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?

7 causes of heavy menstrual bleeding you must know about

Heavy menstrual bleeding, also known as Menorrhagia, refers to the state of abnormally heavy bleeding during periods. It's common for women at the premenopausal stage of their life to experience heavy bleeding during periods; but if you are not among them, heavy menstrual bleeding is a matter of severe concern.

If you normally lose a lot of blood during your periods or experience severe cramps that prevent you from leading your normal lifestyle, you must first identify the cause of it.

Here are some of the most common conditions that are responsible for causing Menorrhagia.

Disturbed hormonal balance: Menstruation involves the shedding of the lining of the uterus (endometrium), whose build-up is generally controlled by the balance between oestrogen and progesterone, the two significant hormones of your body. It sometimes happens that there is excess endometrium generation due to disturbed hormonal balance, which results in heavy menstrual bleeding.

Polyps: Sometimes heavy menstrual bleeding occurs due to the occurrence of uterine polyps, which are tiny growths appearing on the uterus lining. This condition is mostly prevalent among women of child-bearing age caused due to raised levels of hormones.

Intrauterine device (IUD): People who use birth control methods like intrauterine device or IUD are likely to experience certain side effects which include heavy menstrual bleeding. If the cause behind your menorrhagia is an IUD, you might need to remove it to get relief from the condition.

Pregnancy complications: If you experience your period later than usual and it is associated with excessive bleeding, it may be caused by a miscarriage. Moreover, you might also experience menorrhagia incase of an ectopic pregnancy, a condition when the fertilized egg is implanted within the fallopian tube in place of the uterus.

Uterine fibroids: Women of reproductive age may develop noncancerous (benign) tumours in the uterus known as uterine fibroids. These fibroids can be responsible for giving you periods lasting longer than usual accompanied with excessive bleeding.

Cancer: Though it is a rare case, sometimes the reason behind heavy menstrual bleeding may be uterine cancer, cervical cancer or ovarian cancer.

Medications: consumption of certain prescription drugs such as anticoagulants and anti-inflammatory medicines may lead to prolonged or excessive menstrual bleeding.





7 Causes of Heavy Menstrual Bleeding You Must Know About

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

Missing out on your periods or irregular periods once in a while is common. However, the problem arises when irregular periods become every month s story. The irregularity can be an amalgamation of a host of factors. Ignoring the same for long will only complicate things further. For women of reproductive age, the problem can give rise to deleterious consequences, including difficulties in conceiving. In this article, we will discuss some of the common triggers that result in irregular periods and when to seek medical help.

What causes Irregular Periods?
The hormonal balance plays a significant role in the proper functioning of the vital organs of the body. More than often, irregular periods are found to be a manifestation of hormonal imbalance. Some of the conditions that trigger the hormonal imbalance include

PCO is a common medical condition that affects women of reproductive age. PCOS is characterized by the formation of cysts in the ovary (one or both) that affects the ovulation process. In PCOS, there is an increased production of Androgen, especially Testosterone that can cause irregular periods, hair fall, facial hair, weight gain etc.

Time and again doctors and health professionals emphasize the importance of leading a stress-free life. Research suggests stress and anxiety often interfere with the functioning of the Hypothalamus. As a result, the pituitary glands that control and regulate the activities of the ovaries, adrenal glands, and thyroid glands may be affected. These can also trigger a hormonal imbalance giving rise to menstrual problems such as Irregular periods. In case of extreme stress, there may be a short-term cessation of periods (Secondary Amenorrhea).

The hormonal imbalance and irregular periods can also be an outcome of other medical conditions such as endometriosis, a cancer affecting the reproductive organs, fibroids, obesity, diabetes, hyperprolactinemia (characterized by elevated level of prolactin) or even thyroid disorders.

Women who indulge in strict dieting can also suffer from irregular periods. Strict dieting (especially the ones that are without a proper nutritional guidance) can rob the body of the essential nutrients disrupting the hormonal balance.

Irregular periods are normal in women who are nearing their menopause.

When to seek medical assistance?
Irregular periods can be indicative of a severe health problem. Consult a gynecologist

If your regular cycles get delayed by more than 7 days.

There is spotting or bleeding in between the periods.

Your periods last for more than ten days or less than two days.

There is excruciating pain during periods.

The gap between two successive menstrual cycles is more than 35 days or less than 21 days.

Your periods are heavy and unmanageable, affecting your daily routine.

Irregular Periods - When To See A Gynaecologist?

Periods, on their own, can be very uncomfortable but sometimes it can also trigger a rash making it all the more uncomfortable. This is a common problem faced by women who use commercial pads or sanitary napkins during this period. This is because they contain plastics, scents and chemicals that can irritate the sensitive skin in your genital area. Here are a few tips to help you deal with these rashes:

Change Your Pads Regularly: Whether your flow is light or heavy, the same pad should not be worn for more than 4 to 6 hours. Change your pads even if your pad does not look full once this time has passed. Along with menstrual blood, sanitary napkins also soak up sweat and bacteria. The groyne area is naturally moist and warmer than the rest of your body making it the ideal condition for bacteria to grow. Changing your pad regularly keeps these bacteria from multiplying.

Consider Alternatives: One of the main reasons pads cause rashes is because they rub against the skin and this friction irritates the skin. Hence, consider alternatives like tampons and menstrual cups that do not rub against the skin. You could also try cloth pads made using natural unbleached cotton.

Wear Right Underwear: Avoid synthetic underwear and use the only cotton while you are on your periods. This allows the skin to breathe and keeps moisture from building up inside the underwear. Also, ensure that your underwear fits well and can hold your pad in place.

Clean Well: Do not use wipes or tissue to clean your genital area but instead wash gently with water a few times a day. Once washed, dry the skin thoroughly before putting your underwear on. Do not use any type of soap, body wash or scents in the area. Also, avoid bubble baths and saunas.

See a Doctor: In some cases, a rash can also be a symptom of herpes or a vaginal yeast infection. If you alternate between pads and tampons, a rash could also be a sign of toxic shock syndrome. Hence, if the rash persists for a few days, consult a doctor. Your doctor can prescribe a topical cream to be used to relieve the itchiness and inflammation depending on the rash. You could also use an anti-chafing cream on your bikini line. Diaper rash cream is an over the counter cream that usually works well in such cases.

How To Deal With Rashes Due To Periods?

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

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