DISORDERS OF MENSTRUAL CYCLE

AMENORRHEA: The absence of menstrual periods. It is called primary amenorrhea if it occurs at puberty, when a girl normally begins menstruating. Secondary amenorrhea refers to the lack of menstrual periods in women who have previously menstruated. Amenorrhea is normal in pre-pubescent girls and in women who have ceased menstruation due to pregnancy, breastfeeding, or menopause.

Any healthy girl who has not had a period by the time she is 16 years old has primary amenorrhea. Primary amenorrhea may be caused by the delayed onset of puberty. It also may be linked to infertility caused by Turner's Syndrome, a genetic disorder that prevents sexual maturing in girls. Some cases of amenorrhea are associated with birth defects that cause the vagina or uterus to develop improperly.

Secondary amenorrhea may result from a variety of factors. It sometimes occurs for the first few months after a woman has stopped taking birth-control pills. This type is called postpill amenorrhea. Secondary amenorrhea also may be caused by intensive physical exercise, including long-distance running or ballet dancing; extreme weight loss; disorders of the endocrine system (such as tumors of the pituitary gland), and various disorders of the ovaries. An ovarian disorder called polycystic ovary syndrome, or Stein-Leventhal syndrome, is characterized by an extremely irregular menstrual cycle in which ovulation may not occur. This disorder usually involves infertility, but treatment can help make the periods more regular.

Amenorrhea is often caused by psychological factors. Increased stress brought on by such major life events as losing a partner or loss or change of occupation can upset the normal menstrual cycle for a few months or longer. Increased stress can cause hormonal changes, such as raised levels of cortisol and prolactin, which affect menstruation. Periods normally return after the stress subsides.
Treatment of amenorrhea is determined by its cause. Hormone therapy can be effective for primary amenorrhea caused by hormonal changes. Surgery can sometimes alleviate cases related to hereditary problems. Stress reduction and a proper diet can often restore the menstrual period in cases of secondary amenorrhea.

ANOREXIA NERVOSA: This has a wide variety of medical complications that affect every system of the body and can be life threatening. Often, people who are later diagnosed with anorexia nervosa initially seek treatment for the medical symptoms caused by semi starvation. Undernourishment usually causes females with anorexia nervosa to stop menstruating —in fact, this symptom is so typical that it is one of the criteria used to diagnose the disease.

People with anorexia nervosa often suffer from fatigue and muscle weakness, have trouble staying warm, and have dry, yellowish skin, brittle hair, and sometimes hair loss. Changes in the function of the kidneys and gastrointestinal system are common. People with the disorder frequently develop osteoporosis, a loss of bone mass that makes bones fragile and prone to fracture. This bone loss may be at least partially irreversible and delayed or arrested bone development can also lead to stunted growth. Many changes in the function of the heart can occur, such as slow heartbeat, low blood pressure, and heart palpitations. These changes can cause a person to become prone to dizziness and fainting, and abnormal heart rhythms sometimes result in sudden death. Scientists estimate that between 5 and 20 percent of people with anorexia nervosa die of medical complications related to the illness.
Anorexia nervosa results from an interaction of several different factors. Most researchers agree that one of the most important causes of anorexia nervosa is Western society’s emphasis on thinness and body shape as a primary measure of attractiveness. In fact, many believe that most people who develop anorexia are female because there is more pressure for women to be thin. Media images of very thin models and actors lead many people to believe that they will only be considered attractive and successful if they are also very thin. These images may cause many people to develop unrealistic expectations for their own bodies. People may also feel pressure from family members or peers to be thin.

These social pressures interact with a variety of other factors to cause some people to develop anorexia nervosa. Some people who develop the disorder have experienced physical, sexual, or emotional abuse or the loss of someone close to them, such as a parent. Other existing psychological problems, such as anxiety, depression, and compulsive behavior, can also contribute to the development of the illness. In some cases, the characteristics of a person’s family may encourage personality traits associated with anorexia nervosa, such as perfectionism, emotional reserve, desire to conform and avoid conflict, and need for control. The onset of the disorder in the mid- to late teenage years leads some researchers to believe that the disorder sometimes reflects a patient’s fear of emerging sexuality.

Various forms of psychotherapy are used to help people with anorexia nervosa recognize and change their distorted attitudes about food, weight, and body image. Counseling helps people understand and resist societal pressures to attain a certain body shape. Treatment also addresses any other factors, such as abuse, trauma in close relationships, or low self-esteem, that have contributed to the development of the disorder. Frequently, other family members are included in the therapy to help address problems in family relationships that are contributing to the patient’s illness. Group therapy with other individuals suffering from anorexia nervosa is often particularly helpful because it helps people recognize distorted perceptions and behaviors that they share with other anorexics. Patients sometimes meet with dietitians to learn about nutrition and meal planning.

For people with severe illness, psychotherapy treatment may begin with an inpatient program in a psychiatric hospital lasting several days to many weeks. Inpatient treatment is usually followed by a longer period of outpatient psychotherapy. Day programs are also available, in which an individual receives intensive treatment in the hospital during the day but does not spend the night there.

Anorexia nervosa can be difficult to treat because many patients deny they have a problem and resist treatment. Some fear that treatment will involve gaining weight. Recovery from the disorder is a long and uncertain process. Researchers estimate that of those diagnosed with anorexia nervosa, 42 percent recover, 30 percent improve somewhat, and more than 20 percent suffer from a chronic eating disorder.

Little is known about preventing anorexia nervosa. Some professionals have developed prevention programs that combat the cultural emphasis on appearance and the identification of thinness with health, happiness, virtue, and power. These programs stress developing sources of self-esteem that are based on qualities other than physical appearance and promote acceptance of the natural diversity of body type.

DYSMENORRHOEA (Menstrual cramps): Many women suffer from painful crampy periods. This is called dysmenorrhoea. Dysmenorrhoea does not usually start until two to three years after the menarche, and usually only occurs if the menstrual period follows a cycle in which ovulation occurred. Occasional dysmenorrhoea occurs in a period in which ovulation did not occur (called an ‘anovulatory cycle’), particularly if the menstrual blood clots in the uterus, and the small clots are then expelled.
The pain is cramplike in character, felt in the lower abdomen, and usually starts in the 24 hours before the menstrual period and lasts for the first 12 to 24 hours of bleeding, when the discomfort goes.
The cause of dysmenorrhoea is now believed to be due to an extra sensitivity of the body to, or an accumulation in the body of, substances called prostaglandins. Prostaglandins, fatty-acid derivatives, are found in almost all tissues in the human body. More than a dozen biologically important forms of prostaglandins occur, affecting many essential physiological functions.
Administration of drugs that inhibit prostaglandin synthesis, such as ibuprofen and naproxen, relieves dysmenorrhea in most cases. The effects of prostaglandins on blood vessels are also thought to cause some migraine headaches.
The two prostaglandins, thromboxane and prostacyclin, were found to affect the clotting ability of blood: one of them (thromboxane) promoting and the other (prostacyclin) inhibiting the clumping of platelets (thrombocytes), the small corpuscles in the blood that aid in wound healing. Because aggregation of platelets is thought to contribute to stroke and heart attacks, prostaglandin-synthesis inhibitors such as aspirin are now being tested for the ability to prevent these events. Prostaglandins also promote inflammation; thus drugs that block prostaglandin synthesis are effective against arthritis and similar diseases.

ENDOMETRIOSIS: This is a medical disorder in which tissue from the lining of the uterus implants and grows in the pelvic cavity and other parts of the body. The severity of the condition varies widely: In some women, endometriosis causes no symptoms; in others it is painful and debilitating. Experts estimate that endometriosis occurs in approximately 10 to 15 percent of menstruating women between the ages of 25 and 44, most often in women who have never given birth.

The uterus consists of a firm outer coat of muscle, known as the myometrium, and an inner fleshy lining, known as the endometrium. In a menstruating woman, each month the endometrium thickens in response to the sex hormone estrogen, which is produced by the ovaries. If pregnancy does not occur, the endometrial tissue breaks down and discharges through the vagina, accompanied by bleeding.
In endometriosis, endometrial tissue grows in locations outside the uterus, including in or around the ovaries, fallopian tubes, pelvic cavity, and, occasionally endometrial tissue is found in sites far from the uterus, such as the lungs and upper limbs. Endometrium found outside the uterus behaves the same way that it would inside the uterus—it may increase in size and shed with bleeding. This bleeding may cause dense scar tissue to form around the fallopian tubes, ovaries, and other body structures and may eventually interfere with their normal function.

Endometriosis can cause pain in the lower abdomen and pelvic area before, during, and after menstruation, and irregular or heavy bleeding during menstruation. Other common symptoms include pain during sexual intercourse and pain when passing stools or urinating. In extreme cases scar tissue may obstruct the fallopian tubes, preventing the passage of an egg from the ovaries to the uterus and causing infertility. If scar tissue forms on the intestines it may cause obstruction of the bowel, which left untreated can become a life-threatening condition. For reasons unknown, some women with extensive endometriosis do not experience any symptoms while some with minimal disease suffer debilitating discomfort.

Scientists do not know the cause of endometriosis. One theory proposes that endometrial tissue in menstrual blood may travel up through the fallopian tubes and implant in the pelvic cavity. Another theory proposes that the cells lining the abdominal cavity may transform into endometrium. A third theory suggests that endometrium may possess the capacity to invade blood vessels and travel to different parts of the body through the circulatory system, lodging in any organ of the body.
To diagnose endometriosis, a doctor performs a pelvic examination and a laparoscopy. In this surgical procedure, a thin, lighted tube is inserted into a small incision in the abdomen to enable the surgeon to view the pelvic organs.

Treatment of endometriosis may involve either drugs or surgery, and sometimes both. Since endometrial tissue depends on estrogen to grow, physicians prescribe drugs that change the body's estrogen balance and halt endometrium growth. These drugs include high doses of birth control pills and drugs that halt ovulation and menstruation, including danazol and a class of drugs called gonadotropin-releasing hormone analogues. If medications do not work, the endometrium tissue may be surgically removed using laparoscopy. Most commonly the diseased tissue is destroyed by means of lasers attached to the laparoscope. In severe cases, a hysterectomy (removal of the uterus) may be necessary. For most women, the symptoms of endometriosis disappear following menopause.

PREMENSTRUAL SYNDROME (PMS): This disorder is characterized by a variety of physical and emotional symptoms that occur in women before menstruation. These symptoms typically begin at or after ovulation (release of an egg by the ovaries), and continue until menstruation begins.

The most common physical symptom of PMS is fatigue. Other physical symptoms may include cravings for sweet or salty foods, abdominal bloating, weight gain, sore breasts, swollen feet or hands, headaches, acne, and various gastrointestinal problems. The emotional symptoms of PMS generally include depression, irritability, anxiety, or mood swings. Approximately 2 to 5 percent of women have severe PMS symptoms, but many have only mild or moderate symptoms. PMS is most common in women in their 20s and 30s, and ceases entirely at menopause.

Many researchers believe that PMS is the result of changes in oestrogen and progesterone hormone levels that occur during the menstrual cycle. Among other effects these hormonal changes may cause the body to retain more sodium and fluid, leading to swelling or bloating. Recent research suggests that low levels of certain neurotransmitters (chemicals that transmit messages between cells) that affect a woman's sense of well-being and relaxation, and also stimulate the central nervous system may contribute to the emotional symptoms.

PMS is diagnosed by recording symptoms for several menstrual cycles. Symptoms that occur in a predictable pattern (starting before menstruation, then disappearing when it begins) usually indicate PMS. A doctor may perform a physical exam, if necessary, to rule out the possibility that symptoms indicate the presence of disease.

Treatment of PMS involves finding the remedy or combination of remedies that work for each individual. For some women, dietary changes, such as eliminating caffeine and alcohol, and cutting back on salt, will alleviate symptoms. Doctors often recommend vigorous, aerobic exercise because it is thought that exercise stimulates the body's release of various neurotransmitters, supplementing those that are at low levels.

Medications used to treat PMS include diuretics (to ease fluid retention), oral contraceptives (for hormone control), and anti-anxiety medication, for extreme irritability. Low doses of progesterone (a reproductive system hormone) have been used on an experimental basis. Researchers also have conducted experiments using drugs that affect neurotransmitter levels.

TURNER SYNDROME: It is a relatively common genetic disorder that causes abnormal growth development and infertility in females. Turner syndrome is characterized by certain physical features, including short stature, loose folds of skin on the neck, a small jaw, and a higher incidence of heart, kidney, and thyroid problems. Some individuals with the disease experience learning difficulties. There is no cure for Turner syndrome, but early diagnosis of the disease and continuous medical treatment throughout life can promote growth and effectively manage related medical conditions.

Turner Syndrome occurs in about 1 out of every 2,000 live female births. Girls with the disorder do not develop secondary sexual characteristics, the body changes, such as breast development, that occur during puberty. They typically have underdeveloped ovaries, which prevents the onset of menstruation and also contributes to infertility later in life.

Turner syndrome is caused by a partially or completely missing sex chromosome. Chromosomes are gene-carrying structures found within the nuclei of cells. In the human body, all cells except for sperm and egg cells contain 46 chromosomes arranged in 23 pairs. Of these, 22 of the pairs each consist of chromosomes that are almost identical, while the 23rd pair contains special chromosomes that determine the sex of the individual. The sex chromosome pair in healthy males contains an X and a Y chromosome, while the sex chromosome pair in females contains two X chromosomes. In a female born with Turner syndrome, part or all of one X chromosome in her sex chromosome pair is absent. Scientists do not know what causes this chromosomal abnormality—it apparently occurs randomly and is not linked to factors known to increase the risk of a birth defect, such as a pregnant woman’s exposure to drugs, radiation, or disease-causing viruses or bacteria.

Doctors diagnose Turner syndrome based in part on the presence of characteristic physical features. A blood test, ideally given to a baby soon after birth, confirms the diagnosis by detecting the chromosomal abnormality. Early diagnosis followed by regular medical treatment throughout life can offset the most serious problems related to the disease. Treatment options may include regular injections of growth hormone to boost a girl’s final adult height. Doctors may also prescribe treatment with the female sex hormone estrogen to promote the development of secondary sexual characteristics and maintain healthy bones. To combat infertility, women may become pregnant using in vitro fertilization, a procedure in which one or more donated eggs are fertilized outside the woman’s body and implanted

THE MENSTRUAL CYCLE

A typical menstrual cycle lasts 28 days. It begins with three to five days of menstruation, the shedding of the uterine lining, during which hormone levels are low. At the end of menstruation, a pituitary hormone stimulates new follicles to develop in the ovary. These secrete estrogen as they mature, causing cells in the lining of the uterus to proliferate. Mid-cycle, one mature follicle releases an egg.

The empty follicle forms the corpus luteum, an endocrine body that secretes progesterone. Under the added influence of progesterone, the uterine lining thickens further and swells in preparation for the implantation of a fertilized egg. If fertilization does not take place, the corpus luteum dies and hormone levels fall. Without hormonal support, the uterine lining disintegrates and discharges, beginning a new menstrual period and cycle.

Summary of the cycle
Menstruation – Day 1,2,3,4,5
Safe – Day 6,7
Fertile from now – Day 8,9,10,11,12
Highly fertile – Day 13,14,15
Danger Period – Day 10,11,12,13,14,15,16
Late safe days – Day 17,18,19,20,21,22,23,24,25,26,27,28

This is not accurate but only an assumption for a woman whose menstrual cycle lasts 28 days.

ADOLESCENCE

Adolescence is the stage of maturation between childhood and adulthood. The term denotes the period from the beginning of puberty to maturity; it usually starts at about age 14 in males and age 12 in females. The transition to adulthood varies among cultures, but it is generally defined as the time when individuals begin to function independently of their parents.

Physical development
Dramatic changes in physical stature and features are associated with the onset of pubescence. The activity of the pituitary gland at this time results in the increased secretion of hormones, with widespread physiological effects. Growth hormone produces a rapid growth spurt, which brings the body close to its adult height and weight in about two years. The growth spurt occurs earlier among females than males, also indicating that females mature sexually earlier than males. Attainment of sexual maturity in girls is marked by the onset of menstruation and in boys by the production of semen. The main hormones governing these changes are androgen in males and estrogen in females, substances also associated with the appearance of secondary sex characteristics: facial, bodily, and pubic hair and a deepening voice among males; pubic and bodily hair, enlarged breasts, and broader hips among females. Physical changes seem to be related to psychological adjustment; studies suggest that earlier-maturing individuals are better adjusted than their later-maturing contemporaries.

Intellectual development
No dramatic changes take place in intellectual functions during adolescence. The ability to understand complex problems develops gradually. The French psychologist Jean Piaget determined that adolescence is the beginning of the stage of formal operational thought, which may be characterized as thinking that involves deductive logic. Piaget assumed that this stage occurs among all people regardless of educational or related experiences. Research evidence, however, does not support this hypothesis; it shows that the ability of adolescents to solve complex problems is a function of accumulated learning and education.

Sexual development
The physical changes that occur at pubescence are responsible for the appearance of the sex drive. The gratification of sex drives is still complicated by many social taboos, as well as by a lack of accurate knowledge about sexuality. Since the 1960s, however, sexual activity has increased among adolescents; recent studies show that almost 50 percent of adolescents under the age of 15 and 75 percent under the age of 19 report having had sexual intercourse. Despite their involvement in sexual activity, some adolescents are not interested in, or knowledgeable about, birth-control methods or the symptoms of sexually transmitted disease. Consequently, the rate of illegitimate births and the incidence of sexually transmitted disease are increasing.

Emotional development
The American psychologist G. Stanley Hall asserted that adolescence is a period of emotional stress, resulting from the rapid and extensive physiological changes occurring at pubescence. Studies by the American anthropologist Margaret Mead, however, showed that emotional stress is not inevitable, but culturally determined; she found that difficulties in the transition from childhood to adulthood varied from one culture to another. The German-born American psychologist Erik Erikson saw development as a psychosocial process going on throughout life. All three insights are valuable in their own way, but each adolescent shares a unique task: to develop from a dependent to an independent person who relates to others in a humane and well-socialized fashion.