Madeeha Syed

Discover the potential risks of period regulation remedies. Learn about the dark side of these methods. Stay informed with Meri Sehat.

Period Regulation Remedies: The Dark Side

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Ismail Munir

Common Menstrual Myths In The Society

Introduction

If you belong to the latter group, then chances are that once you got over the dying part and gathered the courage to speak to a family member, they informed you of your body&#39;s natural function and likely a few additional pieces of information regarding menses. As per results from a recent study, only 28% of women in Karachi, Pakistan had adequate menstrual health knowledge prior to their first <a href="https://www.merisehat.pk/article/natural-remedies-to-help-regulate-your-periods">period</a>.<a href="#accordion">[1]</a> 
&nbsp;

Understanding Myths Associated With Menstruation

Almost 50% of Pakistan&#39;s population is composed of females.<a href="#accordion">[2]</a>&nbsp;Despite the high prevalence of females, awareness of women&#39;s health issues is limited. There is an unfortunate stigmatization of menstruation in low-income countries, for e.g., sanitary napkins are often sold in brown paper bags and menstrual concerns are not a widely discussed topic. This stigmatization of menstruation and lack of awareness leads to the spread of incorrect practices and knowledge among women. This could be a source of concern as these practices can later have harmful implications on the lives of women and girls.&nbsp;

Every woman has been likely exposed to several myths and superstitions pertaining to periods. The following article will help to shed light on some of these myths.&nbsp; 
&nbsp;

<ul dir="ltr">
	<li>
	<h5>No Baths Allowed</h5>
	</li>
</ul>

A multi-center study conducted on menstrual hygiene practices among Pakistani girls reported that 39% of girls avoid bathing during menstruation.<a href="#accordion">[3]</a>The most common reason for avoiding taking a bath is that it can cause an irregular flow.<a href="#accordion">[1]</a>&nbsp;However, such practices can affect one&#39;s hygiene and predispose girls to reproductive tract infections. Moreover, research has pointed out that there is no link between irregular flow and bathing during menstruation. Instead, warm baths are often encouraged to help relieve painful menstrual cramps in women.<a href="#accordion">[4]</a>&nbsp; 
&nbsp;

<ul dir="ltr">
	<li>
	<h5>Don&#39;t Eat The Pickle</h5>
	</li>
</ul>

Cold water, pickles, eggs, and milk are just some of the food items various cultures advise against consuming during menstruation. Approximately 50% of Pakistani girls report avoiding &#39;cold foods&#39;(e.g., yogurt, ice cream) as they fear that it will stop their periods and increase the chances of blood clots.<a href="#accordion">[3]</a>&nbsp;Similarly, &#39; hot foods&#39; (e.g., liver, eggs, dry fruits) are also avoided for fear of menstrual irregularities. However, there is a lack of scientific evidence linking cold or hot food to menstrual cycle abnormalities.&nbsp; 
&nbsp;

<ul dir="ltr">
	<li>
	<h5>Avoid Exercising</h5>
	</li>
</ul>

Among the general population in Karachi, approximately 53% of women restrict physical activity during menstruation to avoid heavy periods.<a href="#accordion">[1]</a>&nbsp;Walking, sitting, and lifting weights are some of the commonly avoided physical activities among girls and women. However, research shows that aerobic exercise can be beneficial for painful menstrual cramps.<a href="#accordion">[5]</a> 
&nbsp;

Conclusion

In many low- and middle-income countries, periods are considered impure and a process of dirty or impure blood leaving the body. This is likely due to a lack of education regarding reproductive health. Young adolescent girls are often too shy or scared to discuss menstrual issues with their mothers. Moreover, a majority of adult women are also not aware of the physiology of menstruation or good hygiene practices. As a result, there is a high prevalence of misinformation among girls and women. Almost 70% of Pakistani university-going girls believe the source of bleeding in menstruation to be the vagina instead of the uterus.<a href="#accordion">[3]</a>

Therefore, there is a need for the introduction of regular menstrual education awareness programs in schools and universities. Furthermore, primary care physicians should be aware of the common myths and misconceptions regarding menstrual health in a population. Health education campaigns on a community level can ultimately help destigmatize reproductive health issues.&nbsp; 
&nbsp;

Key Points

<ul>
</ul>

<ul>
	<li>Menstruation is a natural phenomenon in a woman&#39;s life that is often stigmatized in various cultures.</li>
	<li>A lack of awareness has led to the development of various myths and practices regarding menstruation. The most common of which is avoidance of taking a bath during periods, not eating certain foods, and avoiding exercise.</li>
	<li>Community-based health education programs can help destigmatize menstruation and propagate correct information and practices among girls and women.</li>
</ul>

[1] Ali, S. A. et al., 2020. Perceptions, Practices, and Challenges Regarding Menstrual Hygiene Among Women in Karachi, Pakistan: A Comparison Between General Population and Healthcare Workers. Cureus, 12(8).

[2] Pakistan Bureau of Statistics, n.d. Census 2017. [Online].

[3] Mansoor, H. et al., 2020. Menstrual knowledge and practices of Pakistani girls: A multicenter, cross-sectional study. Heliyon, 6(1).

[4] Jo, J. & Lee, S. H., 2018. Heat therapy for primary dysmenorrhea: A systematic review and meta-analysis of its effects on pain relief and quality of life. Scientific Reports, Volume 8.

[5] Dehnavi, Z. M., Jafarnejad, F. & Kamali, Z., 2018. The Effect of aerobic exercise on primary dysmenorrhea: A clinical trial study. Journal of Education and Health Promotion, 7(3).

Nimrah H. Sattar

This article or video has been vetted and verified by Meri Sehat’s specialists. It contains citations and research from validated sources.

Mental Health Tips For Dysmenorrhea

If you&#39;re a woman in your 20s, 30s, or really any age, there must have been days when you struggled with your mental health. Dark thoughts, anxiety, low mood, an inability to carry out normal day-to-day chores, chances are you&#39;ve experienced them all. And if you suffer from <a href="https://www.merisehat.pk/disease/dysmenorrhea">dysmenorrhea</a>, then the chances of anxiety, irritability, etc. become much higher. Despite society conditioning us into thinking that period pain is a part of life, there is nothing okay about having to deal with debilitating pain on a monthly basis.

<a href="https://www.merisehat.pk/disease/dysmenorrhea">Dysmenorrhea</a>, also called painful menstruation, affects more than 50% of university students in Pakistan<a href="#accordion">[1]</a>. Along with severe pain, many women also report sleep disturbances, difficulty concentrating on work or studies, and frequent leaves from work or school<a href="#accordion">[2]</a>. Additionally, women with dysmenorrhea have higher depression and anxiety scores<a href="#accordion">[3]</a>. Thus, significantly impacting their quality of life.

So, if you&#39;re someone struggling with dysmenorrhea and its mental health effects, here are some of the things you can do to feel better.

&nbsp;

Understanding Dysmenorrhea And Mental Health

Over five thousand years ago, people in Northern India developed what we now call yoga. The exercise and relaxation method has evolved over the years, but what has remained the same is its ability to help people heal, both physically and emotionally. Yoga isn&#39;t just some exercise. It is also a way for people ground themselves and connect with their thoughts.

In dysmenorrhea, the increased levels of prostaglandins and estrogen cause the uterine muscles to contract. As these muscles contract, they push against the surrounding blood vessels, temporarily cutting off the oxygen supply to the muscle. Thus, resulting in pain around the lower abdomen and back.&nbsp;

Various yoga poses can help relax the muscles and improve the blood supply to the pelvic region. Moreover, the various stretches also help calm the mind and revive your energy. However, no one&#39;s asking you to twist your body into crazy positions. You can start by practicing simple poses such as the pigeon pose, fish pose, bound angle pose, and child&#39;s pose. It&#39;s best to avoid leg lifts and any rigorous physical activity during the first few days of your periods.&nbsp;

&nbsp;

Deep breathing exercises involve a combination of slow, deep inhales and exhales. They help increase blood flow in the blood vessels, relax muscles, and reduce pain perception. Thus, relieving anxiety and depression symptoms among people. It is also one of non-pharmacological methods of reducing pain in women with dysmenorrhea.

&nbsp;

Here&#39;s a simple deep breathing exercise you can try next time you feel anxious or low on emery:

<ol>
	<li>Lie on your back in bed or on a yoga mat.</li>
	<li>Inhale and exhale to relax your body.</li>
	<li>Now place a hand on your belly.</li>
	<li>As you take a deep breath in, feel your belly rise into your hand.</li>
	<li>Breath out slowly and feel the belly move down as the air exits your body.</li>
	<li>Take three more breaths like this, focusing on the movement of your belly and feeling the air filling your body and leaving with every exhale.</li>
</ol>

&nbsp;

Dysmenorrhea can be an extremely debilitating condition for women. Coupled with pain, women are also affected with mental health disorders such as depression and anxiety. Therefore, it is important to increase awareness about the mental health implications of this gynecological disorder. Moreover, researchers believe that psychiatric intervention can help women and adolescent girls suffering from dysmenorrhea have a better quality of life.

<ul>
</ul>

<ul>
	<li>Dysmenorrhea, defined as painful menstruation, is associated with higher depression and anxiety levels among women.</li>
	<li>Yoga is a simple exercise technique that can help relax muscles and calm the mind, helping ease symptoms of depression and anxiety in women with dysmenorrhea.</li>
	<li>Deep breathing exercises involve slow, deep breaths that increase oxygenation of muscles and blood vessels; thus, relaxing muscles and reducing anxiety and depression.</li>
	<li>There is a need for a multidisciplinary approach in women suffering from dysmenorrhea. Psychological intervention can help improve their quality of life.</li>
</ul>

&nbsp;

[1] Yasir, S., Kant, B. & Dar, M. F., 2014. FREQUENCY OF DYSMENORRHOEA, ITS IMPACT AND MANAGEMENT STRATEGIES ADOPTED BY MEDICAL STUDENTS. Journal of Ayub Medical College Abbotabad, 26(3).

[2] Unsal, A. et al., 2010. Prevalence of dysmenorrhea and its effect on quality of life among a group of female university students. Upsala Journal of Medical Sciences, 115(2), pp. 138-145.

[3] Sahin, N. et al., 2018. Assessment of anxiety-depression levels and perceptions of quality of life in adolescents with dysmenorrhea. Reproductive Health, Volume 15.

Medilink Consultant clinic

ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

Managing Pain In Dysmenorrhea

<a href="https://www.merisehat.pk/disease/dysmenorrhea">Dysmenorrhea</a> is a common occurrence among adolescent girls<a href="#accordion">[1]</a>. Also called painful menstruation, the condition affects 50% of university students across Pakistan<a href="#accordion">[2]</a>. In the majority of women, the pain is also associated with nausea, vomiting, fatigue, and mood disturbances.&nbsp;

Dysmenorrhea is of two types: primary and secondary. Primary dysmenorrhea develops in the absence of any underlying medical condition and is usually caused by an increase in prostaglandin activity. On the other hand, secondary dysmenorrhea results from pelvic pathology such as fibroids, endometriosis, pelvic inflammatory disease (PID), ovarian cysts, or several others.&nbsp;

While the level of pain varies from person to person, in many the symptom of dysmenorrhea significantly impacts their quality of life. Difficulty concentrating on studies, sleep disturbances, limited participation in sports, and frequent class and work absenteeism are common feature<a href="#accordion">[3]</a>.&nbsp;

Therefore, effective pain management techniques are highly important in helping women achieve some normalcy in life. There are several pharmacological and nonpharmacological methods available to help relieve pain.&nbsp;

&nbsp;

Understanding Dysmenorrhea And Pain Management

These include conventional treatments such as over-the-counter pain relief medications and hormonal contraceptives:

&nbsp;

<h5>1. Pain Relievers</h5>

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are effective at reducing the levels of prostaglandins in the body. This in turn reduces uterine contraction and helps relieve dysmenorrhea. They are used for both primary and secondary dysmenorrhea. However, their use is contraindicated in people with gastritis, peptic ulcer, renal problems, or bleeding conditions due to adverse effects. Moreover, for many women NSAIDs fail to provide the desired effect of pain relief.&nbsp;In some women, doctors may also prescribe analgesics such as aspirin and acetaminophen in combination with NSAIDs or alone.

&nbsp;

<h5>2. Hormonal Contraceptives</h5>

These work by blocking ovulation and decreasing menstrual flow; thus, alleviating pain. Some options include oral contraceptive pills, hormonal intrauterine contraceptive devices (IUCD), and hormonal injections. While they can provide better relief of pain than NSAIDs, they are associated with side effects such as weight gain, menstrual irregularities, and mood changes. Moreover, they are often prescribed to women not looking to conceive.&nbsp;

&nbsp;

Over the years, the use of nonpharmacological methods which commonly involve complementary and alternative medicine has steadily increased<a href="#accordion">[4]</a>.&nbsp;Bed rest is one of the most common methods employed by university students in Pakistan for pain management followed by oil massage, drinking turmeric milk, and using hot water bottles<a href="#accordion">[5]</a>.&nbsp;

 
Generally, at-home treatments for relieving dysmenorrhea include:

<ul>
	<li>Placing a heating pad or hot water bottle on the pelvic and back area can help reduce muscular spasms.</li>
	<li>Massaging the abdomen and back using essential oils such as lavender, rose, and peppermint.</li>
	<li>Taking warm baths.</li>
	<li>Taking vitamin B1 (thiamine) supplements daily.</li>
	<li>Avoiding caffeine, smoking, and alcohol.&nbsp;</li>
	<li>Daily exercise can also help prevent painful menstrual cramps.</li>
</ul>

&nbsp;

<ul>
	<li>
	<h5>Ginger</h5>
	</li>
</ul>

The use of ginger has also been shown to cause a significant reduction in pain. Researchers attribute the effects to ginger&#39;s anti-inflammatory action that is brought about by the inhibition of prostaglandin synthesis. In a study, ginger was shown to be as effective as ibuprofen and mefenamic acid in relieving pain in women with primary dysmenorrhea<a href="#accordion">[6]</a>.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Complementary Methods</h5>
	</li>
</ul>

Some alternative or complementary methods may also be employed for dysmenorrhea. These include:

&nbsp;

<h5>1. Yoga</h5>

Several yoga poses can provide relief from painful menstruation. The gentle exercise has been linked to the release of endorphins and reducing menstrual pain.

&nbsp;

<h5>2.&nbsp;Acupuncture And Acupressure</h5>

Certain acupuncture points help reduce muscular contractions by regulating blood flow to these areas. Thus, reducing pain.

&nbsp;

<h5>3. Herbs</h5>

Herbal remedies such as chamomile tea, fennel seeds, and cinnamon have anti-inflammatory and antispasmodic action that reduce muscular contractors and relieve pain.&nbsp;

&nbsp;

<h5>4.&nbsp;Transcutaneous Electrical Nerve Stimulation (TENS)</h5>

Through electrical pulses, the body is stimulated to release endorphins which help reduce pain.

&nbsp;

Menstrual pain is often dismissed as a normal part of women&#39;s lives. This results in young women never seeking medical attention for dysmenorrhea. Thus, causing significant physical and emotional distress. Not only can dysmenorrhea affect one&#39;s academic performance but also limit their day-to-day functioning.&nbsp;

Despite the high prevalence of dysmenorrhea, there is a lack of awareness among women about the various pain management methods available to them. The majority of women self-medicate with NSAIDs or analgesics. However, these often cause side effects and/or fail to provide relief. Therefore, there is a need for more effective and safe pain management strategies. Moreover, women should be counseled about the various complementary and alternative medicine methods such as yoga and breathing exercises that can provide relief of symptoms.

&nbsp;

<ul></ul><ul><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Dysmenorrhea is defined as painful menstruation and leads to significant reduction in quality of life.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Pharmacological methods for pain relief involve the use of over-the-counter pain medications such as NSAIDS and hormonal contraceptives.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Since pharmacological therapies can have side effects, many women resort to home remedies such as massage, heating pads, massage, and exercise.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Complementary and alternative medicine methods such as yoga, acupuncture, and herbal supplements are also gaining momentum for treatment of dysmenorrhea.</li></ul>

[1] Ullah, A. et al., 2021. Prevalence of Dysmenorrhea and Determinants of Pain Intensity Among University-Age Women. Pain Medicine, 22(12), pp. 2851-2862.

[2] Yasir, S., Kant, B. & Dar, M. F., 2014. FREQUENCY OF DYSMENORRHOEA, ITS IMPACT AND MANAGEMENT STRATEGIES ADOPTED BY MEDICAL STUDENTS. Journal of Ayub Medical College Abbotabad, 26(3).

[3] Unsal, A. et al., 2010. Prevalence of dysmenorrhea and its effect on quality of life among a group of female university students. Upsala Journal of Medical Sciences, 115(2), pp. 138-145.

[4] Yu, A., 2014. Complementary and alternative treatments for primary dysmenorrhea in adolescents. The Nurse Practitioner, 39(11), pp. 1-12.

[5] Mansoor, H. et al., 2020. Menstrual knowledge and practices of Pakistani girls: A multicenter, cross-sectional study. Heliyon, 6(1).

[6] Jenabi, E., 2013. The effect of ginger for relieving of primary dysmenorrhoea. Journal of the Pakistan Medical Association, 63(1).

To Bleed Or Not To Bleed?

Society, culture, and religion have fixed certain roles for each gender. For women, it is traditionally the role of the mother, the nurturer, and the caretaker. For centuries, they have prioritized family life. Whether they have been asked to, whether there was no other option available, whether out of choice; the thing is many women have come to put others&rsquo; needs above their own. They become givers and, in the process, forget they are also entitled to love and care.&nbsp;

&nbsp;

Moreover, in South Asian communities, women are often restricted in mobility. As a result, they have limited healthcare access, are subjected to male violence, and do not hold the power to make decisions for themselves or their families<a href="#accordion">[1]</a>. This further devalues their role in terms of how they perceive themselves as well as how society perceives them.&nbsp;

&nbsp;

When even their basic needs are not met, women stop paying attention to common and major healthcare concerns. Thus, they are less likely to seek care, especially when it concerns reproductive health. Of course, the existence of cultural taboos does not help this situation; they&rsquo;ve just internalized this lack of confidence along with a poor sense of worth.&nbsp;&nbsp; 
&nbsp;

Understanding Post Menopausal Bleeding

Although menstruation is a natural biological process, in low- and middle-income countries, there are several stigmas surrounding the physiological phenomenon<a href="#accordion">[2]</a>.&nbsp;

&nbsp;

The lack of knowledge regarding female reproductive health and the spread of incorrect information means many women are unaware of when to seek help. A cross-sectional survey conducted at a government hospital in Karachi, Pakistan, found that more than 90% of women had heard of menopause<a href="#accordion">[3]</a>. However, only 30% knew about the symptoms<a href="#accordion">[3]</a>.&nbsp;

&nbsp;

A lack of awareness of <a href="https://merisehat.pk/disease/menopause">menopause symptoms</a> means many women are also unaware of what&rsquo;s normal and what&rsquo;s not. Therefore, they often disregard symptoms such as postmenopausal bleeding.&nbsp;

&nbsp;

But is postmenopausal bleeding a cause for concern? Should you be booking a visit to the gynecologist?&nbsp;

&nbsp;

<h5>Menopause&nbsp;</h5>

Menopause is defined as the cessation of menstrual cycles for a period of 12 consecutive months. Postmenopause is the period following menopause. The average age of menopause is 51 years<a href="#accordion">[4]</a>, whereas in Pakistan, the mean age of menopause for women is 49.3 years<a href="#accordion">[5]</a>.&nbsp;

&nbsp;

The common symptoms of menopause include:

<ul>
	<li>Mood changes</li>
	<li>Hot flashes</li>
	<li>Hair loss</li>
	<li>Vaginal dryness</li>
	<li>Insomnia</li>
</ul>

&nbsp;

Often, these symptoms linger into the postmenopause period.&nbsp;

&nbsp;

IMPORTANT: One thing that&rsquo;s not a normal side effect of menopause, and should be a cause for concern, is the presence of vaginal bleeding.&nbsp;

&nbsp;

<h5>Postmenopausal Bleeding</h5>

Postmenopausal bleeding is defined as vaginal bleeding after a year or more of cessation of menstruation. Approximately 4-11% of postmenopausal women report vaginal bleeding<a href="#accordion">[4]</a>. And about 1-14% of postmenopausal bleeding is secondary to endometrial cancer<a href="#accordion">[4]</a>.&nbsp;

&nbsp;

Although vaginal atrophy is the most common cause of postmenopausal bleeding, 90% of postmenopausal women with endometrial cancer have vaginal bleeding as the presenting sign<a href="#accordion">[6]</a>. Therefore, there is a need for raising awareness about postmenopausal bleeding and its possible causes.&nbsp;

&nbsp;

After menopause, there is a drop in estrogen levels in the body. The tissues lining the vagina and endometrium begin to undergo atrophy. Micro-erosions along with chronic inflammation develop on the epithelial surface. This inflamed endometrium is then prone to slight bleeding.&nbsp;

&nbsp;

Other causes of postmenopausal bleeding include:

<ul>
	<li>Endometrial Or Uterine Cancer:&nbsp;Endometrial cancer could result in a thickening of the uterus lining. It causes the lining to shed and result in vaginal bleeding.&nbsp;</li>
	<li>Polyps:&nbsp;These result from an overgrowth of the endometrium and could appear in the uterus or cervix. They&rsquo;re not cancerous but likely to result in spotting or heavy bleeding.&nbsp;</li>
	<li>Fibroids:&nbsp;Also called leiomyomas, fibroids are noncancerous growth of muscle and tissue that form from the uterine walls. While small fibroids are typically asymptomatic, larger ones could cause vaginal bleeding.&nbsp;</li>
	<li>Endometrial Hyperplasia:&nbsp;Low progesterone levels and too much estrogen result in endometrial thickening. The thickened endometrium is at risk of bleeding and also able to transform into cancer.&nbsp;</li>
	<li>Sexually Transmitted Diseases (STDs):&nbsp;Vaginal bleeding after sexual intercourse might be a result of STDs such as chlamydia and gonorrhea.&nbsp;</li>
	<li>Medications:&nbsp;The use of certain drugs is associated with vaginal bleeding as a side effect. These include tamoxifen, blood thinners, or hormone replacement therapy.</li>
	<li>Pelvic Trauma:&nbsp;Injury to the vagina also causes bleeding.</li>
</ul>

&nbsp;

A cross-sectional study conducted in Mardan, Pakistan, determined the patterns of bleeding and endometrial biopsy in women presenting with postmenopausal bleeding. As per the results, 26% of the patients had atrophic endometrium while 23% had endometrial carcinoma<a href="#accordion">[7]</a>, thus, proving the need for a proper assessment of postmenopausal bleeding in women.

&nbsp;

Another cross-sectional study was conducted among postmenopausal women in Sahiwal, Pakistan. Half of the women were obese, which established obesity as a risk factor for postmenopausal bleeding<a href="#accordion">[8]</a>. Moreover, the incidence of endometrial carcinoma was 7% among women<a href="#accordion">[8]</a>. The study points to the need for endometrial cancer screening programs, especially among menopausal women complaining of vaginal bleeding.&nbsp;

&nbsp;

Regardless of the reason, postmenopausal bleeding is a cause for concern. Therefore, if you notice spotting or vaginal bleeding post-menopause, book an appointment with the obstetrician-gynecologist. Early diagnosis would improve prognosis for the patient, and their overall quality of life.&nbsp;

<ul><li>Postmenopausal bleeding is defined as vaginal bleeding that occurs 12 months after the cessation of the menstrual cycle.&nbsp;</li><li>Vaginal or endometrial atrophy is the most common cause of postmenopausal bleeding. However, 90% of postmenopausal women with endometrial cancer have vaginal bleeding as the presenting sign.</li><li>Other common causes of postmenopausal bleeding include polyps, fibroids, endometrial hyperplasia, medications, and sexually transmitted diseases.&nbsp;</li><li>All cases of postmenopausal bleeding require immediate consultation with the obstetrician-gynecologist. A delay in diagnosis could have a poor outcome for the patient.&nbsp;</li></ul>

[1] Fikree, F. F., & Pasha, O. (2004). Role of gender in health disparity: the South Asian context. BMJ (Clinical research ed.), 328(7443), 823–826.

[2] Arshad Ali S, Baloch M, Riaz L, et al. (August 20, 2020) Perceptions, Practices, and Challenges Regarding Menstrual Hygiene Among Women in Karachi, Pakistan: A Comparison Between General Population and Healthcare Workers. Cureus 12(8): e9894. doi:10.7759/cureus.9894

[3] Karim, F., Ghazi, A., Ali, T., Jabbar, S., Naz, S., & Aslam, R. (2013). Women’s Perception Towards Menopause. Journal of Surgery Pakistan (International), 18(3).

[4] Sung S, Abramovitz A. Postmenopausal Bleeding. [Updated 2022 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.

[5] Jadoon AK, Sohail F, Qabulio SN, et al. Perception and Awareness of Menopause among Premenopausal Women of Different Socioeconomic Backgrounds. J South Asian Feder Menopause Soc 2019;7(1):8–13.

[6] ACOG Committee Opinion No. 734: The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding. Obstet Gynecol. 2018 May;131(5):e124-e129.

[7] Jadoon S, et al. Postmenopausal Bleeding - A Strong Indicator of Endometrial Carcinoma. Pak Armed Forces Med J 2019; 69 (2): 368-72

[8] Perveen, S., Azhar, M. S., Shah, F., Mahmood, F., & Mahmood, U. (2022). Association of postmenopausal bleeding with endometrial carcinoma. Pakistan Journal of Medical and Health Sciences, 16(3), 103–105.

Iqra Mazhar

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I’m Hot. It’s Not Summer, It’s Just Menopause

<a href="https://www.merisehat.pk/disease/menopause">Menopause</a> marks the evident end of regular menstrual cycles. The term can depict any progressions one goes through nearing the end of menstruation, or what one may experience closely after it, indicating the completion of your reproductive years and stages.&nbsp; 
&nbsp;

Menopause and perimenopause can cause side effects like nervousness, mood swings, mind haze, hot flushes, and irregular periods. These side effects can begin a long time before the end of the menstrual cycle and continue a while later. Menopause and perimenopause side effects can hugely affect the individual&rsquo;s life, including social interactions and work. However, there are multiple ways that can help you deal with these side effects. Several medications, for instance, can help replace the missing or reduced chemicals associated with menopause and help ease the unavoidable signs and symptoms.

&nbsp;

Understanding menopause and how to deal with its symptoms

Menopause is a natural process that all menstruating women must go through. It may occur due to one of the following reasons: 
&nbsp;

<ul>
	<li>Natural Menopause: During their 40s, most women observe changes to their regular cycles. The cycles may become longer or more limited, heavier or lighter, more frequent or with much significant dry spells, until the ovaries stop producing eggs and menopause commences. This occurs, on average, by the age of 51 years<a href="#accordion">[1]</a>. 
	&nbsp;</li>
	<li>Surgical Procedures: Surgical procedures such as oophorectomy or removal of ovaries are also associated with causing menopause. The ovaries are responsible for producing hormones, including estrogen and progesterone that control, monitor, and synchronize the monthly menstrual cycle. Thus, medical procedures to remove the ovaries cause early and prompt menopause. The monthly periods halt, and the person goes through the various menopausal signs and symptoms<a href="#accordion">[1]</a>. 
	&nbsp;</li>
	<li>Chemotherapy Or Radiation Therapy: These disease treatments can affect menopause by causing side effects such as hot flashes during or not long after the course of treatment. Following chemotherapy, the stop to the monthly cycle (and fertility) is not necessarily irreversible or long-lasting, so contraceptive measures might be needed<a href="#accordion">[1]</a>. 
	&nbsp;</li>
	<li>Primary Ovarian Insufficiency: Early menopause might result from the inadequate production of reproductive hormones by the ovaries, a condition called primary ovarian insufficiency. It can result from hereditary elements or immune system illness. Hormone treatment is regularly suggested until the normal period of menopause to safeguard the cerebrum, heart, and bones<a href="#accordion">[2]</a>.&nbsp;</li>
</ul>

&nbsp;

Menopause is not easily self-diagnosed and missing a period for more than three months is a concerning state. The most common symptoms of menopause include: 
&nbsp;

<ul>
	<li>Hot Flashes</li>
	<li>Insomnia</li>
	<li>Vaginal Dryness</li>
	<li>Urinary Incontinence</li>
	<li>Mood Changes 
	&nbsp;</li>
</ul>

An individual may experience one or more symptoms and should consult medical healthcare providers to confirm the suspicion of menopause. They will monitor and examine your symptoms to guide you towards an efficient treatment.&nbsp; 
&nbsp;

While certain lifestyle changes and drugs may forestall menopause, it is a natural and inevitable process every menstruating woman must go through. However, certain measures may help alleviate its symptoms.

&nbsp;

<h5>1. Hot Flashes</h5>

Hot flashes are the most prevalent symptoms of menopause. It is the unexpected sensation of warmth in the chest area, but is normally experienced with a greater sensation over the face, neck, and chest. Your skin can blush, as though you are becoming embarrassed. A hot flash can likewise cause extreme perspiration. Assuming you lose a lot of body heat, you can feel chills a short time later. Night sweats are hot flashes that occur at night<a href="#accordion">[3]</a>. 
&nbsp;

Phytoestrogens naturally occur in plants and certain food sources. Research suggests that these substances can, to some extent, reverse the hormonal imbalance associated with menopause<a href="#accordion">[4]</a>. Soy-based food varieties contain elevated degrees of phytoestrogens, so eating loads of tofu is recommended to decrease the overwhelming effects of hot flashes. Moreover, it is highly recommended to stay away from food triggers that can make you sweat as they increase your basal temperature. These include hot drinks, spicy food, and liquor. And remember to stay hydrated! 
&nbsp;

Exercise likewise facilitates the discomfort of hot flashes by bringing down levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Try to get at least 20 minutes of physical activity, three times each week. As per the National Center for Complementary and Integrative Health, acupuncture can also help reduce hot flashes in postmenopausal women<a href="#accordion">[5]</a>. 
&nbsp;

<h5>2. Insomnia</h5>

During menopause, it appears as though you are constantly drained and exhausted. To exacerbate the situation, hot flashes and various other side effects disrupt a person&rsquo;s sleep. Having a consistent sleep routine helps individuals to get the necessary amount of rest, especially during menopause when they are fatigued. To adhere to a timetable, set up your brain and body for rest by fostering a soothing bedtime ritual that starts around a similar time each night. For instance, clean up, listen to calming music, read a book, or do different exercises that help you relax. These practices indicate to your body that it&rsquo;s almost time to sleep. Thus, helping you to nod off with ease. 
&nbsp;

Once you get in bed, abstain from staring at the TV, using your laptop, or checking your phone. The blue light from gleaming electronic screens smothers your body&#39;s development of melatonin, a hormone that affects sleep. Moreover, try to abstain from working, eating, and having a serious conversation with anyone especially your spouse once you have settled into your bedroom. Reinforcing the relationship between your bed and rest might assist you with clearing your brain at bedtime. Ensure you are in a comfortable atmosphere by adjusting the temperature of the AC or heater, and getting a new fluffier pillow. If you live in a metropolitan city, get ear plugs so that the noises outside do not disturb you, and drink a cup of chamomile tea before going to bed.&nbsp; 
&nbsp;

<h5>3. Vaginal Dryness</h5>

The vagina might become dry, or irritated because of menopause and perimenopause. A GP can prescribe estrogen medicines that can be placed into the vagina, in the form of a tablet, cream, or ring. This multifaceted treatment can also help alleviate any urinary side effects of menopause and perimenopause, such as urinary incontinence. These vaginal estrogen medicines cannot enter the circulatory system and just have a local effect. Moreover, they do not have a rigid time frame and can be used throughout the post-menopause stage. Discontinuing the use of the product might bring back the unpleasant symptoms. There have not been any recorded repercussions, therefore, vaginal estrogen is safe to be used with hormone replacement therapy (HRT)<a href="#accordion">[6]</a>. 
&nbsp;

Over-the-counter vaginal lubricants are recommended to address vaginal dryness experienced during intercourse. These items lower the frictional erosion associated with vaginal dryness and prevent any sexual discomfort. It should be noted that only water-soluble lubricants are recommended as the counterpart oil-soluble items, for example, Vaseline increases discomfort and make the situation more complex. Reach out for products intended for the vagina; keep away from hand creams and moisturizers containing alcohol or those that are scented. These can disturb the vaginal tissue and disrupt the vaginal pH<a href="#accordion">[7]</a>.&nbsp;&nbsp; 
&nbsp;

<h5>4. Urinary Incontinence&nbsp;</h5>

While it is characterized as the constant and uncontrollable urge to urinate, most individuals would agree that urinary incontinence is an unwanted disturbance. Fortunately, there are systems to assist with various types of incontinence without drugs or medical procedures. Ensure you are drinking satisfactory water to keep urine diluted. This can be confirmed if the urine is clear or has a light-yellow hue. Keep away from food varieties or refreshments with a high acid or caffeine content, as that can disturb the bladder lining. These include grapefruits, oranges, tomatoes, coffee, and caffeine-containing sodas. Likewise, attempt Kegel exercises to reinforce your pelvic floor muscles and diminish incontinence episodes<a href="#accordion">[7].</a>&nbsp; 
&nbsp;

<h5>5. Mood Changes</h5>

Discussing your mood swings with a healthcare professional can assist you with recognizing the reason, gauging the probability of depression, and settling on the most suitable mediation. For depression, treatment would be different as your doctor might prescribe drugs that alter the chemical imbalance associated with menopause. Normally, these medications take half a month to bring about any noticeable improvement. A few antidepressants have, likewise, been found to treat hot flashes.&nbsp;Antidepressants work best when combined with therapy or psychotherapy. 
&nbsp;

When you reach menopause, you might anxiously wait to transition to post-menopause. This is the period after menopause. However, that does not guarantee complete liberty from discomforting menopausal symptoms. 
&nbsp;

There is no conclusive timetable for when menopausal symptoms begin and end. Your experience generally depends on hereditary qualities. Figuring out how to adapt to your symptoms can bring you long stretches of solace as you progress to the next chapter of your life. 
&nbsp;

While there are no treatments to reverse menopause, an individual can make certain changes in their lifestyle to alleviate the persisting symptoms: 
&nbsp;

<ul>
	<li>Stay hydrated and wear light clothes to avoid intense hot flashes. Also, keep away from spicy food and hot beverages.</li>
	<li>Try to include physical fitness and exercise into your routine to help with hot flashes and insomnia.</li>
	<li>Do not be fickle with your sleep routine. Adhere to a consistent cycle, even on weekends, to get uninterrupted sleep.</li>
	<li>Schedule an appointment with a counselor or therapist to address mood changes in a comfortable and safe environment.</li>
	<li>Engage yourself in social gatherings to increase serotonin.</li>
	<li>Try Kegel exercises to strengthen pelvic bone muscles and reduce the recurrence of urinary incontinence.</li>
</ul>

&nbsp;

[1].Mayo Clinic. (2022). Menopause.

[2].Welt, C. (2020, September 8). Clinical manifestations and diagnosis of spontaneous primary ovarian insufficiency (premature ovarian failure).

[3].Santen, R. J., Loprinzi, C. L., & Casper, R. F. (2020, Feburary 18). Menopausal hot flashes.

[4].Chen, M. N., Lin, C. C., & Liu, C. F. (2014). Efficacy of phytoestrogens for menopausal symptoms: a meta-analysis and systematic review. Climacteric, Vol 18(2), 260-269.

[5].Mudd, L., & Shurtleff, D. (2017, May). Menopausal Symptoms: In Depth. Retrieved from National Center for Complementary and Integrative Health: https://www.nccih.nih.gov/health/menopausal-symptoms-in-depth#hed3

[6].NHS. (2022, May 7). Menopause. Retrieved from NHS

[7].NAMS. (2022). Five Solutions for Menopause Symptoms. Retrieved from The North American Menopause Society:

Zarlish Kazmi

Humza Khizer

First Period? No Worries, We Got You Covered

Menarche &ndash; first menstrual period &ndash; is a normal phenomenon for girls. It is significant because it implies growth, both physically and socially.&nbsp; 
&nbsp;

Menstruation is the &quot;periodic discharge of blood from the uterus.&quot; It may or may not occur as a monthly cycle and continues for the entirety of the women&rsquo;s active reproductive life&quot;<a href="#accordion">[1]</a>. 
&nbsp;

Periods can be very challenging to manage, regardless of how long you have had them; but they are especially difficult the first time when you are totally unprepared for them.&nbsp; 
&nbsp;

In this article, you&#39;ll find everything you need to know about your periods &ndash; from finding the right menstrual products, including napkins and tampons, to managing pains and preserving stained clothes.&nbsp; 
&nbsp;

Puberty is the main cause of menstruation. This is the stage when the girl&rsquo;s body becomes capable of reproduction. The estrogen (female hormone) levels increase in the female body due to the beginning of the menstrual cycle, which plays an important role in the thickening of the endometrium or the inner lining of the uterus.&nbsp; 
&nbsp;

The main purpose of the endometrium lining is to aid a fertilized egg during pregnancy. In case the sperm does not fertilize the ovum (egg), the thickened lining is broken down by your body&#39;s natural mechanism and pushed out of your uterus in the form of periods. 
 
&nbsp;

<h5>When Will I Get My First Period? 
&nbsp;</h5>

Girls start menstruating when they reach the age of puberty, between the ages of 12 and 13<a href="#accordion">[2]</a>. Typically, menstruation takes place 2 years after the development of your breasts. 
&nbsp;

<h5>What Symptoms Should I Look For? 
&nbsp;</h5>

Some girls would not experience any symptoms. Their periods start abruptly and without warning. Other girls experience some symptoms in the days preceding their periods, otherwise known as Premenstrual Syndrome (PMS).&nbsp; 
&nbsp;

Symptoms of PMS include:

<ul>
	<li>Skin problems</li>
	<li>Abdominal bloating and pain</li>
	<li>Breast tenderness</li>
	<li>Pain in the lower back</li>
	<li>Constipation</li>
	<li>Diarrhea</li>
	<li>Fatigue</li>
	<li>Mood swings, feeling sensitive or irritable</li>
	<li>Food craving, especially sweets</li>
	<li>Transparent or white discharge from the vagina 
	&nbsp;</li>
</ul>

To avoid being caught unprepared when your period starts, you should start keeping a &quot;<a href="https://merisehat.pk/article/a-guide-to-period-products">period kit</a>&quot; in your bag as soon as you reach that age and feel that your body&rsquo;s changing. This kit should include: 
&nbsp;

<ul>
	<li>A pair of clean underwear</li>
	<li>Pad, menstrual cup, or tampon</li>
	<li>Cleaning wipes</li>
	<li>Over-the-counter pain relievers, such as ibuprofen 
	&nbsp;</li>
</ul>

<h5>What Should You Do For Your First Period? 
&nbsp;</h5>

Try not to panic if your menstruation has begun and you don&#39;t have anything to utilize for the blood. Until you can obtain a good pad or tampon, you can make a temporary pad out of toilet paper to tide you over. 
&nbsp;

A quick tutorial: 
&nbsp;

1. Fold the layers of a long piece of toilet paper (at least 10 squares) over one another.

2. Place this on your underwear where the napkin would be placed &mdash; down the central part of your underwear, along the piece of fabric between your legs (known as the gusset).

3. Use a second toilet paper to wrap the pad and your underwear repeatedly. This will help keep the tissue in its place.

4. Finish the wrap by tucking the tissue&#39;s end into the top. Now, you have a temporary pad that you can easily manage and remove.&nbsp;

You might think of asking your teacher /school nurse/ friends for a pad if you are at your school. It&rsquo;s nothing to feel ashamed or embarrassed about.&nbsp; 
&nbsp;

Understanding How to Deal With the First Menstrual Cycle

Your first period would continue for a few days. It takes some time for your period to become regular and consistent. Usually, periods last between 2-7 days every month when they become regular.&nbsp; How Much Blood Will Be Lost From Your Body? The first few periods are considered typically light compared to those later in your life and only bring a few patches of red-brown blood throughout the week.Once the hormones have stabilized, your cycle will follow a schedule that will be more predictable. However, it is possible to experience a strong flow in the first few months and it's not always a problem if the bleeding is heavier. But, if you believe you are bleeding too much, you need to inform your parents or consult the school nurse.You can also tell any adult whom you trust if you:<ul><li>Have to replace/change your sanitary napkin and tampon every couple of hours.&nbsp;</li><li>Feel giddy</li><li>Feel dizzy</li><li>Feel heart palpitation</li><li>A period of bleeding that lasts more than 7 days.&nbsp; </li></ul>You might need to be taken to the gynecologist by your guardian to discuss your signs. The doctor can also prescribe some medicines to help you with your symptoms.&nbsp;

In this section of the article, several menstrual products have been outlined. Your choice of product depends on a variety of factors such as flow, pain, comfort etc. It is important to bear in mind that your preferred option might change down the line.&nbsp; 
&nbsp;

<h5>Period Underwear</h5>

The concept of period underwear is quite recent. The only difference between it and conventional underwear is that it is made of a unique fabric that absorbs menstrual blood and keeps it inside the fabric. 
&nbsp;

Period underwear caters to all girls and women, i.e. they have different levels of absorbency of blood. If your first period is light, you might be able to rely solely on these. But, if you feel it&rsquo;s a heavy flow, then period underwear is a great backup; it&rsquo;s pretty helpful in preventing accidental leakage.&nbsp; 
&nbsp;

There are numerous brands available, but they all function similarly. Choose one according to your flow and comfort. 
&nbsp;

<h5>Sanitary Napkins And Panty Liners</h5>

Rectangular pieces of absorbent material that you can stick on the inside your underwear are called sanitary napkins. Every pad has a sticky strip on the underside, allowing for the pad to remain attached to your underwear. Some pads may include &quot;wings&quot; on the sides that you drape over the borders of your underwear. This aids in keeping the pad in position and also prevents leakage. 
&nbsp;

There are many different sizes of pads. Each size is specifically designed to accommodate various degrees of blood flow. The amount of blood a pad can absorb varies depending on its size and is usually indicated on the box/cover 
&nbsp;

You&#39;ll most probably use different sizes of pads within one cycle for example at the start of the cycle, you will need more absorbent pads since the flow is heavy, while towards the end of the cycle a lighter absorption pad would be adequate due to less flow.&nbsp;&nbsp; 
&nbsp;

Most women prefer using pads at night compared to tampons as it is easier to change and if left overnight will not cause any health related issues.&nbsp; 
&nbsp;

At the start of your cycle, you will notice some spotting. To prevent staining your underwear due to spotting, you can use panty liners. These are thinner and more compact. They can also be used towards the end of your periods when your bleeding could be sporadic.&nbsp; 
&nbsp;

<h5>Tampons</h5>

Tampons are menstruation products that are tube-shaped and absorbent. They are placed within the vagina to soak up menstruation blood before it gets to your underwear. 
&nbsp;

Applicator tubes made of cardboard or plastic are often sold with tampons. These tubes have been made to aid you in inserting the tampon into your vagina. A string is on one end of every tampon to help you remove it easily.&nbsp; 
&nbsp;

Tampons are available in various sizes and levels of absorbency. Beware of scented tampons, though, as your vagina might become irritated by fragrance. 
&nbsp;

When it&#39;s time to insert the tampon, carefully press it inside your vaginal canal until only the string is left exposed.&nbsp; If your tampon has an applicator, gently pull it out by holding onto the tube. You should let the tampon stay in your vagina so that it&#39;ll absorb the blood.&nbsp; 
&nbsp;

When it is time to take it out of the vagina, just pull the string till the tampon is free.&nbsp; 
&nbsp;

Please make sure to change your tampon every 4 to 6 hours, but no longer than 8 hours. If left for 8 hours, the risk of infections and&nbsp; irritation increases. You also risk developing Toxic shock syndrome (TSS), although it&#39;s rare but it always better to be safe than sorry&nbsp; 
&nbsp;

<h5>Menstrual Cups</h5>

If you are uncomfortable using pads or tampons, another option is menstrual cups. Cups are inserted into the vagina, similarly to tampons, where they collect blood before it leaves the body. 
&nbsp;

Cups normally come in two size options &mdash; small or large &mdash; generally based on the female&#39;s age and previous delivery experience, their menstrual flow, and cervix height. 
&nbsp;

The smaller variant will probably be more convenient, easy to use and more comfortable for you to insert. You should receive step-by-step instructions for your product, but you can also refer to a guide to insertion and removal.&nbsp; 
&nbsp;

One major advantage of these cups over pads or tampons is that they can be washed and used repeatedly. This implies that you only need to remove the cup, clean it, and reinstall it when it&#39;s time to replace it. 
&nbsp;

The lifespan of reusable cups ranges from 6 months to 10 years with proper maintenance depending upon the type of brand and manufacturer of it. In other words, menstrual cups are not only safe and effective, they also save you money and are eco-friendly.&nbsp; 
&nbsp;

No, not always! Before we get into the details, know that it can happen to anyone. 
&nbsp;

When you start your period, you&#39;ll be learning about how much blood will be shed from your body, the amount your menstrual item can absorb, and when your flow seems to be at its heaviest. 
&nbsp;

Keep a few cleaning wipes in your bag if you can. They can help you remove the stain until you can thoroughly wash the fabric.&nbsp; 
&nbsp;

As a temporary solution, you can tie a jacket around your waist to hide the stain&nbsp; 
&nbsp;

Try this technique to remove the stain when you reach home: 
&nbsp;

1. Soak the stained fabric in cold water as soon as possible. Do not use warm water because that would set the stain and make it impossible to get out.&nbsp;

2. Spray a stain remover if it is available. Be sure to soak the affected region thoroughly. Let it sit for the amount of time labeled on the product&#39;s packaging.&nbsp;

3. If you don&#39;t have a stain remover on hand or wish to use two different methods to make it more effective, you can rub a bar soap or dab some liquid soap into the stain-affected region to build up a thin lather.&nbsp;

4. Wash and repeat the process till the stain washes out.

5. Wash your pants in the washing machine if the stain is not completely removed. Just be certain to use cold water rather than warm.&nbsp;

6. Air dry the washed clothes since the dryer&#39;s heat has the potential to set the stain permanently.&nbsp; 
&nbsp;

<h5>Can Other People Tell That I&rsquo;m On My Period?</h5>

Not at all! You don&rsquo;t have a different appearance or fragrance. Someone could smell the blood only if you leave your napkin or period underwear on for a longer period than advised. 
&nbsp;

You should not use scented menstrual products as they can aggravate your vulva.&nbsp; 
&nbsp;

Wash your vaginal area with lukewarm water if you are worried about body odor. Another great alternative is use of baby wipes to clean your intimate regions during periods. 
&nbsp;

<h5>Can I Still Swim And Play Sports?</h5>

Swimming and other physical activities are allowed during your period. It may also have the potential to lessen cramps.&nbsp; 
&nbsp;

Choose a tampon or a menstrual cup to stop leakage in the water when you intend to swim.&nbsp; 
&nbsp;

For the majority of activities, pads or period underwear can be used.&nbsp; 
&nbsp;

<h5>What Can I Do About Cramps?</h5>

Cramps are, without a doubt, uncomfortable. But think about it this way: your body needs periods &ndash; and, therefore, cramps &ndash; to remove the uterine lining. 
&nbsp;

To feel better:

<ul>
	<li>Follow the directions on the label or advice of medical healthcare professionals for use of&nbsp; over-the-counter pain relievers such as ibuprofen.&nbsp;</li>
	<li>Put a heating pad or heating wrap as a source of heat on your lower back or stomach.</li>
	<li>Take a warm bath. 
	&nbsp;</li>
</ul>

Speak to an adult if your cramps are worsening and you feel sick and unable to get out of bed or do routine activities. In some instances, excruciating cramping could signify an underlying illness like endometriosis so don&rsquo;t ignore or take it lightly and consult a gynecologist&nbsp; . 
&nbsp;

<h5>Other Symptoms I Might Have ?&nbsp;</h5>

Besides cramps, you might also experience the following symptoms:

<ul>
	<li>Acne</li>
	<li>Abdominal bloating</li>
	<li>Sore breasts</li>
	<li>Back pain</li>
	<li>Constipation</li>
	<li>Diarrhea</li>
	<li>Fatigue</li>
	<li>Feeling sensitive or irritable</li>
	<li>Food cravings 
	&nbsp;</li>
</ul>

All these symptoms don&#39;t necessarily need to be present when you have your period. They appear or disappear depending upon the hormonal swings.&nbsp; 
&nbsp;

<h5>How Frequently will I Get It?</h5>

The period is basically one part of the menstrual cycle. This implies that your period will follow a more regular pattern over time.&nbsp; 
&nbsp;

Typically, a menstrual cycle lasts for 28 days. But it can be around 21-45 days, which is also normal.&nbsp; 
&nbsp;

Menstruation may not start consistently for about 6 years following your first period. This is because your body has to learn how to control the release of your reproductive hormones.&nbsp; 
&nbsp;

<h5>How Can I Predict When It Will Come?</h5>

It would take a few years for your periods to develop a regular pattern. But you can keep a track of your symptoms, which would prove useful in spotting patterns and getting (mentally) ready for your period till it arrives.&nbsp; 
&nbsp;

This record can also be used to discuss severe pains with the nurse or other healthcare professionals.&nbsp; 
&nbsp;

You can use signs or code words to aid you in symbolizing the start and end of your period if you don&#39;t want people to know what you are tracking. You can maintain it on paper or on a phone. Or you can download an app. Fitbit, for instance, has a tracking option; others like Flo Period &amp; Ovulation Tracker, Clue Period Tracker &amp; Calendar, and Eve Period Tracker App work, too. 
&nbsp;

<h5>Will I Have Periods Forever?</h5>

You won&#39;t have periods for your entire life, but you&#39;ll have them until menopause. The onset of menopause is directly related to the level of hormones that triggered your menarche i.e. Menopause occurs when these hormones start to decrease in your body. 
&nbsp;

Usually, menopause starts between the ages of 45 and 55. But it&rsquo;s not just the age factor; your period may stop/ become irregular due to stress and other medical conditions as well. Talk to your healthcare professional about when you miss a period. 
&nbsp;

Meanwhile, there&rsquo;s the option of hormonal birth control if you want to stop your periods for health reasons/ travel purposes. Again, it&rsquo;s better to get in touch with your doctor first regarding it.&nbsp; 
&nbsp;

You will not have any periods during pregnancy. In case you experience any bleeding or spotting during pregnancy, please consult your doctor immediately. 
&nbsp;

<h5>Can I Get Pregnant After Menstruation?</h5>

The brief answer? Yes. When the semen comes in touch with the vagina, pregnancy is a possibility. Although the start of a period is mostly considered to mark the start of your reproductive years, it is possible to conceive before your period.&nbsp; 
&nbsp;

Hormones determine everything. In some circumstances, your body may secrete ovulation-inducing chemicals before the start of menstruation. Getting pregnant is conceivable even if you have intercourse during your menstruation.&nbsp; 
&nbsp;

Ultimately, it depends on where you are in your cycle. If you want to prevent pregnancy, you can use any of the contraceptive methods suggested by your doctor.&nbsp; 
&nbsp;

Talk to a responsible adult or visit a doctor if: 
&nbsp;

<ul>
	<li>By the age of 15, you have not begun your period.&nbsp;</li>
	<li>It&#39;s been almost 2 years since you have had your periods and they are still irregular.&nbsp;</li>
	<li>Bleeding occurs in between your periods.&nbsp;</li>
	<li>You are in excruciating pain and unable to carry out routine tasks.&nbsp;</li>
	<li>You must replace your pad or tampon every 1-2 hours as you experience heavy intense bleeding.&nbsp;</li>
	<li>You experience periods longer than 7 days.&nbsp; 
	&nbsp;</li>
</ul>

Make sure you&rsquo;ve kept a record of when your last period began and ended, when did the erratic bleeding start, or any other signs you experienced during your cycle. 
&nbsp;

Women in low- and middle-income countries frequently lack access to medical information, particularly regarding menstruation-related hygienic concerns. Lack of formal guidance from the schools, cultural resistance to using alternate menstruation products, a lack of economic resources, and inadequate water and sanitation infrastructure make this natural process difficult for young girls.&nbsp; 
&nbsp;

As a result, a biological process that naturally dignifies women and girls becomes a source of embarrassment and frustration. Such societal stigmas and beliefs make post pubescent girls more susceptible to engaging in unsanitary behaviors that result in various diseases, including those of the reproductive and urinary systems. 
&nbsp;

Hence, this article aims to provide a comprehensive guide to educate young girls about safe menstrual health.&nbsp; 
&nbsp;

<ul>
	<li>It might be challenging for a parent or guardian to know how to help a child during their first period.</li>
	<li>Every woman goes through the period as part of her regular cycle.</li>
	<li>The guardian should keep it factual. Don&rsquo;t let your menstrual past, whether it&#39;s been positive or negative, influence how you think and eventually affect how your daughter feels about menstruation.</li>
	<li>There are various menstruation product options to help you with the process.</li>
	<li>Make a period kit with some underwear, stain remover, and menstrual supplies that they can conveniently put in a locker or backpack.</li>
</ul>

[1] Fingerson, L. (2012). Girls in power: Gender, body, and menstruation in adolescence. SUNY Press.

[2] Marques P, Madeira T, Gama A. Menstrual cycle among adolescents: girls' awareness and influence of age at menarche and overweight. Rev Paul Pediatr. 2022;40:e2020494. Published 2022 Jan 5. doi:10.1590/1984-0462/2022/40/2020494

Neelam Asad

Natural Remedies To Help Regulate Your Periods

Overview

You may have heard that your menstrual cycle is counted from the first day of a period to the first day of the next. The average menstrual cycle is 28 days, but this can vary from person to person and month to month.Your periods are still considered regular even if they come every 24 to 38 days. Your periods are considered irregular if the time between periods keeps changing and your periods come earlier or later than expected.The treatment depends on finding out what’s causing your irregular periods, but there are remedies you can try at home to get your cycle back on track. Read on to discover eight science-backed home remedies for irregular periods.

Possible Causes

Diet

<ul dir="ltr">
	<li>
	<h5 dir="ltr">Low-carb Diet</h5>
	</li>
</ul>

A high-fat, low-carb diet can lead to amenorrhea&mdash;a condition where you don&rsquo;t get enough carbs to regulate your menstrual cycle.

Low-carb diets may disrupt thyroid function and lower leptin levels in the body, which can also result in amenorrhea. Leptin is produced by fat cells and helps regulate reproductive hormones.

Experts recommend getting 225 to 325 grams of carbs per day if you&rsquo;re consuming a 2,000-calorie diet. This means you should get about 45 to 65 percent of your total daily calorie intake from carbohydrates. 
&nbsp;

<ul dir="ltr">
	<li>
	<h5>High-fiber Diets</h5>
	</li>
</ul>

Fibers are non-digestible carbohydrates that don&rsquo;t provide us with much nutrition, but they have an important role to play in our health. They help maintain a healthy digestive system, and they can also lower the concentration of certain hormones in your body.

One of these hormones is progesterone, which is produced by the ovaries during ovulation. Progesterone helps prepare your uterus for pregnancy by thickening the lining of the uterus and preparing it for implantation of an egg.

Estrogen is another hormone affected by too much fiber in your diet. Estrogen helps regulate your menstrual cycle and maintain healthy reproductive organs. It also helps protect against breast cancer.

FSH and LH are other hormones that may be affected by high intake of fiber in your diet. These two hormones are released from the pituitary gland and stimulate ovaries to release eggs during ovulation so they can be fertilized by sperm cells from a male fetus (sperm).

Now while these fibers and their impact on hormones may lower the chances of women developing breast cancer, it has a bad impact on your periods starting off with irregular periods. 
&nbsp;

If you&rsquo;re wondering why your periods are out of whack, it might be time to take a look at what you&rsquo;re eating.

What we eat can have a big impact on our hormone balance, and that can affect how often we get our periods. If you&rsquo;re not getting enough nutrients from the food, you eat or from supplements, that may stress your hypothalamus, pituitary, and adrenal glands &mdash; the organs that regulate your body&rsquo;s hormone balance. This imbalance can lead to irregular menstruation or even lead to amenorrhea (when you stop having periods altogether).

But don&rsquo;t worry! Here are a few things you can consume to help keep your hormones in check:

<ul dir="ltr">
	<li>
	<h5 dir="ltr">Cinnamon</h5>
	</li>
</ul>

Cinnamon is a staple in our kitchen, and it should be a staple in your diet too. It&rsquo;s great for helping regulate blood flow to the uterus and may treat irregular periods, abdominal pain, nausea and vomiting <a href="http://merisehat.pk/article/a-guide-to-period-products" target="_blank">during periods</a>.

For best results, add a teaspoon of cinnamon powder to a glass of milk and consume it. Cinnamon can help regulate insulin levels in your body which may have an effect on other hormones and the menstrual cycle. In women with Polycystic Ovary Syndrome (PCOS) who often have high insulin levels and irregular periods, cinnamon can cause a more regular period cycle.

Cinnamon supplements may also reduce pain in women who have painful menstrual periods. 
&nbsp;

<ul dir="ltr">
	<li>
	<h5>Turmeric</h5>
	</li>
</ul>

Turmeric is an ancient spice that has been used for over 4,000 years as a natural remedy to help regulate your periods. It can stimulate blood flow in the uterus and pelvic region, helping to regulate your menstrual cycle. Turmeric also contains curcumin, which has been shown to have many beneficial health effects. These include reducing inflammation and improving mood, so taking supplements containing curcumin may decrease symptoms of PMS.

Turmeric is also an emmenagogue, which means it can induce menstruation by stimulating the uterus and expanding it. To reduce irregularity in your cycles, drink haldi doodh (turmeric milk) or turmeric latte regularly! 
&nbsp;

<ul dir="ltr">
	<li>
	<h5>Beetroot</h5>
	</li>
</ul>

&nbsp;Beetroot is a powerhouse of iron, calcium, and folic acid amongst others. This vegetable can reduce water retention and bloating, something which women commonly experience during periods. The iron in beetroot helps to prevent anemia that causes fatigue and weakness during periods. It also provides relief from cramps by improving blood circulation in the body.

Drinking beet juice every day will help improve your health and wellbeing during periods. 
&nbsp;

Bottom Line

When looking for natural remedies to regulate your period, it helps to start with a good understanding of how your body works before you arrive at your ultimate menstrual destination. After all, knowing where you&rsquo;re headed makes sense in travel, and doesn&rsquo;t that make sense in health? Knowing how your body works will help determine what kind of remedy you need, whether it&#39;s a massive lifestyle overhaul or just an indulgence from the kitchen cupboard.

Umna Salah

A. JABBAR DENTAL CLINIC

Sadia Khan

The Mystery Of The Missing Periods

Menstrual disorders, encompassing a spectrum of irregularities, pose a significant health challenge that impacts both the physical and emotional well-being of a woman&#39;s life. From dysmenorrhea to menorrhagia, these disorders span a wide spectrum, each presenting its own set of intricate complexities. Among them, two particular conditions stand out for their distinctive nature and far-reaching implications: <a href="https://merisehat.pk/disease/amenorrhea-97217">amenorrhea</a> and oligomenorrhea. 
&nbsp;

Understanding The Causes Of Amenorrhea And Oligomenorrhea

According to research, irregular menstruation has a prevalence of 5% to 35%<a href="#accordion">[1]</a>. Amenorrhea and oligomenorrhea are two common menstrual irregularities affecting women worldwide. 
&nbsp;

Amenorrhea is like your period taking a break. There are two kinds<a href="#accordion">[4]</a>:

<ul>
	<li>Primary Amenorrhea - This is when a girl doesn&#39;t start her period by age 16. If a girl doesn&#39;t see any signs of breast development or pubic hair by age 13, a doctor should be consulted. And if no period shows up by age 15, that&#39;s a sign to get evaluated too.</li>
	<li>Secondary Amenorrhea - Here, periods that used to be on time suddenly stop for at least 3 months. It&#39;s like your period is ghosting you. 
	&nbsp;</li>
</ul>

<ul>
	<li>Hormonal Imbalances: Sometimes, due to delayed puberty, hormones needed for starting periods don&#39;t kick in properly, and ovarian development fails. Conditions like Turner syndrome or congenital adrenal hyperplasia can lead to this.</li>
	<li>Structural Issues: Problems with the reproductive organs, like an absent uterus or an imperforate hymen (a membrane blocking the vaginal opening), can prevent periods from starting.</li>
	<li>Chromosomal Abnormalities: Certain genetic conditions can affect the development of reproductive organs, leading to primary amenorrhea.</li>
	<li>Thyroid Problems: Issues with the thyroid gland can cause a hormonal imbalance, affecting menstruation.</li>
	<li>Pituitary Gland Disorders: The pituitary gland plays a big role in regulating hormones. Disorders of the pituitary gland, such as prolactinomas or Sheehan&rsquo;s syndrome, can lead to amenorrhea. 
	&nbsp;</li>
</ul>

<ul>
	<li>Pregnancy: The most common reason for missed periods. If you&#39;re sexually active, pregnancy should always be ruled out first.</li>
	<li>Hormonal Imbalances: Similar to primary amenorrhea, issues with hormone production and regulation can disrupt periods.</li>
	<li>Stress: High stress levels can mess with the hormones that control your cycle.</li>
	<li>Weight Changes: Rapid weight loss or gain, often associated with eating disorders or extreme dieting, can cause periods to stop.</li>
	<li>Excessive Exercise: Overdoing workouts can lead to hormonal shifts that halt your menstrual cycle.</li>
	<li>Polycystic Ovary Syndrome (PCOS): A common condition where hormonal imbalances affect ovulation and periods.</li>
	<li>Thyroid Issues: An overactive or underactive thyroid gland can throw off your menstrual cycle.</li>
	<li>Premature Ovarian Failure: When the ovaries stop working before the age of 40, it can lead to amenorrhea.</li>
	<li>Medical Conditions: Conditions like pituitary tumors, ovarian cysts, or certain medications can affect the menstrual cycle.</li>
	<li>Hormonal Birth Control: Stopping hormonal birth control might lead to a temporary pause in periods. 
	&nbsp;</li>
</ul>

Remember, every individual is unique. If you&#39;re experiencing changes in your menstrual cycle, it&#39;s a good idea to consult a healthcare provider to pinpoint the specific cause and discuss appropriate management. 
&nbsp;

The menstrual cycle typically ranges between 21-35 days. However, at times this range can shorten or lengthen due to various causes.

Oligomenorrhea is when your periods don&#39;t stick to a regular schedule. They show up more than 35 days apart. Don&#39;t worry, this can be normal, especially when you&#39;re just starting. Sometimes your flow might be lighter than usual too. However, women with oligomenorrhea may have fewer than 6-8 periods in a year.

Oligomenorrhea has a global prevalence of 13.5%<a href="#accordion">[3]</a>. It often signifies an underlying disease, such as polycystic ovarian disease. Moreover, athletes and dancers are commonly affected by oligomenorrhea, with 11-44% of dancers and 6-60% of athletes reporting the menstrual irregularity. 
&nbsp;

The causes of oligomenorrhea and secondary amenorrhea often overlap. Some common causes of oligomenorrhea include<a href="#accordion">[3][5]</a>:

<ul>
	<li>Young Age: When you&#39;re just starting to have periods, it&#39;s normal for them to be irregular. It can take a few years for your menstrual cycle to establish a regular pattern.</li>
	<li>Stress: High levels of stress can interfere with the hormones that regulate your menstrual cycle, causing it to become irregular.</li>
	<li>Polycystic Ovary Syndrome (PCOS): PCOS is a hormonal disorder that can disrupt ovulation and lead to irregular periods.</li>
	<li>Thyroid Issues: An overactive or underactive thyroid gland can affect your menstrual cycle&#39;s rhythm.</li>
	<li>Weight Changes: Rapid weight loss, extreme dieting, or being significantly underweight can impact your hormones and lead to irregular periods.</li>
	<li>Excessive Exercise: Intense physical activity, especially when combined with low body fat, can disrupt hormonal balance and cause irregular periods.</li>
	<li>Birth Control: Some forms of birth control, like the contraceptive pill, can lead to lighter or less frequent periods.</li>
	<li>Premature Ovarian Insufficiency: Similar to primary amenorrhea, this is when the ovaries stop functioning normally before the age of 40, causing irregular periods.</li>
	<li>Perimenopause: As you approach menopause, your hormone levels start to fluctuate, leading to irregular periods before they eventually stop.</li>
	<li>Medical Conditions: Certain medical conditions like pituitary disorders or problems with the reproductive organs can cause oligomenorrhea.</li>
	<li>Diabetes: Both type 1 and type 2 diabetes have been linked to causing oligomenorrhea.</li>
	<li>Pelvic Inflammatory Disease (PID): The associated infection and inflammation can lead to menstrual irregularities 
	&nbsp;</li>
</ul>

From the mysterious disappearance of periods to the unpredictable gaps between cycles, amenorrhea and oligomenorrhea are like signals from our bodies, telling stories of hormonal balance, stress, lifestyle choices, and sometimes underlying medical conditions. The several factors that shape these disruptions emphasize the need for a holistic and personalized approach to understanding and managing these conditions.

Remember, empowerment through knowledge is key. Recognizing the signs, listening to our bodies, and seeking professional guidance when needed are crucial steps in managing amenorrhea and oligomenorrhea.

[1] Kwak Y, Kim Y, Baek KA (2019) Prevalence of irregular menstruation according to socioeconomic status: A population-based nationwide cross-sectional study. PLoS ONE 14(3): e0214071. DOI: 10.1371/journal.pone.0214071

[2] Patient education: Absent or irregular periods (Beyond the Basics). UpToDate.

[3] Riaz Y, Parekh U. Oligomenorrhea. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.

[4] Nawaz G, Rogol AD. Amenorrhea. [Updated 2023 Jun 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. A

[5] Oligomenorrhea. Cleveland Clinic.

It&rsquo;s a common warning in South Asian households that during your period, you shouldn&rsquo;t take a shower or bathe because &ldquo;It will make you sterile!&rdquo;. For those of you who still believed this: there is no truth to this saying. In fact, it&rsquo;s healthier to always remain clean and observe good hygiene. A warm bath or shower may even help ease stomach cramps due to periods. 

But, if you thought this was the only myth that we had to deal with, I&rsquo;ve got news for you: this is just the tip of the iceberg. 
&nbsp;

Desi Periods Totkas

Here are some common desi totkas that can put your body in harm&rsquo;s way: 

<ul>
	<li>Avoiding Yoghurt&nbsp;And Sour Foods: While this myth is most common in SouthEast Asia, it is believed in by many across Asia. Let me tell you this clearly, in no uncertain terms: There is no direct or even indirect connection of yoghurt or sour foods with periods. 
	However, since so many people believe they are detrimental for your health during periods, that they exhibit side effects of <a href="https://merisehat.pk/disease/stress">stress </a>and <a href="https://merisehat.pk/disease/anxiety">anxiety</a>, such as an upset stomach, cramps, nausea, etc if they even do consume yoghourt and/or sour foods, leading them to believe there might be some truth to this. 
	 
	However, contrary to popular belief, yoghourt can actually help fix your calcium levels and play a vital role in reducing your Pre-Menstrual Syndrome (PMS) symptoms. 
	&nbsp;</li>
	<li>Risking Turmeric Toxicity: We love our good old haldi [turmeric]. It&rsquo;s very good for you and South Asians consider it as the solution to everything &mdash; from adding a little oomph in our dishes all the way to it being our little medical miracle, fixing our health problems, including, it turns out, drinking turmeric milk or tea to relieve period cramps. 
	 
	However, too much of anything, including something good, can be bad and this is also the case with turmeric. Don&rsquo;t get us wrong, turmeric is good for your health but it is also known as an anticoagulant and a blood thinner. 
	So, while you may experience a relief in your period <a href="https://merisehat.pk/disease/premenstrual-syndrome-pms">PMS</a> or cramps, there might be other factors to worry about too. Not only this, but the active ingredient in turmeric, curcumin is known to upset your stomach, make you feel nauseous and is also a known culprit behind <a href="https://merisehat.pk/disease/diarrhea">diarrhea</a>. 
	 
	If you cannot live without your turmeric tea or milk, make sure it is in moderate amounts and do not overdo it. You cannot make the cramps go completely with natural ingredients. 
	&nbsp;</li>
	<li>Asafoetida For The Relief Of PMS Or Other Menstrual Symptoms: Famous for being an effective relief for those suffering from PMS and other menstrual symptoms all over South Asia, asafoetida [hing] definitely has its benefits but not for everyone. 
	Hing has very strong side effects that can affect some people. It is associated with causing nausea, vomiting and diarrhoea due to its pungent smell and a very bitter taste. Not only this, but the active compounds found in asafoetida are known allergens and have caused people skin rashes and difficulty breathing. 
	We are not finished with hing just yet, it has blood-thinning properties which can be a red flag and the culprit behind a heavier flow during your periods. 
	&nbsp;</li>
</ul>

We are not against home remedies, they are a great natural way to solve your problems, however, you need to know what you are having and in what amount. Some natural compounds are very potent and can cause toxic effects even when used in very small amounts whereas others may not produce any effect at all unless you have had tons of it. 

Lastly, always remember, everything comes with its own set of side effects. You just need to weigh the pros and cons and always do your own research before subjecting your body to anything. 
&nbsp;