Menstrual Disorders

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Menstrual disorders are problems that affect a woman’s normal menstrual cycle. They include painful cramps during bleeding, abnormally heavy bleeding, or not having any bleeding. There are a number of different menstrual disorders. Problems can range from heavy, painful periods to no periods at all. There are many variations in menstrual patterns, but in general women should be concerned when periods come fewer than 21 days or more than 3 months apart, or if they last more than 10 days. Such events may indicate ovulation problems or other medical conditions. Menstruation, also called a “period,” is the monthly flow of blood from the uterus through the cervix and out through the vagina.

The uterus is a pear-shaped organ located between the bladder and lower intestine the cervix is the lower portion of the uterus, the fallopian tubes connect the uterus and ovaries.

Ovaries are egg-producing organs that hold 200,000 – 400,000 follicles (from folliculus, meaning “sack” in Latin). These cellular sacks contain the materials needed to produce ripened eggs, or ova. An egg develops within the follicle. The endometrium is the inner lining of the uterus.

During pregnancy it thickens and becomes enriched with blood vessels to house and nourish the growing fetus. If pregnancy does not occur, the endometrium is shed and a woman starts menstruating. Menstrual flow also consists of blood and mucus from the cervix and vagina.

The uterus is a hollow muscular organ located in the female pelvis between the bladder and rectum. The ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth.

The Menstrual Cycle

The menstrual cycle is regulated by the complex surge and fluctuations in many different reproductive hormones, which work together to prepare a women’s body for pregnancy. The hypothalamus (an area in the brain) and the pituitary gland control six important hormones: gonadotropin-releasing hormone (GnRH) is released by the hypothalamus. GnRH stimulates the pituitary gland to produce follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Estrogen, progesterone, and the male hormone testosterone are secreted by the ovaries at the command of FSH and LH.

The menstrual cycle begins with the first day of bleeding.

Phases of menstrual cycle

Follicular: the phase begins with menstrual bleeding. At the start of this phase, estrogen and progesterone levels are at their lowest point, which causes the uterine lining to break down and shed. At the same time, the hypothalamus produces GnRH which stimulates production of FSH and LH. As FSH levels increase, they signal the ovaries to produce follicles. Each follicle contains an egg. As FSH levels surge and decline, only one follicle and its egg continues to develop. The maturing follicle releases estrogen, which signals that an egg is mature and ready for egg release (ovulation).

Ovular: this marks the halfway point in the menstrual cycle. The ovular phase begins with a surge in LH and FSH levels. Ovulation occurs about 12 – 36 hours after LH levels surge. The follicle bursts and releases the egg, which travels down the

fallopian tube to the uterus.

A woman is most likely to get pregnant in the 3 – 5 days before ovulation or the day of ovulation. The egg can live for up to 24 hours after being released.

Luteal: after releasing the egg, the ruptured follicle closes and forms corpus luteum, a yellow mass of cells that provide a source of estrogen and progesterone during pregnancy. These hormones help the uterine lining to thicken and prepare for the egg’s fertilization. If the egg is fertilized by a sperm cell, it implants in the uterus and pregnancy begins. If fertilization does not occur, the egg breaks apart.

The corpus luteum degenerates, and estrogen and progesterone levels drop. Finally, the thickened uterine lining sloughs off and is shed along with the unfertilized egg during menstruation and the menstrual cycle begins again.

Features of Menstruation

Onset of Menstruation (Menarche). The onset of menstruation, called the menarche, typically begins between the ages of 12 – 13 years. Menarche generally occurs 2 – 3 years after initial breast development (breast budding). African-American and Hispanic girls tend to mature slightly earlier than Caucasian girls. A higher body mass index (BMI) during childhood is associated with earlier puberty and menarche. Environmental factors and nutrition may also affect when menstruation begins. Length of Monthly Cycle. The average menstrual cycle is about 28 days but anywhere from 21 days to 35 days is considered normal. Cycles tend to be longer during the teenage years and they also lengthen when a woman reaches her 40s. Cycle length is most irregular around the time that girls first start menstruating (menarche) and when women stop.

Duration of Periods. Most women bleed for around 3 – 5 days but a normal period can last anywhere from 2 – 7 days.Normal Absence of Menstruation. Normal absence of periods can occur in any woman under the following circumstances: when women breast-feed they are unlikely to ovulate. After that time, menstruation usually resumes, and they are fertile again.

Perimenopause starts when the intervals between periods begin to lengthen, and it ends with menopause itself (the complete cessation of menstruation). Menopause usually occurs at about age 51, although smokers often go through menopause earlier.

Types of Menstrual Disorders

Dysmenorrhea (Painful Cramps) is a severe, frequent cramping during menstruation. Pain occurs in the lower abdomen but can spread to the lower back and thighs. It could be primary or secondary.

• Primary dysmenorrhea: is cramping pain caused by menstruation. The cramps occur from contractions in the uterus and are usually more severe during heavy bleeding.

• Secondary dysmenorrhea: is menstrual-related pain that accompanies another medical or physical condition, such as endometriosis or uterine fibroids.Other types of abnormal bleeding are:Dysfunctional uterine bleeding (DUB) is a general term for abnormal uterine bleeding that usually refers to extra or excessive bleeding caused by hormonal problems, usually lack of ovulation (anovulation). DUB tends to occurs either when girls begin to menstruate or when women approach menopause, but it can occur at any time during a woman’s reproductive life.There are two categories: primary amenorrhea and secondary amenorrhea. These terms refer to the time when menstruation stops:Secondary amenorrhea occurs when periods that were previously regular stop for at least 3 months.Many different factors can trigger menstrual disorders, such as hormone imbalances, genetic factors, clotting disorders, and pelvic diseases.

• Causes of Dysmenorrhea (Painful Periods)

• Oligomenorrhea (Light or Infrequent Menstruation): is a condition in which menstrual cycles are infrequent, greater than 35 days apart. It is very common in early adolescence and does not usually indicate a medical problem.

• Primary amenorrhea occurs when a girl does not begin to menstruate by age 16. Girls who show no signs of sexual development (breast development and pubic hair) by age 13 should be evaluated by a doctor. Any girl who does not have her period by age 15 should be evaluated for primary amenorrhea.

• Other types of abnormal uterine bleeding include bleeding after sex and bleeding after menopause, amenorrhea (absence of menstruation) and amenorrhea is the absence of menstruation.

• Metrorrhagia, also called breakthrough bleeding, refers to bleeding that occurs at irregular intervals and with variable amounts. It refers to heavy and prolonged bleeding that occurs at irregular intervals. It combines features of menorrhagia and metrorrhagia. The bleeding can occur at the time of menstruation (like menorrhagia) or in between periods (like metrorrhagia).

• Menorrhagia is menstrual flow that lasts longer and is heavier than normal. The bleeding occurs at regular intervals (during periods). It usually lasts more than 7 days and women lose an excessive (more than 80 mL) amount of blood. Menorrhagia is often accompanied by dysmenorrhea because passing large clots can cause painful cramping. Menorrhagia is a type of abnormal uterine bleeding.

• Prostaglandins, hormone-like substances that are produced in the uterus and cause the uterine muscle to contract

• Endometriosis

• Uterine Fibroid

• Pelvic inflammatory disease

• Ovarian cysts

• Ectopic pregnancy

• The intrauterine device

Causes of Menorrhagia (Heavy Bleeding)

• Hormonal Imbalance: imbalances in estrogen and progesterone levels can cause heavy bleeding.

• Ovulation Problems: (anovulation)

• Uterine Fibroids.

• Uterine Polyps.

• Medications and Contraceptives

• Bleeding Disorders

Causes of Amenorrhea and Oligomenorrhea (Absent or Light Periods)

• Pregnancy

• Breastfeeding

• Hormonal contraceptionAge plays a key role in menstrual disorders. Girls who start menstruating at age 11 or younger are at higher risk for severe pain, longer periods, and longer menstrual cycles. Adolescents may develop amenorrhea before their ovulation cycles become regular. Women who are approaching menopause (perimenopause) may also skip periods. Occasional episodes of heavy bleeding are also common as women approach menopause.Diagnostic Procedures

• Other risk factors include: weight, longer and heavier menstrual cycles are definitely associated with painful cramps, stress, smoking and pregnancy history.

Risk Factors

• Ultrasound

• Hysteroscopy.

• Laparoscopy.

• Endometrial Biopsy.

• Menstrual Hygiene.

• Change tampons every 4 – 6 hours., avoid scented pads and tampons; feminine deodorants can irritate the genital area. Douching is not recommended because it can destroy the natural bacteria normally present in the vagina. Bathing regularly is sufficient.

• Acupuncture and Acupressure. Some studies have reported relief from pelvic pain after acupuncture or acupressure, a technique that applies small pins or pressure to specific points on the body. More research is needed.

• Yoga and Meditative Techniques. Yoga and meditative techniques that promote relaxation may help relieve menstrual cramps.

• Herbs and Supplements.

Treatment for Menstrual Disorders

• Acetaminophen (Tylenol, generic) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, generic) and naproxen.

• Oral contraceptives (birth control pills

• The LNG-IUS (Mirena), a progesterone intrauterine device (IUD.