Gynaecology - what is the normal state of affairs and why

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At the age of 13 (on average) the pituitary kicks into life to produce the hormones to kick the ovaries into action. The ovaries produce oestrogen and progesterone which are responsible for the development of secondary sexual characteristics (growth of the breast, womb and then start of periods).

Throughout the menstrual cycle the level of oestrogen is fairly constant. Progesterone is low during the period (bleed) and during the first half of the cycle (first 14 days). Levels then rise during the second half because progesterone is made by the egg that is released by the ovary. Progesterone means pro (in favour of) gestation (pregnancy). Progesterone prepares the womb to receive an egg which, if fertilised, implants to grow into a baby. The womb lining thickens up to provide a generous "cushion" rich in blood to supply the growing baby. If the egg is not fertilised, it cannot implant and therefore cannot continue to make progesterone. So progesterone levels fall and it is this falling level which results in the shedding of the lining of the womb causing a period.

This understanding is essential if you are to understand the rest of gynaecology! It is the falling levels of progesterone which cause a bleed. This is why progesterones (as in the Pill and HRT) are often used to "control" vaginal bleeding. Giving them by tablets ensure a steady level of progesterone but using progesterone is playing with fire! This is not a long term solution to any problem! See Contraceptive Pill and HRT - don't take them.

Obviously when levels of progesterone wobble about (for whatever reason) there will be irregular vaginal bleeding. The commoneset causes are micronutrient deficiency, Western diets, stress (toxic or psychological) and hypothyroidism. However any irregular bleeding needs full investigation to exclude patholgy such as cancer.

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