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Menstruation and Related Issues

menstrual cycleWhat are some basic characteristics of menstruation?

Women begin menstruation around age 11-14, and continue until menopause at about 51 years old. The monthly cycle lasts about 28 days, but may vary in length among women.

Most girls begin menstruation between the ages of 11 and 14, although younger or older cases have been recorded. The first menstrual cycle, called the menarche, represents the beginning of the reproductive years, and continues until the beginning of menopause, around the age of 51 for most women.

Varying widely from woman to woman, the typical menstrual cycle usually lasts about 28 days. This cycle may be strangely predictable for some women and highly irregular for others. In some cases this variation may be attributed to stress, diet, or rigorous exercise.
What are the stages of the menstrual cycle?

The menstrual cycle begins with the onset of menstruation, then proceeds to the proliferative phase in which the uterine lining becomes thicker and the ovaries prepare to release an egg. Ovulation occurs midway through the cycle, and results in the release of an egg into the uterus. The uterine lining then continues to develop, until the onset of menstruation at the beginning of a new cycle.

Menstruation marks the beginning of the menstrual cycle, and results in the shedding of the uterine lining, called the endometrium. This lining consists of dead and living cells, blood, and glycogen that build up throughout the cycle. Menstrual bleeding usually lasts about 5 to 7 days, and may be light, moderate or heavy. The intensity of bleeding varies throughout each day of menstruation for most women. Estrogen and progesterone levels are at their lowest points during menstruation.

Once the old lining has been shed, increasing levels of estrogen and progesterone stimulate growth of a new endometrium. Also during this time, the pituitary gland increases secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which stimulate development of ovarian follicles. This stage of the menstrual cycle is therefore called the proliferative phase. While LH and FSH levels increase steadily into the midpoint, estrogen levels peak immediately before the midpoint and begin to decline. Progesterone levels continue to increase steadily.

The sudden increase in estrogen causes levels of luteinizing hormone and follicle stimulating hormone to rise dramatically, reaching a peak at about 14 days into the menstrual cycle. This peak causes the ovarian follicle to burst at the surface of the ovary, releasing an egg into the fallopian tube – a process called ovulation. The egg then travels through the fallopian tubes to the uterus, where it dies within one day of release if not fertilized.

Once an egg has been released, the empty ovarian follicle becomes known as the corpus luteum, and begins to secrete estrogen and progesterone. These hormones cause development of the endometrium. Progesterone levels peak around day 21, causing the endometrium to reach a maximum thickness, enriched with blood vessels and glycogen. The ovarian follicle begins to regress, leading to a gradual decrease in estrogen and progesterone levels. Low levels of estrogen and progesterone then lead to the onset of menstruation, and the cycle begins again.

Which nutrients may be useful for menstruating women?

Menstruating women need adequate levels of iron and vitamin A, but should use caution before supplementing with either nutrient.

Red blood cells need iron to make hemoglobin, which in turn carries oxygen to cells throughout the body. Mild iron deficiency may therefore cause fatigue and weakness, and is surprisingly common among otherwise healthy women. Heavy menstruation, pregnancy, and failure to eat enough iron-rich foods all contribute to iron-deficiency in women.

Patients should use caution before supplementing with iron, as high levels of iron may be toxic. Even low levels of iron may cause problems for people who are not deficient. Women should therefore consult with a physician before supplementing, and stay within a low dosing range, about 25-mg of elemental iron taken several times daily.

Women may use vitamin A for prevention of excessively heavy menstrual bleeding. As an antioxidant, vitamin A may also reduce the risk for breast cancer. However, supplemental vitamin A may be harmful if used for extended periods of time. Some studies even indicate that large amounts of vitamin A during pregnancy may cause birth defects.

A less dangerous form of vitamin A, called beta carotene, is a metabolic precursor to vitamin A. Food sources of vitamin A and beta carotene include eggs, liver, dairy products, margarine, and green and yellow vegetables.

What is endometriosis?

Endometriosis occurs when the uterine lining migrates and adheres to extra-uterine places, causing inflammation and scarring. Women may or may not experience symptoms.

Endometriosis occurs when the endometrial lining, normally confined to the uterus, migrates and adheres to extra-uterine places, like the fallopian tubes, ovaries, or vagina. This misplaced tissue then continues to respond to hormonal changes, growing thicker throughout the cycle and bleeding during menstruation. The blood becomes trapped, causing congestion and inflammation in the affected area. Throughout time, this inflammation gives way to scarring and possible blockage of the fallopian tubes or ovaries.

Symptoms therefore depend on the location of the endometrial implant. Common symptoms include intense pain during menstruation, irregular bleeding in between periods, and pain during intercourse. Many women may not experience symptoms.

What are the causes and effects of endometriosis?

A cause for endometriosis has not yet been found. Women often become infertile due to endometriosis, because inflammation association with endometriosis may lead to scarring of fallopian tubes and ovaries. Endometriosis can only be detected through a surgical procedure called laparoscopy.

Some experts estimate that up to 50% of all female infertility cases are caused by endometriosis. The disease is particularly difficult to diagnose, because endometrial implants cannot be seen or felt during a routine pelvic exam. If a woman suspects endometriosis, the physician will conduct a procedure called laparoscopy, in which a fiber-optic viewing tube is inserted through a surgical incision made in the lower abdomen. This enables the physician to see scarring and endometrial tissue.

While endometriosis most commonly occurs on the ovaries or immediately around the uterus, tissue can also adhere to the intestines, the bladder, the vagina, or very rarely in the chest cavity or lungs.

Researchers do not yet know the cause of endometriosis. Risk factors include heredity, having an abnormal uterus, being of Caucasian descent, or giving birth for the first time after the age of 30.

Which nutrient/herbs may be helpful for endometriosis?

Women who suspect endometriosis may want to supplement with vitamin C, vitamin E, vitamin A, iron, fish oils, and black cohosh.

Some research indicates that conditions of oxidative stress or damage may aggravate endometriosis. Vitamins C and E are well known antioxidants, and therefore may help in endometriosis management. Vitamin A and iron have been shown to relieve the negative effects of heavy menstrual flow, and may reduce the amount of blood released from misplaced endometrial tissue. Fish oils contain large amounts of eicosapentaenoic acid, a fatty acid that has been shown to decrease inflammation associated with endometriosis.

Black cohosh has been shown to increase estrogen levels, which may delay or reduce the length of menstruation, thereby reducing the risk for inflammation outside the uterus.

What other problems may occur with menstruation?

Women may experience amenorrhea (absent menstruation), dysmenorrhea (painful menstruation), or menorrhagia (heavy menstruation).

Several common menstrual problems include amenorrhea, dysmenorrhea, and menorrhagia. Amenorrhea occurs when menstruation is absent, and may result from several factors, including pregnancy, menopause, malnutrition, and over-exercising.

Dysmenorrhea, or painful menstruation, may result from stress, ingestion of oxytocic herbs, endometriosis, and surgery. Excessively heavy menstruation, or menorrhagia, is a common condition which affects most women at some point in their lifetimes. While not significantly harmful, menorrhagia may lead to iron-deficient anemia and considerable inconvenience.

What is premenstrual syndrome?

Premenstrual syndrome causes numerous symptoms during the week before menstruation, including depression, moodiness, lower back pain, and many other possible symptoms.

Premenstrual Syndrome, or PMS, affects about 80 percent of women during their reproductive years. In fact, one out of every 10 women has severe PMS that disrupts work or school attendance.

Unfortunately, PMS complaints have often been viewed throughout history as a mere psychological over-reaction. But the possible 150 symptoms that manifest for many women in the week before menstruation are by no means imagined. In addition to the characteristic moodiness and bloating, some women experience diarrhea, lower back pain, headaches, insomnia, and many other symptoms.

What causes and/or aggravates PMS?

Researchers have not yet discovered one single cause for PMS, but possibilities include decreased hormone levels and nutritional imbalances. Stress, caffeine intake, alcohol use, and sodium consumption may aggravate PMS symptoms.

While scientists have not yet pinned down an exact cause for PMS, some possible causes include low levels or imbalance of estrogen and progesterone, low serotonin levels, decreased tryptophan levels, or nutritional imbalances. Stress, caffeine intake, alcohol use, and sodium consumption may also contribute to the severity of PMS symptoms.

Dietary and lifestyle changes, such as regular exercise and daily use of a multivitamin, may significantly reduce or prevent symptoms of PMS. Doctors usually recommend that women exercise regularly, drink plenty of water, and reduce intakes of sodium, caffeine, and alcohol. Stress management and relaxation techniques are also useful.

Which nutrients and herbs may be useful for PMS?

Women who suffer from PMS may want to supplement with calcium, vitamin D, magnesium, vitamin B6, 5-HTP, evening primrose oil, chasteberry, St. John’s wort, black cohosh, and dong quai. Women should consult with a pharmacist before supplementing.

Supplementation with calcium and vitamin D may alleviate many symptoms of PMS, which may be caused by low calcium levels due to fluctuating estrogen. Supplementing with both magnesium and vitamin B6 may reduce symptoms of PMS-related anxiety. Magnesium may also help to reduce water retention. 5-HTP helps the body to produce serotonin, and may therefore help to alleviate mood swings and irritability.

Evening primrose oil contains fatty acids, and may be useful for PMS management. Chasteberry have been shown to decrease symptoms and discomfort associated with PMS at a success rate up to 93%. St. John’s Wort may improve most symptoms of PMS, especially mood swings and depression. Also, black cohosh and dong quai may be useful for PMS, due to their estrogenic qualities.

Some women with PMS may be estrogen dominant; a determination that can be made with a simple blood test. If this is the case, many – if not most – of these women would have fewer PMS symptoms if they used natural progesterone to help balance the estrogen/progesterone ratio.

For those women considering having their ratios tested, look for a doctor who specializes in “bio-identical hormones”.

 

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