We have spoken with the gynecologist César Lizán, medical director of Clínicas Eva, and we have clarified all those doubts that haunt our heads every time our period is about to come. And it is that, if we are attentive to our menstrual cycle, we can realize that things are not going as well as we thought.
- QUESTION: What health problems can we identify with the rule?
ANSWER: A normal and regular period usually supposes a correct functioning of the brain-ovary axis, which is capable of directing regular ovulations and adequate hormonal levels. The first suspicion to keep in mind when there is an alteration in the regularity of the rule is pregnancy. Once pregnancy has been ruled out, there are different alterations that lead to menstrual alterations; some are gynecological in origin , such as fibroids, polyps, polycystic ovary syndrome, endometriosis, pelvic congestion syndrome … ; while others are not of gynecological origin (stress, eating disorders, significant weight changes …)
- QUESTION: What do the different colors of the bleeding indicate, redder, darker, very light …?
ANSWER: The color of blood usually depends on the time that passes from when it originates until we see it outside. Red-colored blood usually indicates current active bleeding while darker bleeds indicate increased oxidation of the blood over time.
- QUESTION: If the cycle is suddenly lengthened or shortened, could it be due to a problem? What if we always have cycles shorter than 28 days or longer than 35 days?
ANSWER: The normal length of a menstrual cycle is 28 plus / minus 7 days, which means that regular cycles of 21 to 35 days are normal. We usually divide menstrual cycles into two phases. A first in which the development of the dominant follicle occurs and ends with its ovulation, and a second phase marked by the production of progesterone by the corpus luteum that ends with menstruation. The second or luteal phase is usually the most constant.
When cycles are lengthened, one must think about possible difficulties for ovulation , as we sometimes find in some patients with polycystic ovary syndrome. In the case of shorter cycles, it is necessary to firstly rule out that there are no polyps or fibroids that cause these bleeds, and secondly, to assess that an accelerated follicular phase is not taking place that produces oocytes of non-optimal quality.
- QUESTION: When is menstrual pain excessive and can we think that we have endometriosis or some other problem?
ANSWER: Dysmenorrhea or menstrual pain is uterine pain at the time of menstruation. This pain can be secondary to some other pathology, such as the endometriosis that you mention and that can also be accompanied by pain with sexual intercourse. There are also other less known pathologies such as adenomyosis or pelvic congestion that can cause it. And we should not forget the possibility of fibroids, cysts, pelvic inflammatory disease … In short, there are many possible causes, but we must not forget that most often no cause is identified that causes it and they end up being classified as what we know like primary dysmenorrhea that can become very disabling.
- QUESTION: Too abundant or too few rules: how can we identify them and what do they indicate in each case.
ANSWER: The normal duration of the rule is 2 to 7 days, but it is very difficult to objectively assess the amount of it. For this reason, when patients complain of excessive periods, we usually request tests to assess blood parameters and iron stores. Again, the causes can be several, but the most frequent are usually fibroids and polyps.
- QUESTION: What changes in menstruation should we pay attention to to detect possible problems ? Whenever one occurs, should we go to the gynecologist?
ANSWER: It is interesting to carry out an evaluation by a gynecologist when some of the following situations occur:
- Possibility of pregnancy.
- Abundant periods that last more than a week or require a very frequent change of tampon or habitual dizziness with the period.
- Irregular bleeding.
- Intense pain before or during menstruation.
- You are 16 years old and have not had your period yet.
- Your menstrual period occurs less than 21 days or more than 35 days.
- You feel very anxious or depressed around the time you have your menstrual period.
- QUESTION: Does having your period at a very young or very late age indicate anything about our future health?
ANSWER: The period usually comes around 12 years. If it comes before the age of 8 or after the age of 15, there may be some associated hormonal and developmental alterations that are interesting to assess.
And keep in mind that bruises or hematomas that come out without blows on the arms and legs are easier to come to us when the period is about to come.
