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Menstrual Irregularities

One of the most common disorders associated with menstruation among younger women is dysmenorrhea or painful periods. Another frequently encountered disorder is per-menstrual syndrome (PMS). PMS is a set of symptoms that may be experienced as the period approaches and usually ends when the bleeding starts. Other menstrual disorders include amenorrhea (absence of bleeding), menorrhagia (heavy bleeding), metrorrhagia (irregular bleeding between periods), polymenorrhea (menstruation at a 2 to 3-week intervals) and post-menopausal bleeding (six months after menopause). There are also certain menstrual irregularities seen during puberty.
What causes dysmenorrhea? Painful menstrual cramps are the cause of much suffering in women who experience them regularly. Far from being a psychological disorder, dysmenorrhea is a very real medical problem and the pain can be extremely severe. It can be caused by higher levels of prostaglandins – chemicals that regulate the tone of the smooth muscles (the non-voluntary muscles of the body such as the blood vessels and uterus). Excess prostaglandins make the smooth muscles contract.

As the next period approaches, the levels of prostaglandins in a woman’s body increase. The levels are highest when the period begins. This causes painful contractions in the uterus. The uterus contracts so violently that it cuts off blood supply. Pain then follows as the muscle is not getting enough oxygen. Also, some of the excess prostaglandins escape from the uterus into the bloodstream, and can thus affect other smooth muscles. This explains some of the symptoms that often go along with dysmenorrhea – headaches, dizziness, diarrhoea and nausea.

What medication helps to relieve dysmenorrhea? Excessive prostaglandins in the lining of the uterus is one of the main causes of dysmenorrhea. Aspirin is a mild prostaglandin inhibitor that helps some women. Ibuprofen is a more effective prostaglandin inhibitor. If you have had an allergic reaction to aspirin, a bad reaction to Motrin, or are under other medication, consult a doctor before taking the medication. Ibuprofen has some gastrointestinal side effects such as indigestion, heartburn, nausea, vomiting and diarrhoea. Most of these can be avoided by eating, or drinking a glass of milk before taking the tablet.

Can dysmenorrhea be relieved without taking medication? There are a number of methods to reduce dysmenorrhea. These include:
Heat: A hot water bottle on the lower abdomen or lower back may help to increase blood flow to the contracting muscles and reduce the spasms and the pain.
Massage: Massaging the back and abdomen can help the woman relax and give some comfort.
Exercise: Walking and aerobic exercises increase blood circulation and help to relax the abdominal muscles.
Rest: Some women find that sleeping, and relaxation exercises help reduce pain.

Amenorrhea-Amenorrhea, which is the absence or suppression of menstruation, has a number of causes. It is also one of the menstrual irregularities of puberty. Amenorrhea can be caused by abnormalities of the female reproductive tract, hormonal problems, or genetic disorders. It is further associated with stress, severe dieting and eating disorders such as anorexia nervosa, depression, drugs such as tranquillisers and antidepressants, obesity, increased levels of exercise, chronic illness such as kidney failure or colitis, and, of course, with pregnancy.

Women athletes, who have little body fat, may also experience amenorrhea. Rarely, cysts or tumours in the ovary may cause amenorrhea. Periods occasionally take some time (not usually longer than 3 months) to occur after a woman discontinues using birth control pills.

How is amenorrhea treated? The way amenorrhea is treated depends on its cause. If amenorrhea is caused by obesity, an exercise programme may restore the periods. If stress is the cause, stress management has to be employed in the treatment of amenorrhea. If there is excessive physical exercise, it will have to be reduced to restore menstruation. If there is hormonal imbalance, progesterone for 7 to 14 days every one or two months may correct the condition. Surgical treatment may be necessary for the removal of tumours or cysts from the ovaries or uterus.

Things you should do if you have amenorrhea:
Missed more than one period? It’s time to see your doctor.
Keep a record of the date your period starts, how long the cycle lasts, the amount of menstrual blood flow and other symptoms.
Find out if your family has a history of the problem.
Tell your doctor about any prescribed or non-prescribed drug you may be taking.

Things you can do to help prevent amenorrhea: Follow a healthy and balanced lifestyle by:
Eating healthy food and eating regularly
Avoiding smoking
Avoiding too much alcohol
Avoiding drugs
Avoiding stress by dividing time between work, rest, and relaxation
Menorrhagia (heavy menstrual bleeding)
When is menstrual bleeding classified as menorrhagia?
What causes menorrhagia?

When is menstrual bleeding classified as menorrhagia? When the menstrual cycle remains the same but the quantity and duration of blood loss during periods increases, it is called menorrhagia. In menorrhagia, there is heavier bleeding for a period of 7 to 10 days. It is a symptom of some other condition and not a disease by itself.

What causes menorrhagia? There are a number of causes of menorrhagia. Some of these are:
General diseases: such as blood dyscrasia, severe anaemia, psychological disorders, matrimonial disharmony, and states of emotional trauma.
Local causes: such as myomata, endometrial polyps, salpingo-oophoritis, retroversion of uterus, first menstrual period after childbirth or abortion (MTP), chocolate cysts in the ovaries, and granulosa cell tumour in the ovaries.
Endocrinal disorders: such as in the early stages of hyperthyroidism and acromegaly, the late stage of hypothyroidism, and in myxedema over the age of 40.
Intrauterine contraceptive device : (commonly known as IUCD).

You should consult a gynaecologist for the diagnosis and treatment of menorrhagia.

Metrorrhagia (Irregular bleeding between periods)

What causes metrorrhagia? The cause of metrorrhagia is always local, in the pelvis.It could be because of carcinoma of the cervix and uterine body, sub-mucous fibroids, uterine polyps, vascular erosions, or growths in the vagina or vulva.

You should consult a gynaecologist for the diagnosis and treatment of metrorrhagia.

Polymenorrhea (periods at intervals of 2 to 3 weeks)
What causes polymenorrhea?
How is polymenorrhea treated?

What causes polymenorrhea? Polymenorrhea is caused by:
Frequent ovulation caused by hyperactivity of the anterior pituitary gland.
Constitutional disorders such as malnutrition, and psychological disturbances.
Pelvic disorders such as chocolate cysts in the ovaries and chronic pelvic inflammation.

How is polymenorrhea treated? Polymenorrhea is treated by improving general health, correcting anaemia, treating pelvic causes (if any), and combined oestrogen and progesterone therapy from day 5 to day 25 of the menstrual cycle. If medical treatment does not work, dilatation and curettage (D & C) may be suggested.

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