Menstrual Cycle - The Common Complaints

The most common issue females report to health care providers are related to menstruation commonly referred to as monthly ‘periods’.

Normal menstrual cycle

 The normal menstrual cycle can vary greatly in time of onset and cessation, duration , frequency , associated discomfort and how it affects a woman’s life.

Menstrual disorders are disruptive physical and/or emotional symptoms just before and during menstruation.

including heavy bleeding, missed periods and unmanageable mood swings. Some women get through their monthly periods easily with few or no concerns.

Control Of Menstrual Cycle

Female sex hormones (Estrogen & Progesterone) have a basic and complex role in control of menstruations, yet menstrual cycle is controlled by a complex interplay of a multitude of hormones, so factors altering the hormonal homeostasis can alter the menstrual patterns.

Types Of Menstrual Disorders:
  • Abnormal uterine bleeding. Excessive or prolonged menstrual bleeding.
  • Amenorrhea. The absence of menstrual bleeding.
  • Oligomenorrhea. Light or infrequent menstruation.
  • Dysmenorrhea (painful periods)
  • Premenstrual syndrome (PMS). ...
  • Premenstrual dysphoric disorder (PMDD)

Causes Of Menstrual Disorders:

Menstrual irregularities have a variety of causes, including pregnancy, hormonal imbalances, infections, diseases, trauma, and certain medications.

Treatment Of Menstrual Disorder

If the prostate cancer is aggressive, it tends to spread outside the prostate at an early stage. Common sites for the spread are the ends of long bones, pelvic girdle and lymph nodes. To determine the spread outside the prostate following tests are helpful:

- Treatment Of Menstrual Disorder
  • Applying a heating pad to the abdomen. 
  • Non steroidal anti-inflammatory medications. (NSAIDs), such as ibuprofen, Mefenamic acid.
  • Hormonal therapies including contraceptive pills, injectables, hormone containing implants or intra uterine systems e.g. Mirena.

Treatment of Abnormal Uterine Bleeding:

- Medical
  • Non steroidal anti-inflammatory medications. (NSAIDs), such as Mefenamic acid.
  • Fibrinolytics such as Tranexamic acid.
  • Hormonal treatments
    • Birth control pills
    • Progestin (can be given by a shot, implant or device placed in the uterus called an IUGS).
  • Gonadotropin-releasing hormone (GnRH) agonists /antagonists;
    • manage heavy period bleeding related to fibroids, generally used to reduce the size before surgery.
- Surgery
  • Hysteroscopy:  Removal of atypical structures from uterus, like fibroids and polyps.
  • Uterine artery embolization: Stops blood flow to fibroids, causing shrinkage.
  • Myomectomy
  • Endometrial ablation:  Destroys endometrial lining by laser, heat, electricity, microwave energy or freezing.
  • Hysterectomy is often used to treat cancer or cancerous changes in endometrium / myomas.
- Prevention

Prevention of abnormal uterine bleeding is not always possible, however risks can be reduced by,

  • maintaining a healthy weight ,
  • Avoiding diets that contain a high amount of animal fat,
  • Practicing safer sex can reduce risk of certain Sexually transmitted infections (STIs) that can cause abnormal uterine bleeding.
- Treatment of Amenorrhea
- Primary Amenorrhea:

requires detailed history, examination, specialized investigations & endocrinologist input.

- Secondary Amenorrhea:

birth control pills or other hormone therapies can restart menstrual cycles. Amenorrhea caused by thyroid or pituitary disorders may be treated with medications. If a tumour or structural blockage is causing the problem, surgery may be necessary.

- Treatment for Oligomenorrhea
  • Hormone therapy (HT).
  • progestin can also help trigger periods.
  • oral contraceptives) containing the hormones estrogen and progesterone to help control irregular periods.

Treatment of PMS and PMDD

  • Changes in diet to increase protein and carbohydrates and decrease sugar, salt, caffeine, and alcohol.
  • Regular exercise.
  • Stress management.
  • Anti-inflammatory medicines.
  • Selective serotonin reuptake inhibitors (SSRI)
  • Birth control pills.

Author:

Dr Zeenat Umar

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