MENSTRUAL IRREGULARITIES

Abnormalities in the menstrual cycle of a woman is called as menstrual irregularities.

Types of Menstruation Irregularities

Various menstrual irregularities include:

  • No menstrual periods until the age of 16 years or absence of menstrual periods for 3 consecutive months and is not pregnant - Amenorrhea

  • Painful menstruation periods - Dysmenorrhea

  • Excessive bleeding which lasts for 8 to 10 days - Menorrhagia

  • Irregular menstrual periods or getting periods frequently - Oligomenorrhea

  • Premature ovarian failure – Normal function of the ovary is stopped

  • Non-cancerous tumours observed in women of childbearing potential - Uterine fibroids

  • Tissues lining the uterus from inside, grow outside the uterus (normally the tissue grows inside the uterus) - Endometriosis

Symptoms of Menstruation Irregularities

Symptoms observed in patients with menstrual irregularities include

  • burning while urinating,

  • fever,

  • painful bowel movements,

  • vaginal discharge,

  • painful cramps, and

  • lower back pain.  

Menstrual irregularities should be diagnosed early to prevent complications such as infertility (inability to get pregnant), anaemia, hemorrhage, and uterine cancer.

Treatment includes:

  • For amenorrhea, medroxyprogesterone will be given to check for with-drawal bleed

  • For dysmenorrhea, ibuprofen and naproxen  (NSAID) are given to relieve pain

  • For menorrhagia, iron supplements and anti-prostaglandin medications are given.  In severe cases of menorrhagia, surgeries such as thermal balloon endometrial ablation, transcervical resection of the endometrium (TCRE), and hysterectomy will be done.

  • For endometriosis, hormonal preparations can be used and/or, Laparoscopic surgery to remove the endometriosis tissue from pelvic peritoneum.

  • Fibroids, depending on their location and size can either be left alone and followed up by ultrasound or  treated by medications and /or Surgery remove the fibroids.

ABNORMAL VAGINAL BLEEDING

Normal vaginal bleeding (menstruation) occurs every 21 to 35 days in every woman. Abnormal vaginal bleeding is any bleeding unrelated to normal menstruation. This can include spotting of small amounts of blood (between periods), or menstrual flow which is heavier than normal.  

Causes of Abnormal Bleeding

Some of the causes for abnormal vaginal bleeding are:

  • Hormonal changes

  • Contraception pills or intrauterine device (IUD)

  • Infection of the vagina or uterus

  • Problem with blood clotting

  • Cancer of the uterus or vagina

  • Trauma to the vagina

  • Polyps or fibroids (abnormal outgrowth of tissues or tumours)

  • Certain diseases

Symptoms of Abnormal Bleeding

Symptoms of abnormal vaginal bleeding include bleeding between periods or after sex, spotting after menstruation, bleeding heavier or for more days than normal, and bleeding after menopause.

Diagnosis of Abnormal Bleeding

Dr Alexander will examine your family health history as well as complete details of your menstrual cycles (dates, length, and type of bleeding). You will also have a physical examination and blood tests to check your hormonal levels to diagnose the cause of your bleeding.

Dr Alexander may also order a pregnancy test to rule out the possibility of pregnancy. A range of imaging tests such as ultrasound or MRI scans, which produce images of your internal organs, may also be ordered to diagnose irregular bleeding.

A cervical smear and swab may be taken and sent for sampling to determine any abnormalities.

Treatment for Abnormal Bleeding

The types of treatment for abnormal vaginal bleeding are based on many factors such as cause of bleeding, age and whether you want to have a child. Most cases of abnormal vaginal bleeding can be treated with medications, except for few cases that may require surgery.

Medications for Abnormal Bleeding:

Hormonal medications used to treat abnormal bleeding depend on whether or not you want to get pregnant and your age factor. Hormones can be given as injections, vaginal creams or through intrauterine devices (birth control device which is inserted into the uterus). The hormones are slowly released into the body by these means and control the abnormal bleeding. Dr Alexander may prescribe other medications such as anti-inflammatory drugs or antibiotics to reduce bleeding and infections respectively.

Surgical treatment for Abnormal Bleeding:  

Dr Alexander will recommend surgical treatment if the bleeding is caused by

  • polyps or fibroids. Surgery is performed to excise the polyps or fibroids by a procedure called hysteroscopy, which uses a flexible tube or endoscope.

  • endometrial ablations (removal of a thin layer of the uterine wall to reduce bleeding) may also be performed. This procedure is reserved for women who finished their family, as accidental pregnancy after this procedure can be complicated and high risk.

  • hysterectomy (surgical removal of the uterus) may be considered if all other forms of treatments have failed. You can no longer conceive after hysterectomy.

Along with these treatments, you can take good care of yourself by eating a well-balanced diet, exercising and getting a proper amount of sleep.

TYPES OF MENSTRUAL DISORDERS

Menstrual disorders are a set of problems that affect a woman’s monthly menstrual cycle (monthly bleeding). They include

  • no menstruation - amenorrhoea

  • light or irregular periods - oligomenorrhoea

  • heavy periods - menorrhagia and

  • painful periods - dysmenorrhoea

Causes of Menstrual Disorders

Hormones play an important role in regulating growth and other bodily functions.

At the onset of puberty, a mixture of female and male sex hormones is produced for sexual maturity. An imbalance in these hormones or increased production of male hormones can lead to hirsutism (high levels of the male sex hormone androgen) and menstrual disorders.

The recent increase in childhood and adolescent obesity is also a major factor that has led to the high incidence of hirsutism and menstrual disorders.

Other causes may include:

  • Dysmenorrhea -may occur due to endometriosis (chronic condition where the uterine lining grows over the ovaries and bladder) or fibroids (noncancerous growth on the walls of the uterus), cyst in the ovaries and the use of intrauterine contraceptive devices (IUDs).

  • Menorrhagia - may be caused due to uterine fibroids, problems in ovulation (release of fully developed ovarian cells), endometriosis, uterine polyps (small benign growth), cancer, severe infection, miscarriage or ectopic pregnancy (pregnancy outside the womb), certain medications and IUDs.

  • Oligomenorrhea - may develop due to polycystic ovary syndrome (ovarian cysts), weight loss, endometriosis, stress and medications.

Treatments for Menstruation Disorders

Dr Alexander may prescribe hormone therapy or oral contraceptive pills to treat menstrual disorders and hirsutism.

Surgical procedures may include the removal of fibroids, cysts or tumors. Surgery may be recommended only in cases of severe menstrual disorders.

MENSTRUAL DISORDERS

Menstruation is a major stage of puberty in girls and refers to physiological changes happening in women at regular intervals of 21-35 days. Menstrual period prepares women for sexual reproduction and fertilization and having a regular menstrual cycle is a clear sign of a healthy individual.

Any abnormalities such as

  • delayed or early menstrual periods,

  • excessive pain bleeding during the periods

indicate that you might be suffering from certain gynaecological conditions and require immediate medical intervention.

Menstrual irregularities

Abnormalities in the menstrual cycle of a woman is called as menstrual irregularities. Various menstrual irregularities include:

  • No menstrual periods until the age of 16 years or absence of menstrual periods for 3 consecutive months without being  pregnant - Amenorrhea

  • Painful menstruation periods - Dysmenorrhoea

  • Excessive bleeding which lasts for 8 to 10 days - Menorrhagia

  • Irregular menstrual periods or getting periods frequently - Oligomenorrhoea

  • Normal function of the ovary is stopped - Premature ovarian failure

  • Non-cancerous tumours observed in women of childbearing potential - Uterine fibroids

  • The tissues lining the uterus from the inside, grow outside the uterus (normally the tissue grows inside the uterus) - Endometriosi

Menstrual irregularities should be diagnosed early to prevent complications such as infertility (inability to get pregnant), anaemia, haemorrhage, and uterine cancer. Treatment includes:

  • For amenorrhea, medroxyprogesterone is given.

  • For dysmenorrhoea, ibuprofen and naproxen are given to relieve pain.

  • For menorrhagia, iron supplements and anti-prostaglandin medications are given.  In severe case of menorrhagia, surgeries such as thermal balloon endometrial ablation, transcervical resection of the endometrium (TCRE), and hysterectomy will be done.

  • For endometriosis, hormonal preparations, pain relievers will be given to shrink the tissues. Laparoscopic surgery is done to remove the tissues lining the uterus.

  • Fibroids can be treated by medications that can slow or stop the growth of cancer and will relieve you from pain. Surgery can also be done to remove the fibroids.