BENGALURU: Irregularities of the menstrual cycle can affect women at some point in their menstruating years. Heavy menstrual bleeding, irregular bleeding, prolonged bleeding or reduced bleeding are common reasons for which women seek a gynaecologist’s help. There are over 355 million menstruating women in India and about 60 per cent of them may need medical help at some time in their lives to deal with period problems.
What is a normal period?
The menstrual cycle is counted from the first day of one period to the first day of the next. The cycle length ranges from 21 to 35 days and can last 2-7 days. It may or may not be associated with pain. In the years just after the onset of menstruation, the cycles may be irregular but this settles over time. Again towards menopause, cycles can get irregular.
What causes menstrual irregularities?
There are many different causes of period irregularities. Here are a few: Polycystic ovarian syndrome, uterine fibroids/polyps, weight gain, extreme weight loss, eating disorders, excessive exercise and mental stress. Pregnancy and breast feeding can also cause missed periods.
What has changed during the pandemic?
Surveys and studies both in India and other countries have found that increasing numbers of women have reported irregularities in their menstrual cycle during the Covid pandemic. The 6th Annual Menstrual Hygiene Survey by Everteen 2021 indicated that 41 per cent of women had experienced irregular periods. Of these only 13.7 per cent had contracted Covid-19. The number of women who have been affected may be even more, as many do not seek medical help due to restricted access to health care. Studies have also reported an increase in premenstrual syndrome (PMS) intensity and a decreased physical and emotional capacity to cope with periods. It is well-known that stress can change the pattern of the menstrual cycle and worsen PMS symptoms.
During the pandemic people have been under tremendous stress due to job losses, financial difficulties, contracting Covid, losing family members to Covid and restricted social interaction. In the early days of the lockdown, there was difficulty in accessing menstrual hygiene products. In rural areas, schools that handed out free sanitary napkins were unable to do so, due to schools being shut. This resulted in girls having to resort to using cloth or rags. Women health care workers faced the practical difficulty of changing sanitary napkins frequently especially when wearing full PPE. It added another stress to an already extremely challenging job of looking after Covid-positive patients.
What is the way forward?
Some of the menstrual irregularities that women face during these extremely challenging times, maybe a consequence of the stress and mental trauma associated with the pandemic. However, women must remember that it would be prudent to consult a gynaecologist to make sure that there is no other underlying cause for the change in period pattern. Physical access to healthcare maybe restricted in some places, but with the advent of teleconsultation, patients with internet access can consult doctors across the country with ease. At the least, an initial virtual consultation with a doctor is recommended if menstrual irregularities persist, so that a more serious underlying condition is not missed. (The author is the director, senior obstetrician and gynaecologist, Fortis La Femme Hospital, Richmond Road)