Menstrual Disorders

Abnormal Uterine Bleeding (AUB), which may include heavy menstrual bleeding, no menstrual bleeding (amenorrhea) or bleeding between periods (irregular menstrual bleeding). 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

    Amenorreah, 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 reasons.

  • Secondary amenorrhea is 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.

Dysmenorrhea is the medical term used to describe severe cramping during a woman’s menstrual cycle. Most women have experienced menstrual cramps before or during their period at some point in their lives, and for some, it's part of the regular monthly routine. However, if your cramps are especially painful and persistent, this is called dysmenorrhea, and you should consult your health care professional regarding your symptoms.

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. That's because prostaglandins speed up contractions in your intestines, resulting in diarrhea, and lowering of your blood pressure by relaxing blood vessels (which leads to lightheadedness).

Premenstrual Syndrome (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 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 Dysphonic 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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