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Introduction to women's health
Women and men share many similar health problems, but women also have their own health issues, which deserve special consideration.
Women's lives have changed over the centuries. Historically, life was particularly difficult for most women. Aside from the numerous dangers and diseases, women became wives and mothers often when they were just emerging from their own childhood. Many women had a large number of pregnancies which may or may not have been wanted. In the past, childbirth itself was risky and not infrequently, led to the death of the mother. Most women in the past did not live long enough to be concerned about menopause or old age.
In 1900, a woman's life span was about 50 years. Now, in the new millennium, average life expectancy for American women is 82 years of age, and it is continuing to rise. Not only are women living longer, but they also can anticipate the possibility of enjoying a better quality of life throughout their span of years. In order to accomplish this, it is essential that women take charge of their own bodies and that they comprehend how they can maximize their personal health and fitness. It is also helpful that men understand and are supportive of the health concerns of the women.
Gynecology is the primary branch of medical science concerned with women's health issues. The word "gynecology" is a word consisting of "gyneco," meaning "woman," and "logic," meaning "knowledge." Taken together, it is "woman knowledge."
It is important that every woman has access to knowledge related to the spectrum of women's health issues, not only about her reproductive system, but about all aspects of her body.
There is credible information available to women not only on such problems as eating disorders, stress, alcoholism, addictions, and depression, but also on basic topics such as good nutrition, heart health, and exercise. For example, it is beneficial that a woman maintain her optimum weight. If a woman's waist size measures more than 35 inches (89 cm), she is more likely to develop heart disease, high blood pressure, and diabetes. Eating sensible meals, eliminating after- dinner snacks, and making physical activity a part of daily life are significant ways to help control weight and lower the risk of a long list of health problems.
Smoking is detrimental to anyone's health, as well as the health of those around them. Unfortunately, women continue to smoke despite the known health risks. Even though the number of female smokers is declining, still about 16% of women in the U.S. continue to smoke. Women are smoking in spite of the well-publicized risks including cancer, heart disease, and innumerable other health issues.
Drinking an excessive amount of alcohol is also harmful to health. Although women typically begin drinking at a later age than men and tend to drink somewhat less, lower doses of alcohol are required for women to develop alcohol-related medical problems including alcohol toxicity, cirrhosis, and hepatitis.
Women should be aware that they metabolize a number of drugs differently than men. In some cases and for some medications, the rate of metabolism may be slower, and in other cases, faster. It is, therefore, essential that women are well informed about the kinds and correct dosages of any drugs they are taking.
There are major differences in anatomy between males and females that require consideration. As more women are now participating in sports, many anatomic differences are being identified, often because men and women athletes sustain different types of injuries. In females, the hamstrings (muscles behind the leg) are not as strong as in males. Women also have a wider hip-to-knee ratio than men. A woman's legs are relatively longer and her torso shorter than a man of comparable size. She has a lower center of gravity, less muscle mass, less dense bones, and higher percentage of body fat.
Anatomic differences between men and women go well beyond the reproductive and skeletal systems. For example, they involve the brain and the heart. In fact, heart disease is the leading cause of death among women in the United States. It is now described as an "equal opportunity killer." Over one in three adult women in the US has some form of cardiovascular disease.
Women tend to suffer their first heart attack 10 years later than men. For reasons that remain unclear (and require more research), the likelihood for a younger woman dying from a heart attack is significantly greater than that of a man. Moreover, the symptoms of an impending heart attack may be somewhat different in a woman than in a man. A woman may more often ignore the symptoms and fail to seek medical attention. Every woman needs to develop her own healthy heart program.
The female reproductive System
Since the female reproductive system plays such an important role throughout the life of a woman, it receives special consideration. A woman's reproductive system includes her uterus, Fallopian tubes, ovaries, cervix, and external genitalia. The breasts can also be included, even though, technically speaking, they are not part of the reproductive system. The breasts do play a major role in pregnancy and motherhood.
Although the primary function of the reproductive system is to conceive and bear children, a female's reproductive system makes a major contribution to her being a woman. Due to the complexity of her reproductive system, she can experience a number of problems ranging from yeast infections of the vagina to fibroids of the uterus or cysts of the ovary.
If a woman is to make informed choices about her health care, she must understand her reproductive system. In the U.S., a common major surgery performed on women who are not pregnant is a hysterectomy. A hysterectomy, the surgical removal of the uterus, ends menstruation and a woman's ability to become pregnant. A woman needs to comprehend her options before she can decide if a hysterectomy is the best solution for her particular medical condition.
A hormone is a chemical substance secreted by one tissue that travels by way of body fluids to affect another tissue in the body. In essence, hormones are "chemical messengers." Many hormones, especially those affecting growth and behavior, are present in both men and women. Nevertheless, women are more often portrayed as being under the influence of their hormones, as being subject to hormonal "tides" or "storms."
Some hormones are of special concern to women. The sex hormones produced by the ovaries are not only involved in the growth, maintenance, and the repair of the reproductive tissues, but they also influence other body tissues, including bone mass as well. This can be a problem for women who strive for lower body fat (for example, athletes, models, and ballerinas) and for women with eating disorders. Women with low body fat often do not produce sufficient amounts of sex hormones. They can, therefore, experience a cessation of menstruation, osteoporosis (thinning of the bones), fractures, and other conditions similar to those faced by many post- menopausal women.
After menopause, a woman's body produces less of the female hormones, estrogen and progesterone. Symptoms of the menopausal transition can be troubling for some women. Many doctors prescribe hormone therapy (HT, HRT, ERT, ET) to ease menopausal symptoms, although this therapy should be administered for a short duration due to increases in heart attack and slightly increased risk of breast cancer associated with hormone therapy.
Hormonal problems for women are not confined to those involving the sex hormones. For example, thyroid disease, including hyperthyroidism (over-activity of the thyroid gland) and hypothyroidism (under- activity of the thyroid), is far more common in women than in men.
Diseases more common in women
Many diseases affect both women and men alike, but some diseases occur at a higher frequency in women. For example, gallstones are three to four times more common in women than in men. About 18% of women in the U.S. suffer migraine headaches compared with only 6% of men, a ratio of three females to one male. Other conditions seen more often in women than in men include irritable bowel syndrome and urinary tract infections.
Urinary tract infections, including cystitis (bladder infection) and kidney infection (pyelonephritis) are significant health problems that especially affect women. Kidney disease is a leading cause of high blood pressure (hypertension). And, after age 50, hypertension is more common in women than in men.
Also more common in women than men are the autoimmune disorders (for example, multiple sclerosis, Sjögren's syndrome, and lupus). In these diseases, the immune system attacks the body's own tissue. Autoimmune disorders afflict at least 12 million Americans and 3/4 of them are women. One autoimmune disorder, rheumatoid arthritis, affects approximately 1.3 million Americans, with 2/3 of the sufferers being women.
Osteoporosis, a condition in which bone density decreases, occurs in both men and women. Overall, however, it is more of a major health concern for women. Some studies have reported that as many as one of every two women over 50 will suffer a fracture related to osteoporosis in her lifetime. By age 65, some women have lost half of their skeletal mass. A woman's doctor can assess her bone density and make recommendations as to how to prevent further bone loss.
Cancer in women
Certain cancers are of specific concern to women. These include not only cancer of the female organs, such as the breast, cervix, womb (uterus), and ovary but also of the pancreas, large bowel (colorectal cancer), and lung.
Breast cancer is the second leading cause of cancer deaths among women. In the U.S., a woman has a 12.4% chance of developing breast cancer in her lifetime. Research studies show that the smaller the breast cancer is when it is detected, the greater the chance of survival. Currently, mammography and breast examinations serve as the recommended screening tests for breast cancer. The discovery of inherited gene mutations permits the identification of at least some women at increased risk for developing breast cancer.
Cancer involving the ovaries is also referred to as ovarian cancer. Because ovarian cancer is very difficult to detect in its early stages, it is often referred to as the "silent killer." Although ovarian cancer can occur at any age, a woman's risk gradually increases over time, and it is much higher if there is a history of ovarian cancer in the family. One in every 70 females in the U.S. develops ovarian cancer.
Colorectal cancer is cancer of the large intestine. Most cases of colorectal cancer occur in people over 50 years of age. A woman with a history of cancer of the breast, uterus, or ovary has an increased risk for colorectal cancer. Regular screening is recommended for all women over 50 years old. Research studies show that eating a diet rich in fruits and vegetables and supplementing the diet with antioxidants may help reduce a woman's risk of developing not only colorectal cancer, but a number of other cancers as well.
Lung cancer is the leading cause of cancer deaths among women. As smoking is the primary cause of lung cancer, it should be obvious that abstinence from smoking is a significant way to avoid this dreaded disease. Smoking cessation is essential in minimizing the damage already caused by smoking and optimizing long-term health.
Women's cosmetic concerns
To many women, "cosmetic" means a make-up preparation for external use, such as lipstick or eye-shadow. "Cosmetic" can also mean a medical procedure done to correct defects or for the sake of appearance. It is probably an underestimate that more than 600,000 cosmetic procedures are performed each year. The variety of procedures and the number of women undergoing cosmetic surgery is continuing to increase.
There are very few areas of the body for which a cosmetic procedure has not been developed. There are processes to improve the texture and tone of skin such as dermabrasion and chemical peels. Collagen and Botox injections can modify unwanted wrinkles and creases. Birthmarks, moles, and varicose veins can be treated with a variety of techniques. Lasers can eliminate unwanted hair, whereas lack of hair (baldness or alopecia) can often be remedied with drugs or surgical implants.
Liposuction is the removal of fat under the skin. Body contouring to reshape or "sculpt" the body is done with ultrasonic and tumescent liposuction techniques. Various "lifts" and plastic surgery remove skin and fat and reposition skin and tissue.
Millions of women have undergone breast augmentation or reduction over the years. These procedures remain both popular and controversial. Breast reconstruction, especially following breast cancer, is usually viewed in a different light. Because all of these cosmetic procedures are also medical in nature, it is important that a woman understand their risks and benefits.
For about 40 years of her life, a woman experiences a normal phenomenon called the menstrual cycle. Regular loss of blood and tissue from normal sloughing of the inner lining of the uterus (menstruation) occurs every 26 to 35 days (more or less monthly) in every normal non-pregnant woman prior to menopause. Each monthly cycle can be divided into a follicular phase (an egg develops), ovulation (egg release) at mid-month, and a luteal phase (during which the uterine lining readies itself to receive a fertilized egg). If the egg is not fertilized, the uterine lining is shed, and a woman has her menstrual period. Then, the entire sequence of events is repeated.
Most women do not have difficulties during the first half of their menstrual cycle, but once the egg has been released, there may be problems such as pelvic pain. During the second half of the cycle, a woman may experience premenstrual syndrome (PMS) and she may have menstrual cramps at the onset of her menstrual flow.
Approximately 70%-90% of women suffer from premenstrual syndrome. PMS symptoms include irritability, nervousness, cramps, bloating, and headaches. A particularly severe condition, premenstrual dysphoric disorder (PMDD) is even more troublesome than PMS.
Every step of a woman's menstrual cycle is controlled by hormones. The production of these hormones is dependent on the general good health of the woman. The loss of too much body weight can result in the cessation of menstruation. There are a number of disorders marked either by absent periods or by periods that are too long, heavy, irregular, or painful. Underlying conditions, which may include polycystic ovary syndrome and endometriosis, need to be medically evaluated.
Ironically, there is a medical condition in which affected women benefit from menstruation. The disease is hemochromatosis, which is characterized by too much iron in the blood. Menstruating women with hemochromatosis can lose enough blood during their menstrual periods that they may not need further treatment to remove the excess iron.
Sexuality deals with a woman's sexual attitudes and practices. During her lifetime, a woman goes through many changes, not only in her body, but perhaps also in attitude and lifestyle.
The sex hormones, such as estrogen and progesterone, have a profound influence on a woman's sex life. Women also produce testosterone, as it is required for sexual arousal. In humans, the sexual impulse is not tied to reproduction and women will engage in sexual activity even when they are not fertile
Little is known about what facilitates or inhibits feminine sexual arousal. It is estimated that 50 million American women have difficulty with sexual arousal. Problems include low sexual desire, sexual aversion, difficulty with sexual arousal (like impotence in men) and pain during intercourse (dyspareunia).
Physical exercise may increase sexual arousal whereas chronic illness, arthritis, cancer, diabetes, cardiovascular disease, mental illness, and depression can inhibit sexual arousal. Alcohol and certain drugs such as tranquilizers can also inhibit the sexual response.
Following the success of sildenafil (Viagra) and other male impotence drugs, there is considerable research now being conducted on drugs that improve blood flow to the vagina and the vaginal region which may assist female sexual arousal.
Fertility, birth control, and infertility
Fertility is the ability to bear children. Most women wish to restrict when and by whom they conceive. In the U.S., 94% of women age 15-44 use some method of birth control in order to prevent unwanted pregnancies.
Ideally, the use of birth control is the responsibility of both sexual partners. The choice of a birth control method should be a joint decision. In reality, the ultimate responsibility for birth control more often than not rests with the woman. Her choices include oral contraceptives, spermicides, diaphragms, cervical caps, rhythm methods, contraceptive implants, and intrauterine devices (IUDs). In general, longer-term protection (for example, oral contraceptives, implants, or IUDs) not requiring last minute decision-making provides better protection (a 0.1-3% "failure rate") than methods (for example, condoms or spermicides) used just before intercourse (5%-15% "failure rate").
Every woman who wishes to use birth control needs to decide which method is best suited for her. She must also determine which methods offer her the most protection against sexually transmitted diseases, including HIV infection and AIDS.
The opposite of fertility is, of course, infertility or the inability to bear children. Infertility affects one in five couples in the U.S. Female infertility tends to become more of a problem as a woman ages, especially after age 35. Regardless of age, a woman and her partner need to be medically evaluated by an infertility specialist to determine the cause for the infertility and, if possible, to correct the problem. The options currently available to infertile couples have been expanded. These include the advanced reproductive technologies, such as in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), or utilization of donor eggs and/or sperm. Adoption, as always, is another option for childless couples.
Optimally, all pregnancies would be planned well before conception. In the United States, it is currently estimated that 40% of all pregnancies are unplanned. This means that many women become pregnant before they are prepared.
The ideal time to start learning about pregnancy is not when a woman is already pregnant. In order for a future mother to maximize her chances of having a healthy baby, she should to know what she can do before she conceives and then what to do after she learns she is pregnant.
For a woman, pregnancy planning means learning everything she can about how her own health and that of her baby can be optimized. For example:
The expectant mother needs to know about those diseases that can complicate a pregnancy by their existence or their treatment, such as depression, epilepsy, thyroid disease, asthma, lupus, or diabetes.
If the mother smokes, she must stop, because women who smoke have a higher incidence of miscarriages and stillbirths.
She needs to be aware of the dangers of alcohol consumption during pregnancy.
She must also know which drugs and medications she can continue to use safely and which ones she must avoid.
There are also a number of prenatal tests that can monitor the health and development of her baby.
Finally, she needs to plan ahead for the labor and delivery. Although pregnancy itself lasts only nine months, it is a period of time in which the maintenance of a woman's health is especially critical.
A woman who has children devotes a large proportion of her life to motherhood. Although a woman's fertility is limited roughly to a 40 year period, her maternal responsibilities may last considerably longer -- 60 years or so. And most mothers never cease being concerned about the health and welfare of their children (and grandchildren), no matter what their ages. In other words, a mother is a mother forever.
During the time of motherhood, a woman is responsible not only for the maintenance of her own health, but also that of her family. Roughly one-third of all children in this country (19 million) live apart from their fathers, which means that society still relies on mothers to protect and nurture their children.
The term menopause is used to describe an event or a period of time in a woman's life. In some contexts, it is used to designate a period of a number of years, typically the time when a woman is in her 40's through the decade of her 50's and beyond. Strictly speaking, a woman is said to have experienced menopause when she has had 12 consecutive months without a menstrual period. On average, menopause occurs around 51 years of age. The premenopausal process, however, usually begins in the early 40's. Diminishing sex hormone levels can be measured in a woman in her mid-30's.
"Menopausal" women represent a major component of the population. An estimated 50 million women in the US have reached menopause. Most women can expect to spend around 1/3 of their lives after menopause has occurred.
Menopause has often been referred to as "the change of life" because it is a time in a woman's life when menstruation stops and she can no longer conceive. Symptoms of menopause may include:
diminished sexual desire,
trouble sleeping, and
Until the 1950's, society's attitude was that menopause is a woman's destiny and she should simply accept her destiny. Now there are many medical strategies to cope with the symptoms of menopause. Women are encouraged to think of menopause not as a cataclysmic event in life, but merely as a time of transition.
The mature woman - post menopause
Before the 20th century, the average woman didn't live long enough to worry about the quality of her life after cessation of menses. Now, most women live for several decades beyond menopause.
This is not necessarily good news. 50% of U.S. women over age 75 are living alone in relative social isolation. Ninety percent of residents in nursing homes are women. Not only does the mature woman often have to deal with osteoporosis, cancer, and heart disease, but she is also confronted with other health problems including hearing loss, diminished vison, incontinence, arthritis, insomnia, memory loss, and sexual dysfunction.
The problems of a sedentary, isolated life style can be compounded by poor diet, smoking, and alcohol or drug abuse. Studies show that it is never too late to benefit from an improved diet, moderate exercise, cessation of cigarette smoking and drug usage, not abusing drugs, and decreasing alcohol consumption.
Disease, rather than normal aging, usually accounts for loss of function in the mature woman. Nothing can be done about the passage of years, but a great deal can be done throughout a woman's life to prevent and treat the diseases that keep her from being in the best possible health.
Due to variations in genes, anatomy, and hormone levels, some diseases attack women more often than men, and vice-versa. However, thinking of diseases that women are more prone to as “women’s diseases” can leave men vulnerable to serious health problems.
Here are seven so-called "women's diseases" that can also strike men. If you experience symptoms, don’t let your gender stop you from getting treatment.
Osteoporosis reduces the density of bone, making it more vulnerable to fractures. One in three women are at risk, but so are one in five men. Women experience rapid bone loss following menopause, but by 65 to 70 years old, men lose bone mass at about the same rate.
Kidney and thyroid problems, vitamin D deficiency, and prolonged exposure to steroids, cancer therapies, and anti-convulsants put you more at risk. You may not have symptoms, so ask your doctor for a bone density test.
Women get breast cancer more often than men because they have more breast tissue. Although only about one percent of all breast cancers affect men, research shows that incidence is on the rise. Men rarely heed the warning signs, so the cancer is allowed to develop. Therefore, men typically don’t survive as long as women once a diagnosis is finally made.
If you're over 50, of African-American descent, or obese, you’re more at risk. Watch for any unusual lumps or skin abnormalities in the chest.
The thyroid is a small gland that rests in the middle of the lower neck, where it produces hormones to control metabolism. If it produces too much, hyperthyroidism results. Symptoms include:
dry, coarse skin and hair
If the thyroid doesn’t produce enough hormones, hypothyroidism results. Symptoms include:
Women are five to eight times more likely to have some form of thyroid disease than men, but men can still be affected.
As more men feel the pressure to be thin and look good, more are falling victim to eating disorders. Only 10 to 15 percent of people with anorexia or bulimia are male, but the effects can be equally devastating. Men also are less likely to seek treatment, leaving them more at risk for complications such as:
Athletes, obese boys, homosexual and transgender men, and those who are anxious or have perfectionist personalities are more at risk.
Bladder infections are much more common in women, but men can get them, too — particularly men with an enlarged prostate, kidney stones, or an abnormal narrowing of the urethra. Treatment involves antibiotics and is typically very effective, but men need to be aware of the symptoms.
cloudy urine or bloody urine
a strong urge to urinate
a burning or tingling sensation during urination
Women are two times more likely than men to be diagnosed with depression, but that may be because their symptoms are different. Women may feel sad and cry more often, whereas men are more likely to show anger, irritation, frustration, and discouragement.
Men may turn to drugs or alcohol, or engage in risky behavior. They are also more likely to complete suicide if they try it. Because of these differences, many men go undiagnosed. Without treatment, depression is likely to worsen.
About 90 percent of those diagnosed with lupus are women, but this autoimmune disorder can also strike men. Symptoms include:
joint swelling and pain
butterfly-shaped red rash across the bridge of the nose and cheeks.
The disease is treated similarly in both genders. Your doctor may overlook it because it is rare in men. If you have symptoms, ask for testing.
Studies show that men are less likely than women to look after their health. They’re 25 percent less likely to have visited their doctor in the past year, and almost 40 percent more likely to have skipped recommended health screenings. They’re also one and a half times more likely to die from heart disease, cancer, and respiratory diseases, and they die an average of five years earlier than women.
If you're not feeling right, check with your doctor. By getting the treatments you need, you can beat the odds.
Heart disease is the leading killer of both men and women. In women, the condition is responsible for about 29% of deaths, reports the CDC.
Yet death in itself isn't the biggest problem for women with heart disease. The real trouble is in premature death and disability, says Cindy Pearson, executive director of the National Women's Health Network.
"There are far too many women dying of heart disease in their 60s, when no one expects to die because that's too young in this country," says Pearson. "There are (also) women, who, for many years, are really ill with heart disease -- being out of breath, not being able to walk up one flight of stairs … because heart disease impairs their ability to get around."
Although more men die of heart disease than women, females tend to be underdiagnosed, often to the point that it's too late to help them once the condition is discovered.
"The symptoms for women are typical for women, and they are often missed by doctors and the patient themselves," Mark explains. "We often think of symptoms … like chest pain. Some people may have that, but others may just have a little bit of jaw pain, shoulder ache, nausea, vomiting, or shortness of breath."
The American Heart Association lists risk factors for heart disease as:
Male sex (men typically develop heart disease at a younger age)
Heredity (including race). People with family history of the disease have greater risk. So do African-Americans, Mexican-Americans, Native Americans, Native Hawaiians, and some Asian-Americans.
High blood cholesterol
High blood pressure
Obesity and overweight
"The burden of heart disease in women is very great," says Gregory Burke, MD, professor and chairman of the department of public health sciences at the Wake Forest University School of Medicine. "The earlier folks adapt healthier behaviors, the lower their overall risk for heart disease or stroke outcomes."
Burke says people can reduce their risk of heart disease by modifying lifestyle to include a well-balanced diet and exercise.
Autoimmune diseases are a group of disorders in which the immune system attacks the body and destroys or alters tissues. There are more than 80 serious chronic illnesses in this category, including lupus, multiple sclerosis, and type 1 diabetes.
According to the American Autoimmune Related Diseases Association (AARDA), about 75% of autoimmune diseases occur in women. By themselves, each disease appears to be uncommon -- except for diabetes, thyroid disease, and lupus -- but as a group, the disorders make up the fourth-largest cause of disability among American women.
It is not known what causes the body to turn on itself, but genetic, hormonal, and environmental factors are suspects.
"That's such a major area of needed research," says dr. Helton.
Since autoimmune diseases are not very well understood, pinpointing specific risk factors is difficult. Symptoms can also be nonspecific, hampering proper diagnosis. However, if you know something is wrong with you or a loved one, it's important to become an active health advocate.
"It's very common for women to make multiple visits to multiple doctors to finally get a diagnosis," she says. "Insist that someone take your symptoms seriously."
If you don't feel like your doctor is taking your complaints seriously, Pearson advises finding another doctor that will take the time to investigate your symptoms.
The normal length of a woman's menstrual cycle is 28 days, but this varies between individuals. Irregular menstruation is when the length of the cycle is more than 35 days, or if the duration varies.
A period, or menstruation, is the part of the menstrual cycle in which the endometrium, which is the lining of the uterus, is shed. This appears as bleeding from the womb that is released through the vagina.
Periods usually start during puberty, between the ages of 10 and 16 years, and they continue until menopause, when a woman is 45- to 55-years old.
Irregular periods, also called oligomenorrhea, can occur if there is a change in contraception method, a hormone imbalance, hormonal changes around the time of the menopause, and endurance exercises.
Treatment for irregular periods during puberty and around the menopause is not usually necessary, but if irregular periods occur during the reproductive years, medical advice may be necessary.
A menstrual cycle lasts around 28 days, but it can vary from 24 days to 35 days, depending on the individual.
Most women have between 11 and 13 menstrual periods each year. Bleeding usually lasts around 5 days, but this too can vary, from 2 to 7 days.
When menstruation first starts, it can take up to 2 years to establish a regular cycle. After puberty, most women's menstruation is regular. The length of time between each period is similar.
However, for some women, the time between periods and the amount of blood shed vary considerably. This is known as irregular menstruation.
The main symptom of irregular menstruation is when the cycle is longer than 35 days, or if it varies in length.
If there are changes in blood flow, or if clots appear that are more than 2.5 centimeters in diameter, this is also considered irregular.
A number of factors increase the chance of irregular menstruation. Most relate to hormone production. The two hormones that impact menstruation are estrogen and progesterone. These are the hormones that regulate the cycle.
Life cycle changes that influence the hormonal balance include puberty, menopause, pregnancy, and childbirth, and breastfeeding.
During puberty, the body undergoes major changes. It can take several years for the estrogen and progesterone to reach a balance, and irregular periods are common at this time.
Before menopause, women often have irregular periods, and the amount of blood shed may vary. Menopause occurs when 12 months have passed since the woman's last menstrual period. After the menopause, a woman will no longer have periods.
During pregnancy, menstruation ceases, and most women do not have periods while they are breast-feeding.
Contraceptives can cause irregular bleeding. An intrauterine device (IUD) may cause heavy bleeding, while the contraceptive pill can cause spotting between periods.
When a woman first uses the contraceptive pill, she may experience small bleeds that are generally shorter and lighter than normal periods. These usually go away after a few months.
Other changes that are associated with irregular periods include:
extreme weight loss
extreme weight gain
eating disorders, such as anorexia or bulimia
endurance exercise, for example, marathon running.
A number of disorders are also linked to missed or irregular menstruation.
Irregular periods can sometimes indicate a health problem, and some of these can lead to further problems, such as fertility issues.
Polycystic ovarian syndrome (PCOS) is a condition in which a number of small, fluid-filled sacs known as cysts develop in the ovaries.
A woman with PCOS does not ovulate, and she does not release an egg every month. Symptoms include irregular or no periods, obesity, acne, and excess hair growth.
Women with PCOS have unusually high levels of the male sex hormone, androgen, or testosterone.
According to the Office on Women's Health at the United States Department of Health and Human Services, PCOS affects between 10 percent and 20 women of reproductive age, or up to 5 million American women. Girls as young as 11 years old have been diagnosed with PCOS.
A thyroid disorder can cause irregular periods. The thyroid gland produces hormones that affect the body's metabolism.
Cervical or uterine cancer, or cancer of the womb, may, in rare cases, cause bleeding between periods or during sexual intercourse.
Endometriosis is a condition in which cells that are normally found inside the uterus, called endometrial cells, grow outside it. In other words, the lining of the inside of the uterus is found outside of it.
Endometrial cells are the cells that shed every month during menstruation, so endometriosis is most likely to affect women during their childbearing years.
The cellular growth involved in endometriosis is not cancerous. There may be no symptoms, but it can be painful, and it can lead to other problems. If released blood gets stuck in surrounding tissue, it can damage the tissue, causing severe pain, irregular periods, and infertility.
Pelvic inflammatory disease (PID) is an infection of the female reproductive system. Among women, it is the most common and serious complication of sexually transmitted infections (STIs), apart from AIDS.
If detected early it can be treated with antibiotics, but if it spreads, it can damage the fallopian tubes and the uterus, resulting in chronic, or long-term, pain. There are many symptoms, and they including bleeding between periods and after sex.
Maintaining a healthful lifestyle can help reduce the risk of some of the causes of irregular periods.
exercising regularly to maintain a healthy weight and reduce stress
following a healthful diet
Some herbal remedies, such as black cohosh, chasteberry, licorice root, and turmeric are all said to help, but research has not confirmed their effectiveness, and they may have adverse effects. It is better to speak to a doctor first.
Treatment, if needed, will depend on the cause.
Puberty and menopause: Irregular periods that occur during puberty or as the woman approaches menopause do not usually need treatment.
Birth control: If irregular bleeding is due to contraception, and it continues for several months, the woman should talk to a health care professional about other options.
PCOS and obesity: In cases of PCOS, overweight, or obesity losing weight may help stabilize menstruation. A lower weight means the body does not need to produce so much insulin. This leads to lower testosterone levels and a better chance of ovulating.
Thyroid problems: Treatment for the underlying problem is likely to be prescribed. This may include medication, radioactive iodine therapy or surgery.
Stress and eating disorders: Psychological therapy may help if emotional stress, an eating disorder, or sudden weight loss have triggered irregular periods. This may include relaxation techniques, stress management, and talking to a therapist.
The doctor may prescribe metformin, an insulin-lowering oral drug for type 2 diabetes, which can help ensure ovulation and regular periods.
A low-dose birth control pill that containing a combination of estrogen and progesterone may help. This will decrease androgen production and will help to correct abnormal bleeding.
Alternatively, taking progesterone for 10 to 14 days each month is likely to regulate the periods.
Irregular periods can indicate a problem with fertility, but this is not always so. Ovulation can occur, even while menstruation is irregular.
Here are some things you can do to track ovulation:
Mark any periods on a calendar, and look for patterns.
Check for changes in cervical mucus. As ovulation approaches, the mucus will be more plentiful, slippery, clear, and stretchy.
Take your temperature each day and note when it spikes. This can indicate that ovulation is occurring.
If irregular periods are linked to fertility problems, these records will help a doctor reach a diagnosis.
Anyone who is concerned about irregular menstruation should seek medical advice.
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