Some women get through their monthly periods easily with few or no concerns. Their periods come like clockwork, starting and stopping at nearly the same time every month, causing little more than a minor inconvenience.
However, other women experience a host of physical and/or emotional symptoms just before and during menstruation. From heavy bleeding and missed periods to unmanageable mood swings, these symptoms may disrupt a woman's life in major ways.
Most menstrual cycle problems have straightforward explanations, and a range of treatment options exist to relieve your symptoms. If your periods feel overwhelming, discuss your symptoms with your health care professional. Once your symptoms are accurately diagnosed, he or she can help you choose the best treatment to make your menstrual cycle tolerable.
How the Menstrual Cycle Works
Your menstrual period is part of your menstrual cycle—a series of changes that occur to parts of your body (your ovaries, uterus, vagina and breasts) every 28 days, on average. Some normal menstrual cycles are a bit longer; some are shorter. The first day of your menstrual period is day one of your menstrual cycle. The average menstrual period lasts about five to seven days. A "normal" menstrual period for you may be different from what's "normal" for someone else.
Types of Menstrual Disorders
If one or more of the symptoms you experience before or during your period causes a problem, you may have a menstrual cycle "disorder." These include:
Abnormal uterine bleeding (AUB), which may include heavy menstrual bleeding, no menstrual bleeding (amenorrhea) or bleeding between periods (irregular menstrual bleeding)
Dysmenorrhea (painful menstrual periods)
Premenstrual syndrome (PMS)
Premenstrual dysphonic disorder (PMDD)
A brief discussion of menstrual disorders follows below.
Heavy menstrual bleeding
One in five women bleed so heavily during their periods that they have to put their normal lives on hold just to deal with the heavy blood flow.
Bleeding is considered heavy if it interferes with normal activities. Blood loss during a normal menstrual period is about 5 tablespoons, but if you have heavy menstrual bleeding, you may bleed as much as 10 to 25 times that amount each month. You may have to change a tampon or pad every hour, for example, instead of three or four times a day.
Heavy menstrual bleeding can be common at various stages of your life—during your teen years when you first begin to menstruate and in your late 40s or early 50s, as you get closer to menopause.
If you are past menopause and experience any vaginal bleeding, discuss your symptoms with your health care professional right away. Any vaginal bleeding after menopause isn't normal and should be evaluated immediately by a health care professional.
Heavy menstrual bleeding can be caused by:
structural abnormalities in the uterus, such as polyps or fibroids
Many women with heavy menstrual bleeding can blame their condition on hormones. Your body may produce too much or not enough estrogen or progesterone—known as reproductive hormones—necessary to keep your menstrual cycle regular.
For example, many women with heavy menstrual bleeding don't ovulate regularly. Ovulation, when one of the ovaries releases an egg, occurs around day 14 in a normal menstrual cycle. Changes in hormone levels help trigger ovulation.
Certain medical conditions can cause heavy menstrual bleeding. These include:
blood clotting disorders such as Von Willebrand's disease, a mild-to-moderate bleeding disorder
idiopathic thrombocytopenic purpura (ITP), a bleeding disorder characterized by too few platelets in the blood
liver or kidney disease
medications, such as anticoagulant drugs such as Plavix (clopidogrel) or heparin and some synthetic hormones.
Other gynecologic conditions that may be responsible for heavy bleeding include:
complications from an IUD
ectopic pregnancy, which occurs when a fertilized egg begins to grow outside your uterus, typically in your fallopian tubes
Other causes of excessive bleeding include:
precancerous conditions of the uterine lining cells
You may also have experienced the opposite problem of heavy menstrual bleeding—no menstrual periods at all. This condition, called amenorrhea, or the absence of menstruation, is normal before puberty, after menopause and during pregnancy. If you don't have a monthly period and don't fit into one of these categories, then you need to discuss your condition with your health care professional.
There are two kinds of amenorrhea: primary and secondary.
Primary amenorrhea is diagnosed if you turn 16 and haven't menstruated. It's usually caused by some problem in your endocrine system, which regulates your hormones. Sometimes this results from low body weight associated with eating disorders, excessive exercise or medications. This medical condition can be caused by a number of other things, such as a problem with your ovaries or an area of your brain called the hypothalamus or genetic abnormalities. Delayed maturing of your pituitary gland is the most common reason, but you should be checked for any other possible reasons.
Secondary amenorrheais diagnosed if you had regular periods, but they suddenly stop for three months or longer. It can be caused by problems that affect estrogen levels, including stress, weight loss, exercise or illness.
Additionally, problems affecting the pituitary gland (such as elevated levels of the hormone prolactin) or thyroid (including hyperthyroidism or hypothyroidism) may cause secondary amenorrhea. This condition can also occur if you've had an ovarian cyst or had your ovaries surgically removed.
Severe menstrual cramps (dysmenorrhea)
Most women have experienced menstrual cramps before or during their period at some point in their lives. For some, it's part of the regular monthly routine. But if your cramps are especially painful and persistent, this is called dysmenorrhea, and you should consult your health care professional.
Pain from menstrual cramps is caused by uterine contractions, triggered by prostaglandins, hormone-like substances that are produced by the uterine lining cells and circulate in your bloodstream. If you have severe menstrual pain, you might also find you have some diarrhea or an occasional feeling of faintness where you suddenly become pale and sweaty. That's because prostaglandins speed up contractions in your intestines, resulting in diarrhea, and lower your blood pressure by relaxing blood vessels, leading to lightheadedness.
Premenstrual syndrome (PMS)
PMS is a term commonly used to describe a wide variety of physical and psychological symptoms associated with the menstrual cycle. About 30 to 40 percent of women experience symptoms severe enough to disrupt their lifestyles.
PMS symptoms are more severe and disruptive than the typical mild premenstrual symptoms that as many as 75 percent of all women experience.
There are more than 150 documented symptoms of PMS, the most common of which is depression. Symptoms typically develop about five to seven days before your period and disappear once your period begins or soon after.
Physical symptoms associated with PMS include:
swollen, painful breasts
Emotional symptoms associated with PMS include:
anxiety or confusion
mood swings and tension
crying and depression
inability to concentrate
PMS appears to be caused by rising and falling levels of the hormones estrogen and progesterone, which may influence brain chemicals, including serotonin, a substance that has a strong affect on mood. It's not clear why some women develop PMS or PMDD and others do not, but researchers suspect that some women are more sensitive than others to changes in hormone levels.
PMS differs from other menstrual cycle symptoms because symptoms:
tend to increase in severity as the cycle progresses
are relieved when menstrual flow begins or shortly after
are present for at least three consecutive menstrual cycles
Symptoms of PMS may increase in severity following each pregnancy and may worsen with age until they stop at menopause. If you experience PMS, you may have an increased sensitivity to alcohol at specific times during your cycle. Women with this condition often have a sister or mother who also suffers from PMS, suggesting a genetic component exists for the disorder.
Premenstrual Dysphoric Disorder (PMDD)
Premenstrual dysphoric disorder is far more severe than the typical PMS. Women who experience PMDD (about 3 to 8 percent of all women) say it significantly interferes with their lives. Experts equate the difference between PMS and PMDD to the difference between a mild tension headache and a migraine.
The most common symptoms of PMDD are heightened irritability, anxiety and mood swings. Women who have a history of major depression, postpartum depression or mood disorders are at higher risk for PMDD than other women. Although some symptoms of PMDD and major depression overlap, they are different:
PMDD-related symptoms (both emotional and physical) are cyclical. When a woman starts her period, the symptoms subside within a few days.
Depression-related symptoms, however, are not associated with the menstrual cycle. Without treatment, depressive mood disorders can persist for weeks, months or years. If depression persists, you should consider seeking help from a trained therapist.
To help diagnose menstrual disorders, you should schedule an appointment with your health care professional. To prepare, keep a record of the frequency and duration of your periods. Also jot down any additional symptoms, such as cramping, and be prepared to discuss health history. Here is how your health care professional will help you specifically diagnose abnormal uterine bleeding, dysmenorrhea, PMS and PMDD:
Heavy menstrual bleeding
To diagnose heavy menstrual bleeding—also called menorrhagia—your health care professional will conduct a full medical examination to see if your condition is related to an underlying medical problem. This could be structural, such as fibroids, or hormonal. The examination involves a series of tests. These may include:
Ultrasound. High-frequency sound waves are reflected off pelvic structures to provide an image. Your uterus may be filled with a saline solution to perform this procedure, called a sonohysterography. No anesthesia is necessary.
Endometrial biopsy. A scraping method is used to remove some tissue from the lining of your uterus. The tissue is analyzed under a microscope to identify any possible problem, including cancer.
Hysteroscopy. In this diagnostic procedure, your health care professional looks into your uterine cavity through a miniature telescope-like instrument called a hysteroscope. Local, or sometimes general, anesthesia is used, and the procedure can be performed in the hospital or in a doctor's office.
Dilation and curettage (D&C). During a D&C, your cervix is dilated and instruments are used to scrape away your uterine lining. A D&C may also be used as a treatment for excessive bleeding and for bleeding that doesn't respond to other treatments. It is performed on an outpatient basis under local anesthesia.
You can also expect blood tests to check your blood count for anemia and a urine test to see if you're pregnant, as well as other laboratory tests.
The more information you can give your health care professional, the better. Take notes on the dates and length of your periods. You can do this by marking your calendar or appointment book. You might also be asked to keep a daily track record of your temperature to determine when you are ovulating. Ovulation kits, that use a morning urine sample, are available without a prescription and are easy to use.
During your initial evaluation with your health care professional, you should also discuss the following:
details about menstrual flow and cycle length
any gynecologic surgery or gynecologic disorders
sexual activity and history of sexually transmitted diseases
contraceptive use and history
family history of fibroids or other conditions associated with AUB
history of a breast discharge
blood clotting disorders—either your own or in family members.
PMS and PMDD
There are no specific diagnostic tests for PMS and PMDD. You'll probably be asked to keep track of your symptoms and write them down. A premenstrual symptom checklist is one of the most common methods currently used to evaluate symptoms. With this tool, you can track the type and severity of symptoms to help identify a pattern.
Generally PMS and PMDD symptoms:
tend to increase in severity as the menstrual cycle progresses.
tend to be relieved when menstrual flow begins or soon afterward.
are present for at least three consecutive menstrual cycles.
Treatments for menstrual disorders range from over-the-counter medications to surgery, with a variety of options in between. Your treatment options will depend on your diagnosis, its severity, which treatment you prefer, your health history and your Doctor's recommendation.
Abnormal uterine bleeding
Medication and surgery are used to treat AUB. Typically, less invasive therapies should be considered first. Treatment choices depend on your age, your desire to preserve fertility and the cause of the abnormal bleeding (dysfunctional or structural). Some treatments may reduce your menstrual bleeding to a light to normal flow.
Medication therapy is often successful and a good first option. The benefits last only as long as the medication is taken, so if you choose this route, you should know that medical treatment is a long-term commitment.
Low-dose birth control pills, progestins and nonsteroidal anti-inflammatory drugs (NSAIDs) may help control heavy or irregular bleeding caused by hormonal imbalances. If your periods have stopped, oral contraceptives and contraceptive patches are highly effective in restoring regular bleeding, although they will not correct the reason you stopped bleeding. Both can also help reduce menstrual flow, improve and control menstrual patterns and relieve pelvic pain during menstruation.
Birth control pills may not be an appropriate treatment choice if you smoke, have a history of pulmonary embolism (blood clots in your lungs) or have bothersome side effects from this medication. The risk of these side effects is even higher if you use the birth control patch, because it contains higher levels of estrogen.
Fathima hospital, backed by specialists from multiple disciplines, specialises in handling high risk pregnancies. It is important to note that women, who are diagnosed with high-risk issues, mostly go on to have a normal pregnancy and a healthy delivery.
Fathima hospital offers pain relief programs that are globally applied to ease pain during labour. There are a number of options to ensure painless delivery, many of which pregnant women here are not aware of.
Fetal medicine focuses on the care of pregnant women where there is a need to monitor the health and wellbeing of the unborn child (fetus). This includes monitoring the rate of the baby’s growth, as well as diagnosing and managing fetal disorders and abnormalities using both invasive and non-invasive methods.
Our specialized fertility experts are highly experienced, and their technology and strict processes ensure high success rates. IVF (In-Vitro Fertilization) is a type of assisted reproductive technology which involves a series of procedures to treat fertility and assist with the conception of child.
Fathima Hospital has customized Antenatal programmes designed to make you feel safe, good and happy, these programmes educate you on the process of childbirth and the different stages of labour - in all, encouraging natural birthing as much as possible.
Postnatal exercises are important for you. They help you regain the strength of your abdominal muscles and help prevent lower back injury and other complications like abdominal organs from "drooping forward" due to lack of support. They also help you regain a flat stomach.
Our OB/GYN surgeons offer a variety of traditional and minimally invasive surgical procedures: Tubal ligation, removal of ovarian cysts, fibroids, growths from the cervix, Removal of the uterus (hysterectomy), ovaries, Hysteroscopy etc.
Fetal medicine, which is an extension of the branch of Ultrasonography, treats the fetus as a patient in utero for any problems it might have. It comprises of Fetal scanning, Procedures such as Amniocentesis, chorionic villus sampling, and cord blood sampling, Screening tests and interpretation of the results.
When it comes to your little one’s health, you need to be extra sure. Hence, you want to know all the whys and when of vaccinations to be administered to your child from the time of birth. Keeping that in mind, we hand you over a vaccination schedule for your baby with all the mandatory and optional vaccines prescribed from the time of birth.
Each pregnancy is unique and you have the right to be involved in all decisions affecting you and your baby. A good relationship with your maternity care provider can make a big difference in planning your pregnancy care. At Fathima hospital, Department of Obstetrics includes a team of expert gynaecologists, foetal medicine Specialist, physiotherapists, and trained and experienced nursing staff. Our hospital is equipped with advanced neonatal care team supported by state-of-the-art NICU infrastructure to ensure that complex and high-risk pregnancies can be managed including extremely premature birthings.
At Fathima Hospital, we provide comprehensive consultations, lab testing, ultrasound scan to provide the best possible care during your 1st Trimister to 3rd Trimister. A typical pregnancy lasts 40 weeks from the first day of your last menstrual period (LMP) to the birth of the baby. It is divided into three stages, called trimesters: first trimester, second trimester, and third trimester. The fetus undergoes many changes throughout maturation. A woman will experience many changes during the pregnancy like morning sickness, or nausea and vomiting due to pregnancy, at 6–8 weeks. A pregnant woman might also feel very tired and notice that she is more emotional than usual due to hormonal changes.
Types of Delivery
Few things in life are more exciting than the birth of a new baby. This has been the case throughout human history, but childbirth options for new mothers have advanced to make the experience more safe. Fathima hospital offers comfortable maternity suites that convert into state of the art delivery rooms. An easy birth and a perfectly executed birth plan is ideal. But we know that even the most carefully planned birth can take twists and turns. In those cases, it's important to be prepared for alternative delivery methods.
A range of tests is available if you are pregnant. These tests can confirm your pregnancy and also monitor your baby’s development in the womb. Regular check-ups with your gynecologist, fetal medicine specislists are an important part of pregnancy care, including information and advice about what tests you and your baby will need. Checking the general health of the mother and baby, the different kinds of tests available to pregnant women include: tests to confirm pregnancy, maternal health screening, routine screening tests (these tell you how likely it is that your baby has a certain health condition), diagnostic tests – for pregnancies at increased risk (these tell you more accurately if your baby has a certain health condition).
Complications can arise in pregnancies for many reasons. Sometimes a woman’s existing health conditions contribute to problems. Other times, new conditions arise because of hormonal and body changes that occur during pregnancy. They can involve the mother’s health, the baby’s health, or both. Some women have health problems that arise during pregnancy, and other women have health problems before they become pregnant that could lead to complications. It is very important for women to receive health care before and during pregnancy to decrease the risk of pregnancy complications. If you are receiving treatment for a health problem, your health care provider might want to change the way your health problem is managed.
High Risk Pregnancy
A high-risk pregnancy is one that threatens the health or life of the mother or her fetus. It often requires specialized care from specially trained providers. Some pregnancies become high risk as they progress, while some women are at increased risk for complications even before they get pregnant for a variety of reasons. Early and regular prenatal care helps many women have healthy pregnancies and deliveries without complications. A high-risk pregnancy may be one that involves chronic health problems, such as diabetes or high blood pressure; infections; complications from a previous pregnancy; or other issues that might arise during pregnancy. Treatment for high-risk pregnancy depends on the risk factors and overall health of the mother and fetus.
Ideally, women of child bearing age should be immunized before becoming pregnant to protect their babies against various diseases. Pregnancy should not deter a woman from receiving vaccines that are safe and will protect both her health and that of her unborn child. Extreme care has to be taken to avoid those vaccines that harm the unborn baby. Pregnant women who aren’t up-to-date on their immunizations may be susceptible to diseases that can harm them or their unborn child. If you’re pregnant, talk to your doctor about which vaccines you may need and whether you should get them now or wait until after your child is born.
Bad Obstetric History
Pregnancy loss is a frustrating and challenging problem for couples and clinicians alike. Miscarriage is often associated with guilt, embarrassment and depressive states. This is particularly true when the patient presents with subsequent pregnancy with added concerns of primary or secondary infertility, irregular menses, absent or irregular ovulation, a known history of uterine fibroids, a family history of miscarriage, advancing age, medical history and a prior history of pregnancy complications. It certainly warrants a detailed consultation and reassurance with a practitioner committed to pregnancy loss evaluation.
Ectopic / Tubal Pregnancy
Pregnancy begins with a fertilized egg. Normally, the fertilized egg attaches to the lining of the uterus. An ectopic pregnancy occurs when a fertilized egg implants and grows outside the main cavity of the uterus. An ectopic pregnancy most often occurs in a fallopian tube, which carries eggs from the ovaries to the uterus. This type of ectopic pregnancy is called a tubal pregnancy. Sometimes, an ectopic pregnancy occurs in other areas of the body, such as the ovary, abdominal cavity or the lower part of the uterus (cervix), which connects to the vagina. An ectopic pregnancy can't proceed normally. The fertilized egg can't survive, and the growing tissue may cause life-threatening bleeding, if left untreated.
A multiple pregnancy occurs when one egg (ovum) splits before implanting or when separate eggs are each fertilized by a different sperm. Identical twins or triplets occur with the fertilization of a single egg that later divides into two or three identical embryos. Identical twins or triplets have the same genetic identity, are always the same sex, and look almost exactly the same. Fraternal multiples develop from separate eggs that are each fertilized by a different sperm. Fraternal twins might or might not be of the same sex and might not necessarily resemble each other any more than two siblings from the same parents might.
Your pregnancy is one of the most exciting times of your life. At Fathima hospital, we will help you enjoy the journey with the support of our expert team, in modern private surroundings.
Families have trusted us for generations at this special time, and we have an enviable international reputation for private maternity care.
Our expertise enables us to safely look after you and your baby, whether it is your first child, your third child, you are expecting twins, or if you or your little one has additional health needs. Whatever your situation, we have the right team to support you. Our packages have been devised with you in mind, to give you the time and attention you need to make the birth of your child as special as possible.
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Fathima hopsital - Maternity care facilities Process Chart
The best practices to ensure the that a mother gets utmost care during pregnancy and labor. Here is a list of our resources enabling to help you prepare for everything, from conception to delivery and beyond. Fathima hospital is fully equipped to comply with the maternity care Process chart.
Treatments and Procedures
The Department of Obstetrics & Gynaecology has the capability and facilities to deal with a diverse range of cases and complexities in partnership with specialty services such as Foetal Medicine, Anaesthesia, Critical care, high risk, painless labour, Gynaecological surgeries for fibroid, prolapsed, endometriosis, ovarian cysts, Laparoscopic and hysteroscopic surgeries