Contents
Menstrual disorders are a symptom of functional or organic abnormalities in the body of a woman. The disturbances may take the form of primary or secondary amenorrhea or disturbances in the rhythm of the menstrual cycle. Treatment mainly involves hormone therapy.
Menstrual disorders – what is it?
It is worth starting with what is menstruation. Menstruation is periodic bleeding from the genital tract of a sexually mature woman, which is a consequence of the changes taking place in the uterine mucosa under the influence of ovarian hormones. The phases of a woman’s life can be divided into two periods:
1. menarche – a woman’s first menstruation between the ages of 9 and 16;
2. menopause – the last menstrual bleeding in a woman’s life, followed by a minimum of a year’s break in spontaneous menstruation (occurs between 45 and 55 years of age).
What should regular, recurrent uterine bleeding be like, with the correct duration and intensity?
- cycle length: 25 – 35 days
- duration of bleeding: 3 – 7 days
- physiological blood loss: 30 – 80 ml
Primary amenorrhea (amenorrhoea primaria) is a lack of bleeding after 16 years of age. Amenorrhoea paraprimaria is the absence of menstruation in women whose first bleeding is after hormonal treatment. Secondary amenorrhea (amenorrhoea secundaria) is at least a 6-month break in menstruation in previously menstruating women. Rare menstruation (oligomenorrhoea) are cycles longer than 32 days – up to 6 months. Polymenorrhoea are frequent periods – cycles are less than 21 days.
Menstrual disorders can affect not only the frequency, but also the profusion and soreness of the bleeding. Algomenorrhoea is painful menstruation. Dysmenorrhoea is dysmenorrhea accompanied by nausea, hypomenorrhoea is scanty menstruation (a reduction in the amount of menstrual blood by more than 20% compared with previous bleeding), hypermenorrhoea – very heavy menstruation (an increase in the amount of menstrual blood by more than 20% compared with previous bleeding). Menorrhagia are heavy and prolonged periods. Metrorrhagia is vaginal bleeding that is not cycle related, often prolonged.
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The causes of menstrual disorders
Since 1976, the World Health Organization (WHO) has recognized the division of the causes of menstrual disorders into seven groups (Table 15.1; quoted from Skałba 2008).
We can also isolate the causes of primary and secondary amenorrhea.
1.Reasons influencing primary amenorrhea include:
- congenital adrenal hyperplasia,
- ovarian hypoplasia,
- gonadal dysgenesis,
- pituitary gland tumors,
- insensitivity to androgens,
- hypothalamic insufficiency,
- intersexualism,
- Rokitansky’s syndrome.
2. Reasons for secondary amenorrhea:
- dysfunction on the hypothalamic-pituitary-ovary axis,
- PCOS – polycystic ovary syndrome,
- uterine atresia.
Menstruation occurs as a consequence of the exfoliation and excretion by the female body of fragments of the lining of the uterine cavity. Sometimes girls don’t get their first period until the age of 17. If, after this time, you still have not had your period, you are suspected of:
- hormonal disorders,
- weight loss
- systemic ailments, e.g. hyperthyroidism,
- ovarian failure
- a defective uterus or vagina,
- a closed hymen that prevents secretions from escaping,
- genital infections,
- excessive stress,
- the woman is using oral hormonal contraceptives or intrauterine devices,
- changes in the uterus as a result of curettage or surgery.
The presence of excessive bleeding at a young age may indicate an immaturity of the endocrine system.
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Menstrual disorders – complete amenorrhea
Pregnancy is suspected in women who have had normal periods, but have not had cyclical bleeding for some time. Pregnancy is considered a cause, especially in women who started sexual intercourse early, even with the use of contraception. Menstruation can also stop because of nervous tension and excessive stress. Drugs often taken by women disrupt normal bleeding, inhibiting it completely. Another cause of menstrual arrest is the abnormal structure of the endometrium, i.e. the endometrium and PCOS, diabetes, ovarian or adrenal tumors.
Menstrual disorders – scanty menstruation
The cause of scanty periods is very often hormonal disorders that occur as a result of the use of contraceptive pills or IUDs. Various types of infections and surgical procedures within the uterine cavity also cause abnormal bleeding. Often, women who do not secrete enough estrogen complain of scanty periods at the gynecological office. The lack of this hormone has a big impact on the endometrium, the endometrium grows abnormally, which is why it often overgrows and insufficient exfoliation during menstruation. Meager periods, like amenorrhea, are common in PCOS and infertile women.
Menstrual disorders – excessive menstruation
Heavy menstruation especially affects young women in their puberty and women who are just before the onset of menopause. In young girls, excessive menstruation is associated with an underdeveloped endocrine system, while in mature women, hormonal disorders are a consequence of the decline of the ovarian function. Other causes responsible for excessive bleeding are: thyroid disorders, uterine polyps, endometritis, the use of intrauterine devices, problems with blood clotting, uterine fibroids.
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Symptoms of menstrual disorders
The most common symptoms that indicate menstrual disorders are:
- shortening or lengthening the time between menstruation,
- intermenstrual spotting
- the appearance of blood clots
- having more heavy periods than usual.
Unfortunately, the above symptoms are very often ignored by women, which is a big mistake. Even slight changes in the previously normal menstruation may mean that something is wrong in our body. Therefore, women should be vigilant and carefully monitor their bodies.
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Menstrual disorders and painful menstruation
During menstruation, there are spasmodic pains in the lower abdomen and the sacro-lumbar region of the spine. They are very often accompanied by other symptoms, such as headaches, nausea and vomiting, breast pain, and even fainting. There are two types of painful menstruation:
1.primary (spontaneous) – no macroscopically visible lesions in the pelvic area; primary dysmenorrhea occurs up to a year after the first bleeding, the symptoms worsen with age – the greatest at the age of 23-27. The pains are much less after the first baby is born. The etiological factors of this type of bleeding may be hormonal disorders, cervical, psychogenic and constitutional factors. In order to diagnose primary dysmenorrhea, a medical interview with the patient, ultrasound examination of the reproductive organ and pelvis as well as cytology are required. Sometimes exploratory laparoscopy and cultures from the cervical canal are also performed. Treatment of this ailment includes the use of non-steroidal anti-inflammatory drugs and ovulation blockers (e.g. combined hormonal contraception) and calcium channel blockers. Vitamin supplementation is also important.
2.secondary (acquired) – pathological changes in the pelvis, causing pain. They occur after a period of regular menstruation without any discomfort. The pain is sometimes so intense that it radiates to the groin and lumbosacral area. They may be accompanied by infertility and dyspareunia. Possible causes of acquired pain are uterine fibroids, polyps on the cervix, endometriosis and adenomyosis. The development of ailments is also influenced by the use of intrauterine devices, developmental defects of the reproductive organ, psychogenic factors and ovarian cysts.
Menstrual disorders – how to treat?
The main action in the treatment of menstrual disorders is the implementation of hormone therapy. Most often, the doctor recommends the use of oral contraceptives and anti-inflammatory drugs. Their use is to regulate bleeding and reduce its profusion.
In extreme cases, endometrial ablation is performed, especially when a woman does not respond to hormone therapy. In the course of excessive and very heavy bleeding, it is recommended to take preparations with the fruit extract of Chasteberry. Its properties reduce the concentration of prolactin and eliminate disorders caused by hyperprolactinemia.
Source: A. Cajdler-Łuba, S. Mikosiński, A. Sobieszczańska-Jabłońska, I. Nadel, I. Salata, A. Lewiński: “FUNCTIONAL DIAGNOSTICS OF HORMONAL DISORDERS WITH ELEMENTS OF DIFFERENTIAL DIAGNOSTICS; Czelej Publishing House
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