Introduction
From the time a woman is born, her body is geared toward a much different lifetime of experiences than a man’s. For this reason, it’s important to look at health issues from a woman’s perspective.
In its infancy, medical science assumed that all health conditions were experienced equally between men and women. Today, with the advancement of medical science, we now know that even conditions common to both sexes such as heart attacks, stress, and diabetes may be experienced differently and that symptoms can vary between a man and a woman. Beyond symptoms, research has demonstrated significant differences between men and women in rates of susceptibility and response to treatment in many major areas of health.1 It’s also important to note that some health issues covered here are not unique to women, but are more commonly experienced by women, which makes it appropriate for them to be addressed in this chapter.
In this day and age, women are taking much more responsibility for their own health. A few of the reasons why this chapter was created include empowering women with knowledge about the changes happening in their body, to offer them a starting point for further research, and to allow them to move forward and make educated choices when facing health issues. The best place to start any health conversation is with your primary health care provider. If you approach this conversation fore-armed with knowledge about the issues you’re going to discuss, you’ll leave the conversation with a solid understanding with regard to health decisions you might make in the future.
On the following pages, we will look at how a woman’s body changes as she grows, focusing in on some of the health challenges she might expect to encounter along the way.
Sugar, Spice, Everything Nice & Hormones
Puberty and Hormones
From the time a baby girl is born, her body begins preparing her to move from being a child to being a woman with the aid of hormones. Puberty is the stage of a girl’s life when her body begins to noticeably change, generally experienced by girls between the ages of 8 and 13. The pituitary gland, a pea-shaped gland located at the bottom of the brain, releases the hormones necessary to begin the cascade of changes that will take place, most significantly the production of estrogen that begins preparing a young woman’s body to support a pregnancy.
Menstruation
The beginning of menstruation is called menarche (pronounced “men-ar-key”). Once begun, a woman’s body goes through the process of preparing to support a pregnancy once a month. This is referred to as her “cycle” or monthly “period”. Her body will go through this monthly cycle for decades until reaching a point known as perimenopause, at which time her body can no longer support a pregnancy as readily as it used to. However, during the decades prior to perimenopause, menstruation can present a few challenges.
A woman’s period is not an identical experience shared by all women, nor is it likely to be the same for one woman from month to month. Some women experience very light periods, lasting only a few days, while others experience a more textbook period lasting up to seven days. Some women have the unfortunate experience of living with heavy periods (longer than seven days, very heavy flow) every month, medically referred to as menorrhagia.
Causes of a Heavy Period
Premenstal Synrome, Cramping, & Endometriosis
Causes of a Heavy Period
In order to review one of the causes of a heavy period, we have to look back at hormones again. Fluctuations in hormone levels can lead to excessive flow. Your primary health care professional can advise you on the best way to calm these fluctuations, generally taking care of the problem.
Uterine fibroid tumors are another very common cause of heavy flow. These tumors are frequently benign, typically occurring in women between the ages of thirty and fifty. The medical community is still uncertain what, specifically, causes these tumors but what is clear is that they are estrogen-dependent. Should it become necessary, there are surgical and non-surgical options for dealing with these tumors however, upon reaching menopause, these tumors generally shrink and disappear altogether.
Cervical or endometrial polyps are both a response to increased estrogen levels. In the case of cervical polyps, they can be caused by an infection and are usually treated in-office by your health care professional with the addition of a course of antibiotics. Endometrial polyps are typically non-cancerous and, if treatment is necessary, can be done on an out-patient basis with a pathology lab evaluating the results after removal.
In any case, a consultation with your primary health care provider is your best first course of action to take.
Premenstrual Syndrome (PMS) and Cramping
Some women sail through, month to month, barely even noticing their period while others will experience PMS and/or cramping, the symptoms of which can range from mildly annoying to positively debilitating. Let’s take a look at each one individually.
Premenstrual Syndrome, or PMS as it’s come to be known, affects an estimated four out of every ten women during the last two weeks of their cycle. To date, medical science has yet to pinpoint a specific reason as to why PMS occurs. It is thought that changes in hormone levels in the body and changes in neurotransmitters in the brain bring about symptoms such as irritability, bloating, fluid retention, weight gain, fatigue, abdominal pain, cravings, and forgetfulness.
Premenstral Syndrome, Cramping, & Endometriosis, cont.,
If symptoms are mild to moderate, usually a change in diet (accomplished by including more complex carbohydrates such as whole grains and vegetables), thirty minutes of daily exercise, reducing your salt intake, and drinking eight or more glasses of water each day can help alleviate these symptoms. Supplements such as calcium magnesium, vitamin B6, vitamin E, Passionflower, and Evening Primrose have shown to be effective as well. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen are helpful for normal pain management as is the application of moderate heat on the affected area. Try not to take on any added responsibilities during these two weeks if you can possibly help it. Stress reduction and relaxation are key elements in avoiding elevated symptoms of PMS. You might also try avoiding caffeine, alcohol, animal fats, and smoking. If you experience severe symptoms each month, it is important to have a consultation with your primary health care provider to determine what other options he/she may be able to offer you. 
Cramping
Menstrual cramps, felt in the abdominal, lower pelvic and lower back regions (and even down into the legs), usually start around the same time as a woman’s period, generally subside after a day or two, and can range from barely noticeable to interfering with your daily activities. Longer periods, heavier flow, smoking, a family history, and beginning menses earlier on in life are thought to be keys as to why a woman may have more severe cramping than others.
Cramping is generally treated with NSAIDs and moderate heat on the affected area to manage the pain. Exercise such as walking, yoga, and abdominal massage can also help alleviate pain. Sleep, rest and relaxation are important and can help to relieve the pain of cramping.
Premenstral Syndrome, Cramping, & Endometriosis, cont.,
Endometriosis
Every month, a woman’s ovaries produce hormones that tell the cells lining the uterus (womb) to swell and get thicker. The body removes these extra cells from the womb lining (endometrium) when you get your period. If these cells (called endometrial cells) implant and grow outside the uterus, endometriosis results. The growths are called endometrial tissue implants. Women with endometriosis typically have tissue implants on the ovaries, bowel, rectum, bladder, and on the lining of the pelvic area. They can occur in other areas of the body, too.
Unlike the endometrial cells found in the uterus, the tissue implants outside the uterus stay in place when you get your period. They sometimes bleed a little bit. They grow again when you get your next period. This ongoing process leads to pain and other symptoms of endometriosis.
The cause of endometriosis is unknown. One theory is that the endometrial cells shed when you get your period travel backwards through the fallopian tubes into the pelvis, where they implant and grow. This is called retrograde menstruation. This backward menstrual flow occurs in many women, but researchers think the immune system may be different in women with endometriosis.
Endometriosis is common. Sometimes, it may run in the family. Although endometriosis is typically diagnosed between ages 25 – 35, the condition probably begins about the time that regular menstruation begins.2
Symptoms, Diagnosis and Treatment of Endometriosis
Symptoms of endometriosis range from absolutely nothing (some women have no symptoms) to pelvic pain (usually occurring just prior to menstruation), cramping, diarrhea, constipation, lower back pain, irregular or heavy menstrual bleeding, painful bowel movements, or pain while urinating.Physical and Emotional Wellbeing
Pain intensity is experienced differently from woman to woman, and even in the same woman, it can fluctuate greatly from month to month (less one month, more another). Exactly where the pain is experienced depends on where the implants are located. If they are located in an area populated by many pain-sensing nerves, more pain will be felt. It should be noted that there is no correlation between how widespread the endometriosis is and how much pain is experienced.
If it is strongly suspected that endometriosis is present, but no surgical procedures are performed, the treatment protocol becomes pain management with NSAIDs such as ibuprofen or naproxen. Failing the successful management of pain with NSAIDs, hormonal treatments, prescription medications, or surgery can be considered. Based on a history of symptoms and the findings of an internal examination, your health care provider will then most likely suggest an ultrasound to determine the presence of endometriosis. Armed with this information, the next step is generally a tissue biopsy and a direct visual inspection (done via laparoscopy; a small-incision procedure).
Physical and Emotional Wellbeing
Support, acknowledgment, and knowledge are important in helping move through the more difficult times, but so is what you eat and how you move about.
When cramping is involved, moving about isn’t the first thing on your mind; when you’re retaining water, your first instinct isn’t to drink more water, however, funnily enough, it should be. Movements, such as the poses found in yoga, help to stretch the muscles which are cramping and ease the pain, while increased fluid intake actually helps you flush more fluid out of your system.
If you’re feeling irritable and an attitude adjustment is in order, walking and fresh air can help lift your mood and take your mind off what’s going on in your body. If you can help it, avoid added responsibility by saying no (as politely as possible) to friends and colleagues. If your period is regular, try to opt out of things like car pools and classes at that point in time each month. It’s not selfish to take care of yourself by spending some time with a good book, a heating pad or warm bath, and a soothing cup of tea. If you throw in a cozy blanket and a warm, fuzzy pair of socks, you may not even notice the inconvenience at all (one can live in hope).
Handling Periods at School – Tips for Parents & Girls
How to Reduce Menstrual Cramps
Endometriosis.org – Global Forum for News and Information
Yoga to Relieve Menstrual Cramps
Yoga for a Healthy Menstrual Cycle & to Help with Fibroids
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