• Menstruation All women menstruate except during pregnancy, nursing a baby, is very underweight, ill or having problems with the reproductive system. Women start to menstruate between the ages of 9 to 18 years, and continue to menstruate till about age 45 to 50 years. Most women menstruate regularly every 21 to 40 days. However, some women menstruate irregularly. Girls should obtain information about menstruation from parents, sisters, peers or teachers in school. This is to enable them to be prepared for their first menstruation. Taking care during menstruation is very important to maintain cleanliness and health. ∼ Feelings about menstruation Some girls may feel embarrassed while others have mixed emotions. There are girls, who have negative feelings after being teased by friends, or feel ashamed and consider menstruation as dirty. Getting menstruation is normal, healthy and very positive. ∼ Some attitudes towards menstruation These are some attitudes people have regarding menstruation: − Menstruating women are unclean.
− Menstruating women are not allowed to participate in festivals or religious
− Menstruating women are sent away and isolated.
− They are not allowed to touch certain objects for fear of spoiling the objects. ∼ Predicting the menstrual cycle Some ways of knowing when menses is due: − Keeping a calendar of menses for 6 months – count day one of one cycle to
day one of the next cycle. Add them up and divide the answer by 6 to get the average cycle length. However, if the variation is too great, this calculation will not help.
− Observe body signs – at ovulation a woman may feel pain or cramping on the
back or abdomen. Menses may come 2 weeks later.
− The breasts feel bigger, heavier and lumpy after ovulation and before
menses. Mark this change on the calendar and note when menses actually comes.
− Headache or backache may be experienced just before menses. There may
also be inability to sleep (insomnia), eruption of pimples and feeling depressed or cranky.
− Appearance of thin and watery vaginal discharge (mucus) during ovulation, is
followed by menses 2 weeks later. Then nearing menses, the vaginal mucus becomes thicker and dryer. This feeling can be felt, if not she can insert a finger into her vagina.
∼ Side-effects of menstruation No side-effects in some women, others may be just slight and a few. − Headache, cramps, skin problems, cramps and puffiness and heaviness
− Feeling of heaviness or extra tired before menses and then feels well once
∼ Taking care during menstruation Some tips on self-care during menstruation: − Observe own body signs so as to plan schedule accordingly. For example,
watching the diet: • Reduce intake of salty foods such as fries, chips, nuts, spicy foods and
soy sauce before and during menses to reduce water retention.
• Reduce intake of sugar, white flour and caffeine.
• Reduce intake of fizzy drinks, chocolate, coffee, cakes, pies and bread.
• Drink plenty of fluids – plain water, herbal tea and fruit juices.
• Take calcium tablets and vitamin C one week before menses to help
• If menstrual flow is heavy, iron tablets may be prescribed to avoid
> Lie down and relax both mind and body.
> Breathe deeply and slowly while in a completely relaxed state.
> Gently massage the abdomen / back while breathing deeply.
> Apply hot water bottle / heating pad on the abdomen / back.
> Adopt the knee-chest position while applying heat on the back.
> Take medication to relieve pain (cramping) – get advice from a doctor
> Exercise regularly and get enough sleep.
∼ What causes the cramps? Theoretically, it is said that menstrual cramps may be due to:
− Uterine and cervical muscle contraction to expel endometrial lining.
− A fall in level of oestrogen and progesterone just before menses.
− Production of prostaglandins from the endometrium, causing the uterus to
∼ Feelings during menstruation There are women who feel good during menstruation. There are women who feel tense and depressed. Women are more likely to fall or hurt themselves during menses. • What to use for the menstrual flow? ∼ Sanitary napkins
These are rectangular pads of cotton layers with plastic outer lining worn inside the underwear (panties) to collect and absorb the menstrual discharge. − Change when nearly soaked through.
− Change several times a day to prevent stale odour that occurs when
− Wrap used napkins in paper and dispose into a proper disposal bin.
− Do not flush used napkins down the toilet. ∼ Tampons Tampons are thin rolls of soft cotton pressed together and a string is attached at the outer end and extends through the vagina and hangs outside the vulva. It is inserted into the vagina to soak up menstrual discharge. Tampon use does not harm a virgin woman. Women using tampons are advised to watch out for toxic shock syndrome (TSS). − Push tampon into the vagina with an applicator at an angle upwards and
− Pull the string to remove the tampon after use.
− Tampons require less changing since there is no odour.
− If menstrual discharge is heavy, tampons must be changed frequently.
− Swimming becomes more comfortable when using tampons.
− Tampons cannot “travel” to other parts of the body since the cervical os
− Wrap used tampons in tissue / newspaper and dispose into proper disposal
− Do not throw used tampons into the toilet bowl.
• Toxic Shock Syndrome
Toxic Shock Syndrome (TSS) was first recognized in children in 1978. In adults it was found that TSS occurs in menstruating women using very high absorbency tampons. These hogh absorbency tampons contain polyester foam and polyacrylate rayon that soak up magnesium from the vaginal discharge. Reduced magnesium level cause staphylocossus to produce large amount of toxin and causes TSS. The incidence of TSS is highest on the 4th day of menses when the menstrual becomes lesser. Certain women have the tendency to be highly susceptible to this toxin. ∼ Signs and symptoms of TSS: − Fever (with body temperature above 38.8OC / 102 OF).
− Desquamation (peeling of skin) of palms and soles occurring 1 – 2 weeks
− Myalgia (pain in the muscles). ∼ Preventing TSS − Avoid use of tampons.
• Alternate tampons with sanitary napkins.
• Should be monitored for possible recurrence.
• Doctor may prescribe antibiotic therapy during subsequent menses to
prevent or reduce the possibility of recurrence.
∼ General care during menstruation − Bathe frequently and thoroughly cleanse the genital area.
− Bathe using warm water if possible to reduce discomfort and cramps. A warm
− Exercise appropriately and regularly can speed up blood circulation and gives
− Drink plenty of water to aid digestion and prevent constipation.
− Get extra sleep during the days before and during menstruation.
Treatment of Congestive Heart Failure When you provide treatment for any medical or dental problem, it is useful to apply an organized approach. A common approach is: conservative, pharmacological and invasive treatment. This lecture will try to use this approach for the treatment of both acute and chronic heart failure. This handout is divided first into acute CHF and second, chronic CHF. Qu