The Menstrual Cycle

Most women begin to menstruate between 11 and 13 years of age and continue until they reach menopause some 40 years later. Although the "normal" cycle is 28 days, there is no cause for concern if periods are spaced 25 to 34 days apart, since precise regularity is rare. During the "typical" 3-to-5 day menstrual period, the average woman loses less than 2 ounces of blood.

The first menstrual period separates childhood from adolescence. Along with breast enlargement and the growth of pubic hair, it signals a young womans sexual maturity. This monthly vaginal discharge of blood, secretions, and cells from the surface of the uterus is the final step in a complex cycle that prepares the body to conceive a child.

Each cycle begins when, responding to a cascade of hormones, a dormant egg cell within one of the ovaries begins to ripen. Cells around the maturing egg release the female hormone estrogen, prompting the lining of the uterus (the endometrium) to thicken in preparation for receipt of a fertilized egg.

When it reaches maturity, the developing egg bursts from the ovary and begins its trip down the fallopian tube to the uterus in a process called ovulation. The supporting cells left behind after ovulation then begin to manufacture another hormone, progesterone, in addition to estrogen. This second hormone fosters further growth in the lining of the uterus.

If fertilization does not take place, the ovum dies and production of estrogen and progesterone stops. Robbed of its sustaining hormones, the thickened lining of the uterus begins to break down. The dead endometrial cells, along with a little blood, are then discharged in the menstrual flow.

Normal menstruation depends on the delicate orchestration of the hormones that govern development of the egg. The menstrual cycle can also be affected by disease, diet, emotions, and defective development of the reproductive organs.

Heavy Bleeding

Occasionally menstrual flow seems heavier than usual, or a period lasts longer than normal. In general, there is little cause for concern unless you find it necessary to use at least two extra sanitary pads or tampons a day. That means you have lost almost 3 ounces of blood over the course of a period. You should also see your doctor if a period lasts more than seven days, or two periods are spaced less than 21 days apart. Heavy or lengthy uterine bleeding occurring at regular intervals is usually a sign of an underlying physical problem.

When you go to the doctor, he or she will want to know about the frequency and amount of the bleeding, whether its accompanied by pain or blood clots, what type of contraception you use, and whether you bruise easily or bleed often from places other than the uterus. The doctor will also do a number of tests. Urine and stool testing can detect possible problems in the urinary tract, stomach, and intestines that might cause the bleeding. If you are in your childbearing years, you should also have a pregnancy test, a Pap smear (if you havent had one in 12 months), a biopsy of the endometrium, and a test for ovulation. If you are not ovulating, the doctor will usually perform a dilatation and curettage of the endometrium.

In addition, if the physician suspects the bleeding stems from inflammation of the vagina, cervix, endometrium, or fallopian tubes, he or she will perform an internal exam, take a blood count, and may take tests for sexually transmitted diseases.

Causes and Cures

Tumors of the pelvic organs could be at fault. Fibroid tumors in the uterus are rarely cancerous but may cause heavy periods. Although small fibroids usually need no special treatment, your doctor may want to remove them. Removal of the entire uterus may be necessary if the fibroids are large or rapidly growing.

Endometrial cancer is another possible cause. Although this disease usually strikes after menopause, every woman over 35 with heavy bleeding should be tested. If the test is positive, a complete hysterectomy (removal of the uterus, ovaries, and fallopian tubes) followed by radiation is the usual treatment.

Polyps,small growths attached to the wall of the uterus, can also cause excessive bleeding. Because there is a slight risk that the polyps will become malignant, especially after menopause, they are often removed.

Excessive estrogen production, combined with lack of progesterone, can cause continuous stimulation and overdevelopment of the endometrium, leading to heavy bleeding in both adolescence and the premenopausal years. To correct the condition, your doctor may prescribe progesterone to stop the bleeding. When periods become normal, one or two weeks on Provera each month for two or three months should promote shedding of the endometrium. If the problem stems from imbalance of other hormones, such as those in the thyroid, pituitary, or adrenal glands, the doctor will correct it with medication.

There are several other diseases that could be at fault. Both underactivity of the thyroid (hypothyroidism) and advanced liver disease can cause heavy bleeding. Women with leukemia (cancer of the white blood cells) and certain other blood disorders may also develop the problem.

Some medications can promote heavy bleeding. Among the offending drugs are steroids, digitalis (Digitoxin, Digoxin), and blood thinners such as Coumadin. Withdrawal of estrogen or progesterone medication can also be a cause.

A woman who menstruates normally loses little iron during her period, but if you bleed heavily, you may develop anemia (iron deficiency). In that case, the doctor will usually stop the bleeding with hormones and advise you to take an oral iron preparation.

Curing Vaginal Infections

If youve ever been troubled with inflammation and infection of the vulva and vagina, you are far from alone. This problem, known as vulvovaginitis, is the most common gynecological disorder in the United States today. Fortunately, vulvovaginitis, while uncomfortable, is essentially harmless and usually responds promptly to simple treatment. Its symptoms include itching, irritation, or pain in the external genital area (the vulva) and pain in the vagina during intercourse. The vaginal discharge is often heavier than usual. It is frequently discolored (yellow, gray, or greenish), and may have an unpleasant odor.

Healthy vaginal discharge is made up of aging cells cast off from your vaginal walls, secretions from the cervix that help protect your uterus from infection and aid in fertility, and chemicals produced by vaginal bacteria and fungi ("yeasts"). Normally the discharge has no odor.

Some changes in vaginal discharge are normal, and bear no relation to a possible infection. These changes are governed by your menstrual cycle and the shifting hormonal patterns of puberty and menopause.

Relatively high levels of sexual hormones are necessary to produce vaginal discharge. So, during both childhood and menopause when hormone levels are low, discharge is minimal. Because girls have little or no vaginal secretion before puberty, parents who note a discharge in their childs diaper or underwear should consult a pediatrician.

During the reproductive years, your discharge changes in response to your monthly cycle. As your hormone levels drop after a menstrual period, the discharge becomes light. Then, as new eggs begin to develop in your ovaries, estrogen and progesterone levels increase, stimulating production of a white, milky or creamy discharge. At ovulation (approximately two weeks before your next menstrual period), this discharge changes abruptly and dramatically, becoming transparent and stretchy rather like egg white. This "fertile mucus" announces peak fertility of your monthly cycle. Fertile mucus generally lasts for only a day or two. Your discharge then turns white and creamy again and may be slightly heavier than earlier in the cycle. With your next menstrual period, the entire process begins once more.