The Indian Women’s Health Report 2021*

Working women face a conflict of interest while balancing familial/ personal and professional obligations

anemia

Anemia is global health concern, especially among children, adolescent girls, women of reproductive age, pregnant and postpartum women.7 Iron is an essential nutrient and component of the haemoglobin in red blood cells which helps in transport of oxygen around the body.8 In anemia, the red blood cell count is reduced and the body’s ability to meet the oxygen demands of tissues is impaired.9 Iron deficiency anaemia (IDA) is a condition in which the body has too little iron in the bloodstream. This form of anaemia is more common in adolescents and in women before menopause. Blood loss from heavy periods, internal bleeding from the gastrointestinal tract may also lead to IDA.10 Anemia has both immediate and long-term negative consequences on health. Anemia, especially iron-deficiency anemia, during pregnancy is associated with several adverse outcomes for both the mother and her baby.9 The impact of anaemia in young women is perhaps less discussed but is associated with greater postpartum haemorrhage and a consequential increased mortality risk.8

Do Heavy Periods Mean a Bleeding Disorder?
  • Not always. Other causes of heavy periods can include:
    Health conditions like thyroid issues or fibroids
    Hormonal imbalances which prevent proper shedding of the uterine lining
    Certain medicines like anti-inflammatory drugs and blood thinners
Symptoms of Bleeding Disorders
  • Frequent or hard-to-stop nosebleeds
  • Large bruises from small injuries
  • Heavy menstrual bleeding (such as soaking a pad or tampon every hour, bleeding over 7 days, or having large clots)
  • Blood in stool or urine
  • Prolonged bleeding after injury, surgery, or dental work
  • Anemia, causing paleness, fatigue, or weakness
How Do Bleeding Disorders Affect Pregnancy? Women with bleeding disorders face risks during and after pregnancy, including
  • Iron-deficiency anemia
  • Bleeding during pregnancy
  • Heavy bleeding after childbirth (postpartum hemorrhage)

If you have or think you may have a bleeding disorder and are planning a pregnancy, consult a doctor, especially one experienced with high-risk pregnancies.

Hemoglobin levels chart

To help diagnose anemia/IDA, your doctor may ask for a blood test to check your complete blood count (CBC), hemoglobin levels, blood iron levels, and ferritin levels (stored iron).

Hemoglobin levels chart

There are various treatments available to treat anemia based on your symptoms, severity and other conditions. Consult your gynecologist to seek the treatment, which is best suited to you.

polycystic ovary
syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a common condition that occurs when a woman’s ovaries or adrenal glands produce more male hormones than normal. It may also lead to formation of cysts (fluid-filled sacs) in one or both the ovaries.

What Are the Symptoms of PCOS?

The symptoms may vary from person to person. Common symptoms may include –

  • Irregular periods: Some women have missed or fewer periods, while others have frequent periods or stop having them altogether.
  • Excess hair growth: Often appears on the face, chin, or body areas typical for men (called “hirsutism”).
  • Acne: Common on the face, chest, and upper back.
What Causes PCOS? PCOS has no cure, but symptoms can be managed. Treatment may include
  • Iron-deficiency anemia
  • Bleeding during pregnancy
  • Heavy bleeding after childbirth (postpartum hemorrhage)

menorrhagia

Bleeding Disorders

A bleeding disorder makes it hard for the body to stop bleeding. These disorders are often inherited but can also be caused by other health issues or certain medicines.

Heavy Menstrual Bleeding (HMB)(3,4)

Heavy menstrual bleeding, or menorrhagia, is when a woman face heavy period that may last for more than 7 days. If left untreated, they are at increased risk of anemia, pain during menstruation, hospitalizations, blood transfusions, limitations in daily activities, time lost from work or school, and a reduced quality of life.


When to see a doctor – Visit your doctor if you have:

  • Vaginal bleeding so heavy that it soaks at least one pad or tampon an hour for more than two hours in a row
  • Bleeding between periods
  • Vaginal bleeding after menopause

There are various treatments available based on your symptoms, severity and other conditions. Consult your gynecologist to seek the treatment, which is best suited to you.

Acute Uterine Bleeding (AUB)(5,6)

Bleeding is considered as abnormal uterine bleeding when there is –

  • Bleeding or spotting between periods
  • Bleeding or spotting after sex
  • Heavy bleeding during period
  • Menstrual cycles that are longer than 35 days or shorter than 21 days
  • “Irregular” periods in which cycle length varies by more than 7 to 9 days
  • Bleeding after menopause

 

Abnormal uterine bleeding can be a chronic condition, which means that it has happened often for at least the past 6 months.However, sometimes there are sudden, unusual episodes of abnormal bleeding which is called as acute abnormal uterine bleeding.

 

At what age AUB is more common –

 

It can occur at any age. However, at certain stages of a woman’s life it is common for periods to be somewhat irregular:

  • Periods may not occur regularly when a girl first starts having them (around age 9 to 14).
  • During perimenopause (around age 50), the number of days between periods may change. It is common to skip periods or for bleeding to get lighter or heavier at this time.

If you experience any such changes, consult with your obstetrician–gynecologist) for effective treatment.

 

menopause

understanding menopause

Menopause is when a woman’s periods stop permanently, defined as not having a period for 12 months in a row. Menopause is a normal part of aging and every woman goes through it. It usually occurs naturally, most often after age 45.The time leading up to menopause is called the menopausal transition, or perimenopause. This transition usually begins when woman is in her 40s, but sometimes it can start earlier. It can last for several years. The most common age for reaching menopause is between 45 and 55 years old.

What Are Common Symptoms of Menopause?

During menopause, hormone levels change and can cause

  • Hot flashes: Sudden feelings of heat, often with sweating and chills afterward.
  • Vaginal dryness: Can make sex uncomfortable.
  • Irregular periods: Periods may be lighter or heavier, and timing can vary.
  • Hot flashes: Sudden feelings of heat, often with sweating and chills afterward.
  • Trouble sleeping
  • Forgetfulness or difficulty concentrating
  • Urinary issues: Leaking when sneezing or trouble holding urine.
  • Mood changes: Feeling irritable or experiencing crying spells.
  • Depression and anxiety
  • Changes in sexual desire

If menopause symptoms affect you, consult a doctor for advice on managing them.

There are hormonal as well as non-hormonal treatment options to treat menopausal symptoms. It is advised to consult physician before starting any medication.

What Is Menopausal Hormone Therapy? Hormone therapy (sometimes called hormone replacement therapy) can help relieve symptoms like hot flashes and dryness. However, like every treatment it has both benefits and risks, so doctors advise using the lowest dose for the shortest time. A lower-dose topical therapy (like a cream or vaginal ring) is also available for dryness.

The menstrual cycle is the hormonal process a woman’s body goes through very month to prepare for a possible pregnancy.

Menstruation, or “period,” is the monthly shedding of the uterus lining. If no pregnancy happens, hormone levels drop, signaling the body to start a period.

How Long is a Menstrual Cycle? A menstrual cycle is measured from the first day of one period to the first day of the next. The average cycle length is 28 days, but it varies for everyone and may differ month to month.

What is Ovulation? Ovulation is when an egg is released from the ovary and can be fertilized. The most fertile days are the three days before and the day of ovulation.

When Should I See a Doctor? Visit your doctor if you have:

  • No period for three months (and are not pregnant or menopausal).
  • Irregular periods, very heavy bleeding, or periods longer than 8 days.
  • Heavy bleeding (changing pads/tampons every 1-2 hours).
  • Severe menstrual pain not relieved by over-the-counter painkillers.

How Does My Menstrual Cycle Affect My Health?

Hormonal changes throughout the cycle can influence various health conditions

  • Anemia: Heavy bleeding can cause low iron levels, leading to fatigue and weakness.
  • Asthma: Symptoms may worsen at certain times in the cycle.
  • Depression: Those with a history of depression may experience stronger symptoms pre-period.
  • Diabetes: Irregular cycles, especially those longer than 40 days, may raise type 2 diabetes risk.
  • IBS: Irritable bowel symptoms can worsen before the period.
  • Fertility Issues: Conditions like PCOS, endometriosis, or weight issues can affect cycle regularity and fertility.

Understanding your cycle can help you spot health changes and seek help if needed.