What is normal period?

A period, menses or menstruation is the shedding of the inner lining of the uterus.

• A normal cycle anywhere between 24 to 35 days, with an average of 28 days.
• Bleeding lasts for 2-5 days.
• Average 2-3 pads per day
• There is no associated pain compromising day-to-day life.

At the beginning of the cycle, whole endometrium is shed and then it gradually rebuilds and the uterus prepares itself to receive a fertilised egg. If a fertilised egg isn’t received, the uterus lining sheds through the vagina, and that is the menses or period

What are different types of period problems a woman may face?

Any variation in the frequency, duration or quantity of a normal period is defined as a period problem. Most importantly, it must be different from before. Most period problems signal towards hormonal changes or gynaecological issue. Periods can be:

• Cycles are shorter than 24 days or longer than 35 days
• Bleeding lasts for less than 2 days or more than 5 days.
• Bleeding more than 2-3 pads per day
• There is associated pain compromising day-to-day life.
• No periods at all

Following are details of common period problems experienced by women:

1. Oligomenorrhea is infrequent periods where the cycle repeats after more than 35 days. One off oligomenorrhoea in itself is not major health concern, this can happen duringstressful times, exams, moving houses or places or anything unusual in life. However, recurrent late cycles can indicate conditions such as polycystic ovarian syndrome PCOS. It can also happen in women who exercise vigorously or are long distance runners. These are because of hormonal imbalances which need life style changes and/or medical treatments

2. Menorrhagia is heavy or prolonged periods. This excessive blood loss in menorrhagia can make it difficult for the woman to perform her day-to-day activities. Common causes of menorrhagia include endometriosis, uterine fibroids, adenomyosis, endometrial polyps, and cancer in the uterus. Menorrhagia is seen in women with thyroid problem too. It can also occur as a side-effect of certain medications of liver or kidney disease. Blood loss can make them feel weak and tired, leading to iron deficiency anaemia.

3. Dysmenorrhea is pain and cramping during periods, in varying degrees. Sometimes it can be due to cramp in the uterus and other times it can be a disorder in the uterus. When severe, it does interfere with the day-to-day activities and has a negative impact on the quality of life of the women as well as those living with her. Dysmenorrhoea is noted in cases with endometriosis, uterine fibroids, adenomyosis, endometrial polyps, pelvic inflammatory disease PID. Treatment for dysmenorrhea depends upon the underlying cause. Accurate diagnosis is vital to treatment for relief of period cramps.

4. Premenstrual Syndrome (PMS is collection of physical, emotional, and psychological changes that a woman may experience a week before her periods. Symptoms and their intensity vary from woman to woman and usually resolve around the start of bleeding. Bloating, breast tenderness, stress or anxiety, headache, fatigue, mood swings, irritability, food cravings, changes in libido, muscle pain, joint aches, trouble falling asleep, and stomach cramps are the most common symptoms of PMS. Lifestyle changes that include a healthy diet, plenty of fluids, moderate exercise along with some mild medications help treat PMS in most women.

5. Amenorrhoea is absence of periodsin a normally menstruating woman (after puberty and before menopause). Amenorrhoea is classified as primary and secondary. If a woman never had a period and is 16 years of age, this is a case of primary amenorrhoea. If a woman had regular periods and then has no periods for 6 months or more, this is a case of primary amenorrhoea. Secondary amenorrhoea is reported as the lack of periods in women who have previously been menstruating for six months or more. Most common cause of amenorhhoea is pregnancy. Other causes include PCOS, premature ovarian failure, genetic disorders, tumours or hormonal issues. Amenorrhoea is a common sideeffect of cancer treatment. Amenorrhoea can also occur in women with eating disorders, women who exercise too much, or those who are stressed. Treatment for amenorrhoea, again, is dependent upon its causes.

6. Premature Ovarian Failure POF is complete cessation of periods i.e. menopause before the age of 35 years. This happens when all the eggs in the ovary are used up. Ovaries fail to produce estrogen hormone. Thus, women with POF often find it difficult to conceive. They may present with hot flushes, night sweats, vaginal dryness, decreased sexual desire, bone pains etc. Hormone replacement therapy are suggested in women with POF, especially to regulate estrogen levels and reduces the chances of osteoporosis.