Dr. Shazli Azad

Vaginal bleeding is something that most women experience between their periods when they are not due for a menstrual cycle. It is considered as an abnormal occurrence when you bleed before you are expecting your menstrual period, or after you are done with your monthly cycle. It is usually characterised by bouts of spotting where a thick brown reddish discharge may be experienced. Also, this kind of bleeding is considered abnormal if it occurs during pregnancy or menopause.

Here are a few causes of abnormal vaginal bleeding:

-  Hormones: An imbalance in the hormones like the estrogen and progesterone can lead to abnormal vaginal bleeding. These are the hormones that help in regulation of the monthly menstrual cycles. An imbalance can occur due to side effects caused by birth control pills that may not suit the individual, a contraceptive patch, or even contraceptive implants and injections. Further, an intrauterine device may also be the cause for this kind of bleeding. The hormonal balance can also get affected due to internal ailments like a dysfunctional thyroid gland and ovaries.

-  Pregnancy and Delivery: Some amount of spotting is considered normal in the first trimester of one's pregnancy. Yet, severe bleeding and persistent spotting must be reported to the gynaecologist immediately. Women also bleed for a while after the delivery of the baby, in the post-partum period. This may also happen when an abortion takes place as the uterus may not have come back to its original size and due to remaining foetal tissues within. Complications during the pregnancy like an ectopic pregnancy or a miscarriage can also lead to such kind of bleeding. An ectopic pregnancy is one where the egg gets implanted in the fallopian tube instead of entering and implanting itself in the uterus.

-  Fibroids: Uterine fibroids are usually considered as non-malignant and non-cancerous growths within the uterus. These are common in many women who have gone through child birth. These fibroids can also cause some amount of bleeding and spotting.

-  Infections: When there is an infection in the reproductive organs like the ovaries and uterus of the patient, there may be some amount of bleeding. An infection in this area can also cause inflammation, which is one of the primary causes of abnormal bleeding. This can also occur due to a sexually transmitted disease or STD, as well as painful intercourse and sexual abuse which can lead to scarring as well.

-  Cancer: One of the least common causes includes cervical, ovarian and other forms of cancer. 

Stress and diabetes can also cause abnormal vaginal bleeding in rare cases. It is best to see a doctor as soon as such bleeding takes place.
 

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 develops to be a 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 the effective precautions and seek proper medical care:

WEIGHT

Body weight is responsible for affecting the 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.'

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.

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.

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.

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.

Endometriosis is a common gynecological disorder where the tissue lining the uterus grows outside the uterine cavity. Endometriosis is caused most commonly by menstrual blood flowing back into the fallopian tubes instead of leaving the body. This endometrial tissue may then leak into the abdomen through a surgical scar or cut in the uterine lining, leading to endometriosis. Here are five things you should know about this condition.

It is hard to diagnose

The first roadblock to diagnosing endometriosis is that though it is a very common condition, there is a lack of knowledge about it. The classic symptoms include heavy periods, painful bowel movements and urination, depression, fatigue and pain all over the body. The only way to correctly diagnose endometriosis is through a laparoscopy or keyhole surgery.

Endometriosis is not equal to infertility

One of the myths surrounding endometriosis is that it causes infertility. However, this is not true. When treated properly, endometriosis does not affect your fertility, and it is still safe for you to have children. At the same time, you should also know that being pregnant does not cure the condition.

It can reduce your sex drive

One of the symptoms of endometriosis is chronic pain all over the body. This coupled with fatigue and depression can reduce your sex drive drastically. Additionally, the act of intercourse itself also becomes painful for women suffering from endometriosis. This pain can be dealt with through pain relievers, or by experimenting with positions to find the one which is most comfortable for you.
Some women have a higher risk of endometriosis

The exact cause and triggers of endometriosis are still unknown. However, certain factors are said to raise the risk of endometriosis. These are:

1. Genetics: Endometriosis may be passed genetically from generation to generation.
2. Pelvic infections: Scarring of the uterine walls via infections or surgeries can give the menstrual blood that falls back to the fallopian tubes a way out of the uterine cavity, and hence lead to endometriosis.
3. Short Menstrual cycles: Women with menstrual cycles that are shorter than 27 days, or those who have periods that last longer than 7 days are more susceptible to endometriosis than others. However, myths that suggest delayed pregnancy as one of the causes of endometriosis are false.

There is no known cure

The treatment for endometriosis addresses it many symptoms as there is no known cure for the disease itself. Even a hysterectomy will not cure this disease unless it includes the removal of your ovaries as well. Over the counter pain medication may help deal with the muscle aches, while hormonal treatments that slow down the production of estrogen can help with the painful menses. Light exercises such as walking and swimming can also help deal with the discomfort of endometriosis.

The vagina is a tube-like muscular structure of the female genital tract that extends from the cervix to the vulva. It is a delicate organ which is prone to injuries and infections.Complications related to urination, menstruation and sexual intercourse- all affect the vaginal health.

Here are five questions associated with vaginal problems that are commonly experienced but rarely discussed:

1. Why does it feel itchy before menstruation?
The hormonal cycle reduces the amount of estrogen secreted right before the period starts. This reduces the moisture content of the inner membranes of the vagina; the skin becomes thinner and slightly dry. This can cause the itching. However, if the itching and burning sensation is too severe, it could be an infection and should be checked out.

2. What is the white discharge?
The greasy white discharge is due to the ovulation cycle. It usually occurs once a month because the amount of secretion increases right before ovulation. Some women may experience this discharge more frequently but it is nothing to worry about unless there is an unpleasant odor. Odorous discharge could be a sign of bacterial infection.

3. How often should you have a vaginal examination?
You should get a vaginal examination at least once a year. This is important for a general health assessment and the prevention of sexually transmitted diseases. If you are using birth control medication, there might be irregularity in the hormonal cycles and this can lead to a number of conditions- another reason to get an annual vaginal examination.

4. Does it smell differently at different times?
It usually smells differently for every woman and even that unique smell changes with the cycles of ovulation and menstruation due to changes in the pH level of the vagina. The normal vaginal pH value is between 3.8 and 4.6. Before menstruation, it may smell acidic followed by a bitter smell for a few days after menstruation. It may also smell differently after a workout (due to sweat) or after sex (due to lubrication). However, a foul smell accompanied by discharge, might be a cause for concern.

5. Why does it feel dry sometimes?
Vaginal dryness is normally experienced by women after the age of 45 or after pregnancy. However, dryness is also common just before menstruation. It also happens in women who use anti-allergy medications or birth control pills because they cause dryness in all the mucous membranes of the body.