Men have the chromosomal composition XY while women have XX. However, the main difference between men and women physiologically is that women menstruate (have monthly periods) and are capable of bearing children.

Menstruation occurs between the ages of 10 and 16 at menarche (the first menstrual period). The exact age depends on genetics, on the age at which other females in the family menstruated. It also depends on socioeconomic conditions, general health, nutritional status and the amount of physical exercise.

Internationally, the age of menarche has been decreasing. It can occur as early as nine years. This may be because of childhood obesity — which is practically an epidemic — as well as our present diet, which has a lot of fast food. Also, the food we eat contains hormones, chemicals and preservatives.

Menarche is considered delayed if it does not occur after 16 years or one year after thelarche (breast development). It needs to be investigated as it may be due to undiagnosed long-standing illnesses or chronic diseases such as diabetes or kidney disease, which can make it harder for girls’ bodies to grow and develop. Scans can be done to check the uterus and ovaries for normality, and blood tests done to measure hormone levels.

After the first menstruation, the second period may be delayed. A wait-and-watch policy can be adopted for at least a year. Sometimes, the periods become irregular (less than 21 days or longer than 45 days). Menstruation may also be heavy, painful or continuous, or there may be intermittent spotting throughout the cycle.

These problems may be caused by concurrent illness, rapid weight changes, medications taken for some other disease, polycystic ovaries, fibroids in the uterus or thyroid malfunction. These problems need to be investigated, diagnosed and appropriate treatment started.

Menstruation does not go on forever; it stops at a certain age (menopause), usually around 52 years. Again, this is dependent on genetics and any concurrent illnesses. Before final cessation, periods become scanty, the intervals become prolonged and there may be weight gain, hot flashes and vaginal dryness. These can occur as early as
10 years before menstruation finally ceases. Menopause is diagnosed if there are no periods for 12 months. It can be confirmed with blood tests.

Menopause before the age of 45 is called early menopause; at 40 or younger, it is considered premature menopause. In 50 per cent of women, no cause can be found. In others, it may be due to surgical removal of the uterus and ovaries, a family history of early menopause, infections like mumps or HIV, or chemotherapy.

Although menopause is a normal occurrence, the drop in the level of
female hormones like oestrogen causes bone weakness and osteoporosis, loss of muscle mass and weight gain. The female hormones also protect against heart diseases, so the incidence of strokes and heart attacks increases after menopause.

Menopausal women need to have a pap smear to check for cervical cancer and a mammogram to check for breast cancer. They need to be evaluated for diabetes and hypertension and have a bone mineral density test. If the menstruation recurs after one year, or there is spotting or bleeding after intercourse, a complete gynaecological evaluation is required.

Sometimes, insomnia and anxiety could set in after menopause. Yoga, meditation and relaxation help control these symptoms. It is better to try this before opting for medication.

All women need to do aerobic exercises for 40 minutes every day to keep their bones and muscles strong and their hearts healthy. It also helps to regulate their hormones, ensuring regular and painless periods. It will also help to reduce the incidence of hot flashes and sweats after menopause.

The writer has a family practice at Vellore and is the author of Staying Healthy in Modern India. If you have any questions on health issues please write to yourhealthgm@yahoo.co.in