A woman's changing menstrual cycle

MENSTRAUL HEALTH

About 30 years ago, my periods came rather "unexpectedly". I was 13 years old, in P6. I woke up that fateful morning to go to the bathroom to prepare for school and to my horror, there were patches of blood on my bed sheets.

I freaked out, to say the least. I had had a clue about it from my mama, who had hinted on something to the effect that when I stopped being a girl and grew into a woman, my body would undergo some fundamental changes.

Little did I know, then that these changes were not going to only happen on the day my periods came, but that they would continue until the age of menopause. During my teens and while I was in my 20s, I had an extremely heavy flow and excruciatingly painful cramps. I would stock up on Ibrufen months in advance because without those painkillers, the pain would be unbearable.

It got so bad that twice I fainted for having a low blood Hb; which went to an all-time low level of 4.1 g/d as opposed to the normal one of about 12.1 to 15.1 g/d, all because of over bleeding during my periods. During my late 30s, I was diagnosed with fibroids, which almost cut my life short. I was saved after undergoing an operation in which those monstrous fibroids were removed.

Since then, as I have continued to glide into my 40s, everything has stabilised. Normal flow, no pain whatsoever and I am singing glory hallelujah throughout my periods.

In fact, it's almost incredulous what medical interventions can do. It is unbelievable that I can go through my periods smiling, literally. I always consider this a medical miracle!

Nevertheless, when I turned 42 this year, and having never conceived before, I find that my ovulation signs are more dramatic and clearly defined than they were 20 years ago. When I was younger, ovulation would sneak up on me subtly, as if playing tricks on me.

I would only be conscious that I was ovulating when I lingered over that male colleague's desk a little more than I normally would, sometimes finding everything he said funny, when I normally would think he was boring. During such moments, I would quickly catch myself thinking: "Ding, ding, Bex, you are ovulating."

It is a different story now. In fact, my ovulation comes with drumrolls and quite some bit of noise that, quite frankly leaves, me perplexed. First I experience a sharp pain in my lower abdomen, so sharp that it seems to flow down my inner thighs to my toes. It is that dreadful.

As I am trying to contain myself, I cringe at an even more piercing pain in my lower back simultaneously rubbing my lower abdomen, holding tightly to wherever I will be sitting or standing. This goes on for about two days.

Even though I have normal and painless periods now, it got me thinking about the likelihood of even more intense menstrual cycle changes darting about like popcorn as I age gracefully. Could it be that my cycle started changing again when I crossed the 40s' line?

I am pretty sure that I am not alone in this periodic maze. From the very first day you got your period, you have been able to count on it coming back month after month (except during pregnancy) for close to four decades, if you are like me.

Call it what you will — a curse, a burden, a life sentence to your femininity — but you'll probably be dealing with it until around age 52, which is the average age for women to reach menopause. Despite its inevitability, you will experience some changes in your menstrual cycle throughout the decades, especially since your period is directly tied to your hormones.

During your mid 30s and when you turn 40, your body really starts to shake things up. I found this out when I chatted up a couple of ladies in their 30s and 40s' age-bracket about their cycles. Although not anyone of their experiences is similar, the underlying fact is that, children or not, a woman's cycle fluctuates as she grows older.

Meanwhile online medical sources say before you reach menopause, your body goes through perimenopause, a transition time between normal periods and full menopause (defined as 12 straight months without a period), which can last one to five years. Perimenopause is a time that's characterised by irregular menses, which are usually more spaced out.

As your hormones start to fluctuate. For some women, the perimenopause phase strikes even earlier than the 40s' mark.

Take Maggie Tabara, for instance, a corporate mother of three whose menstrual cycle was one hell of a tumble until she got saved by childbirth. "I am 43, no, I am not one of those women who hides my age.

I have three children and besides showing me to love unconditionally, they also brought great relief to my monthly cycle. I would be the envy of my friends because after birth, I would not see my cycle again for at least a year! And when they returned, they were a breeze. Until two years ago.

Oh my God! The back pain. The pain during ovulation. Then sometimes feeling sick. I spoke to a few peers who told me they experienced a shift, if you will, in their cycle after hitting the fourth floor.

My younger sister has an interesting theory: "Maybe it's nature's way of giving us one last reminder to procreate one last time before it's too late." The story is not any different for Irene Kanyerere, a young mother of one: "When I was younger, my flow was very normal, pain-free and lasting only five days. Now at 36 and with a six-year-old son, it fluctuates a lot.

Although it has gotten generally heavier, some months are worryingly heavier than others and may go on up to seven days. Ovulation has also been very painful in the last two years, which had never been the case before and soon after I conceived."

While pondering about this menstrual change avalanche that seems to hit women as they grow older, I met up with my dear friend Sheila Kityo, a mother of three children who surprised me with the changes that were happening in her corner.

  Throwing her head back in laughter, she thanks God for the gift of childbirth, which brought relief to her menstrual period pains. "Before childbirth, I used to have terrible, terrible, terrible menstrual pain.

It was so bad that I would either do an overdose of diclofenac, taking about four tabs at a go, or rush for an injection immediately. When I conceived, everything changed. With three children now, I don't even feel the slightest cramp, and my days are regular.

They are not inconsistent as was the case before. The flow is also okay and the difference is remarkable," Kityo tells me, while praying that this state of affairs stays as it is.
 
Expert view
Dr Evenly Nabunya, the executive director of the Specialised Women's and Neonatal Hospital in Mulago says as women grow older, some complications such as fibroids set in, almost always accompanied by heavy flow and cramps.

She explains that fibroids increase the surface area and as the lining sheds off, the womb squeezes and expels the fibroids just as it does to the baby during delivery, hence feeling that excruciating pain of cramps. Additionally, the uteruses of women who have had children enlarge and so is the area where the blood comes from compared to those who have not had babies.

Also, when women become more sexually active, they may contract sexually transmitted infections which manifest as pelvic inflammatory diseases. As such, these may cause pain which gets worse during the menstruation period.

When we talked to Dr Andabati Gonzaga, who is the executive director at Bethany Women's and Family Hospital located in Luzira, we found that he agrees with Dr Nabunya on this issue and  estimates that up to 60% of women in their 40s experience significant changes in their menstrual cycle.

These include changes in the blood flow which may increase, reduce, become more frequent or the intervals occur far too apart. Others may experience pain. Dr Andabati notes that changes that are characterised by heavy bleeding with clots are usually associated with fibroids or adenomyosis.

He describes adenomyosis as a condition of the womb that is characterised by painful heavy bleeding.
While enlightening us further on fibroids, Andabati says they are swellings which align in the muscles of the womb. Sometimes they may be located close to the inside of the lining of the womb.

These are also known as sub-mucus fibroids and are characterised by heavy bleeding. During menstruation, the clear lining of these fibroids peels off causing abnormal bleeding. He notes that sometimes the womb squeezes and tries to expel these fibroids as a foreign body, just the way it does during delivery of a child.

This, according to Dr Andabati causes pain. He has a word of caution for women, though, to whom he recommends that as they grow older and notice changes in their flows, they must always seek medical attention to ascertain the cause of these changes so that they can get proper diagnosis and treatment.

Endometriosis is another of those medical conditions that causes severe period pain and heavy flow in women as they age. In this case, the tissue in the inner lining of the womb develops over the ovaries or on top of the womb. During menstruation, the lining of the tissue also sheds off, causing severe pain.

"People who have had previous pelvic surgery are prone to getting painful periods," he says. Andabati says menstrual changes related to hormonal alterations resulting from advanced age can improve with healthy diet, adequate rest and regular physical exercise.

That said, however, Dr Charles Kiggundu, a consultant gynecologist/obstetrician in Mulago Hospital says not every woman who is in their 30s, 40s or even 50s experiences changes in their menstrual cycle. "Some young women below the age of 30 experience severe pain and heavy bleeding during menstruation while some older women have blissful periodic seasons. There is no rigid procedure to these things."