A woman's health is intricately linked to her menstrual cycle, which is an important sign of her overall well-being. Throughout puberty and menopause, hormonal changes affect not only fertility but also mood, energy, and long-term health. A normal cycle usually indicates balance, whereas abnormalities may suggest problems such as PCOS, endometriosis, or thyroid disease.

Our bodies do not always work in a perfect clockwork operation and unexpected vaginal bleeding can often confused us. Is it a mere spotting? A normal period? A symptom of something more concerning? Differences between spotting, menstrual bleeding, and intermenstrual bleeding should be understood is crucial for maintaining reproduction health.

Here is a short guide to help you differentiate while you are confused.

Spotting

Spotting is vaginal bleeding that doesn't happen as part of your regular menstrual period. It commonly manifests as fine droplets or smears of blood on clothing or toilet tissue. The intensity of the blood ranges from deep red (recent blood) to pink (having cervical mucus mixed in it) or brown (older, oxidized blood). Spotting is not very much and can't be seen in a way that needs either a tampon or a pad to absorb.

Common Causes of Spotting

Spotting is caused by numerous factors, and in the majority of instances, it is nothing to worry about. Some frequent causes are:

Hormonal Birth Control Transitions: New birth control technique, for instance, birth control pills, IUDs containing hormones, or implants, results in temporary spotting as the body adapts.

Ovulation Bleeding: A few individuals get spotting light around the time of ovulation as a result of hormonal changes. It normally happens in the mid-cycle and could be followed by slight cramping.

Cervical Ectropion: A harmless condition when cells from the inside of the cervical canal migrate to the outer cervix, causing the outer cervix to become more sensitive and prone to faint bleeding on coitus or physical activity.

Early Pregnancy (Implantation Bleeding): 15–25% of pregnant women experience light spotting around 10–14 days post-conception, which is confused with an early period.

When to See a Doctor

Spotting is usually harmless, but it's best to consult a doctor if:

• It continues after a few months of initiating new birth control
• Is accompanied by pelvic pain or abnormal discharge
• Occurs after frequent intercourse
• Occurs during pregnancy and is not verified as implantation bleeding

Menstrual Bleeding

There is a time, also known as a period or menstruation, when the uterine lining sheds due to changing hormone levels. It would last for approximately 2-7 days and is heavier initially. The hue and texture of period blood shift during the menstrual cycle:

Red: New active bleeding at the start of a period

Brown or dark red: Older, slower blood in leaving the uterus

Clots: It's normal to have small clots, but bigger clots may be a sign of heavy menstrual bleeding (HMB)

Why You Have a Period Essentially?

Menstruation is a part of the reproductive cycle, and it happens around every 21–35 days. When there's no pregnancy after ovulation, hormone levels fall, causing the uterine lining to be shed.

Signs Your Period May Be Abnormal

Though periods differ in different people, there are some signs that point towards probable underlying conditions:

• Prolonged bleeding (longer than 7 days)
• Heavy flow necessitating pad/tampon changes every 1–2 hours
• Severe cramps that disrupt daily life
• Irregular periods or absent periods

If you have any of these, conditions such as polycystic ovary syndrome (PCOS), endometriosis, or thyroid disease may be involved, and a medical visit is in order.

Intermenstrual Bleeding

Unlike spotting, intermenstrual bleeding is heavier and unexpected between regular periods. It may be from bright red to dark brown and can contain blood clots.

Possible Causes of Bleeding Between Periods

Sexually Transmitted Infections (STIs): Chlamydia and gonorrhea can lead to inflammation and abnormal bleeding.

Pelvic Inflammatory Disease (PID): A bacterial infection of the reproductive organs and can lead to abnormal bleeding.

Uterine Fibroids or Polyps: Benign growths in the uterus that may cause unexpected bleeding.

Endometrial Hyperplasia or Cancer: In some instances, abnormal bleeding may be a sign of abnormal cell growth in the lining of the uterus.

When to See a Doctor

See a doctor if intermenstrual bleeding is:

• Frequent or persistent
• Associated with pelvic pain or discomfort
• Associated with abnormal discharge, fever or painful sex

Recognizing your body's rhythms can assist you in identifying normal versus abnormal bleeding. Monitoring your menstrual cycle through an app or calendar may flag changes that should be checked with a doctor. If you have any questions regarding abnormal bleeding, visiting your health care provider is the way to go.

Dr Srivanjani Santosh, Pediatrician, Social Activist and First Aid trainer, who had earlier spearheaded the ORS campaigned for eight years, urging FSSAI to ban the misuse of the term 'ORS' on non-WHO=standard sugar drinks, has once again shared an important health video on rabies vaccination. Dr Santosh shared that if any mammal, including dog, cat, horse, cow, buffalo, monkey or bat scratch or bit a person, they must be vaccinated with rabies shot.

She also pointed out something many miss: the location of administering the rabies shot. In her video she urged people to not get the shot administered in buttocks, and to only get it on their shoulders or thighs. She also claimed that many clinics and hospitals, despite knowing this fact, are administering rabies vaccination on buttocks.

Also Read: Hangover Star Ken Jeong's Wife Beats Stage 3 Breast Cancer

Why Does Location Of Administration Matter In Rabies Shot?

The World Health Organization (WHO) strongly recommends that rabies vaccines must be injected into the deltoid region, which is the upper arm or near the shoulder region in adults.

In small children, the WHO notes that deltoid region, as well as anterolateral area of the thigh muscle, which is also the upper thigh works.

WHO notes that like any other injections, rabies vaccine should not be given in the gluteal region, that is the buttocks, because of low absorption due to the presence of adipose or the fat tissue.

This video comes at the time when a case of a Birmingham woman losing all her limbs to dog's lick has made headlines all over the news. Health and Me also reported on the same.

Read: Woman Loses All Her Limbs After Getting Sepsis From Dog Lick

Health and Me spoke to Dr. Rakesh Pandit, Senior Consultant & HOD, Internal Medicine at Aakash Healthcare, who further explained, that as per guidelines by the WHO, the rabies vaccine should not be given in the buttocks as they have a heavy layer of fat. The body might not properly absorb the vaccine if it is injected into this fat instead of the muscle, which could result in a vaccine failure.

"A vaccine failure in case of rabies is like a death sentence because the disease is one hundred percent lethal once it shows the signs. The injection site for the vaccine depends on the patient's age; older children and adults must receive the vaccine in the upper arm or shoulder, while infants and toddlers must receive it in the thigh. The vaccine must also be administered with the right needle length to reach the required depth," he said.

Dr Pandit further elaborated, "The place of administering the vaccine (arm or thigh, subcutaneous or intramuscular) has an effect on the immune response, speed at which the vaccine is absorbed, pain and the risk of side effects." He said, "Some vaccines give best results when given in muscle for better immunity. Other vaccines may need subcutaneous administration. When given at the correct site, the vaccines ensure maximum effect, safety and reduced local reactions like swelling."

Read: 36% Of Rabies Death Comes From India: This Is What You Should Do After A Dog Bite, Explains Doctor

What Should One Keep In Mind While Getting A Rabies Shot?

Dr Mule points out that even when there are minor scratches, without bleeding, you must get a rabies shot. "Rabies can be contracted through broken skin. Such exposures still require medical evaluation and, in most cases, rabies vaccination."

What Should One Do Immediately After Being Bitten Or Scratched?

• Wash the wound immediately for at least 15 minutes with soap and running water
• Apply an antiseptic such as povidone-iodine
• Do not apply home remedies like turmeric, chili or oil
• Seek medical care promptly for rabies vaccination and possible immunoglobin

Dr Mule points out that the rabies vaccine should be started as soon as possible. "Ideally within 24 hours of a bite or scratch. However, even if there is a delay of days or weeks, vaccination should still be started immediately as rabies has a variable incubation period," he says.

The temperature of the vaccine matters. "Rabies vaccines are temperature-sensitive and must be stored between 2°C and 8°C. Exposure to heat or freezing can reduce vaccine potency. Poor cold-chain maintenance is a known reason for vaccine failure in rare cases," points out the doctor.

Dr Mule points out that the vaccine should be given intramuscularly in the deltoid or upper arms for adults, as gluteal or buttock injections could lead to inadequate absorption and reduce effectiveness.

A simple strep throat infection, can trigger sudden skin inflammation, leading to psoriasis, particularly in children and young adults, according to a study.

Researchers from the Karolinska Institutet in Sweden showed that a strep throat infection caused by the Group A Streptococcus (GAS) bacterium, can trigger guttate psoriasis by altering the behavior of key immune cells. Guttate psoriasis is an often sudden-onset form of psoriasis with small, red, "drop-shaped" scaling spots on arms and legs.

While neutrophils -- the most common type of immune cell -- are the first immune cells to respond to GAS infection, the study showed that during a streptococcal infection, the immune cells behavior changes depending on their environment.

Notably, among people with guttate psoriasis, the neutrophils presented with antigens -- fragments of pathogens that signal and guide other immune cells -- get accumulated. Once accumulated, the immune cells activated the T cells, leading to inflammation, explained the researchers in the paper, published in the journal eBioMedicine.

"Doctors have long known that strep throat can precede guttate psoriasis, but the biological explanation has been unclear," said Avinash Padhi, first author of the study and Research Specialist at the Division of Dermatology and Venereology, at Karolinska.

"Our findings suggest a link between infection and skin inflammation through the accumulation of antigen-presenting neutrophils in patients' skin," Padhi added.

How Cells Shape Immune Response

Magdalini Lourda, senior author of the study and senior research specialist at the Department of Laboratory Medicine, noted that the "results challenge the traditional view of neutrophils as simple first-line defenders".

The findings show that the neutrophils play "a wider role in shaping immune responses, which may be important when designing future treatments."

How Was The Study conducted?

To find how neutrophils work in psoriasis, the blood neutrophils from psoriasis patients were compared with those from healthy individuals. Blood neutrophils from patients with severe strep-related lung inflammation were also compared.

What Is Guttate Psoriasis?

Guttate psoriasis is a distinct form of acute-onset psoriasis. It is an inflammatory skin disease characterized by the sudden appearance of red, scaly, and smaller skin lesions widespread over the body.

The condition typically follows an infection, most commonly tonsillitis caused by Group A Streptococcus (GAS). Adolescents and young adults are the most affected. It accounts for about 2 per cent of all cases of psoriasis.

Genetics, environmental triggers, such as an upper respiratory tract infection, and the onset of an inflammatory condition in a distant organ are the major risk factors.

The condition may be diagnosed by skin biopsy, throat swab culture, and blood tests.

Hangover star Ken Jeong's wife Tran Ho Jeong in 2007 discovered a hard lump in her breast while she was breastfeeding their newborn twins Alexa and Zooey. She was diagnosed with stage 3 triple negative breast cancer (TNBC) in 2008.

What Is Stage 3 Triple Negative Breast Cancer?

As per the American Cancer Society, it is an advanced aggressive, and fast-growing cancer that has spread to nearby lymph nodes or tissue, however, does not distant organs. It is characterized by the absence of estrogen, progesterone and HER2 receptors, which requires a combined approach of chemotherapy, surgery, and sometimes also radiations As per the American Cancer Society, TNBC accounts for about 10 to 15 per cent of all breast cancers.

At stage 3, TNBC has grown extensively and invaded nearby tissues and is likely to spread to lymph nodes. However, it has not metastasized to distant organs.

Also Read: Zimbabwe Among the First African Countries to Roll Out Breakthrough HIV Injections

Hangover Star Ken Jeong's Wife Cancer Journey

As doctors said, for Tran, it was a "year of hell". She underwent 16 rounds of chemotherapy when Ken was filming The Hangover. This was then followed by a mastectomy and radiation therapy.

"I am going to survive this. I am going to fight. I have to live for the girls and for Ken," she said. After two years of battle, Tran was finally declared cancer free in 2010. Ken called it "the greatest moment" of his life.

What Happens In Breast Cancer?

As per the World Health Organization (WHO), breast cancer is the most common cancer globally with around 2.3 million new cases every year. At the rate of 1 in every 8 person in both sexes and a quarter of all cancer in women with 70% mortality occurs due to constrained resources.

It is a disease where abnormal breast cells grow out of control and form tumors. If it is left unchecked, the tumors can spread throughout the body and become fatal.

It originates in the milk ducts or the milk-producing lobules of the breast. The earliest form is not life-threatening and can be detected in the early stages. Cancer cells can spread into nearby breast tissue and create tumors that cause lumps or thickening. These invasive cancers can spread to nearby lymph nodes or other organs and metastasis can be life-threatening and fatal.

Signs And Symptoms Of Breast Cancer

The common signs are:

• A breast lump or thickening, often without pain
• Change in size, shape or appearance of breasts
• Dimpling, redness, pitting or other changes in the skin
• Change in nipple appearance or the skin surrounding the nipple (areola)
• Abnormal or bloody fluid from the nipple

Treatment

The treatment depends on the stages and subtypes of the cancer. However, common treatments involve:

• Surgery to remove breast tumor
• Radiation therapy to reduce recurrence of breast cancer around the breast tissues
• Medicals to kill cancer cells and prevent spread
• Therapies like hormonal and chemotherapy or targeted biological therapy