What is considered a normal menstrual cycle? At what age should a woman start having menses?
It should be between 21 and 35 days, but the text book one is 28 days because it is easiest, and most women tend to experience it at 28 days because of the moon’s cycle. Bleeding during the cycle should be between two to seven days. In terms of flow, if a woman is using sanitary pads, they should use about four to six pads per day. Women bleed between 50mh to 80mh, which is equivalent to half a cup, during an entire menstrual period. The youngest mother in the world is an eight-year-old, though most girls begin experiencing menses between when they are 10 to 16 years old. If a girl has not started experiencing menses by then, they should contact an expert to find out why.
Why do some women experience heavy menses and others some low flow?
There is no specific reason, it is just the same reason some people have whitish eyes and others bluish. Heavy menses are not normal. However, if someone uses more than 10 pads a day or their cycle lasts three weeks, that is considered a heavy flow. Blood clots during menses is also a sign of heavy flow.
The most common cause of heavy flow in Africa is because of fibroids, infections and hormonal problems. Sometimes, it is as a result of miscarriage.
Haematological problems and medication may also cause heavy flow.
What causes irregular periods and does it signify a serious reproductive health problem? Is breast cancer part of it?
A normal cycle should last between two and seven days. Most irregular cycles are due to hormonal problems. There are women who go for months or even an entire year without experiencing menses, a problem that can be treated if identified.
Breast cancer is not attributed to irregular periods. However, people have related use of some hormones or contraceptives with a slight risk of developing cancer.
Is sex during periods safe? Can a woman get pregnant during this stage in her cycle?
If you have sex during periods, you are unlikely to get pregnant. However, we do not recommend for people to be sexually active during this period because of hygiene issues. But there are people who are comfortable doing it.
Can contraceptives cause adverse effects on menses? What are the possible solutions?
It depends on the type of contraceptives used. Combined oral contraceptive pills used as medication for women with irregular periods helps control their cycles. Combined oral contraceptives come as a pill, patch or injection. They have estrogens which are likely to have irregular cycles because they cause bleeding. For progestin only contraceptives, some women may have normal cycles while others may bleed every day. Others may not get periods at all. There is an individual reaction and regulation is used as a mitigation with those with negative impacts.
What is menstrual hygiene and how important is it to the general health of a woman?
Menstrual hygiene entails how a woman takes care of themselves during a cycle. In the old days, women would use rags to hold the flow. Now, they use sanitary pads and menstrual cups. Proper hygiene makes a woman comfortable and prevents social embarrassment.
Women are embracing menstrual cups which they say are safe and cost effective. How effective are they and why do some women develop rashes when using sanitary pads?
I know of some women who testify on the safety of menstrual cups. Some say the cups boost their confidence during menstruation. For virgins, menstrual cups may cause discomfort and pain. They are cost-effective and can be used for a year or two continuously. Sanitary pads made of synthetic material are the ones that cause rashes. Synthetic material does not allow air to pass through, and increases possibilities of getting rashes and infections. I would recommend use of pads made of cotton. It also depends on how long someone wears a pad — if you put on a single pad for an entire day, you will definitely feel uncomfortable and may get rashes. Sanitary pads should be changed after every four hours.
What causes painful menses? What is endometriosis and what makes menstrual days of women with the condition a nightmare?
A number of women experience painful periods due to fibroids, infections, primary dysmenorrhea and endometriosis -- a painful disorder in which tissue that lines in the inside of a woman’s uterus grows outside the uterus. Simple medication can be rolled out, to reduce pain. If it is not helpful, the majority will undergo surgery and hormonal therapy. Use of progestins are also encouraged to reduce pain.
Does geography affect menses?
I have not done any research or read anything on this, but there are certain diseases that are more common in some regions. For instance, fibroids are common in black people. If someone travels from, say from Nanyuki to Mombasa, they may experience change or delay in periods.
What is the influence of diet and exercise on menses?
Lactose, coffee, salt and sugar are known to cause painful periods. Uptake of fluids and foods rich in iron and fruits during menses are encouraged to avoid a lot of dehydration. Exercising helps ease abdominal and joint pains and release stress during their cycle.
What is the biggest misconception men have about menses?
Men understand menses. Culture was a major challenge in some communities where a girl on her periods was married off earlier.
By Dr Maureen Owiti as told to Mercy Kahenda. Dr Owiti is a consultant obstetrician and gynaecologist at KNH and Gynacare, Fortis Suites.