Menstrual Irregularities

Abnormalities in the menstrual cycle of a woman are menstrual irregularities.

Types of Menstruation Irregularities

Various causes of menstrual irregularities include:

  • Amenorrhoea - No menstrual periods until the age of 16 years or absence of menstrual periods for 3 consecutive months

  • Dysmenorrhoea - Painful menstruation periods - 

  • Menorrhagia - Excessive bleeding which lasts for 8 to 10 days and is defined as more than 80ml blood loss per month

  • Oligomenorrhea - Very infrequent periods

  • Polymenorrhea - Very frequent periods

  • Premature ovarian failure – Normal function of the ovary is stopped. Also called premature menopause

Menstrual irregularities should be diagnosed early to prevent complications such as infertility (inability to get pregnant), anaemia, haemorrhage, and uterine cancer. Treatment includes:

  • For dysmenorrhoea, ibuprofen and naproxen are given to relieve pain.

  • For menorrhagia, iron supplements and anti-prostaglandin medications are given.  In severe cases of menorrhagia, surgeries such as thermal balloon endometrial ablation, transcervical resection of the endometrium (TCRE), and hysterectomy will be done.

  • For endometriosis -hormonal preparations and pain relievers can be given. The gold standard of treatment for endometriosis is laparoscopy.

  • Fibroids can be treated by medications that can slow or stop the growth of cancer and will relieve you from pain. Surgery can also be done to remove the fibroids.


Symptoms of Menstrual Disorders

Symptoms associated with menstrual disorders are:

  • Irregular periods

  • Lower back pain

  • Sense of burning during urination

  • Infertility (difficulty getting pregnant)

  • Fever

  • Abdominal cramps

  • Unusual vaginal discharge

Causes of Menstrual Disorders

Hormones play an important role in regulating growth and other bodily functions.

At the onset of puberty, a mixture of female and male sex hormones is produced for sexual maturity. An imbalance in these hormones or increased production of male hormones can lead to hirsutism (high levels of the male sex hormone androgen) and menstrual disorders. This is a condition called Polycystic Ovarian Syndrome (PCOS).

The recent increase in childhood and adolescent obesity is also a major factor that has led to the high incidence of hirsutism and menstrual disorders.

Other causes may include:

  • Dysmenorrhoea - may occur due to endometriosis (chronic condition where the uterine lining grows over the ovaries and bladder) or fibroids (noncancerous growth on the walls of the uterus), cyst in the ovaries and the use of intrauterine contraceptive devices (IUDs).

  • Menorrhagia - may be caused due to uterine fibroids, problems in ovulation (release of fully developed ovarian cells), endometriosis, uterine polyps (small benign growth), cancer, severe infection, miscarriage or ectopic pregnancy (pregnancy outside the womb), certain medications and IUCDs.

  • Oligomenorrhoea - may develop due to polycystic ovary syndrome (ovarian cysts), weight loss, endometriosis, stress and medications.

Treatments for Menstruation Disorders

Dr Cook may prescribe hormone therapy or oral contraceptive pills to treat menstrual disorders.

Surgical procedures may include the removal of fibroids, cysts or tumours. Surgery may be recommended only in cases of severe menstrual disorders.


What is Dysmenorrhoea?

Period pain or dysmenorrhea is a condition of painful menstrual periods. Menstrual cramps or pain is felt in the abdominal areas and can occur before the menstrual cycle begins and can continue for 2 to 3 days.

Primary dysmenorrhea is the common painful condition in women with no abnormalities in the pelvic region. Women may experience severe pain before or at the onset of menstrual periods and the pain persists for 2–3 days.

Causes of Primary Dysmenorrhea

Primary dysmenorrhea is caused by the elevated levels of the hormone prostaglandin produced by the tissues lining the uterus (womb). Prostaglandin triggers the uterine muscles to contract and push the uterine bleeding/clots out of the body through the cervix.

Primary dysmenorrhoea can be seen in young girls from menarche or just after. It can often resolve spontaneously at the end of the teenage years.

Causes of Secondary dysmenorrhoea

Secondary dysmenorrhoea is the painful condition that may be caused because of other gynaecological problems. This kind of pain begins early in the menstrual cycle and lasts longer than primary dysmenorrhea.

Conditions that may cause secondary dysmenorrhea include

  • endometriosis,

  • adenomyosis

  • fibroids,

  • infection,

  • ovarian cysts,

  • narrow cervix

  • intrauterine device for birth control.

Symptoms of Dysmenorrhoea

Some of the commonly observed symptoms are

  • back pain,

  • leg pain,

  • nausea,

  • vomiting,

  • diarrhea,

  • headache,

  • irritability,

  • weakness and

  • fainting.

Diagnosis of Dysmenorrhoea

Dr Cook will perform a pelvic examination to identify if there are any other problems associated with menstrual cramps.

Blood tests and cervical cultures will confirm if there is any sign of infection. Other diagnostic tests may be required which include MRI scan and ultrasound scan.

Non Surgical Treatment for Dysmenorrhoea

If the menstrual cramps are because of the underlying medical conditions, then treating the conditions will help to relieve pain.

The conservative approach includes non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain and contraceptive pills which decrease the production of prostaglandins by preventing ovulation. However, these medicines are taken before the menstruation begins.

NSAIDs are contraindicated if you have a history of kidney and stomach problems.

The other home remedies such as a heating pad to the pelvic area, regular exercises, massage to the back and abdomen, low-fat diet, and intake of calcium and thiamine tablets may help to treat period pain. Some women can find acupuncture useful.

intra-uterine contraceptive deviceS

An intra-uterine contraceptive device IUD releases progesterone which causes hormonal thinning of the endometrium. 95% of women find their periods are lighter and less painful. 30% do not have any periods with an intra-uterine contraceptive device

Surgical Treatments for Dysmenorrhoea

  • Laparoscopy for endometriosis - with excision of deposits of endometriosis. This is known to alleviate pain. An intra-uterine contraceptive device can be inserted in the uterus following this procedure.

  • Hysterectomy – It is the surgical removal of the entire uterus. It is recommended if you have fibroids, uterine prolapse, cancer in the uterus, and vaginal bleeding. This procedure will stop periods. It is not recommended for women who want to have children.


What is Menorrhagia

Menorrhagia is a condition characterized by abnormally heavy or extended menstrual bleeding.

Symptoms of Menorrhagia

The most common symptoms of menorrhagia are:

  • Menstrual flow that soaks one or more pads per hour for several consecutive hours

  • The need to use double sanitary protection to control the flow of blood

  • Need to change your pad frequently during the night

  • Menstrual period that lasts longer than seven days

  • Menstrual flow that includes large blood clots and flooding

  • Affect the daily routine activities due to heavy menstrual flow

  • Fatigue, weakness or shortness of breath (symptoms of anemia)

Causes of Menorrhagia

The cause of menorrhagia is not known in some cases. However, several conditions that may cause menorrhagia include

  • hormonal imbalance,

  • dysfunction of the ovaries,

  • uterine fibroids (non-cancerous (benign) tumors of the uterus),

  • uterine polyps,

  • adenomyosis (where endometrial glands are found in the muscular wall of the uterus),

  • Non hormonal intrauterine devices (IUDs) - including Load 375,

  • cancer,

  • inherited blood disorders,

  • certain medications (anti-inflammatory medications and anticoagulants), and

  • pelvic inflammatory disease (PID),

  • thyroid problems,

  • endometriosis, and

  • liver or kidney disease.

Diagnosis of Menorrhagia

Dr Cook will do a pelvic examination and may recommend other tests or procedures such as

  • pelvic ultrasound scan

  • biopsy of the lining of the womb if the woman is over 40 years of age.

  • hysteroscopy

Biopsy is a technique of removing a piece of tissue from the inner lining of the uterus and examining it under a microscope. This is done to make sure that the cells are growing normally.

Dr Cook may also recommend an examination called hysteroscopy, which involves placing a tiny tube with a light through your cervix to obtain a direct view of the lining of the womb.

Non Surgical Treatments for Menorrhagia

Treatment options will depend on the cause of menorrhagia, the severity of menorrhagia and the overall health of the patient. Some common treatments include:

  • Iron supplements may be started if your iron levels are low.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) may help reduce menstrual blood flow as well as cramping.

  • Oral contraceptives may be given to help reduce bleeding and make menstrual cycles more regular.

  • Oral progesterone may be given to help correct hormonal imbalance and reduce menorrhagia.

  • Intra-uterine Contraceptive Device IUD is a type of intrauterine device which may be used to release progesterone in the womb that thins the uterine lining and reduces the blood flow.

Surgical Treatments for Menorrhagia

Surgery may be needed if medication therapy is not successful. The surgical procedures include:

  • Dilation and curettage (D&C): It is a procedure in which the cervix is dilated and the lining of the uterus is scraped to reduce menstrual bleeding. You may need additional D&C procedures if menorrhagia recurs. This procedure also allow the gynaecologist to take biopsy and check for abnormal endometrial cells. This is considered diagnostic not therapeutic.

  • Hysteroscopy: This procedure involves the use of a hysteroscope, a tiny tube with a light to view your uterine cavity and to remove abnormalities such as a polyp or a fibroid that may be causing heavy menstrual bleeding.

  • Endometrial ablation: It is a procedure that permanently destroys the entire lining of your uterus (endometrium) resulting in little or no menstrual flow. Dr Cook performs a Novasure Endometrial Ablation

  • Hysterectomy: It is a surgical removal of the uterus and the cervix.

Surgical procedures such as hysterectomy, endometrial ablation, and endometrial resection are for women who decide not to be pregnant or have finished their family. Therefore, discuss with Dr Cook about the treatment options if you plan to get pregnant in the future.

For endometriosis, hormonal preparations can be used and/or, Laparoscopic surgery to remove the endometriosis tissue from pelvic peritoneum.

Fibroids, depending on their location and size can either be left alone and followed up by ultrasound or  treated by medications and /or Surgery remove the fibroids.