So, what about ovulation?

Doesn’t menstruation mean I am ovulating and that I can get pregnant?

Possibly. Ovulation may begin with menarche or it may not. When there is no ovulation, you are going through anovulatory cycles.

Pregnancy it has been known to occur even before the menarche. You need to understand that menarche may happen without involving the release of ova at all. The blood flow is from the uterine tissue disintegration and that may happen without ovulation. This is why you need to realize that there are many stops where essentially anything can go wrong, resulting in menstrual irregularities.

So what are the irregularities?

Anything in menstrual cycle that is not normal is an irregularity. Here are some common definitions:

No flow:   Amenorrhea

Long cycle(Infrequent):   Oligomenorrhea

Short Cycle:   Polymenorrhea

Heavy Flow:   Menorrhagia

Pain:   Dysmenorrhea

This is the usual nomenclature applied to menstrual irregularities. These are basically the descriptions of the irregularity. The underlying cause is the actual disease or Illness that needs to be treated. This is why an abnormality in your menses is worth following up. Sometimes they may be affected by vague circumstances ,but it is better to end up with a “don’t worry” diagnosis than a late diagnosis of something much more serious.

What are the vague / external circumstances?
These are numerous. Just to explain what these external factors can do, notice the following:
A.    Early onset of menarche (earlier than 12 years of age)
1.    Childhood Obesity
2.    Family Conflicts
3.    Absence of father figure
4.    Ovarian  or other tumors
B.    Late onset of menarche (later than 16 years of age)
1.    Close association with father / father figure
2.    Large family
3.    Abnormal pathology of reproductive tract

The menstrual cycle is itself affected by all these factors and more. These factors are:
1.    Stress: Family related or socially induced
2.    Sudden weight gain or weight loss
3.    Eating or emotional disorders
4.    Excessive exercising
5.    Unhealthy lifestyle i.e. smoking

What possible diagnoses can cause menstrual irregularities?
There is a wide array of possible diagnoses that we can reach depending upon the type of irregularity an individual is facing. We will discuss each possible diagnosis in further detail in the later articles in the series.

Will early diagnosis save me?
Do not assume that you have something untreatable. Having time as your ally is even better. However in order to get started on the treatment, you do need a diagnosis. Getting started as soon as possible is the best option as the majority of the illnesses can be treated medically with a good prognosis.

What is a normal period?
A normal period has the following characteristics:
A normal period is Eumenorrhea.
1.    This is a cycle of 28 days plus or minus 7 days
2.    Bleeding of 2-7 days
3.    Blood loss of 10-80 mL

When there is a deviation from this pattern, you are looking at a menstrual irregularity.

What about pain?
Some amount of pain and mid-cycle symptoms are normal. Excessive pain, intolerable pain in menstruation, called dysmenorrhea, is an irregularity.
We will discuss individual disturbances in the next article.

Now we will move to the understanding of a normal menstrual cycle.

The ovarian cycle and the uterine cycle

The ovarian cycle and the uterine cycle are two different things happening together and dependent on one another. The ovarian cycle is happening in the ovaries and the uterine cycle in the uterus. The blood flow is due to the effects of the menstrual cycle on the uterine cycle, resulting in a uterine blood flow.

It all begins with the birth of a female child. When a female child is born, she has 100,000 primary oocytes in her ovaries, waiting for puberty when they will become secondary oocytes. After that, with each menstrual cycle they take the form of ova. An ovum is a potential egg that gets fertilizes by a sperm.

100,000 oocytes mean potentially 100,000 menstrual cycles. However, that does not happen. A normal healthful female reproductive life consists of 34-35 years that can be approximately 400 normal menstrual cycles, using only 400 oocytes.

What is menarche?

The beginning of the menstruation with the first menstrual cycle is called menarche.  This is the onset of puberty and is marked by the following changes in the female body:

1.    Change in body shape
2.    Widening of pelvis
3.    Typical fat distribution
4.    Response of ovaries to the pituitary hormones with secretion of estrogen
5.    Growth of the breasts, body hair, and uterus

What is thelarche then?

Thelarche is a term referred to the 2 years preceding menarche. It primarily is characterized by development of the breasts.

Can you tell me about menstruation before we move on the menstrual irregularities?

Estrogen released by the ovary is more specifically released by a mature ovarian follicle. The follicle will cause the release of GnRH from the Hypothalamus in the brain, which will cause the secretion of FSH and LH from the brain’s pituitary gland. These hormones will induce ovulation. Once an ovum is released from a mature follicle in the ovary, it is ready to form a zygote with a sperm. If the sperm can get to the ovum through a normal fallopian tube (one that has either never been ligated or one that has undergone a tubal reversal), there is a chance of fertilization. Fertilization results in a zygote. The follicle left behind will become a Corpus Luteum and begin to secrete progesterone. This is the ovarian part of the cycle.
Now the progesterone will be preparing the uterus to receive a freshly conceived zygote. However, if that does not happen, the follicle finally dies and the uterine tissue starts disintegrating, resulting in blood flow, completing the uterine cycle.

So when do the irregularities occur?

This was a very brief summary of what happens in the cycle. There are a lot of places where things could go wrong, ultimately resulting in menstrual irregularities. We are trying to explain here what happens normally and how many processes need to happen correctly in order to ensure proper menstruation. There may be a hormonal imbalance, a born deformity in the reproductive system, absence of ovulation, or perhaps many other problems that may affect the normal menstrual cycle.

Wait, wait, absence of ovulation? If I am having menses, doesn’t that mean I am ovulating as well?

No, you may or may not be ovulating. Menstrual abnormalities, as noted above, have many causes.

I don’t understand this?

You will.
Continue patiently with the rest of the articles in the menstrual irregularities series.