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 regular menstrual cycle is a clear sign of 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 menstrual cycle of woman is called as menstrual irregularities. Various menstrual irregularities include:

• Amenorrhea – No menstrual periods until the age of 16 years or absence of menstrual periods for 3 consecutive months and is not pregnant
• Dysmenorrhoea – Painful menstruation periods
• Menorrhagia – Excessive bleeding which lasts for 8 to 10 days
• Oligomenorrhoea – Irregular menstrual periods or getting periods frequently
• Premature ovarian failure – Normal function of the ovary is stopped
• Uterine fibroids – Non-cancerous tumours observed in women of child bearing potential
• Endometriosis – In this tissues lining the uterus from inside grow outside the uterus (normally the tissue grows inside the uterus)

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, haemorrhage, and uterine cancer. Treatment includes

• For amenorrhea, medroxyprogesterone will be 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 fibroid and will relieve you from pain. Surgery can also be done to remove the fibroids.

Menorrhagia

Menorrhagia is a condition characterized by abnormally heavy or extended menstrual bleeding. With menorrhagia, you may have an adequate blood loss and pain that disturbs your normal activities.

The most common symptoms of menorrhagia are:

• Menstrual flow that soaks one or more pads per hour for several consecutive hours
• The need to use double sanitary protection to control the flow of blood
• Need to change your pad frequently during the night
• Menstrual period that lasts longer than seven days
• Menstrual flow that includes large blood clots
• Affect the daily routine activities due to heavy menstrual flow
• Fatigue, weakness or shortness of breath (symptoms of anemia)

The cause of menorrhagia is not known in some cases; however several conditions that may cause menorrhagia include hormonal imbalance, dysfunction of the ovaries, uterine fibroids (noncancerous [benign] tumors of the uterus), uterine polyps, adenomyosis (where endometrial glands are found in the muscular wall of the uterus), intrauterine devices (IUDs), pregnancy complication, cancer, inherited blood disorders, certain medications (anti-inflammatory medications and anticoagulants), and other medical conditions such as pelvic inflammatory disease (PID), thyroid problems, endometriosis, and liver or kidney disease.

Your doctor will do a pelvic examination and may recommend other tests or procedures such as a pelvic ultrasound scan or a biopsy of the lining of the womb if the woman is over 40 years of age. Biopsy is a technique of removing a piece of tissue from the inner lining of the uterus and is examined under a microscope. This is done to make sure that the cells are growing normally. Your doctor may also recommend an examination called hysteroscopy, which involves placing a tiny tube with a light through your cervix to obtain a direct view of the lining of the womb.

Treatment options will depend on the cause of menorrhagia, the severity of menorrhagia and the overall health of the patient. Some common treatments include:

• Iron supplements may be started if your iron levels are low
• Non-steroidal anti-inflammatory drugs (NSAIDs) may help reduce menstrual blood flow as well as cramping
• Oral contraceptives may be given to help reduce bleeding and make menstrual cycles more regular
• Oral progesterone may be given to help correct hormonal imbalance and reduce menorrhagia

• Mirena, a type of intrauterine device which releases progestin in the womb that thins the uterine lining and reduces the blood flow may be used.

Surgery may be needed if medication therapy is not successful. The surgical procedures include:

• Endometrial ablation: It is a procedure that permanently destroys the entire lining of your uterus (endometrium) resulting in little or no menstrual flow.
• Dilation and curettage (D&C): It is a procedure in which the cervix is dilated and the lining of the uterus is scraped to reduce menstrual bleeding. You may need additional D&C procedures if menorrhagia recurs.
• Hysterectomy: It is a surgical removal of the uterus and the cervix that leads to infertility and the cessation of menstrual periods.
• Hysteroscopy: This procedure involves the use of a hysteroscope, a tiny tube with a light to view your uterine cavity and to remove abnormalities such as a polyp that may be causing heavy menstrual bleeding.
• Endometrial Resection: It is a surgical procedure that uses an electrosurgical wire loop to remove the lining of the uterus.

Surgical procedures hysterectomy, endometrial ablation, and endometrial resection may reduce your ability to become pregnant. Therefore discuss with your doctor about the treatment options if you plan to become pregnant in the future.