246 Where There Is No Doctor 2011
Signs of menstrual problems:
• Some irregularity in the length of time between periods is normal for certain
women, but for others it may be a sign of chronic illness, anemia, malnutrition,
tuberculosis, worsening HIV infection, or possibly an infection or tumor in the
womb.
• If a period does not come when it should, this may be a sign of pregnancy. But for
many girls who have recently begun to menstruate, and for women over 40, it is
often normal to miss or have irregular periods. Worry or emotional upset may also
cause a woman to miss her period.
• If the bleeding comes later than expected, is more severe, and lasts longer, it may
be a miscarriage (see p. 281).
• If the menstrual period lasts more than 6 days, results in unusually heavy
bleeding, or comes more than once a month, seek medical advice.
THE MENOPAUSE
(WHEN WOMEN STOP HAVING PERIODS)
The menopause or climacteric is the time in a woman’s life
when the menstrual periods stop coming. After menopause,
she can no longer bear children. In general, this ‘change of life’
happens between the ages of 40 and 50. The periods often
become irregular for several months before they stop completely.
There is no reason to stop having sex during or after the
menopause. But a woman can still become pregnant during this
time. If she does not want to have more children, she should
continue to use birth control for 12 months after her periods stop.
When menopause begins, a woman may think she is pregnant.
And when she bleeds again after 3 or 4 months, she may think
she is having a miscarriage. If a woman of 40 or 50 starts bleeding again after some
months without, explain to her that it may be menopause.
During menopause, it is normal to feel many discomforts—anxiety, distress, ‘hot
flashes’ (suddenly feeling uncomfortably hot), pains that travel all over the body,
sadness, etc. After menopause is over, most women feel better again.
Women who have severe bleeding or a lot of pain in the belly during menopause, or
who begin to bleed again after the bleeding has stopped for months or years, should
seek medical help. An examination is needed to make sure they do not have cancer or
another serious problem (see p. 280).
After menopause, a woman’s bones may become weaker and break more easily.
To prevent this, it helps to eat foods with calcium (see p. 116).
Because she will not have any more children, a woman may be more free now to
spend time with her grandchildren or to become more active in the community. Some
become midwives or health workers at this time in their lives.