1ST CITY CLINICAL HOSPITAL

03/28/2024

• What is a normal and “abnormal” menstrual cycle?

The normal duration of the menstrual cycle in women of reproductive age is 21-35 days (minimum 8-9 menstruation per year).

Teenagers have their own standards:

- the first year after the first menstruation (menarche) - the length of the cycle can be 20-90 days. In total, there must be 4 or more menstruation per year;

- in the second year - the cycle shortens and there should be 6 or more menstruation per year;

- 4th year after the start of menstruation, cycles become even shorter and are normally 21-35 days (on average 28-35);

- 3-5 years after menarche there should be 8 or more menstrual cycles in 12 months.

In women over 40 years of age, menstrual cycles become longer (50 - 60 days), or vice versa, they may become shorter. These age-related fluctuations are associated first with the physiological processes of the formation of the reproductive system, and then with the extinction of its function.

The normal duration of menstrual flow is 2-7 days; blood loss is 5-80 ml per cycle (this is approximately 2-3 tablespoons of blood, maximum 4-5). If you change your pad more often than every 2 hours because it is soaked with blood and you have a large number of blood clots or anemia - the amount of blood loss during menstruation is excessive, consult a doctor.

When you say “my period is 3 days late, what could it be?”

You need to know that 3 days is NOT a “delay”. The problem of irregular menstruation can be discussed when menstruation does not occur within 7-10 days of the expected period.

Every conditionally healthy woman WITHOUT gynecological diseases has the right to 3 menstrual cycles a year without ovulation, that is, a cycle disorder. This is because you are not a computer. You may have stress, sleep disturbances, weight fluctuations, illnesses, and your body reacts to all this by fluctuating hormone levels, which causes changes in the menstrual cycle.

In addition, the results of one ultrasound where you were told: “You do not have a corpus luteum/dominant follicle” does not mean that you have a DISEASE. We count the number of menstruation per YEAR, analyze the history of ALL menstrual cycles, discuss other complaints and further tactics with your gynecologist.

Menstruation is the “bloody tears” of the uterus about an unfulfilled pregnancy. During the menstrual cycle, the lining of the uterus (endometrium) thickens and prepares to receive the fertilized egg. If you do not become pregnant, your estrogen and progesterone levels will begin to fall and extremely low levels of these hormones will “cause” menstruation.

Regular menstrual cycles are evidence of regular ovulation, with rare exceptions.

Sex hormones are produced by the ovaries during the menstrual cycle. The uterus is just a reservoir, a “bag” for bearing the fetus. Therefore, removal of the uterus does not affect a woman’s hormonal levels.

Sex during menstruation can lead to pregnancy , this is due to the lifespan of sperm, but it does not cause illness and is generally safe for a woman’s health.

• How can I tell if my breasts are okay?

Every woman should examine her breasts monthly. We will tell you about the main points of breast self-examination.

Women of reproductive age should choose one day of the menstrual cycle for self-examination of the mammary glands, the most suitable one being 1 day after menstruation.

Women experiencing menopause , older women, pregnant women, breastfeeding women, as well as those taking hormonal medications or contraceptives, simply need to choose the same day of the calendar month to examine their breasts.

The average duration of the breast self-examination procedure does not exceed 5 minutes, but here is how it should be carried out - the testing algorithm and palpation technique:

- bra inspection

It is necessary to closely inspect the area of ​​the area in the cups of the bra(s) for minor stains left by discharge from the nipples.

- visual inspection of the mammary glands

It must be done in front of a large mirror, in two starting positions: standing, arms down, and standing, arms up. It is necessary to check whether there are changes in the contours and shape of the glands, their symmetry, and also check how evenly they shift during bends to the sides and during alternate placing of hands behind the head. You should pay attention to whether these movements cause retraction of the nipples, whether discharge appears from them, or whether elevations or depressions form on the skin of the chest.

- examination of the skin of the mammary glands

It is necessary to check the skin, assessing by eye and touch its elasticity, shade and uniformity of color, the condition of the dermis: swelling, rash, diaper rash, redness, wrinkling, tightness, dimples and tubercles of the “lemon peel” type. Attention! You should not pinch the skin on the iron between your fingers. The lobed structure of breast tissue can cause a false sensation of tightness.

- palpation of the chest in the starting position: standing

For ease of self-examination, palpation is best done by lubricating your fingers with cosmetic gel or cream. You need to palpate the right gland with the pads of 4 closed fingers of your left hand, and the left breast needs to be palpated with the pads, not the tips (!), of 4 closed fingers of your right hand. Palpation movements are soft, point-circular, first superficial and then deep. The direction of palpation movements is from the collarbone downwards and from the sternum to the side. Finally, the armpit area is examined for the size and tenderness of the lymph nodes.

- palpation of the chest in a lying position

The most crucial moment of self-examination of the mammary glands. You need to lie on a flat, hard or semi-hard surface. The hand of the friendly gland is placed behind the head or extended along the body.

Palpation can be carried out using one of two techniques:

• palpate each mammary gland “in small squares”, from top to bottom, from the inner edge of the collarbone to the outer;
• palpate the mammary glands one at a time, moving along a concentrically tapering spiral, moving from the armpit to the nipple.

The final stage of breast self-examination is palpation of the area under the nipples and the nipples themselves. If, as a result of all the above manipulations, discharge appears, you should go to a mammologist.

For your convenience, the main steps are presented below in the picture:

• Tell us the most common misconceptions about COCs (combined oral contraceptives)?

Whether to take COCs or not is a conscious decision of each patient after consultation with an obstetrician-gynecologist. And today we want to dispel some MYTHS about COC:

“COC can lead to infertility”

Taking COCs does not affect a woman's fertility in any way. If you stop taking COCs, your chances of getting pregnant are the same as before taking them.

“COC helps cure infertility”

COCs do not treat infertility. Never. There are no exceptions.

“COCs cause early menopause”

This is impossible even in theory. This is easy to verify by reading the composition and mechanism of action of these drugs.

“Taking COCs causes illness and can lead to cancer.”

Taking COCs may worsen the course of certain diseases and may contribute to the development of thrombosis. Therefore, before starting treatment, it is necessary to assess the presence of risk factors. If you have significant risk factors (for example, there are cases of breast cancer in the family, you are overweight, diseases of the cardiovascular system, liver, kidneys, etc.), then you should consult an obstetrician-gynecologist and possibly Consider alternatives to hormonal contraception:

- intrauterine device

- barrier methods of contraception (condom)

- male and female sterilization, etc.

According to some studies , the risk of developing breast cancer in women who drink alcohol (three to six alcoholic drinks per week) is higher than in those who use hormonal methods of contraception, in particular COCs.

Hormonal contraception reduces the risks of developing ovarian, endometrial and even colorectal cancer.

“Before taking COCs you need to get tested”

You should not start taking COCs on your own; you should consult with an obstetrician-gynecologist who will prescribe and conduct the necessary examinations for you. They will help identify contraindications to taking COCs.

“COCs are very harmful pills. It would be better to have an abortion, but not them.”

COCs are the second most popular method of contraception in the world (although there are strong differences between countries). Yes, these drugs have side effects. For some women they are strictly contraindicated, for others they are not suitable. This is fine. We are all different. But any abortion, as a serious medical intervention, inevitably carries with it the risk of complications and enormous damage to the physical and mental health of the woman.

• How can I confirm that I am pregnant?

One of the methods for diagnosing pregnancy is ultrasound examination of the pelvic organs , in which the doctor visualizes the presence of an embryo (fetus) in the uterus. Ultrasound during pregnancy is relatively safe and is done strictly according to indications, and not for monitoring pregnancy online! Therefore, in the early stages, another possible method to confirm pregnancy and its normal development is to determine the level of B-hCG (beta subunit of human chorionic gonadotropin) in the blood.

During pregnancy, the level of B-hCG increases along with the gestational age. It can help determine the presence of pregnancy even before a missed period. The table below shows the possible levels of B-hCG at different times (hCG level for non-pregnant women is less than 5 mIU/l, the result is doubtful 5-25 mIU/l).

But, you need to know that an increase in B-hCG can also be observed with neoplasms of the lungs, kidneys, uterus, gastrointestinal tract (gastrointestinal tract), fetal pathology, etc.

Human chorionic gonadotropin can also be detected in the urine of a pregnant woman; the very principle of a urinary pregnancy test is based on this . You can purchase it at a pharmacy or even in a store and do it yourself. Tests come in different sensitivity, pay attention to the numbers on the packaging: 10 mIU/ml, 25-30 mIU/ml. The lower the number, the more accurate the test - the sooner it will show that you are pregnant. On average, the test shows pregnancy on the 14th day after conception (4-5 obstetric weeks).

• What is normal vaginal discharge and what affects it?

Vaginal discharge is normal for absolutely every woman. It is not possible that they do not exist, this is a delusion. Vaginal discharge is, in fact, a mixture of desquamated vaginal epithelial cells, vaginal transudate, vaginal microflora and mucous discharge from the cervical canal.

Normally, the vagina is not sterile; it is a whole microcosm in which a huge number of bacteria, viruses and fungi live.

The vagina has its own protective system (self-cleaning system). The vaginal mucosa is lined with stratified squamous non-keratinizing epithelium, the cells of which are rich in glycogen. It is this glycogen that is the main nutrient for lactobacilli (Dederlein's rods), which break it down into glucose and lactic acid, creating an acidic environment in the vagina (pH from 4.0 to 4.5). An acidic environment helps maintain a normal biocenosis, creates its own microcosm where everyone “lives in friendship and harmony,” and suppresses the growth of opportunistic and pathogenic microorganisms.

The nature of vaginal discharge is affected by:

• nutrition;
• sexual activity;
• taking medications, including antibiotics;
• stress;
• use of oral contraceptives;
• phase of the menstrual cycle;
• pregnancy;
• hygiene products (gels, soaps, pads, etc.).

The normal amount of vaginal discharge per day is from 1 to 4 ml. They are white or slightly yellowish, may be transparent, and are generally odorless or have a slightly sour odor. If you have vaginal discharge of a different nature, consult your doctor!

Team of authors: obstetrician-gynecologist of the highest qualification category (head of department) of the obstetric observation department Tereshko E.V. obstetrician-gynecologist, assistant at the department of obstetrics and gynecology, educational institution "Belarusian State Medical University" Runets U.F.

Date 03/15/2024