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Coping With Heavy Menstrual Bleeding

Dr. HelloDox Care #
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Menorrhagia is a condition in which a woman has heavy or prolonged periods during her regular monthly cycle. Such heavy menstrual bleeding can be inconvenient and uncomfortable, but it may also signal a more serious health problem.

Contrary to what many think, each woman's menstrual cycle has its own unique timing and variation. While the average period occurs every 28 days and lasts for four days, fluctuations between 21 and 32 days are considered normal. Soaking through a sanitary pad or tampon every two to three hours is considered a heavy period. Likewise, prolonged periods are those that last for more than seven days.

Menorrhagia: Underlying Health Concerns

A number of underlying issues can cause heavy menstrual bleeding, such as uterine fibroids, noncancerous tissues that grow in and around the uterine wall, explains Steven R. Goldstein, MD, obstetrician and gynecologist at the New York University Langone Medical Center and professor of obstetrics and gynecology at New York University School of Medicine. If you're dealing with menorrhagia, your doctor will need to rule out fibroids as a first step.

Other conditions that can cause heavy menstrual bleeding include:

Anovulation, or the ovaries' failure to produce or release mature eggs
Polyps on the endometrium, the inner lining of the uterus
Endometrial cancer
Endometrial hyperplasia, or a thickening of the uterine lining
Abnormal thyroid or pituitary gland function
Changes in hormone levels, such as at menopause
Changes in the contraceptives you take
Pelvic inflammatory disease or another infection
Changes in lifestyle and eating habits, stress, excessive weight gain or loss, travel, intense exercise, and surgery or recent trauma can also all contribute to the onset of menorrhagia.

For some women, even childbirth can be a cause. "Sometimes heavy bleeding occurs after a woman has had a child, or several children," says Dr. Goldstein. "Pregnancy causes the surface area of the uterus to expand, which means that after childbirth, there is twice as much surface area to shed through menstruation as before, hence the heavier bleeding than before childbirth."

Menorrhagia: When to See a Specialist

It's common for periods to vary in duration and flow, so there is no need to rush to the doctor when one cycle is heavy. Goldstein suggests monitoring your periods and visiting a specialist after three unusually heavy or prolonged cycles.

Your doctor may order certain tests to determine the specific cause of your menorrhagia, including:

A Pap test, which involves obtaining cells from the cervix during a pelvic exam
An endometrial biopsy, which involves inserting a thin instrument through the opening in the cervix and taking a small sample of the endometrial lining
A pelvic ultrasound, an imaging test that uses sound waves to take pictures of your internal organs
All of these are outpatient procedures, though some may require anesthesia. Test results are generally available within seven days.

Menorrhagia: Treatment Options

If other medical conditions are ruled out and you still have menorrhagia, there are several options to consider. Talk to your doctor about whether any changes in lifestyle and eating habits can help reduce menstrual bleeding or if you should consider medical treatments, which have varying degrees of effectiveness and possible side effects. According to one study, oral progestogen pills are a common treatment for menorrhagia, and yet one of the least effective. Another study found it more effective to deliver hormones through an intrauterine device (IUD) that releases synthetic progestogen levonorgestrel hormone within the uterus. And a third found that using a simple over-the-counter NSAID (non-steroidal anti-inflammatory drug), such as ibuprofen and naproxen, can reduce menstrual blood loss by up to 60 percent.

A newer option with results in the same range as NSAIDs is the drug tranexamic acid, approved by the U.S. Food and Drug Administration in late 2009. The first non-hormonal medication to be given the green light for menorrhagia, it targets a protein that helps blood to clot. Tranexamic acid does have some side effects; discuss all the pros and cons with your ob-gyn.

In severe situations, you might want to ask about surgery, such as a hysterectomy to remove your uterus (after which childbearing is no longer possible). Another option is the less radical endometrial ablation, which removes the endometrial lining so that it no longer bleeds each month. This procedure may need to be repeated in order to remain effective and should not be considered if you plan to become pregnant in the future. While women typically cannot get pregnant after endometrial ablation, it is possible and poses risks for you and the baby. Both hysterectomy and endometrial ablation are serious steps that need careful consideration.

Because menorrhagia symptoms vary from woman to woman, your physician will outline one or a combination of options to effectively treat your menorrhagia and help you to get through your monthly cycle more comfortably.

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What Is Amenorrhea?

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Find out about what causes amenorrhea, and how it can be treated. Amenorrhea is the absence of menstrual bleeding in a woman of reproductive age.

There are two main types of amenorrhea:

Primary amenorrhea This is when a girl over age 15 has never had her period.

Secondary amenorrhea This is when a woman who has had regular periods stops having her period for six months or longer.

What Causes Amenorrhea?
Natural changes in the body can cause your periods to stop.

For instance, women stop menstruating during pregnancy and breastfeeding.

There are many potential causes and risk factors for amenorrhea. Sometimes the cause is unknown.

Causes and risk factors for amenorrhea include:

Obesity
Having very low body fat (less than 15 to 17 percent body fat)
Deficiency of leptin, a hormone that regulates appetite
Polycystic ovarian syndrome (PCOS)
Overactive thyroid gland
Extreme emotional stress
Excessive exercise

Use of some contraceptives (it can take several months for periods to start again after stopping certain forms of birth control)

Certain medications (certain antidepressants and blood pressure medicines can increase levels of a hormone that prevents ovulation)

Chemotherapy and radiation treatments for cancer

Noncancerous pituitary tumor
Scar tissue in the uterus (uterine fibroids, a cesarean section, or certain abortion procedures can scar the uterus)
Other causes of hormonal problems that may lead to amenorrhea include:

Long-term illness, such as heart disease or cystic fibrosis
Genetic defects or disorders
Problems with the ovaries
Amenorrhea Symptoms
The major symptom of amenorrhea is the absence of periods.

You may experience additional symptoms depending on the cause of your amenorrhea.

Other symptoms may include:


Weight gain or weight loss
Changes in breast size, or milky discharge from the breast
Acne
Hair loss
Increased facial hair growth
Headaches or vision changes
Pelvic pain
Amenorrhea Diagnosis
There are a number of steps your doctor will take to determine whether you have amenorrhea.

First, your doctor will ask you about your symptoms to get a better picture of your medical history.

Your doctor may also perform a pelvic exam and do a pregnancy test to rule out the possibility of pregnancy.

Tests for amenorrhea may include:

Blood tests to check your hormone levels
Genetic testing
Pelvic ultrasound
Computed tomography (CT) scan
Magnetic resonance imaging (MRI)
Amenorrhea Treatment
The treatment your doctor recommends will depend on the cause of your amenorrhea.

Treatments for amenorrhea may include medications, surgery, lifestyle changes, or a combination of these measures.

Lifestyle changes may include:

Taking steps to reach a healthy weight and maintain that weight (if you're under- or overweight)
Interventions to reduce stress
If you're an athlete, modifying the way you train or eat
Medical treatments for amenorrhea may include:


Hormonal medications, such as birth control pills
Estrogen replacement therapy
Medications for PCOS
Surgical treatments for amenorrhea may include:

Removal of scar tissue in the uterus
Removal of noncancerous pituitary tumor

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Ten menstrual hygiene tips every girl and woman should know

Dr. HelloDox Care #
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When a girl has a period for the first time, it is a distinct step into womanhood. Here are some tips to help you stay clean and hygienic during your periods.
Most of us go through our periods very secretively and don’t really bother to figure out if our practices are hygienic or not. At times, we may wear the same napkin for a whole day. Women is villages and smaller towns still use reusable unhygienic cloth during their periods. And since periods are considered unclean, they are not even allowed to use detergent for washing the soiled cloth well in some households.

Here are some tips to maintain hygiene during your periods, some of which you may not know about:

1. Choose your method of sanitation:

Today there are a number of ways including the use of sanitary napkins, tampons and menstrual cups to stay clean. In India, most unmarried girls prefer to use sanitary napkins. If you do decide to use a tampon remember that it is essential to choose one that has the lowest absorbency rate for your flow. While there are some women who choose to use either different types of sanitary napkins on different days of their periods or different methods of protection (like a tampon and a sanitary napkin), there are some who prefer to stick to one type and brand. The best tip here is to try and use one brand for one type of protection for a while to know if it helps your needs. Frequent switching between brands can make you uncomfortable since brands are as unique as you, they suit everyone differently.

2. Change regularly:

Menstrual blood – once it has left the body – gets contaminated with the body’s innate organisms. This rule applies for even those days when you don’t have much bleeding, since your pad is still damp and will have organisms from your vagina, sweat from your genitals, etc. When these organisms remain in a warm and moist place for a long time they tend to multiply and can lead to conditions like urinary tract infection, vaginal infections and skin rashes.

The standard time to change a sanitary pad is once every six hours, while for a tampon is once every two hours. That being said, you have to customize the changing schedule to your needs. While some women might have a heavy flow and would need to change more often, others will need to change less frequently. There are a few instances where your sanitary napkin or tampon might not be completely used – usually on days when you have a lesser flow – but you must change at regular intervals.

In the case of tampons it is very important because, if left inserted into the vagina for long periods of time it can cause a condition called TSS or toxic shock syndrome – a condition where bacteria infiltrate the body leading to severe infection that can send to the body into shock – that requires emergent treatment and can lead to serious complications and even death.

3. Wash yourself regularly:

When you menstruate, the blood tends to enter tiny spaces like the skin between your labia or crust around the opening of the vagina and you should always wash this excess blood away. This practice also tends to beat bad odour from the vaginal region. So, it is important to wash your vagina and labia (the projecting part of female genitals) well before you change into a new pad. If you cannot wash yourself before you change make sure to wipe off the areas using toilet paper or tissue.

4. Don’t use soaps or vaginal hygiene products

The vagina has its own cleaning mechanism that works in a very fine balance of good and bad bacteria. Washing it with soap can kill the good bacteria making way for infections. So, while it is important to wash yourself regularly during this time, all you need to use is some warm water. You can use soap on the external parts but do not use it inside your vagina or vulva.

5. Use the right washing technique:

Always wash or clean the area in a motion that is from the vagina to the anus. Never wash in the opposite direction. Washing in the opposite direction can cause bacteria from the anus to lodge in the vagina and urethral opening, leading to infections. Read about urinary tract infections.

6. Discard your used sanitary product properly

It is essential to discard your used napkins or tampons properly because they are capable of spreading infections, will smell very foul. Wrapping it well before discarding it ensures that the smell and infection is contained. It is advised not to flush the pad or tampon down the toilet since they are capable of forming a block and can cause the toilet to back up. More importantly it is imperative that you wash your hands well after you discard your used napkin since you are likely to touch the used portion of the pad or tampon while discarding it.

7. Beware of a pad rash

A pad rash is something that you might experience during a period of heavy flow. It usually occurs when the pad has been wet for a long time and rubs along the thighs causing it to chaff. To prevent this from occurring, try to stay dry during your periods. If you do have a rash, change your pads regularly and stay dry. Apply an antiseptic ointment, after a bath and before bed – this will heal the rash and prevent further chaffing. If it gets worse do visit your doctor who will be able to prescribe you a medicated powder that can keep the area dry.

8. Use only one method of sanitation at a time

Some women who have heavy flow during their periods tend to use either (i) two sanitary pads, (ii) a tampon and sanitary pad (iii) a sanitary pad along with a piece of cloth. This might seem like a good idea, but it actually is not, changing regularly is a better option. Using two pads or a tampon and a sanitary pad is bad because the two pads absorb the blood and you don’t see that they are completely used up you are unlikely to change at regular and healthy intervals. This can lead to rashes, infections and in the case of tampons even TSS. Another consideration is that if one does use a piece of cloth as extra protection that cloth may not be the cleanest thing to put next to your private parts. Lastly, the whole two pad structure is extremely uncomfortable and can leave you with a bad rash and an even worse temper.

9. Have a bath regularly

To some it may seem like the most inane advice, but in some cultures it is believed that a woman should not bathe during her periods. This myth was based on the fact that in the olden days women had to bathe in the open or in common water bodies like a river or lake. But with indoor plumbing having a bath is the best thing you can do for your body during your periods. Bathing not only cleanses your body but also gives you a chance to clean your private parts well. It also helps relieve menstrual cramps, backaches, helps improve your mood and makes you feel less bloated. To get some relief from backaches and menstrual cramps, just stand under a shower of warm water that is targeted towards your back or abdomen. You will feel much better at the end of it.

10. Be ready with on-the-go stuff during your periods

When you have your periods it is important to be ready. It is important to have extra sanitary pads or tampons properly stored in a clean pouch or paper bag, a soft towel, some paper tissues or towels, hand sanitizer, a healthy snack, bottle of drinking water, a tube of antiseptic medication (if you are using one).

Changing your pads/ tampons regularly is essential, so you will need extra. More importantly storing them properly so that they don’t get contaminated is as important as changing. Pads or tampons that remain in your bag without a clean pouch to protect it can also lead to infections like UTI (urinary tract infection) or vaginal infections. The soft towel can be used to wipe your hands or face if you wash them. Paper towels are the important to wipe off the excess water after you wash your private parts. It is best you don’t use toilet paper for this as it tends to shred and tear when it touches water. Your hand sanitizer is a very important factor here. You will need it to clean your hands and you can use it to clean the flush knob and tap faucet as well. The snack is a backup in case you feel weak or run down during the day and the bottle of water is to help you stay hydrated throughout the day.

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PCOS Diet: Know The Causes, Symptoms And Foods For Polycystic Ovary Syndrome

Dr. HelloDox Care #
HelloDox Care
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Polycystic Ovary Syndrome (PCOS) is one of the most common conditions that affect women in more ways than one. It is a hormonal disorder that may cause infrequent or prolonged menstrual periods. Moreover, in this case PCOS may cause excessive hair growth on the face and body or baldness and this condition can contribute to long term health problems like diabetes and heart diseases. We take you through PCOS, its causes, symptoms and the foods you must eat to reduce the effects of this condition.

What is PCOS?

Polycystic Ovary Syndrome (PCOS) is a health condition in women where cysts get formed in the ovaries, caused by an over-production of hormones known as androgens. This causes women to suffer from various health problems and as per the PCOS Awareness Association, there is no cure for this health condition yet, but there are many ways to decrease or eliminate PCOS symptoms. Some of the biggest health problems that are associated with PCOS are heart diseases, diabetes, high cholesterol, high blood pressure and even stroke.

PCOS Causes

The PCOS cause is not yet understood completely, but most health experts associate it with genetics that can be one of the factors. PCOS can run in to your family and chances are higher in case of women who have irregular periods or diabetes.



Ideally, ovaries tend to make a small amount of male sex hormones called androgens; however, in case of PCOS, the ovaries start to make more of them that may cause you to stop ovulating as a result due to which you may get acne and grow extra facial hair on the face and body.

What are PCOS Symptoms?

PCOS symptoms can vary from person to person and how severe the case is. Some of the PCOS symptoms may include-

Acne

Extra hair on the body and face. In some cases, hair can be thicker and darker as compared to normal human body.

Thinning hair on the scalp.

Weight gain and excessive trouble in losing weight.

Women with PCOS tend to gain weight easily as they have higher than normal level of insulin, a hormone that is produced in your pancreas that helps the cells in your body turn sugar into energy.

One of the PCOS symptoms may include fertility problems.

Irregular or no periods may also be one of the many PCOS symptoms. In some cases, many may have very heavy bleeding.

These PCOS symptoms may cause a person to fall into depression.

PCOS Diet: What foods should you have?

According to Neha Shetty, Senior Nutritionist, Reduce - Talwalkar's, "PCOS diet should be such that it helps reduce weight and positively affects hormones and improves insulin resistance. A moderate intake of complex carbohydrates, high protein and fair intake of healthy fats is advisable. Consuming sufficient amount of omega-3 fats should also help women with PCOS." In order to combat the many symptoms of PCOS, it is important to focus on a healthy diet. Here's what your PCOS diet should look like.



1. Load Up On Fibre



Women with PCOS have higher insulin levels, but eventually become insulin resistant, meaning you aren't able to use the produced insulin effectively. In order to produce productive insulin levels, it is important to load up on fibrous foods. High fibre foods like whole grains, cruciferous vegetables, beans, lentils, broccoli, legumes, nuts and seeds help fight insulin resistance by slowing down digestion and reducing the impact of sugar on the blood.



2. Consume More Lean Protein



PCOS can cause you to gain weight. Eat more lean protein as they are more likely to keep you fuller for longer and prevent you from reaching for unhealthy snacks. This way, you won't be adding up to calories and not gain weight. Your PCOS diet should consist of tofu, chicken and fish.

3. Eat Foods That Reduce Inflammation



One of the PCOS causes may also include inflammation that is responsible for creating an imbalance in the hormones. According to the PCOS Nutrition Center, eating foods that helps reduce inflammation can minimize PCOS symptoms. Load up on tomatoes, kale, spinach, almonds, walnuts, olive oil, fruits, fatty fish and whole grains that have anti-inflammatory properties.



4. Load Up On Omega-3 Fatty Acids



Omega-3 fatty acids are known to balance hormones and also improve insulin levels. Consume foods like fish, olive oil, avocado and nuts and seeds.



5. Take A Low Glycemic Diet



Your PCOS diet should have low glycemic index; women with PCOS are generally insulin resistant causing the insulin levels and blood sugar levels to rise unnaturally. In that case, loading up on low glycemic foods like fruits and vegetables, whole grains, lean protein and healthy fats can help reduce many symptoms of PCOS.

PCOS Diet: Foods to avoid with PCOS

According to Nutritionist Neha, there are various foods that can make your condition worse than ever. Some of the foods to avoid with PCOS may include-



1. Processed foods



Processed foods have high sodium content and may contain unhealthy fats that may only worsen your case. Make sure you limit the amount of processed foods like junk food, canned products, fried foods, et al.



2. Milk



Milk has the tendency to increase the testosterone levels; thanks to its high protein content that limits the normal testosterone metabolism. High testosterone levels can worsen your situation, so prefer having skimmed milk than full-fat.

3. Simple and refined carbohydrates



Women with PCOS are at a higher risk of developing diabetes and gaining weight. Sugary foods and refined flours end up increasing the blood sugar level.



4. Soy and fat



Soy products generally cause delay in ovulation and if you are trying to conceive, there may be a chance that your consumption of soy may be affecting it.



5. Caffeine and alcohol



Caffeine and alcohol have long been associated with infertility, which may worsen the case in women with PCOS.

PCOS weight loss

Losing weight is a gradual process, but in case of PCOS, it may take even longer as your body is already dealing with many hormonal imbalances. PCOS weight loss regime should be followed in a discipline to see effective results. It is important to eat the right diet, exercise well and ensure taking medications routinely. Regular exercises may help a lot by improving insulin resistance and ovulation and further help burn fat.

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Top 7 Foods That Induce Menstruation: Induce Periods, The Natural Way

Dr. HelloDox Care #
HelloDox Care
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Women who suffer from PCOD or other similar fertility issues, find a hard time getting their periods on time. In cases like these, imbalance of hormones is majorly seen as the cause of delay in the regular menstrual flow. Sometimes, reasons like stress, overeating or undue pressure also causes irregularity in periods. In order to combat this, some women sought medical treatment and begin medication, while other hops on to Ayurvedic treatment. The rest of the lot falls on altering their diets to elevate this condition or focus on changing their lifestyle in hopes for some respite.


It's been seen that apart from simply having a nutrient-rich diet and exercising regularly, there are other factors that are known to induce periods and regulate menstruation. Folk wisdom dictates that there are certain foods when added to one's diet are known to be effective in bringing periods early or on its scheduled time.


It's a known fact that for a woman, menstruating regularly is important for her reproductive health. It is what keeps a woman's fertility and hormones level balanced. Given that certain food when consumed in addition to proper medication and a balanced diet are reported to induce periods. It becomes a prospective solution for these common woes widespread among female sex.

Having said that, here's a list of top 7 foods, which are easily available at home and are sworn by our grandmas as great for consumption before and during the periods:


1. Coffee


The presence of Caffeine in coffee is reported to stimulate oestrogen, which causes your periods to come early. Caffeine is also the chemical known for relieving pain during menstruation. Dr. Sarita Gupta who is a gynaecologist shares her opinion, "there are certain foods that is recommended during menstruation to relieve pain. Coffee is the most prominent among them because of caffeine and its migraine and headache relieving properties."

2. Nuts


Snacking on almonds and walnuts can be a good way to prepare yourself before the impending shark week. Both of these variety of nuts are rich in fibre and proteins; their function in inducing internal heat can further be a basis for regulating periods. Eating a handful of these before periods can be good for your health and consequently your fertility.

3. Fruits (rich in vitamins C)


Fruits like papaya consists of carotene, which is known to stimulate oestrogen hormone causing periods to get preponed. Pineapple is another such fruit, high in vitamin C, which is believed to generate heat in the pelvic region, causing further contraction in uterus and is a reason for shedding of uterine lining. Henceforth, making your periods to come on its scheduled time or preventing its delay.


Mangoes are known to have similar effects during periods. Vitamin C in these fruits is what increases the amount of oestrogen in body and reduces progesterone hormone, which is the reason for contraction in uterus and shredding of blood lining, respectively.

4. Dates


Date fruits generate heat that is why they are preferred in winters. Drinking warm date milk can definitely be relieving during menstruation. If taken every night before sleep during wintery months, it surely has positive effects on your reproductive and menstrual health.

5. Jaggery


It is another heat-generating food that is preferred in winters. Although, it is primarily known for treating the occurrence of scanty periods. However, it is also proved to be beneficial to bring your periods on time.


Jaggery is also advised by many doctors to be consumed during the periods because of its propensity to increase haemoglobin in the blood. Dr. Ridhika Kaushik, who is practicing medicine at Dayal Hospital, says, "We advise our patients to take jaggery in small amounts during menstruation, to maintain the iron level in the body."

6. Turmeric


It's an emmenagogue that functions as a stimulator of blood flow in uterus and pelvic region. Its antispasmodic effects expand the uterus, signalling the onset of menstruation. This phenomenon is most talked about in the Chinese traditional medicine. Drinking turmeric with hot water or milk can be really useful for women looking forwards for their periods to come around its scheduled time.

7. Ginger


It is another emmenagogue and naturally considered as a herb, which is known to induce menstrual flow. Ginger can be taken throughout the year in many forms, ranging from food to beverages. Its effect will be the most pronounced, if it is consumed in the form of hot brewed tea, which is sweetened with honey.


Honey, in itself, is very soothing for your body, especially during menstruation. When combined with ginger, it accentuates its effect by increasing internal heat in your body and causing periods to be preponed.

In addition to their general properties as stated above, most of these foods (ginger, jaggery, turmeric, almonds and pineapple) have anti-inflammation properties that can also help in eliminating menstrual cramps. So, this time add one of these foods to your diet to see the result immediately.

Dr. Devendra Khairnar
Dr. Devendra Khairnar
MD - Allopathy, Pediatrician, 8 yrs, Pune
Dr. Sairandhri Shinde
Dr. Sairandhri Shinde
MBBS, Gynaecologist Infertility Specialist, 10 yrs, Pune
Dr. Ramit Kamate
Dr. Ramit Kamate
MBBS, Infertility Specialist In Vitro Fertilization Specialist, 1 yrs, Pune
Dr. Deepti Shukla
Dr. Deepti Shukla
MD - Allopathy, Dermatologist Trichologist, 12 yrs, Mumbai City
Dr. Dharmendra Singh
Dr. Dharmendra Singh
MS/MD - Ayurveda, Cardiologist Diabetologist, 1 yrs, Pune
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