Menstrual Cycles 101
Menstrual bleeding is the monthly shedding of the uterine lining that occurs in women from puberty to menopause. Every month, your body produces a series of hormones in a particular sequence that act to cause the uterine lining to thicken in preparation for a pregnancy, then to slough if a pregnancy has not occurred. Although they may seem like a nuisance, regular menstrual cycles represent a complex series of anatomic and physiologic changes. Regular cycles give us an outword sign that our bodies are producing an appropriate level of hormones in a balanced fashion and that our reproductive tracts are responding to those hormonal signals as they should.
The length of your menstrual cycle is determined by counting from the 1st day of bleeding in one cycle, until the first day of bleeding in the next cycle. These cycles typically vary from 21 to 35 days in length, and menstrual bleeding usually lasts between 3 and 7 days, with 5 days being an average duration. The amount of bleeding that women experience with their cycles varies, and is difficult to measure precisely, but a “normal” amount of bleeding has been estimated to be approximately 43ml per month. What? In practical terms, a “normal” amount of bleeding can result in a woman saturating between 3 and 8 tampons or pads per day.
Young women typically begin menstruating between the ages of 11 and 13 (called “menarche”) and the average age of menopause is 51 years. Over the course of her lifetime, a woman can have more than 500 menstrual cycles before she undergoes menopause. That’s a lot of periods! Menopause is defined as the absence of menstrual cycles, and is defined to have occurred when a woman has not had a cycle for 12 months. Vaginal bleeding that occurs after a woman has gone through menopause is always abnormal and needs to be evaluated by a physician to look for causes that can include cancers of the reproductive tract.
Every woman’s menstrual cycle is unique. Some women are lucky enough to have no problems with their cycles, while others can suffer with painful cramps (called dysmenorrhea) during their menses, very heavy bleeding (called menorrhagia) or irregular bleeding (metrorrhagia). Other problems that women can experience related to their menstrual cycles include mood swings that occur due to the hormonal shifts that occur during their cycles. Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD, a very severe form of PMS) are a spectrum of mood disturbances that women can experience due to fluctuating hormone levels.
For those of you who do suffer from menstrual cycle disturbances, do not despair! There are many treatment options that can help control your symptoms. The first step is to see a doctor and have a thorough history taken and physical exam performed to determine the cause of the problem. Laboratory work (blood tests) and imaging studies (such as an ultrasound) may be necessary as well.
Nutrition and exercise: good nutrition & regular exercise are important for optimal menstrual health. Being overweight can cause menstrual irregularities, and regular exercise and even small amounts of weight loss can help to regulate menstrual bleeding.
Oral contraceptive pills (OCPs) are a very effective and safe way to regulate menstrual cycles. Certain formulations have also been found to be effective in treating PMS symptoms, too. Ask your doctor about the ‘non-contraceptive’ benefits of OCPs. Progesterone pills or injections are available and can be useful in some for treating menstrual irregularities. NSAIDs (non-steroidal anti-inflammatory drugs) have been shown to decrease the amount of pain AND bleeding that occur when taken regularly during the menstrual cycle. Some anti-depressant medications can be used to treat PMS symptoms effectively.
The Mirena IUS (intra-uterine system) is a contraceptive device, that is placed inside the uterine cavity by your provider. It contains the hormone levonorgestrel that is slowly released within the uterus and the hormone acts to thin the lining of the uterus over time, resulting in less menstrual blood loss and less cramping for many patients.
There are both minor and major surgical options that can be considered for patients with heavy or irregular bleeding who have completed their childbearing. An endometrial ablation, such as Novasure is a very safe, minimally invasive procedure that can be done in the office or in the operating room that can result in greatly diminished bleeding or in cessation of uterine bleeding for some. Uterine fibroid embolization (UFE) is a minimally invasive procedure performed by specialized radiologists that can be effective in treating certain patients who suffer from uterine fibroids, a common cause of irregular bleeding in women.Myomectomy
A myomectomy is a surgery for patients who suffer from fibroids, wherein only the fibroids are removed, but the uterus remains in place. It is most often chosen for patients who still wish to have children in the future.Hysterectomy
Hysterectomy is a major surgery in which the uterus is removed. Deciding to have a hysterectomy is a big decision. Your doctor will be able to answer questions about what the options are for removing or leaving your cervix (the lowermost portion of the uterus) at the time of the surgery, and about whether or not to remove your ovaries at the time of surgery. Factors such as your age, your family history of certain types of cancers, the reason you are having your hysterectomy are all important considerations to look at in deciding whether or not to have your ovaries removed at the time of surgery.
Talk to your doctor about which option is best for you. Hysterectomies can be performed via several routes, including trans-vaginal and laparoscopic which have much faster recovery times than traditional hysterectomies where a big incision is made on the abdomen. Talk to your doctor about what type of hysterectomy is best for you.