11 Sep “IRREGULAR” MENSTRUATION
Even The Day-Night Cycle Ain’t That Regular
“Irregular” Menstruation. We all have heard of it. How can we not, when it is constantly being blasted from noisy stereos mounted on top of rickety cars without functional engines. How can we not, where the very airwaves around us is constantly being polluted with it, assaulting our ears, disturbing our inner peace with thoughts of being unwell, thoughts of being less feminine and less fertile than the woman next door; and constituting major psychological “blues”.
” Irregular menstruation! Irregular menstruation!! Mensisi gi o na agba chanfa; ifu ya taata, onwa ozo ifu ya mgbe di iche? Ngwa bia were ogwu a ka odozie mensisi gi ka o na agba siriri-werere” [ Irregular menstruation! Irregular menstruation!! Is your menses going zigzag? If you see it today, next month you will see it on a different date? Oya come and take this drug so that it will make it to be regular like clockwork]
I’m sure each and every one of us have heard a message similar to the above more than once irrespective of which part of Nigeria we are in. That shows how widespread the message of “irregular” menstruation has gone. And one would think that a subject matter so popular would equally be well understood by all and sundry. But sadly it is not so.
As a student, while taking history I usually dismissed the issue of menstrual irregularities with the question: is your menses regular? To which I almost always got the answer no. Funny thing is that when you probe further you will realise that what people consider as “Irregular menstruation” is as far from the true meaning as the heavens are from the earth.
Most will tell you that they experience their menses on different dates of the month [say 17th of this month and then 20th of the following month], and that makes it “irregular”.
Others, because they have read that the “normal” menstrual cycle lasts 28 days, will tell you that they are having abnormal menstruation just because their cycle length is not exactly 28 days. Wew!
THE FACT
The female monthly cycle is regulated by an interplay of both hypothalamic,pituitary and ovarian hormones, each of which is subject to various environmental factors, giving rise to a wide range of both INTERPERSONAL and INTRAPERSONAL [normal] variations in the menstrual cycle.
Even though that arbitrarily the “normal” length of the menstrual cycle is set at 28days [both for the purpose of academic convenience and for the fact that a majority of females have exactly a 28 day cycle], slight deviations from it shouldn’t be considered as an irregularity.
As a rule of the thumb, the following VARIATIONS are recognised as NORMAL:
INTERPERSONAL VARIATIONS.
The normal cycle length [that is number of days from the onset of one menses to the next] is given as a range spanning from 21days to 35 days[ I.e 28 +/- 7days]. While the normal duration of flow is given as 2 to 7 days, with most people having 3 to 5 days of flow.
This means that a cycle length as short as 21 days or as long as 35 days is considered normal, where as cycle lengths less than 21 and greater than 35 are considered abnormal, and respectively termed Polymenorrhoea and Oligomenorrhea.
On the other hand, bleeding for either less than 3 days or more than 7 days are considered abnormal and are respectively termed Hypomenorrhea and Menorrhagia[Heavy bleeding]. This does not however suggest that menstrual bleeds lasting within the periods accepted as normal cannot be “heavy” as any menstrual flow associated with a quantity greater than 80mls of blood per day, or clots, or any of: dizziness, breathlessness,a racing heart beat etc; are still considered Menorrhagia.
Note that the above have only addressed the duration of flow and cycle length, and not “regularity” per se.
INTRAPERSONAL VARIATIONS.
There is as much intrapersonal variations as there are interpersonal variations. And this also is equally associated with some erroneous misconceptions. For example, the misconception of expecting to experience one’s menses on the same exact date every month. I think common sense alone, not even science, is enough to debunk this misconception as there are even variations in number of days in each month with some months having 31 days and others 30, 29 or even 28. So what happens in the months of February, April,June, September, and November [months with less than 30 days] , for someone who sees her menses every 31 days? Of course it will naturally roll over to the next month. Get the point?
As for the regularity in the cycle length, a little irregularity is expected given that the menstrual cycle is subject to a delicate interplay between a myriad of hormones which are in turn subject to a host of systemic and environmental factors [even things as flimsy as stress, change in environment, weight loss or gain, etc]. So it is normal for one to have different cycle lengths in different cycles, say 28 days this cycle and 31 or 26 days during the next cycle.
It becomes “abnormal” or worrisome when the difference between it and the norm for the individual is numerically more than 7 days, or the difference is greater than the difference between the individual’s longest and shortest possible cycles. [ Some confusing shit, that last sentence inint? Well cram it! *Tongue out *lol]
Some Menstrual Issues That Should Raise Genuine Concern.
1. Intermenstrual bleeding [I.e vaginal bleeding in between two periods]
2. Post coital bleeding[bleeding after sex in the absence of “virginity”]
3. Short periods [cycles 4. Long periods [cycles > 35days]
5. Heavy menstrual bleeding
6. Menses associated with severe pain
7. Amenorrhoea [ cessation of menses for more than 90days, or missing of one’s period for 3 consecutive times, in the absence of pregnancy]
8. “Concealed” menstruation.
9. Altered colour of menstrual effluent/blood
Etc.
ADMONITIONS
1. “Irregular” menstruation does not necessarily mean what it sounds like; it has a specific definition [scroll up for details]. Also it is not a disease entity per se, but could be a manifestation of a wide range of illnesses including not just genital infections but organic systemic diseases as well. Also it can sometimes be due to relatively benign causes such as stress.
2. Learning health tips from these drug vendors that roam our streets with rickety cars could be misleading; thus the average Nigerian believes that E’coli and “Staph” are STDs, and that you can see them with the unaided eye [ ” …lee nke anyuru anyu; come and see the peed form ” ]. Please unlearn yourself today.
3. Y’all should go and get the book “Every Woman”, there’s a reason it was named so! So if you are a woman and you have not read it, YOU ARE WRONG!
I’m out!
Good morning.
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