Dr Lee Say Fatt

Меոѕtruаtion means having your periods. During your periods, you will be bleeding from your uterus (womb) and the blood flows out from the vagina.
A woman will start getting their periods when they enter through puberty. They will continue to get their periods until they reach “menopause.” This is the time when periods naturally stop at average of 50 to 52 years old.

Basics

Periods occur due to certain hormonal effects on the inner lining of the uterus (womb). These elevated hormones are produced by the ovaries in a cyclical manner and occurs at the start of puberty. This is also the time when it is physically possible to get pregnant. During each cycle:
• The inner lining of the uterus starts to thicken due to the effects of oestrogen. This thickened lining is intended to support a pregnancy.
• One of the ovaries will start to produce an egg and will be release once it matured. This is termed as ovulation.
• Pregnancy occurs when the release egg is fertilized by the sperm. If no pregnancy occurs, then the thickened lining will be shed as bleeding and termed as a period (menstruation).
In many women, this cycle repeats itself about once a month. Some women may get an irregular menstrual cycle.

What is abnormal menstruation?
• You have heavy menses when you:
 Soak through a pad or tampon every 1 or 2 hours
 Need to change your pad or tampon several times during the night
 Pass clots or stains your clothes, undergarments or pajamas (term as flooding)
 Excessive flow will lead to anaemia – anaemia is a condition when your body doesn’t have enough red blood cells to carry oxygen to your tissues, making you feel weak, tired, headaches, having trouble breathing when you exercise or doing routine work, palpitation (feeling your heartbeat too fast) when you exercise.
• Have periods that last for more than 8 days
• Bleed in between periods
• Get your period more often such as 2 to 3 episodes in a month.
• Have moderate to severe pain and cramps in your lower belly before or while you are bleeding
• Suddenly bleeding again after you have not had periods for at least a year, and when you think that you are already menopausal.
There are many causes of abnormal menstrual bleeding. For more details, click HERE and HERE to read more.

Frequency of a period
At the beginning of puberty when a person first starts getting their period, the cycle may not be every month. Sometimes, it may even skip a month or two. This is still normal or may come more frequently. Fortunately, over time, most menstrual cycles tend to be more regular. Most women get a period about once a month. A normal cycle can range from 24 days to 38 days. The cycle length is counted from the first day of your last period to the first day of your next period. During each period, the flow usually lasts from a few days to about a week.
It is a good practise to keep track of your menstrual cycles and monitor the duration and amount of flow. You should then consult your doctor when there is a drastic change

Associated symptoms with menstruation
During menstruation, some women may have other symptoms, and this can occur either before or during the bleeding days. These symptoms are related to hormonal changes. If this happens before the start of menstruation, it is term as premenstrual syndrome (PMS). You can click on the link to read more.

What can affect my period?
It’s normal for your usual cycle to come a few days earlier or a few days late. Several factors may affect your menstrual cycles – either making it less often or not at all. These include:
• pregnancy
• breastfeeding
• heavy exercise especially the extreme form, feeling very stressed, or big changes in body weight
• certain health or endocrine problems, such “polycystic ovary syndrome (PCOS)” or thyroid disorders.
• certain medicines, including certain birth control pills
• peri-menopause (some women may enter menopause at a much earlier age)
If you do not have periods for extended period or the cycles are very irregular, your doctor may order some blood tests to find the cause for it.

What are the different types of menstrual products?
There are many different products you can use during your period. They include:
• Pads – this is the most popular and the pad is placed on the inner lining of the underwear to absorb the blood. Different sizes and thickness are available. Most pads sold are the disposable type.
• Tampons – this type is to be inserted into vaginal and are made of super absorbent material. During period, the tampon will expand slightly as it absorbs the menstrual blood. Some tampon comes with disposable applicators to help easy insertion into vagina. The tampons have a string that hangs outside of the vagina to make it easy to remove. It should be changed at least every 4 to 8 hours. Leaving a tampon in for too long is not advisable due to risk of infection.
• Menstrual cups – These are small, soft and flexible cups that is inserted into the vagina to collect the menstrual blood and prevent it from falling out. It comes indifferent brands and sizes. They can be worn for up to 12 hours. It can be washed and reused.
• Period underwear and swimwear – These are specially made underwear and swimwear that can be worn during menstruation. It can absorb blood. It can be washed and reused.
The choices depend on your own preference, your lifestyle and the type of activities that you may want to do during the menstruation. Some women may prefer to use tampons or menstrual cups during hiking or swimming instead of pads. Cost is also an issue for considerations. In the long term, reusable may be cheaper and more eco-friendly

Restriction during period
There is usually no restriction and most of the time a woman can do all her normal activities unless it is too heavy or associated with severe pain. In such instances, she should consult her doctor to find out why and get treated. There are no dietary restriction as well.

Steps to relieve period related discomfort
• Take pain relief medications such as ibuprofen, mefenamic acid, or naproxen. These are called Nonsteroidal anti-inflammatory drugs (NSAIDs), unless you have known allergies.
• Apply heat pad or hot water bottle on your lower belly – This can help relieve ϲrаmрѕ. Please be careful to avoid causing burn to your skin.
• For some women, regular exercise can help reduce menstrual cramps and pain. Therefore, it may be worthwhile to try and see if this helps you.

You should consult your doctor if you have the following:
• you still have not had your period by 15 years of age.
• your menstrual cycles are only 3 cycles or less in a year.
• the menstrual flow is progressively heavier with passage of large clots and flooding.
• the period pain is getting more severe.
• Heavy bleeding lasting more than a week.

Disclaimer

This is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. It is important for readers to seek proper medical advice when necessary.

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Most women (especially in their first pregnancy) are often unsure when to go to the hospital to give birth. Below is a list of symptoms and signs you should be aware of that will require you to go to the hospital for further evaluation.

Symptoms and signs of Labour

1. When your waters break, you will notice a clear or urine–like fluid coming out; the amount may vary from a gradual trickle to a sudden gush. If you notice a green or dark stain fluid; this may be meconium (the baby’s first poo) and can be a sign of foetal distress. There is a risk of infection if your waters break too soon before labour and the waters could bring the cord down as well, compressing your baby’s oxygen supply (however, this is very rare).
2. You have some slight bleeding and often mixed with mucus. This is called “show” and arises from the plug that keeps the cervix closed. Labour can start any time after this, although it could be as long as a few days. This does not occur in every woman, so just because you have not seen yours it doesn’t mean you aren’t in labour.
3. Having contractions – when contraction starts, it is usually irregular and mild. It will slowly progress to a more regular contractions, becoming stronger, last longer and come closer together. If this happens, then it is almost certainly labour.

Foetal movement

Fetal movement is an indicator of well-being. It is still normal for movement to slow down during the last few weeks as the head descends into the pelvis, and there will be less space for the foetus. However, if your baby is not moving at all for the whole day, or not moving as much as normal, you need to be seen as soon as possible. If you are unsure, please seek advice as soon as possible or go straight to labour room especially when you are already in the third trimester of pregnancy.

Sometimes the pain or the contraction you felt may be classified as false labour. This occurs if:

• it is irregular and infrequent.
• slowly disappear and you feel the decreasing intensity or frequency when you change position, walk, or rest.
• are not particularly uncomfortable and limited to your lower abdomen.
• no progressive increase in discomfort and frequency of pain.
• there are no cervical findings to suggest labour (this entails a vaginal examination by either the midwife or doctor to assess the opening of the uterus).

However, you are likely to be in labour if:

• there is progressive increase in frequency and intensity of the contraction, duration lasting usually 40 to 60 seconds.
• persistent despite changing in position, walk, or rest.
• associated with leakage of fluid (due to rupture of the membranes).
• associated with changes in the cervix (progressive thinning and dilatation)

Sometimes the only way you can know for sure whether you’re in labour is by seeing your health care provider as soon as possible. When you arrive at the hospital, your doctor, a nurse, a midwife, or a resident physician will perform an abdominal palpation to feel for contraction and also do a pelvic examination to determine whether you’re in labour. The practitioner also may hook you up to a monitor to see how often you’re contracting and to see how the foetal heart responds. In certain situation, your health care provider may advise you to stay under observation for several hours to see whether the situation is changing.

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This is common in the first three months of pregnancy and occurs in 50% to 80% of pregnant women. The symptoms often occur in the morning (from 6-9 am) but may occur at any time during the day. The impact and severity of the nausea and vomiting is different for each woman.

SIGNS AND SYMPTOMS

It ranges from mild to severe nausea with or without vomiting. This is usually during the first 12 to 14 weeks of pregnancy. It may continue longer, and for a few women, may last throughout pregnancy. By the end of the third month, most symptoms will resolve in the majority of women. The symptoms are more severe in those with multiple pregnancy or molar pregnancy.

CAUSES

The exact causes of nausea and vomiting during pregnancy are unknown. Nausea may result from rising levels of human chorionic gonadotrophin (pregnancy hormone) in the blood or other hormonal changes that take place to permit normal growth of the fetus.

Read more