Dr. Shalini Varma

Once a lady has delivered, either by normal deliver or by cesarean, she normally has bleeding lasting for few days to few weeks. Upto 6 days post delivery, whether it is a normal or a cesarean section, that bleeding is taken as normal as long as it is not heavy or it is bothering the general life of the patient. After 6 weeks any bleeding is taken as their menses. Normally if you take 100 women, 80% of the women go back to the previous menses in about 3 to 4 months time. But it can come as early as 6 weeks , maybe as late as a year or more. As the periods come back, initially it could be irregular pattern, there are cases where they go back to the regularity at the earliest too. Lot depends on their lifestyle, and diet and exercise pattern and sleep patterns have been affected in the post partum period. A lot depends on how their periods were behaving prior to the pregnancy part especially if they have had a previous case of irregular menses, or PCOD or if they had heavier menses or shorter menses. But most women regain their normal menses within a few months post delivery. We do not need to investigate any woman for irregular or prolonged or delayed menses in the immediate postpartum period unless we have get any doubt whether she has got pregnant in the interim period. Otherwise for a year as long a she is breastfeeding her child, we can wait and there is no need to investigate a lady if she has irregular menses for up to a year post partum.

"Even if a lady is pregnant, there cud be episodes of bleeding ranging from mild, moderate to even severe. First and foremost you have to make sure that fetus is not miscarried only an ultrasound can make sure that a viable pregnancy is present or not. It could be a threatened abortion were the fetus is fine and growing but there are signs of miscarriage which can be treated especially, with bed rest and with injections and progesterone supplementation. There could be a situation where there is no miscarriage and the fetus is fine but there could be large clot near the fetus, which is called as the subchorionic hematoma. The treatment is again symptomatic again with rest, progesterone supplementation and serial follow up sonography. The only dangerous thing that we should think at this stage when a patient knows that she is pregnant and she is pregnant is an ectopic pregnancy, which I most likely otherwise called as the tubal pregnancy because the rupture of a tubal pregnancy and missing its diagnosis can even cost the life of the mother. Once diagnosed the treatment is very simple but it requires surgical or medical depending on the stage of gestation"

"Period time is a little tumultus time for most women especially because there are lot of hormonal changes happening, some go through it smoothly, some may have issues. Very common complaint is headache which can start a few days prior to menses and it worsens in the day of menses. There is even a terminology called as cateminial headache where every women during every cycle starts experiencing it prior to the menses and once the menses is over it clear off automatically. Lifestyle changes, food factors and hormonal factors are interrelated. Hence such headaches can be symptomatically treated, but better treated with lifestyle changes rather than drugs at a time. Though the headache could be related to the periods alone, it is mandatory to rule out other causes which can also be causing the headache, especially if the patient is in the reproductive age group, only if we rule out other cases, we can put the terminology as catamenial headache or headache that is specially related to the menses"

"When a lady in her menstrual phase the blood that comes out is the lining of the uterus which is called as the endometrium along with shedding of the blood vessels that have been formed in the menstrual cycle. As a protective phenomenal by the body itself, certain proteins called as the prostaglandins are released in the lining of the uterine canal. This is to reduce the bleeding and to keep it under control. When a lady bleeds more than what is normal, this is what we call excessive bleeding or menorrhagia or excessive bleeding during periods, the amount of bleeding is more than what these coagulatory system can control. Hence the woman produces larger clots that what can be controlled, along with the menstrual flow. Small clots are part of normal cycle but bigger clots making the patient uncomfortable and painful. The pain during menses is called as dysmenorrhea, which is worsening with each periods can be pathological. In such cases we have to investigate what are the causes. It can be anything related to the uterus like large fibroids, or adenomyosis where the bleeding is excessive or it can be related to ovarian factors were the ovarian cysts can cause these. Even thyroid related problems can cause excessive clotting and heavy bleeding"

"The hormones especially the female hormone estrogen and progesterone work in cyclical factor, our lifestyle including dietary pattern, exercise, even sleep to a certain extent can affect the cyclical pattern of hormones behaving in our body. When a lady is stressed, either physical, mental or emotional, the cyclical patterns gets disturbed thus causing hormonal changes and these hormonal changes eventually lead to irregularity in periods. Very common example is polycystic ovarian disease where women do put on weight related to the lifestyle disorders thus causing irregularity in hormones and thus causing irregularity in periods. In the premenopausal age group, that is 45 and above, especially when they are gong through a little precarious hormonal period, stress adds to the trouble. They are already go through a rumbler like phase, where the hormones are fluctuating and at this stage stress in any form can worsen the irregularities even in pregnancy when the hormones are irregular, they have problems related to pregnancy"

"Whenever woman in the reproductive age group, that is between 15 years to 45 years, has bleeding other than at a time when she is expecting menses, first and foremost is to rule out pregnancy and pregnancy related complications. It could be a sign of early miscarriage where she has missed her pregnancy in totality or it is a complication of pregnancy like ectopic pregnancy or tubal pregnancy. In some cases the intermenstrual bleeding in between her periods could be stress related. It could be hormone tablet related like she is on contraceptive pills. In the 40 plus age it could be a sign of cervical erosion. And infection or a cervical polyp, in the latter premenopausal age group it could be a sign of early cancer carcinoma of the cervix and hence she would need a regular checkup including a pap smear and a biopsy including an ultrasound examination. At times an ovarian cyst or a polycystic ovarian disease can also cause irregular spotting often or in between her expected menses"