A normal menstrual cycle involves complex hormonal interactions that stimulate the ovaries to produce and release estrogen, progesterone and ova (eggs). Menstruation normally occurs in the first five days of the cycle as a result of a decline in estrogen and progesterone levels when pregnancy does not occur. Without these hormones to support the uterine lining, it pulls away, tearing capillaries and causing bleeding.
In the follicular phase (Days 6 to 14), a shift in follicle-stimulating hormone (FSH) and luteinizing hormone (LH) triggers production of estrogen from the ovaries, which encourages the growth of a new uterine lining, known as the endometrium. At the midpoint of the cycle, rising estrogen levels cause LH levels to surge, and in response, the ovaries release an egg, typically between Days 12 and 14.
In the next phase, Days 14 to 28, the site of egg release (corpus luteum) secretes copious amounts of progesterone, necessary to prepare the endometrial lining to receive a fertilized egg. At this stage in the luteal phase of the cycle, progesterone levels exceed estrogen levels. If pregnancy does not occur, progesterone and estrogen levels drop, leading to menstruation, and the cycle begins again.
The cycle continues until an average age of 52 and would normally only be interrupted by pregnancy and breastfeeding. Hormonal problems, including imbalances in the estrogen/progesterone ratio, can interfere with normal cycles. Problems with menstruation include amenorrhea (absent periods), menorrhagia (excessive bleeding), dysmenorrhea (extremely painful menstruation) and irregular periods. There is often a variety of underlying conditions that prompt these symptoms.
Amenorrhea means the absence of periods. Periods typically begin in the early teens and should continue, unless pregnancy occurs, until menopause. A physician should examine girls who haven’t started puberty by the age of 13, or who start puberty but do not menstruate within five years, and girls who have reached the age of 16 without menstruating.
Amenorrhea may be caused by an abnormality in the pituitary gland, brain, adrenal glands, ovaries or other components of the reproductive system. Thyroid imbalances are often a factor in infrequent or absent periods (See Thyroid). Hormonal irregularities such as polycystic ovary syndrome may prevent the release of an egg, disrupting the hormonal cycle (See Polycystic Ovary Syndrome). High levels of stress or Cushing’s syndrome can cause excess cortisol production, suppressing production of the necessary reproductive hormone DHEA, and resulting in the disruption of periods. Anorexia, excess exercise and being overly thin may interfere with the menstrual cycle, as can scarring of the uterus or placental tumors called hydatidiform moles.
Dysmenorrhea is marked by painful cramps, headaches, nausea, vomiting and frequent urination, with menstruation severe enough to interfere with the normal activities of five to fifteen percent of women. Primary menstrual pain may result from uterine contractions that occur when blood supply to the endometrial lining diminishes. The expulsion of clots is also a source of pain. Secondary dysmenorrhea can be the result of such conditions as endometriosis, adenomyosis (abnormal cell growth), fibroids and abdominal adhesions (See Uterine Fibroids, Endometriosis).
Whether you are experiencing heavy periods, painful periods or no periods, these abnormalities must be reported to your doctor. Be sure that you receive a referral to a gynecologist, who should perform an ultrasound (either vaginal or abdominal) to help discover the cause of your symptoms. Abnormal bleeding, pelvic pain or abdominal fullness should not be ignored.
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