suffers from it.
What every adolescent should know about menstruation.
Menstruation usually begins around 11 years of age, but there is a wide variation in this and anytime between 9-14 years is normal. If onset of menses is delayed beyond this, examination and tests of the girl are required to confirm that there is no problem.
Initially, the periods can be very irregular and may not become regular upto 12 – 18 months of starting. This is due to immaturity of the hormone axis and is normal. Too heavy bleeding during menses needs check up and treatment as it may be a sign of a bleeding disorder or hormonal problem and can result in anemia and weakness. Gradually the menses will normalize and the girl will bleed for 3 – 5 days every 28-30 days, which is the normal cycle.
Menstrual hygiene is very important and must be taught to all young girls. Frequent baths during the periods, changing pads frequently, disposing off the pads hygienically is absolutely necessary. Even today, there are lots of myths about menstruation like not eating pickle, not entering the kitchen, taking total rest during this time etc., all of which are illogical.
The adolescent girl is going through a lot of hormonal changes in her body which reflect in her physical, mental and emotional state. Mood changes, irritability, emotional swings are related as much to hormones as to environment. The attitude of the family towards menstruation will help her deal with it for the rest of her life. If it is treated as dirty, unclean and she is isolated, she will have a negative response to menses forever. If it is treated as a wonderful process of growing up or maturing and having the amazing ability to bear children later, she will treat it positively and it has been shown that these girls get much lesser pain and discomfort during menses as well as less premenstrual syndrome (PMS)
During the teenage years many girls experience PMS. This may cause bloating, breast pain, depression and irritability prior to menses and the symptoms disappear after the periods. This is perfectly normal and restriction of salt, refined flour, caffeine and chocolates alongwith light exercise during this time helps relieve symptoms. Also addition of calcium, B-complex, primrose oil and such supplements may help reduce symptoms. Occasionally, hormone treatment is required in severe cases.
Painful periods (dysmennorhoea) is another common problem in teenagers and many girls miss school and college because of it. This is usually due to excessive local production of prostaglandin’s and can be reduced by light exercise, hot showers and antiprostaglandin tablets taken at the onset of menses. In some girls regular hormonal pills have to be given if there is severe pain.
Often during the growing years, there is a variation in the size of both breasts and this causes immense worry to the girl. This variation is common, may sort itself out once full growth is achieved or once in a while the discrepancy may remain till adulthood. This has to be managed by wearing a suitability-padded bra or later by surgery and there are no creams or medicines, which can help this.
There are many myths associated with menstruation and growing up and proper sex education and counseling or a meeting with a good gynaecologist should be a part of growing up.
Everyone knows the teen years can be difficult - for both teens and parents. All those physical changes during puberty can make adolescents feel awkward and unsure of themselves.
This is particularly true for girls when it comes to menstruation. For a girl, getting her first period is a physical milestone and a sign of becoming a woman. But it can also be confusing, particularly if she encounters certain problems like irregular periods or premenstrual syndrome (PMS).
Common Menstrual Problems
Most issues teens confront when they start menstruating are completely normal. In fact, many girls and women have had to deal with one or more of them at one time or another:
One out of every four girls suffers from it. It causes all the problems that she most detests - weight gain, acne, facial hair growth and irregular periods. Not only young girls but even middle aged women may be affected by the problem of PCOD.
This is a problem that often runs in families and the mother and daughters may both be affected as there is a strong genetic component in its inheritance. One of the main problems in PCOD or Polycystic Ovarian Syndrome (PCOS) as it is now called – is resistance to insulin.
As the person usually has high insulin levels – she has a tendency to gain weight and to develop diabetes as she grows older. Also, as there is a problem of anovulation the ovary does not produce eggs every month, hence the girl suffers from irregular periods (usually delayed) scanty or heavy flow and often has difficulty in conceiving. Due to the excess of male hormone in the system, there is acne and excess facial hair growth. Some girls with PCOS may be thin and not show acne etc but sonography will show ovaries with multiple small water filed cysts thus establishing the diagnosis. Also a hormone check will show high levels of male hormone and also high levels of insulin. As a result of abnormal hormones and irregular periods for many years, these women have a higher chance of developing cancer of the womb.
The treatment of PCOS depends a lot on the symptoms the patient has. The most important thing in the obese patients is weight loss as it significantly improves the entire picture. Lifestyle change is necessary which includes improvement in diet, increase in exercise and keeping weight in control.
For a young lady who has lot of pimples and facial hair and has irregular periods the best treatment is combined hormonal pill. Some of these drugs contain medicines which reduce facial hair growth and within a few months the patient has significant improvement. The existing facial hair can be treated cosmetically, and new growth will reduce. Also pimples will clear out and menses will become absolutely regular with regular hormone treatment.
The other group of women in whom conceiving is the major problem the treatment is totally different. They require medicines such as clomiphene or gonadotrophin injections to induce ovulation. Sonography is done to check if the egg is coming out every month or not (ovulation). Many of these patients have a very erratic response to drugs, either no effect or an excessive number of eggs growing in response to normal dose of medicines. Hence great care has to be taken when these women are treated for infertility. Many of these women become pregnant either with simple treatment or with test tube baby treatment (IVF) but there is also a high miscarriage rate in women with PCOS.
A good drug in these women with high insulin levels is metformin, an antidiabetic drug but which has been proven to improve the metabolism and help weight loss in obese PCOS patents even when their sugar levels are normal. Another treatment for patients with many cysts in their ovaries is laparoscopic burning of the cysts with a thin needle through which a current is passed (laparoscopic ovarian drilling). This is a simple short procedure and requires 2 – 3 small (1 cm) cuts on the belly through which the laparoscope (telescope) and camera are passed. As the cysts are burned, the male hormone levels fall and the patient may begin to ovulate spontaneously. This is a good technique especially in infertile patients where the tubes also have to be checked to see if they are open or not, as the procedures can be combined.
The problem of polycystic ovaries is massive; the important point is to have a healthy lifestyle with a good diet and exercise which will help to control this epidem
FAQ
Q.1. I am 27 years old, married for 4 years and have been trying for a baby since then. I have always had irregular periods and am overweight. My husbands semen report is normal. I am desperate, please help. Farzana
Ans: It is possible that you have polycystic ovarian syndrome (PCOS) where there is obesity, irregular menses and sometimes acne and excessive facial hair growth. In these patients the egg does not come out every month, as a result some patients have difficulty in conceiving. You must do your hormone tests and sonography to check ovulation. There are many tablets and injections available which help the eggs to grow. Sonography (follicle study) will check the growth and the exact time of rupture of egg. At this time if an insemination of husband semen is done, the pregnancy rate is high. Ofcourse, for all this, you need to have normal open tubes, which need to be tested by an X ray (HSG) or laparoscopy. (Keyhole surgery to look at the womb and the tubes etc.)
Q.2. Since one year I have been getting delayed periods and have put on lots of weight. I have also got excess facial hair. What can the problem be? Anita
Ans: It is possible that you have a problem called polycystic ovarian disease (PCOD). In this the ovaries get enlarged and develop many small cysts. These patients may present with various symptoms such as weight gain, acne, hirsuitism (excessive hair growth), abnormal periods or inability to conceive. The treatment will depend on the age of the patient and the problems she is facing. The treatment is almost always hormonal. Weight loss is necessary if the patient is overweight. Sometimes drugs which are used in diabetics may also be prescribed. The surgical treatment consists of laproscopic drilling of the cysts in the ovaries. The kind of treatment chosen is individualized to the needs of the patients.
In India the pattern of teenage sexuality has always been different from developed countries. However, the situation is changing as girls start their periods earlier now as compared to in the past and the age of marriage is progressively getting later. There is a long interval between sexual maturity and sexual gratification. Premarital sex is still considered taboo but much less so than in the past. The last 10 years have seen a significant increase in unmarried adolescents being exposed to sex due to massive invasion of western values through television and the internet and movies. Also teenagers tend to reject social conventions due to peer pressure and are keen to adopt more liberal westernized culture. In cities the teenagers today have more money to spend, more parties and pubs to go to and are allowed to have late nights and hence have much more opportunity to interact with the opposite sex.
Unfortunately, sex education has not kept abreast with the changing trends and is practically non-existent in our schools and colleges. Only a few elite schools have counselors to solve the regular problems of teenagers, which may than increase and become major issues. Contraceptive knowledge is poor and how to actually use pills or condoms properly is unknown to most. As a result teenage pregnancy and sexually transmitted diseases especially herpes, gonorrhea and non-specific vaginosis are on the increase. Herpes causes painful blisters around the vaginal area and unless properly treated can keep on recurring. HPV (human papilloma virus) infection causes warts in and around the vagina and may increase significantly the risk of cancer of the cervix later. Some infections may manifest only as urinary burning and increase in frequency of passing urine. Infections like Chlamydia, which cause no obvious symptoms but can cause damage resulting in infertility in the future, are fairly common in teenagers. Adolescents are more prone to sexually transmitted diseases (STD’s) than adults due to low antibodies, large surface area of the cervix (mouth of the uterus) and improper treatment. There is awareness of HIV amongst many teenagers but they believe that with a single partner they need not use protection. This can be dangerous. It is absolutely necessary for the man to use a condom to protect himself and his partners from all these infections. The female condom, when it becomes freely available, will also be a good option.
There are many common misconceptions among teenagers. Most of them believe that having occasional sex will not make them pregnant. Many practice withdrawal method or safe period for contraception, which has an extremely high failure rate. Contraceptive pills will make them put on weight or cause them long-term harm or difficulty in becoming pregnant later. The fears of these issues prevent them from using contraceptive pills, which actually is completely wrong. The harm they will suffer form an unwanted pregnancy and subsequent abortion is much higher than that caused by contraceptive pills.
Girls are taking emergency contraception often nowadays, which can spell havoc with the system if taken regularly as they have relatively high doses of hormone and are for occasional use only.
If a period is missed, most girls prefer to think that it is due to stress or exertion or weakness. The commonest cause is pregnancy, if they are exposed to unprotected sex. The earlier the pregnancy is picked up, the better it is, as the pregnancy can be terminated by tablets alone (abortion pill) and there is no need to undergo a surgical procedure which is much more risky.
White discharge is a common problem and girls believe that this causes weakness, backache etc. In reality these are usually simple non specific or trichomonal or fungal infections which can be easily treated and definitely do not cause weakness. Sometimes they may be a symptom of more severe sexually transmitted disease, therefore a checkup is required.
Masturbation is bad and causes weakness is another misconception. Self gratification in both sexes is natural and has no damaging effects on the body.
If an adolescent feels that he or she is mature enough to be in a relationship and is ready for sexual interaction with the partners, then they should also be mature enough to take precautions to protect themselves or then bear the consequences of their actions such as an unwanted pregnancy or a sexually transmitted disease.
FAQ
Q.1. I suffer from lower abdomen pain, breast tenderness, depression and mood changes before my menses. I also feel very bloated. I am 18 years old. Please help. Tannushri
Ans: You seen to be suffering from Premenstrual syndrome( PMS). This is a common problem and starts few days before the periods and improves after the menses. It is important to reduce caffeine, refined flour, salt and oily food prior to menses. Yoga or exercise helps reduce symptoms of PMS. Also calcium, vitamin B and evening primrose oil supplements may help. In rare cases hormonal therapy may be required.
Q.2. I have lot of white discharge, which stains my panty. I also get itching over my private parts. Is this a serious problem? Deepa.
Ans: White discharge from vagina is a common problem and usually due to a fungal or mixed infection. This is easily treatable with either oral or vaginal tablets. However, if you are getting repeated episodes then you must check your blood sugar levels and do a pap smear, which is a simple cancer screening test for the cervix (the mouth of the uterus).There maybe an ulcer or redness (erosion) on the cervix which can be treated by a biopsy and cauterization. Sometimes excessive discharge, especially if blood tinged, may also be a sign of cancer cervix.
Q.3. Me and my boyfriend had unprotected sex a few days ago. My friends told me to take the morning after pill, which I did. Now I am worried that I may become pregnant. Is it possible for pregnancy to still occur? Avantika
Ans: The morning after pill or emergency contraception should be taken within 72 hours of unprotected intercourse. The sooner it is taken, the better it is. However it is not completely reliable and there can be a pregnancy despite the use of these tablets. They may also cause irregular bleeding. These pills will give no protection against sexually transmitted diseases, hence it is safer to use a condom . If you are regularly sexually active, it is better to start on oral contraceptive pills which are low dose hormone pills which give excellent protection against pregnancy.
