Signs & Symptoms
Some women feel a period coming days before they get it. Others are hardly aware they have it. Friends who compare notes about their periods will probably find that menstruation-the monthly shedding of the lining of the uterus, or womb affects each of them a little differently, both physically and emotionally.
The menstrual cycle has its ups and downs of hormones, and different people react differently to hormonal swings. Just before and during menstruation, levels of the female hormones estrogen and progesterone are low. That's when some women feel bloated, irritable or blue, or "just crummy." Just crummy might mean cramps, sore breasts, backache, headache, nausea, and feeling tired.
A day or two after your period starts you begin to feel better. Hormone levels go back on the upswing and you get back to what you've accustomed to during the rest of your cycle.
Some 20 to 40 percent of menstruating women have PMS, or premenstrual syndrome. Starting anywhere from mid-cycle to a few days before menstruation begins, women with PMS may have one or all of a virtual laundry list of physical and emotional symptoms. They include breast swelling and tenderness, fluid retention, increased thirst or appetite, craving for sweets and salty foods, headaches, anxiety, restlessness, irritability, depression, hostility, and loss of self confidence. PMS doesn't usually affect teenagers, though. It increases with age and is more prevalent in the 30's and 40's.
Other Monthly Changes
Estrogen and progesterone levels are very low at the beginning of the cycle. During menstruation, levels of estrogen, made by the ovaries, start to rise and make the lining of the uterus grow and thicken. In the meantime, an egg (ovum) in one of the ovaries starts to mature. It is encased in a sac called the Graafian follicle, which continues to produce estrogen as the egg grows.
At about day 14 of a typical 28~ay cycle, the sac bursts and the egg leaves the ovary, traveling through one of the fallopian tubes to the uterus. The release of the egg from the ovary is called ovulation.
Some women know when they're ovulating, because at mid-cycle they have some pain typically a dull ache on either side of the lower abdomen lasting a few hours. The medical word for this is mittelschmerz, from the German, meaning middle pain. Some women also have very light bleeding, or spotting, during ovulation.
After the egg is expelled, the sac-now called a corpus luteum - remains in the ovary, where it starts producing mainly progesterone. The rising levels of estrogen and progesterone help build up the uterine lining to prepare for pregnancy.
The few days before, during and after ovulation are a woman's "fertile period"-the time when she can become pregnant. Because the length of menstrual cycles varies, many women ovulate earlier or later than day 14. It's even possible for a woman to ovulate while she still has her period if that month's cycle is very short. (Stress or other problems can sometimes cause a cycle to be shorter or longer.) If a woman has sex with a man during this time and conception occurs (his sperm fertilizes the egg), she becomes pregnant.
The fertilized egg attaches to the uterus, and the corpus luteum makes all the progesterone needed to keep it implanted and growing until a placenta (an organ connecting the fetus to the mother) develops. The placenta then makes hormones and provides nourishment from the mother to the baby.
If an egg is not fertilized that month and the woman doesn't get pregnant, the corpus luteum stops making hormones and gets reabsorbed in the ovary. Hormone levels drop again, the lining of the uterus breaks down, menstruation begins, and the cycle repeats.
Cramps
More than half of menstruating women have cramp-like pain during their periods. The medical term for menstrual pain is dysmenorrhea.
Cramps are usually felt in the pelvic area and lower abdomen, but can radiate to the lower back or down the legs.
Many girls have cramps severe enough to keep them home from school. Dysmenorrhea is the most frequent cause of absenteeism from school among younger women.
Women seem to go through phases when cramps are severe, then get better for several years, and then maybe worsen again. Most women find they have less menstrual pain after having children.
Mechanically, cramps are like labor pains. Just as the uterus contracts to open up the cervix (neck of the uterus) and push out a baby, it contracts to expel menstrual blood. Often, after several years of menstruating or after childbirth, the cervical opening enlarges. The uterus doesn't have to contract as much to discharge the menstrual flow, so there is less cramping.
Menstrual pain may also come from the bleeding process itself. When the uterine lining separates from the wall, it releases chemicals called prostaglandins. Prostaglandins cause blood vessels to narrow, impeding the supply of oxygen to the uterus. Just as the pain of a heart attack comes from insufficient blood to the muscles of the heart, too little blood to the uterine muscle might cause the pain of menstrual cramps. Menstrual pain can have other causes including tumors, fallopian tube infection, and endometriosis, a condition in which fragments of the lining of the uterus become embedded elsewhere in the body.
NonDrug Treatment For Cramps
Sometimes, simple measures are all that's needed to feel better. Cutting down on salt might help reduce fluid buildup, and support hose may alleviate swelling in the legs or ankles. Extra rest or sleep is one way to deal with fatigue, and using a heating pad or hot water bottle eases cramps for some. Exercising also helps reduce pain in many young women, and may lift a blue mood as well.
Exercising during menstruation lessens pain because it causes release of brain chemicals called endorphins, which are natural painkillers. Exercise may also decrease pain by affecting prostaglandin metabolism. Exercise may also help because it increases blood flow, and because it makes a lot of people feel better in general.
Medications For Cramps
Ibuprofen, the active ingredient in some nonsteroidal anti-inflammatory drugs (NSAlDs) such as Advil, Nuprin and Motrin IB, inhibits prostaglandin production, thus easing the discomfort of cramps. Aspirin also suppresses prostaglandins, but it's often not as effective for menstrual pain. Avoid aspirin for children or teenagers who have chickenpox or flu symptoms because Reye syndrome, a rare but sometimes deadly illness, may develop.
Several nonprescription NSAIDs, such as Midol, Pamprin and Aleve, are specifically formulated for menstrual symptoms. Read the labels of these medicines before you buy them, because different formulations often contain different ingredients or strengths of ingredients. For example, Teen Formula Midol contains acetaminophen for pain and pamprin (a mild diuretic) for fluid retention. Pamprin contains acetaminophen, pamprin and pyrilamine maleate (an antihistamine) for tension and irritability. Cramp Relief Formuia Midol IB contains as its sole ingredient ibuprofen. Manufacturers may change their product's ingredients from time to time, so it's a good idea to check the label each time you buy the product.
Plain acetaminophen products like Tylenol and Aspirin-Free Aspirin also may help menstrual pain. It takes time for pain relievers to work, so it's best to take them before the pain gets severe.
If needed, your doctor may prescribe stronger painkillers or diuretics, or even oral contraceptives. One side effect of birth control pills is relief of menstrual cramps. They prevent the lining of the uterus from building up so much, so there's less bleeding. This means less prostaglandin production and blood vessel narrowing because there's less lining to separate, and fewer contractions because there's less tissue to push out. In severe cases, hormones (e.g., gonadotropin-releasing hormone [Gn-RH]) can stop ovary function and relieve pain.
Notify Your Healthcare Provider If
You or a family member has questions about the monthly menstrual cycle.
Menstrual bleeding becomes excessive (soaking one or more pads or tampons an hour).
You use tampons and develop signs of toxic shock syndrome (TSS): sudden fever over 102oF, vomiting, diarrhea, dizziness, fainting, sunburn-like rash. TSS is a rare, but serious (and sometimes fatal) disorder. Seek medical help immediately.
2006-08-23 20:37:22
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answer #5
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answered by Anonymous
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