Menstrual Health

Proactive for her

If you are born with this extra set of organs for reproduction, you’ll know they also demand extra attention and care. Before we get into the maintenance of these organs, it is important to acquaint ourselves with them first.
A woman’s reproductive system comprises the ovaries, fallopian tubes (both of which you have one on each side), the uterus, and the vagina.
Ovaries: The first important function of the ovaries is to house the eggs, also known as oocytes. Interestingly, the number of eggs that will be available lifelong can be determined within a few hours of birth. Once this window closes, your body does not generate new eggs ever. These eggs are stored in the ovaries and are simply sitting there until you hit puberty. Once you attain puberty and your menses start, the development of these eggs is also restarted. Under the influence of special hormones (known as gonadotropins- big word!), the ovarian cycle is activated. Once activated, your ovaries select 100-1000 eggs each month, and in a game of survival of the fittest, only one egg makes the cut and continues to grow, while the others perish away. Around mid-cycle, this egg matures and is signaled to be released. This is known as ovulation, the second important function of ovaries. After ovulation, the remaining shell of the egg in the ovaries becomes corpus luteum, and its function is to produce enough progesterone, in case there is a pregnancy. This is the third important function of the ovaries. If no pregnancy, by day 21-22 of your menses, the corpus luteum perishes and you get your periods. The ovarian cycle repeats itself. 
These tightly controlled ovaries are very sensitive to the slightest hormonal imbalance in your body, to stress, heavy exercise, anorexia, binge eating, processed foods, mental health problems, various medicines, various naturally occurring food items, and also artificial as well as natural preservatives. In case of disturbance, irregular periods and irregular bleeding problems set in.
Uterus: The uterus is a muscular bag, whose main and only function is to give a warm, growing, and secure home to the baby and provide it with good nutrition. The uterus is divided into the body, where the baby attaches and grows, and the cervix, which works like a stop valve until the baby is ready to come into this world.
Inside the uterus, a spongy cushion that is rich in blood supply grows every month, which is known as the endometrium. This endometrium grows in close relation to your ovarian cycle. As the ovaries get ready to release an egg, your uterus readies its home in anticipation of the coming guest – a baby! In the absence of a pregnancy, once the corpus luteum perishes, there is a lack of hormonal support for the endometrium to grow. And so it breaks down at the end of the month, marking that time of the month. The uterine muscle starts to contract to push this old useless endometrium out, resulting in cramps during periods. Once the period ends and the ovarian cycle resumes, the uterus again starts afresh and starts building this endometrium again, restarting the uterine cycle.
The second part of the uterus is the cervix, which connects the uterine cavity to the vaginal cavity. The cervix has multiple functions. It helps in draining menstrual blood into the vaginal cavity and out of the body. It helps to keep pregnancy safely inside the womb until it is ready, and also produces cervical mucus which helps in getting pregnant (fertile cervical mucus). Additionally, it protects the uterine cavity from infections. The cervix is different from the uterus as it has no muscular component. It is a very dynamic part that constantly changes in different phases of your life. It is also the second most common site of cancer in women, which is a conversation for another time.
The ovarian and uterine cycles work in very close association. Any disturbance in the ovarian cycle will also disturb the uterine cycle, which can lead to too little bleeding, too much bleeding, bleeding for fewer days, bleeding for too many days, or cause the development of fibroids and multiple other problems. 

<img src="https://pfh-images-production.s3.ap-south-1.amazonaws.com/files/images/Female Anatomy-min__efa7082b-bbcf-4c24-9b12-6fddd1cb108c.jpeg" alt="female anatomy" style="height: auto;width: auto"/>

Fallopian tubes: The fallopian tubes originate inside the uterus, travel sideways and end just above the ovaries. The end inside the uterus is circular (known as ostia) while the ovarian end has finger-like projections called fimbriae, which pick up the egg once it is released. The fallopian tubes are hollow structures. On the inside lumen, they are covered with small bristle-like structures known as cilia, which are responsible for the transport of things inside the tube. Fun fact: depending on which day of your menstrual cycle you are on, the hormones decide if things will move towards the uterus (first half of the cycle) or away from the uterus (second half of your cycle). These fallopian tubes are extremely important, as the fertilization (union) of eggs and sperms, development of the baby (embryo), and nourishing it till it is ready to enter the uterine cavity and latch on the endometrium (cushion) happens within these tubes. The first 5-6 critical days of development of pregnancy occurs in these tubes. 
These tubes are easily infected by diseases such as tuberculosis, STI’s such as chlamydia, gonorrhoea, syphilis, pelvic infectious diseases, abdominal surgeries such as appendicitis, surgery on the ovary (for ovarian cyst), etc. If the tube gets blocked at the uterine end or at the ovarian end, it loses its functional capacity and can lead to problems in getting pregnant. Infected blocked tubes can also get filled with water or pus and be a cause of pelvic infection or the formation of tubo-ovarian mass causing further problems. Damage to the tubes can cause the developing embryo to get trapped in the tubes (known as ectopic pregnancy), which is a medical emergency if not dealt with at the earliest.
Vagina: The vagina is a hollow, round, muscular wall meant for copulation (penetrative sex) between partners. The functions of the vaginal cavity are to drain menstrual fluid, allow penetration during intercourse, deposit seminal ejaculate, and nurture and nourish the sperms for a few days. The vagina has a separate set of glands that function to maintain vaginal health. The secretions from these glands are the first line of defense against vaginal infections. Too frequent use of intimate hygiene products can disrupt this balance and make infections more frequent. Normally, vaginal fluid is acidic in pH and it helps stop the growth of many bad bacteria and fungi. The vaginal cavity also has good bacteria and fungi which also protects from infection. 
STI’s, vaginal fungal infections, bacterial vaginosis, etc. are all vaginal infections that can occur if proper hygiene is not maintained by both partners. Maintaining vaginal health is easy: habits such as washing regularly with plain water, washing and wiping from the front (backward only after passing urine), wearing loose clothing during hot days, proper use of menstrual hygiene products and regularly changing them, using barrier contraceptives (condoms), etc. can ensure a healthy, happy vagina that is free from infection!
So there you have it! We’ve briefly explored various reproductive organs in this article, and potential problems that may arise from each of them. Do you feel like you know your body a little better? It’s a pretty cool system that just works quietly in the background, isn’t it? &nbsp;
Disclaimer: This information is educational and should not be construed as medical advice. Please consult your doctor before making any dietary changes or adding supplements.&nbsp;
<a href="https://bit.ly/3bQlBcZ" target="_self"><ins>Proactive For Her</ins></a><ins> </ins> is a digital clinic for women, offering accessible, personalised, and confidential healthcare solutions. We offer out-patient care, diagnostic services and programs for various health concerns of Indian women, across their lifetime - from puberty to pregnancy to menopause.


Doctor talks is back with a new article by Dr. Ankita Kaushal, an infertility specialist who explains what happens in the female reproductive system in a way that we wish was taught in school! Are you unsure about the difference between the vulva, vagina and cervix is? Say no more!

Doctor Talks: Female Anatomy 101: All You Need to Know But Were Afraid to Ask.

Sexual health

What is menstruation?
Menstruation refers to monthly bleeding, often called “period.” When we menstruate, our bodies discard the monthly build-up of the lining of our uterus (womb). Menstrual blood and tissue flow from the uterus through the small opening in the cervix and pass out of our bodies through the vagina. 
During the monthly menstrual cycle, the uterus lining builds up to prepare for pregnancy. If you do not get pregnant, estrogen and progesterone hormone levels begin falling. Very low levels of estrogen and progesterone tell your body to begin menstruation. 
What is a menstrual cycle?
The menstrual cycle is the monthly hormonal cycle a woman’s body goes through to prepare for pregnancy. Your menstrual cycle is counted from the first day of your period up to the first day of your next period. Your hormone levels (estrogen and progesterone) usually undergo ups and downs throughout the menstrual cycle.
What do we mean by Irregular menstruation?
To understand irregular periods, we need to have a reference point where we understand what is normal only then we can say something is off normal.
Explaining what a regular period is, Dr. Ankita Kaushal said, “Regular Periods are a monthly occurence. The range between two periods should be anywhere between 21 days to 31 days. It can also be extended to an upper limit of 35 days. So, one part of the definition is the interval. The second part of the definition is bleeding. The duration of bleeding can be from 2 days of bleeding up to 7 days of bleeding.
A lot of people these days are using sanitary napkins, menstrual cups, or tampons. So as far as the bleeding is concerned, you’re using 4-5 sanitary napkins every day for the day of your heavy flow and 2-3 sanitary napkins the days you have low flow. This sums up what a regular period is.
The commonly observed presentation of irregular periods in today’s female population is delayed. It’s important to understand that irregular periods can happen at any age. So, we have very young girls who are teenagers, then there is a bracket of 25-35 and then there is a bracket of 45 and above. The reasons for irregular periods in these 3 age groups are different.

<img src="https://pfh-images-production.s3.ap-south-1.amazonaws.com/files/images/irregular-periods-pcos__ff349f11-6553-4ce5-bc32-3d82a910e13a.jpeg" alt="irregular periods" style="height: auto;width: auto"/>

Common Causes of Irregular Periods
Sometimes, a woman’s period is delayed by 40-45 days. Irregular menstruation is a symptom that is indicative of an imbalance in your body. On and off, women experience irregular periods. Period irregularity could be every third or fourth month or it could be that someone who has had regular periods is now suddenly experiencing irregular periods. 
Speaking of causes, the first and most common <a href="https://proactiveforher.com/blogs/pcos/irregular-periods-and-pcos" target="_self"><ins>cause of irregular periods</ins></a> in every menstruating woman is pregnancy. If you’re sexually active and have missed your periods you have to check for pregnancy, even if you had protected sex. 
Thyroid abnormality: The second common cause is Thyroid abnormality. The thyroid controls a lot of things in the body mainly metabolism, our hot and cold temperature perception, and also our menstrual cycles. The most common abnormality that we find is a deficiency in thyroid hormones or hypothyroidism.
Cyst: Cyst is a water-filled balloon. Ovaries have small follicles that contain the egg. This rupture every 14th day of our period. Now there could be a situation where due to some odd reason this balloon which was harbouring a good egg didn’t rupture because of some temporary hormonal imbalance. It couldn’t release the egg and it became a cyst.
Prolactin hormonal imbalance: Our body produces a hormone called prolactin. Whenever the mother is breastfeeding it’s the prolactin hormone that comes into play. Whenever there is a sudden change in sleep pattern, if the prolactin shoots up it can also cause irregular periods. There is also another hormone known as cortisol. High levels of cortisol can also cause problems. Cortisol is also known as the stress hormone.
Polycystic ovary syndrome (PCOS): PCOS is the most common reason for irregular menses of the reproductive age group.
Breastfeeding: When you’re breastfeeding that is the time the periods will be irregular or completely absent. The hormones that come into play in breastfeeding prevent ovulation and hence it is completely normal for new mothers to not get their periods in the first 3-6 months after childbirth and even longer in some cases.
Lifestyle causes of irregular periods
Exercise Regime: If you exercise too much it’s going to alter the corticosteroid levels in your body. Corticosteroid is a kick-starter of your day which in turn is going to affect your thyroid levels and metabolism of your body. All this is going to affect the reproductive hypothalamic adrenal ovarian axis. Once that hormonal axis gets disturbed temporarily your periods will be irregular. If you have suddenly started exercising then the cause of your periods could be exercise. You’re adopting an exercise regime for a healthier and fit body and if it’s going to make you unhealthy, then it’s time to change. If your exercise is a high-intensity form of physical activity which is not suited to your body, your body is unable to cope up, your periods may become irregular.
Binge-eating disorders: With bulimia and binge-eating disorders, the high volume of food intake in such a short period, the sugar level spikes in the body. You’ve eaten 4-5 packets of your favorite chips, and you purge all that out. So, there’s going to be a sharp drop in sugar levels and insulin levels. These erratic blood sugar levels are responsible for a hormonal imbalance and hence, irregular periods.
Anorexia Nervosa: Anorexia Nervosa is when it’s fixed in a girl’s mind that even if she eats a little portion of food she is going to put on weight. It is at a more psychological level than at a physical level. In anorexia nervosa because of major energy deficiency, there is no ovulation and hence, there are no periods.
Each woman experiences their periods differently. When getting irregular periods, you must talk to your physician and discuss your concerns. To know more about menstrual health, visit us at <a href="https://www.proactiveforher.com/" target="_self"><ins>https://www.proactiveforher.com/</ins></a>
This blog has been transcribed from a webinar titled ‘<a href="https://www.youtube.com/watch?v=88q6C14gxvM&list=PLtPPqKCj7D-xqkgnrHiSQIgSB9g_Z4na0&index=4" target="_self"><ins>Irregular Periods with Dr. Ankita Kaushal’</ins></a>.&nbsp;

Disclaimer : This information is educational and should not be construed as medical advice. Please consult your doctor before making any dietary changes or adding supplements.
<a href="https://www.proactiveforher.com/?utm_source=website&utm_medium=blogs&utm_campaign=conclusion" target="_self"><ins>ProactiveForHer</ins></a> is a digital clinic for women, offering accessible, personalised, and confidential healthcare solutions. We offer out-patient care, diagnostic services and programs for various health concerns of Indian women, across their lifetime - from puberty to pregnancy to menopause.

As women, we tend to ignore our own health needs. One of the health problems that we face but ignore, is irregular periods. These can happen for a lot of reasons. In this article, Dr. Ankita Kaushal in a free-flowing conversation with Dr. Renuka Dangare talks about irregular periods.  Before we start, let’s understand what menstruation and the menstrual cycle actually are. 

Ankita Kaushal

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