Thursday, February 16, 2017

2017 A NEW BEGINNING ON WOMEN'S HEALTH

PROBLEMS OF MENSTRUAL CYCLES
 All women are born females , however as we grow older, in this day and age this often changes either due to developmental abnormalities or more recently due to personal preferences, why and how this happens is not yet scientifically  understood.  One hallmark of being a woman is a regular menstrual cycle.
Menstrual cycles start after the ovaries; the female sex glands start maturing an egg each month. This stage is called menarche.  A female baby in utero has thousands of immature eggs called primordial follicles by the time the baby is born, only about 2ooo are viable immature eggs are there.

PRIMORDIAL FOLLICLES(EGG BUDS) IN THE OVARY
20 WEEKS OF FOETAL LIFE......20 MILLION
AT BIRTH...2 MILLION
AT PUBERTY........500 THOUSAND
AT MENOPAUSE....FEW OR NONE

When these are finished we no longer have a period. This is what is called menopause, after this time women do not have a menstrual cycle and cannot get pregnant. It is only during the fertile time of their lives that women can only get pregnant, that is when they are having regular menses (periods).  Menstrual cycle is absolutely important for female development and fertility. However it is often full of problems from menarche to menopause.  In the next few posts I will discuss these problems.
The first menstrual cycle women have is called Menarche and it usually happens in the middle years at junior school. At the ages of 9 to 12 often delayed up to 15,this confirms the possibility of fertility in their future life.  This stage of their lives is expressed as puberty. It usually starts first as the development of breast buds, an odd pimple, pubic hair and the start of axillary hair, between the ages of nine and fifteen.  Once upon a time mothers used to tell their daughters about this. Now generally this is all discussed at  school or on social media between girls.  In my time I was not aware of this, one day when I started to have vaginal bleeding at school, I said to a senior friend of mine that I have got TB (Tuberculosis). In those days TB was very common, the only time we heard of bleeding was with TB (Tuberculoses of the lungs). In the  afternoon  after I arrived home I discussed all this with my mother , she explained all this to me in great detail including the problems that can  arise . I was not very happy. I was in grade ten, in those days it used to be a very important year for education. I did not ask it to happen now, could it not wait until summer vacation.
I was very lucky; I did not have my next period until the summer vacation. This can often happen in the starting years of puberty
 In our body we have three main reproductive organs, a uterus, two fallopian tubes attached to it and the two main sex organs lying on either side of the uterus and the ovaries. The uterus is a hollow organ with a cavity which holds the baby as it develops. It is the lining of the uterus which under goes changes during menstrual cycle.
The lower end of the uterus has a gate way, the cervix, this opens in a tube called the vagina. Sounds simple, but it is most important, as our genital tract is connected to the outside world through this tube.  The menstrual blood flows to the outside world, sperm enter the uterus through this to fertilize the egg to enable us to make a baby.  When the baby is ready, it comes into the world through this tube screaming. We also have other covers for our genital parts, these help us in protecting the genital tract from infections.


One other very important structure is a thin membrane with a small central hole for drainage.  Many others organs in our body are involved in female maturation (puberty and menstruation as already mentioned) fertility and sexual activity. These organs are called endocrine glands. There secretions work at distant organs. These are pituitary and Hypothalamus located in the brain, Thyroid gland (located in the neck) and to some extent a gland called adrenal. When a female baby is born after three or four days later they can have a small vaginal bleeding, this in fact is a period. The infant’s uterus was influenced by her mother’s hormones, when they are withdrawn after birth and the baby has a small bleed. Many young mothers get very worried about this but this is a very good sign that all the baby’s female organs are in good form.  The infant does not have another bleed until menarche.  It is received in different cultures in different ways. In some cultures it is even celebrated. For us women it often causes many problems during our life span. Generally women have 450 periods during their life time. However we have to have them for our development, fertility and pleasure (sexually). During pregnancy and after a certain age called menopause, we do not have a period.
We do not clearly understand what starts the periods, the ovary is a remarkable organ after a certain age it responds to a hormone FSH (FOLLICULER STIMULTING HORMONE) when some of it’s premature follicles start to grow. This comes from the pituitary controlled by the hypothalamus. When an egg grows it in turn secretes another hormone called oestrogen. Only one follicle continues to grow, the rest are demised. The oestrogen produced by what we call the dominant follicle creates a surge for pituitary gland to release a hormone called luteinising hormone (LH). This results in the release of the egg from the growing follicle.  This process is called ovulation. This is what grows to be a baby.




During this time the lining of the uterus is also thickened. After the egg is released, the empty shell of the follicle becomes a yellow body called corpus luteum .  This secretes a second hormone called Progesterone this helps to mature the lining of the uterus to receive the fertilized egg just in case it was fertilized. Then the progesterone level remains increased to protect the egg. If there is no egg the increased level of oestrogen suppresses the pituitary. The levels of oestrogen and progesterone drop indicating the end of menstrual cycle. Normal cycle is a reassuring sign that ovarian function is normal. The menstrual blood is usually 40 mls; it consists of broken up endomentrial lining and secretions from the vagina and cervix and is dark brown in colour.
During the menstrual cycle the broken up endomentrium releases chemicals called prostaglandins and they are responsible for period pains and cramps.

All these hormones when withdrawn cause the period and along with prostaglandins cause many symptoms which we will discuss in the next post.  

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