Sexual & Reproductive Health

The menstrual cycle is regulated by the rise and fall of hormones, and is a natural process whereby the body prepares for pregnancy. About once a month, the uterus grows a new lining (known as endometrium) in preparation for a fertilised egg. In the absence of a fertilised egg, the uterus lining sheds and this leads to the monthly menstruation bleeding. An average menstrual cycle lasts 28 days, but the cycle length and period flow may vary between individuals.

Menstruation usually starts occurring in females aged 11, and typically stops between ages 45 – 60. Menstrual bleeding usually lasts between 3 – 7 days. The end of the last menstrual period is known as menopause. Menstruation is an important part of being healthy. Talk to your gynaecologist if you experience irregular or heavier-than-usual bleeding.

What happens during a menstrual cycle?

The menstrual cycle consists of 3 phases: follicular (before egg release), ovulation (egg release), and luteal (after egg release). The infographic below illustrates the complex interaction of hormones and the changes that occur during a menstrual cycle.

(Click to view enlarged image in a new tab)

Follicular phase (Day 1 of bleeding) – The pituitary gland releases a hormone which prompts the development from follicle to egg in the ovary. This releases estrogen which thickens the lining of the uterus in preparation of the possible embedding of the fertilised egg.

Ovulation (Day 14) – A mature egg is released from the ovary. The rise in estrogen leads to a surge in hormones that trigger ovulation where the egg enters the fallopian tube and moves towards the uterus. The egg disintegrates within 24 hours if fertilisation does not occur.

Luteal phase (Day 14 – 28) – The empty follicle collapses after the egg is released and becomes a corpus luteum, which produces the hormone progesterone. This further thickens and nourishes the uterus lining. If fertilisation occurs, the fertilised egg is implanted into the uterus lining and progesterone levels stay high. If no fertilisation occurs, the egg and corpus luteum disintegrates. Estrogen and progesterone levels decline and the menstrual cycle starts again, where the lining of the uterus is shed along with the unfertilised egg.

A regular menstrual cycle is important for a woman’s health and well-being. Certain conditions such as endometriosis may result in painful menstrual cramps or abnormally heavy bleeding. Consult your gynaecologist if you encounter any changes to your menstrual cycle.

Managing menstrual cramps and pain

Most women encounter some pain during menstruation. While period pain is common, in certain instances, the pain may become unbearable and severe enough to affect daily activity. Dysmenorrhoea is the medical term for painful cramps experienced before or during menstruation. Symptoms include:

• Pain in the lower back, hips, or inner thigh area
• Pressure in abdomen
• Pain in abdomen
• Bloating or diarrhoea
• Headache or nausea
• Breast tenderness

Mild menstrual cramps may be relieved by the following methods:

• Place a heat pad on the abdomen
• Take a warm bath
• Have adequate rest
• Exercise regularly
• Avoid caffeine, salt, and alcohol
• Refrain from smoking

Talk to your gynaecologist if you encounter menstrual cramps. Certain medical conditions such as endometriosis may cause period pain. Consult your gynaecologist to find out more.

References:

1. Proctor M, Farquhar C; Diagnosis and management of dysmenorrhoea. BMJ. 2006 May 13;332(7550):1134-8.
2. MedicineNet.com
3. Wong CL, Farquhar C, Roberts H, et al; Oral contraceptive pill as treatment for primary dysmenorrhoea. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD002120.

Sexual health is defined by the World Health Organisation as ‘a state of physical, mental, and social well-being in relation to sexuality’. Embracing female sexuality is a vital part of emotional and physical health, and it is important to understand some of the common issues faced by women pertaining to sexual wellness.

The human papillomavirus (HPV) infects the reproductive tract and causes cervical cancer, which is the 10^th & most common cancer affecting women in Singapore. Globally, cervical cancer is the 4^th most common cancer in women, with an estimated 266,000 deaths and 528,000 new cases in 2012. In women, HPV may also cause mouth and throat cancers, cancer of the vulva, vagina, anus, as well as genital warts. HPV infection can be transmitted through sexual contact.

HPV vaccination causes the body’s immune system to produce antibodies that then protects against HPV infection. The HPV vaccine is delivered in 3 shots, and is recommended for all girls and women aged 9 – 26. However, studies have shown that the HPV vaccine is beneficial for women above 26 as well. In the United States, the recommended age is up to 45 years old and in Europe, there is no age limit at all. Talk to your gynaecologist to find out if the HPV vaccine could benefit you or your child.

Today, many forms of contraceptives are available for effective birth control. Common contraceptive methods include:

• Natural family planning
• Female condom
• Male condom
• Vaginal ring
• Contraceptive patch
• Oral contraceptives
• Injectables
• Intrauterine device

Talk to your gynaecologist to understand more and select the method which best suits your need.