Menstruation disorders
Some women get through their monthly
periods easily with few or no concerns. Their periods come like clockwork,
starting and stopping at nearly the same time every month, causing little more
than a minor inconvenience.
However, other women experience a
host of physical and/or emotional symptoms just before and during menstruation.
From heavy bleeding and missed periods to unmanageable mood swings, these
symptoms may disrupt a woman's life in major ways.
Most menstrual cycle problems have
straightforward explanations, and a range of treatment options exist to relieve
your symptoms. If your periods feel overwhelming, discuss your symptoms with
your health care professional. Once your symptoms are accurately diagnosed, he
or she can help you choose the best treatment to make your menstrual cycle
tolerable.
How the Menstrual Cycle Works
Your menstrual period is part of your menstrual cycle—a series of changes that
occur to parts of your body (your ovaries, uterus, vagina and breasts) every 28
days, on average. Some normal menstrual cycles are a bit longer; some are
shorter. The first day of your menstrual period is day one of your menstrual
cycle. The average menstrual period lasts about five to seven days. A
"normal" menstrual period for you may be different from what's
"normal" for someone else.
Types of Menstrual Disorders
If one or more of the symptoms you experience before or during your period
causes a problem, you may have a menstrual cycle "disorder." These
include:
- abnormal uterine bleeding (AUB), which may include heavy menstrual bleeding, no
menstrual bleeding (amenorrhea) or bleeding between periods (irregular
menstrual bleeding)
- dysmenorrhea (painful
menstrual periods)
- premenstrual syndrome (PMS)
- premenstrual dysphonic disorder (PMDD)
Read:
Infertility in Women solution
A brief discussion of menstrual
disorders follows below.
Heavy menstrual bleeding
One in five women bleed so heavily during their periods that they have to put
their normal lives on hold just to deal with the heavy blood flow.
Bleeding is considered heavy if it
interferes with normal activities. Blood loss during a normal menstrual period
is about 5 tablespoons, but if you have heavy menstrual bleeding, you may bleed
as much as 10 to 25 times that amount each month. You may have to change a tampon
or pad every hour, for example, instead of three or four times a day.
Heavy menstrual bleeding can be
common at various stages of your life—during your teen years when you first
begin to menstruate and in your late 40s or early 50s, as you get closer to menopause.
If you are past menopause and
experience any vaginal bleeding, discuss your symptoms with your health care
professional right away. Any vaginal bleeding after menopause isn't
normal and should be evaluated immediately by a health care professional.
Heavy menstrual bleeding can be caused by:
- hormonal imbalances
- structural abnormalities in the uterus, such as polyps
or fibroids
- medical conditions
Many women with heavy menstrual
bleeding can blame their condition on hormones. Your body may produce too much
or not enough estrogen or progesterone—known as reproductive hormones—necessary
to keep your menstrual cycle regular.
For example, many women with heavy
menstrual bleeding don't ovulate regularly. Ovulation, when one of the ovaries
releases an egg, occurs around day 14 in a normal menstrual cycle. Changes in
hormone levels help trigger ovulation.
Certain medical conditions can cause heavy menstrual
bleeding. These include:
- thyroid problems
- blood clotting disorders such as Von Willebrand's
disease, a mild-to-moderate bleeding disorder
- idiopathic thrombocytopenic purpura (ITP), a bleeding
disorder characterized by too few platelets in the blood
- liver or kidney disease
- leukemia
- medications, such as anticoagulant drugs such as Plavix
(clopidogrel) or heparin and some synthetic hormones.
Other gynecologic conditions that
may be responsible for heavy bleeding include:
- complications from an IUD
- fibroids
- miscarriage
- ectopic pregnancy, which occurs when a fertilized egg
begins to grow outside your uterus, typically in your fallopian tubes
Other causes of excessive bleeding
include:
- infections
- precancerous conditions of the uterine lining cells
Amenorrhea
You may also have experienced the opposite problem of heavy menstrual
bleeding—no menstrual periods at all. This condition, called amenorrhea, or the
absence of menstruation, is normal before puberty, after menopause and during
pregnancy. If you don't have a monthly period and don't fit into one of these
categories, then you need to discuss your condition with your health care
professional.
There are two kinds of amenorrhea:
primary and secondary.
Primary
amenorrhea is diagnosed if you turn 16 and
haven't menstruated. It's usually caused by some problem in your endocrine
system, which regulates your hormones. Sometimes this results from low body
weight associated with eating disorders, excessive exercise or medications.
This medical condition can be caused by a number of other things, such as a
problem with your ovaries or an area of your brain called the hypothalamus or
genetic abnormalities. Delayed maturing of your pituitary gland is the most
common reason, but you should be checked for any other possible reason
Secondary
amenorrheais diagnosed if you had regular
periods, but they suddenly stop for three months or longer. It can be caused by
problems that affect estrogen levels, including stress, weight loss, exercise
or illness.
Additionally, problems affecting the
pituitary gland (such as elevated levels of the hormone prolactin) or thyroid
(including hyperthyroidism or hypothyroidism) may cause secondary amenorrhea.
This condition can also occur if you've had an ovarian cyst or had your ovaries
surgically removed.
Severe menstrual cramps
(dysmenorrhea)
Most women have experienced menstrual cramps before or during their period at
some point in their lives. For some, it's part of the regular monthly routine.
But if your cramps are especially painful and persistent, this is called
dysmenorrhea, and you should consult your health care professional.
Pain from menstrual cramps is caused
by uterine contractions, triggered by prostaglandins, hormone-like substances
that are produced by the uterine lining cells and circulate in your
bloodstream. If you have severe menstrual pain, you might also find you have
some diarrhea or an occasional feeling of faintness where you suddenly become
pale and sweaty. That's because prostaglandins speed up contractions in your
intestines, resulting in diarrhea, and lower your blood pressure by relaxing
blood vessels, leading to lightheadedness.
Premenstrual syndrome (PMS)
PMS is a term commonly used to describe a wide variety of physical and
psychological symptoms associated with the menstrual cycle. About 30 to 40
percent of women experience symptoms severe enough to disrupt their lifestyles.
PMS symptoms are more severe and disruptive than the typical mild premenstrual
symptoms that as many as 75 percent of all women experience.
There are more than 150 documented
symptoms of PMS, the most common of which is depression. Symptoms typically
develop about five to seven days before your period and disappear once your
period begins or soon after.
Physical symptoms associated with
PMS include:
- bloating
- swollen, painful breasts
- fatigue
- constipation
- headaches
- clumsiness
Emotional symptoms associated with
PMS include:
- anger
- anxiety or confusion
- mood swings and tension
- crying and depression
- inability to concentrate
PMS appears to be caused by rising
and falling levels of the hormones estrogen and progesterone, which may
influence brain chemicals, including serotonin, a substance that has a strong effect
on mood. It's not clear why some women develop PMS or PMDD and others do not,
but researchers suspect that some women are more sensitive than others to
changes in hormone levels.
PMS differs from other menstrual cycle symptoms because
symptoms:
- tend to increase in severity as the cycle progresses
- are relieved when menstrual flow begins or shortly
after
- are present for at least three consecutive menstrual
cycles
Symptoms of PMS may increase in
severity following each pregnancy and may worsen with age until they stop at
menopause. If you experience PMS, you may have an increased sensitivity to
alcohol at specific times during your cycle. Women with this condition often
have a sister or mother who also suffers from PMS, suggesting a genetic
component exists for the disorder.
Premenstrual Dysphoric Disorder
(PMDD)
Premenstrual dysphoric disorder is far more severe than the typical PMS. Women
who experience PMDD (about 3 to 8 percent of all women) say it significantly
interferes with their lives. Experts equate the difference between PMS and PMDD
to the difference between a mild tension headache and a migraine.
The most common symptoms of PMDD are
heightened irritability, anxiety and mood swings. Women who have a history of
major depression, postpartum depression or mood disorders are at higher risk
for PMDD than other women. Although some symptoms of PMDD and major depression
overlap, they are different:
- PMDD-related symptoms (both emotional and physical) are
cyclical. When a woman starts her period, the symptoms subside within a
few days.
- Depression-related symptoms, however, are not
associated with the menstrual cycle. Without treatment, depressive mood
disorders can persist for weeks, months or years. If depression persists,
you should consider seeking help from a trained therapist.
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- It helps nourish your blood, kidneys and uterus to promote conception
- It helps normalize and regulate the menstrual cycle.
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