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Menopause: The Great Ending of The Menstrual Cycle

Menopause: The Great Ending of The Menstrual Cycle

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The menstrual cycle – the epitome of the reproductive cycle, which gives birth to life and plays a significant role in the transition from girlhood to womanhood, is considered nature’s phenomenon, gifted to women (minus the agonising PMS symptoms, of course). And after decades and decades of operating the same painful cycle every month, a woman’s menstrual cycle decides to retire into solitude in the mature years of her life.. (great news, right?!) 

But do you know what really happens in this ending stage of a woman’s menstrual cycle? 

This week’s blog unravels the grand (or rather, long-served) ending of this extraordinary cycle: ‘Menopause’. Keep reading as we explain each stage of menopause and how you can prepare for it.

What is menopause?

As the word suggests, menopause involves the permanent pause of a woman’s menstrual cycle. It is the period that indicates the end of a woman’s menstrual cycle, where usually, if a woman has gone 12 months without her menstrual period, she is said to be having her ‘menopause’.

When does menopause occur in a woman’s life?

It usually occurs between the ages 40 and 50.

The female sex hormones - partners in crime

Before we dive in deeper, it’s important to know the two main female sex hormones- oestrogen and progesterone. Oestrogen is responsible for the development of secondary sexual characteristics in a young woman and functions such as menstruation, ovulation and pregnancy. Similarly, progesterone also plays an equally significant role in the menstrual cycle, ovulation and pregnancy. They are indeed two hormones tirelessly working hand in hand in a woman’s body!

The stages of menopause

stages of menopause
  1. Perimenopause

This is the first stage that leads up to menopause. Perimenopause is the period in which a woman’s body makes the transition from having an active menstrual cycle to menopause (menopausal transition). Several changes in hormonal levels occur. In this stage, oestrogen levels begin to rise and fall unproportionately. Furthermore, menstrual cycles may either increase or decrease, causing irregular periods. Women may also have menstrual cycles despite ovaries not releasing an egg (ovulation). During this stage, it is possible for symptoms related to menopause, like hot flashes, vaginal dryness, etc., to be present.

  1. Menopause

Menopause occurs when the female body stops producing the hormones that cause menstrual cycles. These hormones include oestrogen, progesterone, luteinizing hormone and follicle-stimulating hormone. A woman would then not get her period for 12 months consecutively.

       3. Post-menopause

This is the final stage of menopause in which a woman hasn’t experienced her period for over 12 months. The body produces significantly fewer amounts of hormones (oestrogen and progesterone), and women will no longer experience a monthly period nor can get pregnant for the rest of their lives. During this stage, the symptoms of menopause may linger around; however, they are less intense.

Symptoms of perimenopause and menopause

  • Irregular periods

Due to hormonal changes in the perimenopause stage, the duration of time between periods may become longer or shorter. Also, period flows may range from light to heavy, while missing periods are common.

  • Hot flashes and sleep problems

A hot flash is the sudden feeling of warmth in the upper body. These intense feelings spread over the face, neck and chest areas and skin may redden, causing sweating as well. Often, hot flashes may happen at night, causing inconvenience during sleep.

  • Decreased fertility

During the menopausal period, a woman’s ovulation starts to become irregular. This decreases the ability to conceive. Although, it’s important to note that it’s still possible for a woman going through perimenopause to get pregnant, therefore if you are a woman suspecting that you are going through perimenopause and still have your periods regularly, it is advisable to use birth control until you haven’t got your period for more than 12 months.

  • Mood changes

A woman may undergo several mood swings, irritability and an increased risk of depression during the perimenopausal period.

  • Changes in sexual function/libido

As a woman’s testosterone and estrogen levels drop, it becomes more difficult for her to get aroused, and this causes issues with libido and sexual drive.

symptoms of menopause

Other symptoms

  • Loss of bone – Calcium deficiency in bones
  • Vaginal and bladder problems
  • Increased hair growth on areas such as the face, chest, neck

Not having it with menopause? Fret no more, we give you healthy tips to make this period in your life easier below!

Lifestyle changes for better management of menopause

managing menopause

Menopause is a natural process that all women experience once their reproductive cycles reach maturity, and it may be an uncomfortable experience for most women. However, here are some methods in which the symptoms of menopause can be controlled better to reduce its discomfort.

  1. Consume foods rich in vitamin D and calcium

Vitamin D and calcium have proved to improve bone health. As a woman undergoes menopause, hormonal changes result in the weakening of bones, increasing the risk of osteoporosis. Foods like yoghurt, milk, fish and eggs are good sources of these nutrients.

  1. Maintain a moderate/healthy weight

During the menopause period, hormonal changes, aging and lifestyle causes weight gain. This would increase the risk of cholesterol and diabetes.

  1. Exercise regularly

Exercise and work out sessions have been proven to improve sleep and mental health of menopausal women. Therefore, regular exercise may subside the sleep issues menopausal women undergo.

  1. Ensure a consistent intake of a protein-rich diet

Proteins help reduce muscle loss and increase overall body strength in women experiencing menopause.

  1. Consume foods abundant in phytoestrogens such as soya beans, tofu, flaxseeds

Phytoestrogens are a source of dietary oestrogen from naturally occurring plant compounds that have the same function as oestrogen in human bodies. Thus, phytoestrogens may play a vital role in hormonal balance during menopause and reduce symptoms like hot flashes.

When to see a doctor

It is advisable to meet with a gynaecologist if you experience

  • Vaginal bleeding after not having a period for 12 months
  • Recurring or chronic urinary tract infections (UTIs)
  • Bleeding after sex
  • Abdominal pain

These signs may indicate more serious underlying medical conditions that need to be diagnosed to begin early treatment. Every woman’s menopausal period is unique and different to one another. If you are experiencing difficulty managing your uncomfortable menopause symptoms, the SLMC-registered gynaecologists on oDoc will help you navigate them, providing improved health and well-being.

Sources

  1. Menopause – Symptoms and Causes, Mayo Clinic (2020)
  2. Perimenopause – Symptoms and Causes, Mayo Clinic (2021)
  3. 11 Natural Remedies for Menopause Relief, Healthline (2022)
  4. Menopause, The University of Utah (2022)
  5. Bleeding after menopause: Is it normal? Mayo Clinic (2020)
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Endometriosis

Endometriosis

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No woman looks forward to “that time of the month.” Dealing with nausea, stomach cramps, mood swings, back pains and fatigue, all whilst facing that undeniable social pressure of pretending to be ‘normal’ and going about your daily activities. Because periods are a natural bodily function… right? It’s not like a cold where you would be rightfully exempted from resuming your daily tasks.

Sadly, sometimes the society we live in doesn’t accurately weigh the impact of periods on our daily functioning. A good example of this is one of the most common gynecological diseases, endometriosis, often going undetected for years because the abdominal pain it causes is dismissed as regular menstrual cramps. Endometriosis is typically a progressive condition. Therefore it’s wise to look out for signs early on and get regular checkups with your VOG to manage any symptoms you have. You can easily channel a VOG in just three taps on oDoc!

What is endometriosis?

The lining of your uterus is made up of tissue called the endometrium. When this tissue grows outside your uterus, it’s known as endometriosis. This disorder causes endometrial-like tissue to grow on your ovaries, fallopian tubes, bowel, and even tissues lining your pelvis.

Unfortunately, this endometrial-like tissue acts as endometrial tissue would — meaning that according to the hormonal changes in each stage of the menstrual cycle, it thickens, breaks down and bleeds. But because it has no way to exit your body, it becomes trapped! This triggers an inflammatory response, and the surrounding tissue becomes irritated, eventually developing scar tissue and adhesions, which are bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other. This leads to pain and other complications discussed below.

Symptoms of endometriosis

Just like all the chocolates we eat on our period are unique in their own way, the endometriosis symptoms experienced by you may differ from that of someone else. Some people experience mild symptoms, but others can have moderate to severe symptoms. The severity of pain you feel doesn’t indicate the stage of the endometriosis you have. You can have a mild degree of endometriosis, but experience agonizing pain or have a severe form of it and have minimal discomfort. That is why it’s important for you to get regular gynecological exams to stay on top of your reproductive and sexual health!

Pelvic pain is the most common symptom of endometriosis. You may also have the following symptoms:

  1. Painful periods – Most women have period cramps, but endometriosis can leave you with debilitating pain. You can get cramps 1 or 2 weeks around menstruation
  2. Heavy menstrual bleeding or bleeding between periods
  1. Painful intercourse – Women might have intense, localized pain during penetration
  2. Infertility – When endometriosis affects the ovaries or fallopian tubes, it may reduce the eggs’ chance of becoming fertilized and implanting into the uterus lining
  1. Painful bowel movements and/or urination
  2. Pain in the abdomen, lower back, or thighs, often lasting throughout the cycle

It’s wise that you get regular gynecological exams, which will allow your VOG to monitor any changes. This is particularly important if you have two or more symptoms.

Endometriosis Treatment

Until endometriosis is better understood, only the symptoms can be treated without the underlying causes. Endometriosis treatment depends on your symptoms and goals.

For example, suppose your goal is to minimize the pain. In that case, you may be prescribed over-the-counter pain medications such as Ibuprofen or hormonal medicines such as the oral contraceptive pill, which can suppress the period and stop mild to moderate endometriosis from progressing. It decreases fertility by preventing the monthly growth and buildup of endometrial-like tissue, reducing the pain.

Other options are available if you wish to conceive, such as undergoing a laparoscopy. In this minimally invasive surgery, your doctor will make small incisions in the abdomen to explore and surgically remove any problematic tissue without damaging your reproductive organs. Even though the name of this surgery sounds scary, most women can go home on the same day as the operation, and it will take roughly five to seven days to recover.

However, if you don’t respond to conservative treatments, your doctor may recommend a total hysterectomy as a last resort. In this operation, your surgeon removes the uterus, fallopian tubes and in some cases, even the ovaries, depending on the severity of the disease.

Life with endometriosis

Living with endometriosis can be difficult as symptoms can significantly impact your quality of life. It may take a toll on your mental health as finding an effective treatment and dealing with the anxiety of symptoms flaring up can be emotionally taxing. It may even cause financial strain depending on the cost of your treatment plan or if your symptoms interfere with your ability to maintain a job. It may also lead to an unfulfilled sex life which may cause a bridge between you and your partner.

To improve your quality of life with endometriosis, it’s good to reduce stress by regularly partaking in leisure activities, exercising and getting adequate sleep. While endometriosis can be isolating, remember that you’re not alone. There are many ways to find support, like joining an online or in-person support group and talking to a mental health professional to work through your feelings. You can easily channel a mental health professional in simply three taps on oDoc!

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Your Little Girl’s First Period

Your Little Girl’s First Period

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Wonder what to tell your child about periods? Here’s some help to get you started.

The earlier you have the ‘period’ talk with your child, the better. She needs to know about the menstrual cycle and all the changes that puberty brings. A one-time tell-all discussion might be too much for her to take in, so plan a series of conversations revolving around this subject. But most importantly, the conversations you have with your daughter about menstruation can lay the groundwork for future talks about dating and sexuality.

Alright, so where do you start?

What’s a period?

A period is the part of the menstrual cycle when a woman bleeds from her vagina for a few days.

What does it mean to get the first period?

Puberty is when a girl’s body changes from looking like a child to looking more like an adult, producing adult-level hormones. Every month, starting around the first period, estrogen and progesterone hormones prepare her body for a possible pregnancy. As a result, it causes the lining of her uterus to build up to provide comfortable housing for a fertilised egg to begin development. 

Approximately after a month, if the egg hasn’t been fertilised, the buildup of tissue in the uterus will break down and bleed. This blood is what is seen during a period. The cycle repeats every month and is called a menstrual cycle. 

It’s normal for a cycle not to be regular after the first period. Periods may be hard to predict. It usually occurs every 3 weeks (28 days). However, irregular periods are common for the first 1 or 2 years after the first period.

When do most girls get their first period?

Puberty often begins when the child is around 11 years old, although anywhere between 8 and 14 years is considered the “normal” age. It’s generally one of the most memorable events in a young girl’s life. On average, a first period occurs when a girl is about 12 years old.

How can you keep her informed about knowing when her first period is coming?

signs of the first period

How to prepare for her first period?

It’s always good to be prepared, especially as the first period is unpredictable. Here are a few steps to make sure she’s ready when her first period occurs.

  • Being able to talk with a trusted adult and ask any question she has
  • Always carry sanitary pads, tampons, or any other menstrual products 
  • Keep an extra pair of pants
  • Look for places in her school where she can get sanitary products in case of an emergency.
  • Explain some of the pros and cons of types of menstrual products
  • Emphasising that periods are natural
  • Use clear, concrete words for body parts and body functions

How can you keep her informed about knowing when her first period is coming?

Key takeaways

Most girls will get their first period sometime between the ages of 10 and 15. However, a first period can occur as young as 8, so it’s always better to be prepared. The age of the first period can be impacted by genetics, diet, environment, weight, and other factors.

You can help your child prepare for her first period by having an open and direct conversation about periods and what she needs to expect. It would also be a good idea if she could have a few extra menstrual products in her bag for emergency purposes. It’s important to be ready and educated about the first period as it is a great way for your child to approach this growing-up milestone.

If you have any concerns regarding menstruation, you can speak to a VOG doctor via  the oDoc app from the comfort and privacy of your home. GPs and Family Physicians are also available to consult.

Download oDoc today on the App Store or Play store.

References

  1. Tween and teen health, Mayoclinic (2020)
  2. All about periods, KidsHealth (2018)
  3. When will I get my periods, KidsHealth (2018)
  4. At What Age Do Most Girls Get Their First Period?, Healthline (2021) 
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Sexually Transmitted Infections And Diseases: What You Need To Know

Sexually Transmitted Infections and Diseases

Sexually Transmitted Infections And Diseases: What You Need To Know

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What are STIs and STDs?

Sexually Transmitted Infections (STI) and Sexually Transmitted Diseases (STD) are usually acquired by sexual contact. The bacteria, viruses or parasites that cause sexually transmitted diseases may pass from person to person in blood, semen, or vaginal and other bodily fluids. However, these infections can be transmitted nonsexually as well. For instance, from mothers to their babies during pregnancy, childbirth, breastfeeding, blood transfusions or shared needles.

What is the difference between STIs and STDs?

It is the fundamental difference between an infection and disease. Most diseases start with infections. Infection occurs when the bacteria or virus first enters the body and multiplies, progressing it into a disease. Likewise, sexually transmitted diseases initially begin as sexually transmitted infections. 

There are more than 20 known types of STDs/STIs. In Sri Lanka, annual estimates of detected STI cases vary from approximately 60,000 to 200,000, of which government clinics report only 10-15%. About half of these are detected in people aged 15-24. Luckily, most STDs can be treated and cured.

What are the most common STIs/STDs in Sri Lanka?

  • Genital herpes
  • Gonorrhoea
  • Non-gonococcal urethritis (NGU)
  • Syphilis
  • Genital warts
  • Chlamydia infection

What are the most common symptoms of STIs/STDs?

Why is it important to prevent STIs/STDs?

Most STDs can be cured or treated with medication. However, the consequences of ignoring it can include infertility, cervical cancer,  pregnancy complications, congenital disabilities, pelvic inflammatory disease and an increased risk of HIV transmission.

How can the transmission of STIs/STDs be prevented?

The only effective way to completely prevent the transmission of STIs/STDs is abstinence. However, for sexually active persons, consistent and correct use of condoms is highly effective in preventing such infections or diseases.

Questions to ask your doctor?

There has almost always been a stigma around any STD, and it usually trickles down to anyone diagnosed with it. People also feel ashamed that they are somehow damaged. It is important to remember that only a few STDs could be life-threatening. However, with proper treatment, most of it has minimal health impacts. You can have a good life despite having an STD. The majority of it is treatable, and some are even curable. Those STDs for which there is not yet a cure, such as HIV, can still be manageable if adequately taken care of.

Here are a few questions you could ask your doctor:

  1. Should I be checked for STIs?

  2. Can I get an STI by open-mouth kissing?

  3. What if I am pregnant?

  4. Can STIs/STDs cause other health problems in women/men?

  5. How can I prevent having STIs/STDs?

Suppose you are experiencing any of the symptoms mentioned above or need any information on STIs and how to protect yourself or get tested. In that case, you can consult a Sexual Health specialist or an on-demand GP via the oDoc app.

Reference:

  1. What you need to know about sexually transmitted infections, MedicalNewsToday (2021)

  2. Sexually transmitted infections (STIs), World Health Organisation (2019)

  3. What is a sexually transmitted infection?, FPA Sri Lanka (2017)

  4. Types of Sexually Transmitted Infections, Healthy children.org (2015)

  5. How to Reduce Shame and Stigma When You Have an STD, Everydayhealth.com (2019)

  6. How Can You Tell If You Have HIV? HIV.gov (2020)

  7. STD vs STI: Common Types, Symptoms, and Treatment, State Urgent Care (2019)

  8. Sexually transmitted infections (STIs), NHS (2021)

  9. HIV/AIDS in Sri Lanka, The World Bank (2012)

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How well do you know your breasts?

How well do you know your breasts?

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It’s that time of year again: when your social media is flooded with pink ribbons, radio waves are abuzz with tips and fundraisers gain momentum. October is breast cancer awareness month. 

As of 2021, Breast cancer became the most common cancer globally by accounting for 12% of all new annual cancer cases worldwide, says the World Health Organization. In Sri Lanka, around 3000 new cases are identified each year and breast cancer is the most common tumour. Turns out, in very rare instances, men too can get it.

breast cancer

Despite being so common, breast cancer is also highly treatable if detected early. We break down the steps you can take to assess and lower your risk levels.

What is breast cancer?

Breast cancer is cancer that forms in the breast of the cells. 

 

What are the symptoms of breast cancer?

Generally, symptoms of breast cancer are linked to a palpable or visible change in the breast tissue. Some common symptoms includes:

what is breast cancer
breast self-exam

This means that breast self-exams are extremely important. Regular exams help you get familiar with the normal shape and texture of your breasts so that any anomalies can be quickly identified. 

How to perform a breast self-exam in five steps

  1. Stand directly in front of a mirror, place your arms on your hips and look at your breasts. 

Look for: 

  • Breasts that are usual shape, size, colour
  • Breasts that are evenly shaped without any distortion or swelling

    2. Raise your arms and look for the same changes

Look for: 

  • Any fluid (watery, milky or yellow fluid or blood) coming out of your nipples

3. Lie down on a flat surface. Use your right hand to feel your left breast and vice versa. Use the finger pads of your hand to apply a firm and smooth circular motion (size of a coin) to your breast. Keep the fingers close together. 

Cover the whole breast from side to side, up to the collarbones and into the armpit. 

Feel for: 

  • Any lumps or bumps within the breast.
  • Feel for the texture of the lumps or bumps.
  • Check if the lump or bumps are movable.

4. Feel your breasts in the same manner whilst you are standing or sitting. This is ideally done in the shower as the water and soap allow for a smoother movement.

What to do if you discover a lump or any visible changes

Do not panic. Not all breast lumps or bumps mean breast cancer. In fact, most turn out to be benign (non-cancerous). Non-cancerous breast lumps can be caused by hormonal changes, injuries or a benign condition. However, it is vital that all bumps are discussed with a medical professional. 

Don’t be shy, speak to a medical professional. Early detection does save lives. So if you have noticed a lump lasting for longer than one menstrual cycle, it’s important to speak to a family doctor or a GP. The doctor will most often refer you to an imaging test. Ultrasounds are often the only test used for women under 30 whilst ultrasound and mammograms are used for women over 30. 

Do ask questions. Here are a few you can ask your GP to help you gain clarity.

  • What tests are needed to find out if the lump is cancerous?
  • In addition to a physical exam of my breasts, will you check the lymph nodes in my armpits and neck?
  • Should I get a mammogram?
  • Will I need a biopsy?
  • What does a biopsy involve?
  • How long will it take to get the results?
  • If the tests are negative but the lump is still there, what are the next steps?
  • If the tests are clear and the lump goes away, how often should I follow up with you?

If unsatisfied with answers or level of care, do get a second opinion. 

How often should I perform a breast self-exam?

Do it every month around 7-10 days after your period starts. This is when your breasts are as tender or lumpy and make sure to examine them before  you start menstruating as well. Therefore, you can understand the natural changes. 

If you are no longer menstruating, do it at regular intervals every month.

In both instances, make sure to journal the changes with date

What are the risk factors?

Risk factors are aspects that make it more likely that someone could develop breast cancer, however, having one or a combination of these factors doesn’t mean you’ll get it. A healthy awareness of risk factors will allow you to take steps to mitigate the risk.

    • Gender: women are more likely than men to develop breast cancer
    • Age: incidence of breast cancer increases with age
    • Personal history of breast conditions or breast cancer: if you have developed breast cancer in one breast, there is a higher risk of developing it on the other.
    • Family history of breast cancer: if a close female relative has experienced breast cancer, there is an increased risk however in most diagnosed patients, there is no family history of breast cancer
    • Genetic predisposition: the most well-known gene mutations are the BRCA1 and BRCA2 and can be passed from parents to children. Though these genes can greatly increase the risk, it is not inevitable. 
    • Obesity
    • Alcohol intake
    • Postmenopausal hormonal therapy: whilst women are on hormone replacement medications, they have an increased risk. However, once they stop the medications, this risk declines. 
    • Beginning your period at an age younger than 12
    • Beginning your menopause at an older age
    • Having never been pregnant
    • Having your first child at an age older than 30

How can I reduce my risk of breast cancer?

Whilst there are no hard and fast rules on ensuring one doesn’t develop breast cancer, the following non-exhaustive list is to help you mitigate your risk:

  1. Regular self-exams
  2. Consuming alcohol in moderation 
  3. Exercising at least 30 minutes four times a week
  4. Maintaining a healthy weight 
  5. Consuming a healthy, balanced, sustainable diet
  6. Limiting postmenopausal hormone therapy 
  7. Limit exposure to radiation

When it comes to breast cancer, early detection does help save lives. 

Make sure to carry out your self-examination, consult your doctor regularly and live a healthy life. Ignorance is usually bliss, just not here.

In 2022, Breast Cancer Awareness month focuses on the disparity of resources to fight this disease across the globe. If you are looking to take the first step, we are here

If you’d like to speak with a GP or a family doctor to discuss your questions or concerns, our oDoc partner doctors are available. Download oDoc here to get started. 

Sources

  1. Breast Self-Exam, Breastcancer.org (2022)
  2. What Is Breast Cancer?, CDC (2022)
  3. Breast cancer, Mayo Clinic
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Endometriosis

April 4, 2022

Endometriosis No woman looks forward to “that time of the month.” Dealing with nausea, stomach cramps, mood swings, back pains and fatigue, all whilst facing

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