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Menstrual Disorders Management

Irregular Periods

Irregular Periods, also known as abnormal menstruation, is categorized by:

  • Periods occurring less than 21 days apart, or more than 35 days apart
  • Missing more than three periods in a row, or no period for more than 90 days
  • Menstrual flow that is much heavier or lighter than normal
  • Prolonged periods (more than seven days)
  • Painful periods that are accompanied by nausea, extreme cramping or vomiting
  • Bleeding or spotting in between periods, after sex, or after menopause

Causes of Irregular Periods

There are many different causes of irregular periods, ranging from common to more serious.

  • Changes in your routine: changes in your exercise routine, travelling, illness, stress, or any significant weight gain or loss may impact your period.
  • Birth Control: Any hormonal birth control methods can affect your period. For questions on how your birth control may affect your period, contact us.
  • Uterine polyps or fibroids: Uterine polyps are noncancerous growths in the lining of the uterus, and fibroids are benign growth that attach to the wall of the uterus. Both of these have the potential to cause pain or heavy bleeding during your period.
  • Endometriosis: Endometriosis occurs when the tissue that lines the uterus grows outside of the uterus. Endometriosis can cause abnormal bleeding, pain during sex, and pain before and during menstruation. 
  • Pelvic Inflammatory Disease: Pelvic inflammatory disease (PID) is a bacterial infection that affects the female reproductive system. PID can result in irregular periods, though other symptoms include pain in the lower abdomen, nausea, vomiting, fever, and a heavy vaginal discharge.
  • Polycystic Ovary Syndrome (PCOS): PCOS occurs when the ovaries produce large quantities of the male hormone, androgen, and cysts form in the ovaries. Because the androgen affects hormone levels, women with PCOS may menstruate irregularly, or may cease to menstruate at all.
  • Premature Ovarian Insufficiency: This occurs when the ovaries do not function properly in women under the age of 40, ceasing menstruation. Premature ovarian insufficiency can occur in women who are undergoing radiation or chemotherapy for cancer treatment, women with chromosomal abnormalities, or who have a family history of ovarian insufficiency. 
  • Medical Conditions: Certain medical conditions such as certain cancers, blood disorders, or complications associated with pregnancy, may result in irregular or abnormal menstruation.

The cause of the irregular period can be diagnosed by:

  • Blood tests
  • A pelvic ultrasound
  • An endometrial biopsy

Treatments 

More common cases of irregular periods can be regulated through use of a hormonal birth control. 

Uterine fibroids can be treated medically, with a low dose hormonal birth control or progestin injections such as depo-provera , or surgically with a myomectomy procedure. 

While there is no cure for endometriosis, certain birth controls and over the counter pain relievers may assist with discomfort and surgery is used for some cases.

Heavy Menstrual Periods

If you experience abnormally heavy or prolonged periods, then you may be suffering from menorrhagia

Those who are diagnosed with menorrhagia cannot participate in day-to-day activities because their bleeding and cramping is so severe. Other symptoms of menorrhagia may include:

  • Bleeding through one or more tampons or pads every hour for 2 or more consecutive hours
  • Needing to use multiple forms of sanitary items to control your menstrual flow
  • Having an inability to participate in normal daily activities due to the amount of bleeding
  • Interruption of sleep schedule in order to change out sanitary products
  • Experiencing a menstrual flow of longer than a week
  • Passing blood clots larger than a quarter
  • Showing signs of anemia

Causes of Heavy Menstrual Periods

There are many different factors that may contribute to heavy menstrual periods, including:

  • Hormonal imbalances: Hormonal imbalances can be caused by polycystic ovary syndrome (PCOS), thyroid problems, obesity, resistance to insulin, or dysfunction of the ovaries.
  • Uterine polyps or fibroids: Uterine polyps are noncancerous growths in the lining of the uterus, and fibroids are benign growth that attach to the wall of the uterus. Both of these have the potential to cause prolonged periods and/or a heavy flow.
  • Adenomyosis: Adenomyosis occurs when glands from the endometrium become embedded in the uterine muscle, resulting in heavy bleeding and painful periods.
  • Intrauterine device (IUD): Menorrhagia is a well-known side effect of using a non hormonal intrauterine device for birth control.
  • Pregnancy complications: A single, heavy, late period may be due to a miscarriage. Another cause of heavy bleeding during pregnancy includes an unusual location of the placenta.
  • Other medical conditions: Certain cancers such as uterine or cervical cancers, liver or kidney disease, and inherited bleeding disorders may be associated with menorrhagia.

Treatments

Menorrhagia, depending on the severity, can be treated by medication or certain medical procedures. 

Some medications include:

  • Over-the-counter pain relievers: medications like Ibuprofen and Aleve can relieve heavy, painful menstruation
  • Tranexamic acid: helps to reduce blood loss and only needs to be taken at the time of bleeding
  • Hormonal birth control methods: birth control pills and IUDs can help reduce heavy periods

Possible procedures are:

  • Dilation and curettage: dilation and curettage (D&C) consists of a doctor dilating the cervix, and then suctioning tissue from the lining of the uterus to reduce bleeding
  • Myomectomy: a myomectomy is the surgical removal of the uterine fibroids
  • Polypectomy: surgical removal of endometrial polyp
  • Endometrial ablation: this procedure uses laser to destroy the lining of the uterus
  • Uterine artery embolization: this procedure ultimately aims to inject the blood vessel within the uterine artery with materials to decrease blood flow to the fibroids in the uterus
  • Focused ultrasound surgery: this surgery treats excessive bleeding by shrinking the fibroids by use of ultrasound waves
  • Hysterectomy: In serious cases, the removal of the uterus and cervix may become necessary, resulting in an end of fertility and menstrual cycles

Painful Periods

Painful periods, known as dysmenorrhea, is one of the most commonly reported menstrual disorders. There are two types of dysmenorrhea: primary and secondary.

Primary dysmenorrhea is pain that comes directly from a menstrual period, such as cramps. It is typically caused by natural chemicals from the uterus called prostaglandins.

Secondary dysmenorrhea is pain caused in the reproductive system, and may begin later in life than primary dysmenorrhea. The pain associated with secondary dysmenorrhea may last longer than normal menstrual cramps and may get worse over time.

Certain disorders that can cause secondary dysmenorrhea include

  • Endometriosis: Endometriosis occurs when the tissue that lines the uterus grows outside of the uterus.
  • Adenomyosis: A condition where tissues that normally line the uterus begins to grow in the muscle wall of the uterus.
  • Fibroids: Non cancerous growths that form on the walls of the uterus.

Diagnostic Testing for Dysmenorrhea

  • Physical exam
  • Pelvic ultrasound
  • Laparoscopy

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