blood and to prevent soiling of clothes. These pads are elongated folds of cotton wool covered with absorbant material. They can be self adhesive to be stuck to panties or can be worn with a belt which comes with the pads.

There are three varieties: regular, large and extra large. The regular variety is used just before menstruation as a safety measure and when the flow is slight. The pad is to be changed every time it is full. The vulva should be cleaned with soap and water before using a fresh pad. Those who cannot afford to buy sanitary pads, should use clean soft cotton cloth folded into pads. These can be cleaned with hot water and soap, dried well, folded and reused.

The used sanitary pads should be wrapped in a paper and thrown into the dust bin. They should not be flushed into the toilet bowl, since they can block the drain. They should not be thrown on the garbage heap or in the building chowk. A tampon is also used, instead of sanitary pad to absorb the menstrual flow.

Tampon is a cyclindrical pad made of absorbant material having a thread at one end. The tempon is inserted in the vagina with its thread left outside the vulva. Tampons should be used when the flow is not heavy. It is better to use cotton panties during the period, and should be changed as often as necessary to keep them fresh and clean. It is better to keep a pad handy in the bag in anticipation of first day of the menstruation. Menopause It is the stopping of menstruation and is the end of reproductive period. It occurs usually around the age of 45 years.

The menstruation becomes irregular and the flow increases towards the approach of the menopause. This is due to aging of the ovaris which do not respond to the hormones released by the brain. Apart from pregnancy and menopause, there could be other causes for not getting menstruation. Examination tension, anaemia, tuberculosis, thyroid diseases, ill health or removal of the uterus (hysterectomy) could lead to stopping of menstruation.

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