WOMEN’S BODIES: SOME MENSTRUAL PROBLEMS OF ADOLESCENCE
Heavy periods Heavy bleeding can happen early in puberty while periods are still irregular. This can occasionally lead to embarrassing ‘overflow’ from pads and tampons (see Helen’s story).
Helen’s story
Helen, aged 15, had no problems with menstruation except an occasional bit of heavy bleeding during the first 24 hours. During her last period this happened during the night. In the morning she found that blood had overflowed onto her nightgown and the sheets, and when she got up she left a few drips on the floor between her bed and the bathroom. A few weeks later, around when her next period was due, Helen was invited to stay overnight at her friend Jenny’s home. Jenny’s mum was very houseproud and a fussy housekeeper. What if Helen’s period started and stained the snow-white sheets! Although her mother assured her that this was unlikely, she decided to take no chances. Before leaving home she slipped a couple of old bathtowels into her overnight bag. Before going to bed at Jenny’s, she put a layer of newspapers and one towel under the bottom sheet and a towel between herself and the sheet. Then she put on two thick pads and two pairs of underpants. Next morning she found that her period still had not started, but that during the night her nose had bled!
It happens because, before ovulation begins, there is no progesterone in the second half of the menstrual cycle to change the blood vessels in the endometrium. Without the effects of progesterone there is less control on the amount of bleeding when the endometrium dies and is shed. The bleeding tends to be heavy for several days of the period. Heavy periods for this reason settle down when ovulation becomes regular. However, if it’s gone on for a year or more it could make you quite anaemic. See your doctor about it if you think you’re losing too much blood, if menstrual blood forms clots, or if you become pale, easily tired and lacking in energy.
After regular ovulation and menstruation are established, some women continue to have a day of heavier flow (often the day after the period starts) but this is usually no problem if you’re prepared for it.
Painful periods Pain with periods is called dysmenorrhoea (pronounced dis-men-o-ree-a). From about the mid-teens some young women experience cramp-like lower abdominal pain for a day or so during menstruation. This is usually due to primary dysmenorrhoea, which typically occurs in young women who haven’t had children and who have normal reproductive organs.
What causes period cramps?
When the lining of the uterus breaks down just before menstruation begins, it releases substances called prostaglandins. These cause the muscle in the wall of the uterus to contract. This contraction prevents too much bleeding when the lining is shed, and helps the uterus to empty efficiently. If the contractions are very strong or sustained, they are felt as cramps. Some of the prostaglandins may get into the bloodstream and make matters worse by causing spasm of the bowel muscle, resulting in nausea, vomiting and diarrhoea.
Until a girl starts to ovulate the ovaries don’t produce progesterone. Without the changes caused by progesterone, the lining of the uterus doesn’t release prostaglandins during menstruation. This explains why periods are usually painless for several months up to a couple of years after the menarche.
The pain of primary dysmenorrhoea; typically begins just before or after the j set of bleeding, and rarely lasts beyond 2 hours (often less). It is a cramp-like pain
that waxes and wanes in spasms, often felt in the lower abdomen, b sometimes going through to the low back or down the insides of the thighs, may vary in intensity from one month to the next.
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