Woman to Woman – A closer look at a woman’s monthly menstrual cycle

Whether a routine or emergency visit to your healthcare provider, radiological testing, eye examinations, or a visit to the dentist, female patients are usually asked about their menstrual cycle. When did it first start (menarche), how often does it come, what is the flow like, heavy or light, and most importantly what is the date of the last menstrual cycle? How detailed the questioning will be depends on age, presence or absence of symptoms, bleeding or the lack thereof.

Over the last decade, the age of menarche has been decreasing. African American girls are starting as early as 8 years of age and the mean age for White females is 9 years of age. This decreasing age has been attributed to our increase intake of animal meat that has been injected with hormones to enhance growth. This increase in hormone, stimulates the hypothalamus-pituitary axis much sooner than expected. The ovary is stimulated much earlier, to do what is was made to do: release of an egg with the intent to procreate. This excess hormone is stimulatory to an already immature system and may signal the start of menstrual cycles.

What is too little or too much and possible causes will vary depending on the age of the female. Bleeding in females less than 21 usually is not worrisome and may simply represent cycles that have not become regular or problems with clotting. Further evaluation no matter what the age, may require additional history taking, and/or diagnostic testing to determine a possible cause. However, some of the other causes of bleeding such as pregnancy, pregnancy complications such as an ectopic or miscarriage, ovarian cysts, vaginal infections, tumors, polyps, fibroids, sexually transmitted infections, cancer of the cervix, uterus, vagina or vulva, fluctuating hormone levels, or vaginal injury, weight loss or gain, thyroid and pituitary conditions, complications of intrauterine devices, bleeding disorders, complications associated oral contraceptives, structural problems with the uterus require additional testing.

During a normal menstrual cycle, females lose a few teaspoons of blood or 10 to 80cc per cycle. The length of the cycle may vary from every 21-35 days. Cycles that occur every 21 days or less is described as polymenorrhea. Cycles that occur more than 35 days is described as oligoovulation or oligomenorrhea.Cycles for more than three months is referred to as amenorrhea. Bleeding outside of these parameters may warrant further evaluation by your healthcare provider.

Although your menstrual cycle may occur regularly, the amount of the flow may be abnormal. The frequency of your cycle as well as too much or too little flow may require further evaluation. A woman’s ovary produce estrogen, progesterone and testosterone. Each of these hormones has a different effect on your menstrual cycle. Estrogen is stimulatory and makes the endometrium or lining of your uterus grow. An increase in estrogen may cause too much growth of the endometrium. This can cause bleeding when you are not on your cycle as well as a heavier cycle.

Although a large amount of estrogen is produced in the ovaries, it is also produced in the adrenal glands as well as the skin where it is converted from testosterone. The reverse is true as well; not enough estrogen and there will be little to no growth of the endometrium. No growth of the endometrium will be evident by no regular cycle as well as very little flow. Progesterone is responsible for ovulation, maintaining a pregnancy until about 10 weeks gestation when the placenta can take over production, and keeping the effects of estrogen to a minimum. Estrogen stimulation left uncontrolled by progesterone may lead to overgrowth or thickening of the endometrium referred to as hyperplasia and in turn to endometrial cancer. Too much progesterone may lead to common symptoms of premenstrual syndrome such as feeling bloated, mood swings, weight gain, breast tenderness. The effects of low levels of progesterone may include irregular cycles, or spotting, Testosterone is necessary for estrogen production. High levels increase estrogen production and in turn the levels of progesterone are low. This may evident by lack of cycles, increase in hair growth (hirsutism), oily skin, and loss of hair around the temporal area. Therefore, women with high testosterone will not ovulate or release an egg as evident by irregular or absent cycles. Any of these imbalances may affect your menstrual cycle and the amount of blood flow.

To further discuss bleeding, your cycle or other women’s health care issues, the staff at Women’s physicians are available Monday – Friday at one of our three northern VA offices.

Make an appointment today.
Call (703) 834-1071

Dr. Gloria Ivey-CroweDr. Gloria Ivey-Crowe received her M.D. degree from Georgetown University School of Medicine and did her residency training in Obstetrics & Gynecology at Georgetown University Hospital. She is affiliated with the Women Physicians of Northern Virginia, an all female medical team, with offices in Reston, Ashburn and Chantilly/South Riding. Dr. Ivey-Crowe has three children. In her spare time she enjoys needlecraft and reading.

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