24-2 The Reproductive Process in WomenAs women, we all know about our “periods” or our “menses”. Since the age of twelve or thirteen years, monthafter month we have been visited by our periods. Many a times we must have wondered about this monthlyvisitor of ours and at times even got angry when it came at the wrong time. Let us try to understand this“visitor” called our periods and see the role that it plays in a woman’s body.From “menarche”, (the first time a girl has her “periods”) until her “menopause” (when she stops havingher “periods”), a woman bleeds a few spoons every month while she undergoes her menstrual cycle.When a girl first starts “bleeding”“Menarche” is the first time a girl has her “periods”. Usually agirl starts bleeding from her uterus when she is between 11 to A girl14 years old. But there are some girls who start bleeding as becomesearly as nine or as late as eighteen. As long as everything else a womanis normal, there is nothing to worry. and she gets herIf a girl has turned eighteen and not yet got her first “periods”, do “peri-check the person for anaemia (Page 19-11). It could be the reason. ods”For girls above 18 who are yet to bleed refer to a doctor because theremay be a reason which can be corrected by a small operation. Our Menstrual CycleEvery month a woman goes through a “cycle”. Bleeding or “periods” is just one part ofthis monthly cycle.Why do we have our menstrual cycle?The menstrual cycle is to allow the egg from a woman to meet the sperm from a man andcreate new life. This new life is quickly taken to a cushioned site in the mother’s wombwhere it may stay for nine months. Understand the “Menstrual Cycle”Let us look at what hap-pens in a menstrual cycleand how it happens. To un- Days 22- 28 Days 1 -5derstand better, let us mark If no fertilised egg Bleeding (mensesthe first day of bleeding / reaches the womb, its or “periods”)“periods” as Day 1 of the thick lining gets readywoman’s cycle. The aver- to break downage normal cycle of awoman lasts 28 days and Day 6-7so, the cycle would last Egg begins tofrom Da1 to Day 28. 28 Day grow in ovary MenstrualIf the “month” of a Cyclewoman from Day 1 of her Day 8 - 11periods is divided into Womb thickens Fertile Period to get ready tothree parts, the middlepart is the one when she Can get pregnant receive fertilisedcan get pregnant. She eggmust use contraceptives ifshe wants to avoid preg- Days 15-21nancy. For a 30 day cy- Egg moves towards Days 12-14cle, Day 11 to Day 20 need fallopian tube Ovulation (egg released)contraceptives. The other (even if it does not Very Fertile; mucusdays are “safe”. meet sperm) thin & slippery
The Menstrual Cycle of Women A new egg (ovum) starts ripening in the ovary I. V. II.1. If the egg does not meet the 1. The inner walls ofsperm, it dies within 24 hours of the uterus (womb)release. starts becoming2. If there is no conception, the thick.walls that were made ready to 2. At the same time,receive the baby are then shed. the egg grows inside3. The layers come out of the a balloon-like sac ofvagina as mentrual blood or the the ovary. 24-3bleeding that we experience asmonthly periods. IV. III. 1. Inner walls of the womb keeps thickening. 1. If the egg meets the 2. Blood vessels are made on the lining of the womb; sperm inside the fallopian so that blood can be supplied to the baby if the woman tube, it results in the for- conceives. mation of an embryo 3. The bag around the egg bursts and the egg is re- (baby) leased. 2. The embryo moves to 4. The egg then enters the fallopian tube (usually on the womb and gets at- Day 14 of the of cycle) tached to it. It grows here 5. A sticky transparent watery fluid comes out of into a baby for 9 months. thevagina at this time; the chance of a woman getting pregnant is highest at this time.
24-4 Disorders of Menstrual CycleI. Less or No menses a. Pregnancy: This may be b. Anaemia : Less the most important reason why blood is another “periods” (menses) stop in a common reason why woman. Throughout pregnancy women do not get and till a few months after a child periods or bleed very is born , the “periods” do not begin little during her “pe- again. No “periods” is not a certain riods”. Treating the sign that the woman will not get anaemia (II Phase pregnant. After a few months of a Manual, Page 19-11) brings the “pe- child being born, even without riods” back and reassures the woman “periods” returning, she could get that she is not pregnant. pregnant. c. Body chemical problem: Women who have never been able to bear a child, have a short height (and may be has a man-like built and hair on face & body) also do not get their monthly “periods”. Such women may need to see a doctor if they want to have a child. The body may not be producing some hormone (chemical in the body) as much as is needed. A doctor may be able to give such hormones to the women to make them normal. d. Menopause: A woman undergoes menopause around the age of 45 years (between 45 and 55 years). This phase lasts from a few months to a few years in some women. In this phase, hormones (body chemicals) of women start decreasing to the levels similar to that of men. Many changes take place: 1. The “periods” become less and irregular; After the menopause and they slowly stop. age, a woman’s chance 2. The woman undergoes “hot flashes” – she of losing Calcium from feels unusually hot especially in the upper her bones increases (es- part of the body and face. pecially if her life be- 3. The woman may get mood swings (prob- comes less busy and she ably from an awareness that she is grow- gets little exercise). She ing old) may suffer fractures 4. Her skin may get rougher; and slowly a few from simple falls. A woman’s risk of getting hair may be seen in the face in the beard & heart diseases may also moustache area. increase after meno- 5. The vagina and the uterus slowly become pause. smaller.II. Increased Bleeding III. Irregular BleedingThe amount of blood during “pe- Many women complain that their periods are not regular.riods” may be different for differ- For some, the “periods” may be coming too often (say onceent women. What is “heavy bleed- in 15 days). For others, their periods may be delayed by aing” for one woman may be nor- week or two (which may cause quite a bit of anxiety).mal in another. Generally, thepresence of clots in the “periods”can tell of heavy bleeding. If it con- What to do if “periods”are not regular?tinues for a number of days or it If the woman is less than 35 years of age, one can try to correcthappens every month, it may cause the irregular bleeding by giving her Oral Contraceptive Pillssome worry. (OCPs) for three months continuously. The pills contain hormones and often set the cycles right when they are given regularly. Do If no symptoms of P.I.D tell the woman that such pills are normally taken to avoid hav- (see II Phase Manual, ing children but may also be given for such purposes. Page 15-15), do not try to Or else, other people may scare her to stop the pills. treat it. It is better to re-fer the patient to a doctor. If the woman is more than 35 years of age, it would be better to refer the woman to a doctor.
24-5 Know the Answers The Menstrual Cyclea. Please Fill in the Blanks :1. The first menses is called _____________ and a girl normally gets her first menses between the ages of _____ and _____.2. A woman normally gets her monthly periods till she is around _______ age. The last stage of menses in life is called _____________.2. A normal menstrual cycle lasts for ____ days and the egg is released on the ____ day of the cycle.3. Sperms from the man meets the egg in the ____________________________ and if fertilised the new life moves to the ________________ where it stays for _________ months.4. If the egg does not get fertilised, then the _________ sheds its thick lining which comes out of the vagina as a woman’s ________________.5. A woman is most fertile (could get pregnant) during the _____________ phase of the menstrual cycle which falls on the _______ day of the cycle. She should not have sex without some contraceptive from the __________ day to the _______ day of the cycle.