Most women attain menopause between the ages of late 40s and early 60s, the average age being about 51. This is an important milestone in a women's gynecological history. One major change is altered female hormone levels, and this leads to a lot of physiological changes. From hot flashes to mood swings, there is also increased predisposition to osteoporosis and uterine cancer.

If you have not had your menstrual cycles for close to 12 months, chances are you are into menopause. So, that means absolutely no vaginal bleeding anymore whatsoever. However, if you experience bleeding, even spotting, be on the alert. It is not normal and needs to be examined, and if required, diagnosed and treated.

Postmenopausal bleeding or PMB, as it is popularly called, can be due to a variety of reasons. While it could be something as trivial as inflammation of the uterine or vaginal lining, it could also be an indication of more severe issues like cancer.

Atrophic vaginitis: Decreasing hormonal levels lead to increased dryness and therefore inflammation of the vaginal and uterine tissue. This is one of the common causes of bleeding after menopause.

Endometrial atrophy: Also caused by lower hormone levels, the lining of the body of the uterus gradually thins down and can get inflamed.
Polyps: Noncancerous growths in the uterus, cervix, vulva, or vagina can also lead to bleeding.

Infections: General infection of any area along the uterine tract could lead to occasional bleeding.

Cancers: Though only 1 in 10 PMB cases turn out to be cancers, the prognosis improves with early diagnosis and intervention.

Diagnosis: As repeated above, reach out to your doctor if you notice postmenopausal bleeding.  

Diagnostic methods could include the following:
1. Physical exam
2. Transvaginal ultrasound
3. Endometrial biopsy
4. Hysteroscopy
5. Dilatation and Curettage

Treatment: Needless to say, this would depend on the diagnosis. For very minor cases with diagnosis like altered hormone levels, no treatment may be required other than modification of the hormone replacement therapy. For endometrial atrophy and atrophic vaginitis, use of estrogen creams and pessaries would be sufficient. Polyps would require removal followed by cauterization (application of slight heat) to stop the bleeding.

Cancer: This would depend on the type and location and require a combination of chemotherapy and surgery.  Removal of the uterus also may be required in some cases. So, if you have had bleeding of any sort after a year of menopause, do not ignore it. 


Is Postmenopausal Bleeding Normal?

A collection of symptoms typically occurring between ovulation and menses (discharge of blood and from the uterus) is defined as premenstrual syndrome (PMS). Premenstrual syndrome symptoms can either be physical or emotional.

Physical symptoms and signs include:
i. Muscle or joint pain
ii. Headache
iii. Fatigue
iv. Weight gain due to fluid retention
v. Bloated abdomen
vi. Breast tenderness
vii. Acne breakouts
viii. Diarrhoea or constipation

While other behavioural and emotional symptoms include:
i. Anxiety or tension
ii. Depressed mood
iii. Crying spells
iv. Anger or irritability and mood swings
v. Food cravings and appetite changes
vi. Insomnia
vii. Social withdrawal
viii. Poor concentration

Causes 
The exact cause of PMS is unknown. But there are several contributing factors, such as:
1. Cyclic hormonal changes: The hormones oestrogen and progesterone fluctuate a lot while preparing for a normal menstrual cycle. This fluctuation causes some of the symptoms of PMS.
2. Chemical changes: The fluctuation of serotonin, a kind of neurotransmitter (brain chemical), affects the mood, which causes some of the emotional symptoms of PMS. For instance, insufficient serotonin triggers premenstrual depression, insomnia, food cravings and fatigue.
3. Depression: If the PMS symptoms are severe, depression could be the underlying cause, though it doesn't usually trigger all of the symptoms.

Treatment
There is no permanent cure for PMS, but a few lifestyle changes and home remedies can work very well for you. Some treatment options include:

1. To ease abdominal bloating, drink lots of fluids
2. Eat a balanced diet comprised of plenty of vegetables and fruits. Reduce your alcohol, caffeine, salt and sugar intake.
3. You can take supplements such as magnesium, calcium, vitamin B-6 and folic acid to reduce mood swings and cramps.
4. Take vitamin D supplements to relieve symptoms
5. Sleep for at least eight hours in the night to counter fatigue
6. Exercise to improve your emotional health and reduce bloating
7. Try to reduce your stress as much as you can; read a book or walk to relieve some stress.

Besides, these lifestyle changes, you can take over-the-counter medications such as aspirin and ibuprofen to reduce stomach cramps, muscles aches and headaches. Diuretics (drugs that increase urination) are excellent treatments for bloating and fluid retention. However, consult your doctor before consuming any medication or supplement.

Causes and Treatment of Premenstrual Syndrome

4 Types of irregular periods and their causes

Menstruation is a cyclical process when at a certain time of the month, the lining of the uterus is shed and vaginal bleeding occurs. Sometimes there can be abnormalities in this cycle. Irregular periods in women are abnormal variations in the length, volume, duration and quality of menstrual cycle. Irregular periods aren't uncommon among menstruating women.

Abnormalities in periods can be of the following nature:

- Varying time between successive periods
- Loss of more or less blood than usual
- Varying length of your periods

Based on these categorizations, the different types of periods are:

1. Irregular menstrual bleeding - Irregular menstrual bleeding is characterized by bleeding that takes place for more than 20 days in a solitary cycle, which can lengthen over a period of a year.

2. Absent menstrual bleeding - In this type of menstrual bleeding, a woman does not get her period at all within a span of 90 days.

3. Heavy menstrual bleeding - This involves excessive blood loss that may intervene with a woman's physical, psychological and social quality of life.

4. Heavy and prolonged menstrual bleeding - This is less common than heavy menstrual bleeding and is different from in terms of duration. A different type of therapy is required to treat the condition as it is more severe in nature.

5. Light menstrual bleeding - Light menstrual bleeding is characterized by less blood loss than usual.

Irregular periods can be caused due to several reasons. Some of them are:

- Switching from one birth control pill to another or taking certain medication
- Excessive exercising
- Breastfeeding or pregnancy
- Stress
- Hyperthyroidism
- Polycystic ovary disease (PCOS)
- Uterine fibroids
- Getting an IUD (intrauterine device)
- Gradual thickening of uterine lining or the development of polyps on the uterine lining
- Scarring of the lining of the uterus can also be a possible cause

Changes in the body's level of hormones can also disrupt a woman's periods. Estrogen and progesterone are the chief hormones that play a crucial part in the menstrual cycle and influence the flow as well, thereby giving rise to abnormalities if their balance is disturbed.

When it comes to treating irregular periods, modifying your lifestyle, treating the underlying issue behind an irregular cycle, changing your birth control pills (if that is the cause), opting for hormone therapy or even surgery are viable treatment options.



All about Irregular Periods : Their Types and Causes

Heavy menstrual bleeding, technically called menorrhagia, is one of the most common types of abnormal bleeding from the uterus. Menstrual bleeding is said to be heavy if there is so much blood that a tampon or pad remains soaked for several hours. 

Here are all the possible causes of heavy menstrual bleeding:
1. Hormonal imbalance
Estrogen and progesterone levels are the primary control mechanism for periods. If the ovaries have a problem in functioning, hormonal imbalances may occur. Heavy menstrual bleeding is most common in females who are at the start of menopause. Puberty menorrhagia can occur in adolescents who are experiencing their first menstrual period. 
2. Fibroids
Fibroids most commonly occur around the age when women can get pregnant. Uterine fibroids are non-cancerous growth on the uterus.
3. Ectopic pregnancy
An ectopic pregnancy is when a fertilized egg stays in the fallopian tube, but does not reach the uterus.
4. Blood thinners
These are medicines, which are usually anticoagulant or antiplatelet drugs.
5. Problems with iud
A non-hormonal intrauterine device is a t-shaped device used for birth control which is inserted into the uterus.
6. Adenomyosis
This is a condition in which the muscular wall of the uterus also gets the lining of the uterus intermingled with it. However, this condition is rare and only happens in middle aged women with several children.
7. Pid
Pid stands for pelvic inflammatory disease and refers to any infection within the organs of the reproductive system.
8. Cancer
Uterine, ovarian and cervical cancer are just some of the cancers, which may cause heavy menstrual bleeding.
9. Other diseases
Liver, kidney and thyroid diseases are all included.

Possible Causes of Heavy Menstrual Bleeding

The amount of emotional upheaval that periods, or no periods (for that matter) can cause, is something that every woman is aware of. It's normal to miss your period for different reasons occasionally, but it is a matter of concern if this absence persists over a period of time. The condition is then termed as a case of secondary amenorrhea. Although most people are quick to consider pregnancy while dealing with the various reasons for missed periods, there are a number of possibilities which are seldom mulled over, but should be considered in order to take effective precautions and seek proper medical care:

1. Weight
Body weight is responsible for affecting hypothalamus and this may, in turn, upset your menstrual cycle. BMI level under 18-19 may result in triggering irregularities since enough estrogen will not be created. This is also why underweight women, who suffer from bulimia or anorexia, tend to miss their periods frequently. 

On the other hand, overweight women may stop ovulating due to increase in the production of estrogen and therefore, have heavy, infrequent periods. Therefore, it is essential that body weight be regulated to avoid any disappointment at 'the time of the month.'

2. Stress
Any type of physical or emotional stress is bound to affect your cycle. This is because, the production of stress hormones in the body increases and an elevated level of adrenaline and cortisol may impair the functioning of the reproductive system. Under stressful situations, the body employs its amino acids to assist the neurotransmitters to produce stress hormones over sex hormones. As a consequence, the chances of missing your periods increase.

3. Exercising Too Much
While regular workout is indispensable for battling a sedentary lifestyle, overdoing it might cause your body to produce lesser estrogen and delay your periods. Women, who are into athletics and gymnastics, are more likely to suffer from amenorrhea. In fact, other aspects of over-exercising, like sleeping less, fasting, and infections also contribute to such irregularities.

4. Breastfeeding
Prolactin is the hormone that aids in milk production and may also repress ovulation for a while. Many breastfeeding moms may not get their periods for a month or more as a result. But this doesn't do away with your chances of getting pregnant. A span of three months is expected to pass before the abnormalities are done away with.

5. Food Allergies
Celiac disease or untreated gluten allergy can directly harm hormone production. They are directly related to your gut health and your adrenal glands which is why they can influence the sex hormone creation.


5 Reasons For Absent Periods

Keeping track of your cycle probably doesn't sound that interesting or important, but you can benefit a lot by doing that. There are changes that your body goes through and there are specific times when you are ovulating; knowing all these would make your life a lot easier, which is only possible by tracking your period.

1.   Know about your body: Getting your period every 28 days has always been considered normal but only 15% of women get their periods on the clock. Many factors such as stress, illness, exercise, etc. can cause delay in  your period. This is where tracking your cycle can help you find the pattern that is specific to your body condition. During your cycle there are lots of changes happening in your body. The hormones cause a change in the fluid produced from your cervix and also lead the basal temperature of your body to increase. Monitoring these changes through tracking your cycle is known as the symptothermal method. By this way you know about how fascinatingly your body works.

2.   Desire to get pregnant: Tracking your cycle will help you get pregnant. During your cycle, there is a specific time which heightens the possibility of conceiving. The fluid production from the cervix due to hormonal change is the cause of such possibility. Knowing your cycle can take out the stress from trying to get pregnant and it can also help determine any abnormalities that are preventing your pregnancy.

3. Avoid pregnancy: If you know the time when you are most likely to get pregnant through tracking, you obviously know when not to have sex, if you are trying to avoid pregnancy. Using symptothermal method for the purpose of birth control has proven to be 99.6% effective, which is higher than birth control medications.

4. Health benefits: You can reap a lot of health benefits by tracking your cycle. Conditions like fibroids, polycystic ovarian syndrome and endometriosis are quite common in women, which can be detected by tracking your period. If anything is wrong in your reproductive system, the cycle will indicate it.

4 Reasons To Keep Track Of Your Periods

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