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10 things you must know about PMS
Ramya Arora, a 23-year old bank executive is in a dilemma. Her sister is getting married next month in Bangalore. The wedding will be a traditional one. Her family has an orthodox outlook.
She is excited. On the other hand she is dreading the event because the wedding date coincides with the wrong time of the month for Ramya. If her parents find out, she will not be allowed to attend the wedding.
Veena Rathod, a 22-year-old swimming champ, will be attending a prestigious swimming event in Mumbai a few weeks from now. Again, it is the wrong time of the month for her. She needs a fix too.
Everyday situations like these make women resort to various methods to postpone their menstrual cycle.
What are these methods? Are they safe? .
What causes periods
Every 26 to 34 days, a healthy woman of child-bearing age has a menstrual period.
During this time, the lining wall of the uterus, that has thickened in preparation for a possible pregnancy, sheds itself. The event of menstruation occurs when the body stops producing the hormone progesterone. The sudden withdrawal of progesterone makes the lining of the uterus stop growing and start shedding itself.
The bleeding occurs over a period of three to seven days. An average woman today has around 350 to 450 periods in her lifetime.
During their periods, many women experience painful cramps or a dull ache in their lower back and thighs. This is due to uterine contractions. Most women are able to carry on with their regular activities without much ado, but in a few rare cases, the period might be debilitating.
The degree of flow varies from person to person depending on the hormonal makeup of the body.
How pills work to delay your period
Oral contraceptive pills (like Mala D, Femilon) with a mix of estrogen and progesterone, two female hormones, are used by some women for this purpose. The mechanism is simple. By taking these pills, you are simulating the natural cycle.
Ovulation does not occur because the pills suppress the hormones required for ovulation. The hormone pills are taken for 21 days, starting from the sixth day of menstruation.
From the 21st day, non-active pills (or 'placebo' or 'empty' iron pills instead of the regular ones) are taken and they work just like withdrawing progesterone. So the progesterone withdrawal leads to menstrual bleeding. Then the hormone (active) pills are again started after a break of seven days.
For your convenience, oral contraceptive packs usually have seven placebo/inactive (or iron) pills without the hormone. These are labeled 22 through 28 and are usually a different colour. This ensures that you do not have to take an actual seven-day break. You can complete taking one strip of 28 tablets and then start the next strip beginning with tablet one.
That was a lesson in contraception. What about delaying your period?
The mechanism is quite similar. Let us say you continued taking those pills without the seven-day break. On day 22, you would need to discard the placebo pills labeled 22 through 28 and start the next strip with active tablets. This way you continue taking active pills until the time you want to start menstruating again. If you don't have any irregular bleeding or other side effects, you might be able to safely delay your period by around six weeks by this method.
However, if you do have persistent or irregular bleeding or other adverse effects, you must contact your doctor to address your concerns.
"For this method to work, you must start taking the pills a few days after your last period. If you start them just before the period you want to avoid, there is a high likelihood they will not work," says Dr Swati Dighe, a practicing gynaecologist from Mumbai.
There is no general consensus in medical science on the safety of this practice. Science just does not have enough information or research to prove that this is entirely healthy.
There are no known differences in side effects when oral contraceptives are used to delay periods as opposed to contraception.
However, being on the pill off and on irregularly might not be a very good idea for two reasons. It might be difficult to tell if you are pregnant. Secondly, if you do get pregnant while on the pill, there could be side effects that could affect the baby.
Every action has a reaction
So oral contraceptives taken for delaying your period can have the same side effects as those taken for contraception. What are these side effects?
"Unfortunately there is not enough information about oral contraceptives available to the general public. Women either think that contraceptive pills are really harmful or are led to believe by callous physicians or promotional ads that they are totally harmless. Both opinions are incorrect," says Dr Amit Rathod, a public health specialist from Bangalore.
Oral hormonal contraceptives can cause breast tenderness, nausea, headache, mood changes, leg cramps, acne, bloating, weight changes and, in some cases, pigmentation on the face.
One dangerous side effect could be the development of blood clots in the leg and other regions of the body. These clots could dislodge and travel to other crucial organs like the brain and block a blood vessel there.
New oral contraceptives like Femilon (from Organon) have significantly low hormone content and have fewer side effects, but the risk of developing blood clots remains the same as traditional pills.
Watch out for major warning signs -- these usually occur with prolonged intake of contraceptive pills -- such as severe chest or abdominal pain, bloating, headache, blurred vision, severe leg pain, shortness of breath or lump in the breast. If you develop any of these symptoms, contact your doctor IMMEDIATELY.
Do they always work?
Another issue could be the failure of the method. Oral contraceptives can sometimes cause "breakthrough bleeding", which means they can cause a certain amount of bleeding or spotting in between periods. If you consume any medication that interferes with the pill (such as antibiotics), the chances of breakthrough bleeding are more.
If the breakthrough bleeding occurs on the D-day, it could look like a period and defeat the whole purpose of taking these pills.
If your periods are really painful and you have the authority to reschedule the major event, then you can try and consider this option before the medical one.
Dr Anjali Rajurkar, a leading gynecologist from Nanded, Maharashtra summarises the bottom line very well.
"Delaying your period once in a while for a major event might be okay, but it is advisable to not make this a common practice. Oral contraceptives do have side effects. The idea of women being able to control their periods is definitely exciting but more in-depth research is needed in this area, " she says.
A word of caution
Age is no bar for using this method. But before you use oral contraceptives, you must make sure you do not suffer from any of the following conditions:
Your doctor knows best. You MUST schedule a consultation with your gynecologist before you take these pills.
Have you used oral contraceptives to delay your periods? Did you experience any side effects? Share your experiences.
Dr Roopa Nishi Viswanathan, an MBBS from KEM Hospital, Mumbai, has a masters in nutrition from the University of Texas at Austin, USA.
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