Dr. K. Shilpi Reddy
HOD & Sr. Consultant Obstetrician & Gynaecologist,
High-Risk Pregnancy Care, Minimal Invasive Surgeon (Mini Lap, Laparoscopy, Robotic Team)
Menstrual disorders includes disruptive physical and/or emotional symptoms just before and during menstruation, including heavy bleeding, missed periods and unmanageable mood swings.
There are many types of menstrual disorders, including:
- Abnormal uterine bleeding. Excessive or prolonged menstrual bleeding
- Amenorrhea. The absence of menstrual bleeding
- Oligomenorrhea. Light or infrequent menstruation
- Fibroids. Noncancerous uterine tumors
- Premenstrual syndrome (PMS). Physical and emotional discomfort prior to menstruation
- Premenstrual dysphonic disorder (PMDD). Severe physical and emotional discomfort prior to menstruation
Menstrual disorders can be caused by multiple factors, including:
- Uterine fibroids
- Hormonal imbalances-Thyroid problems
- Clotting disorders-Von Willebrand’s disease, ITP
- Cancer-Leukemia,Pre-cancerous Lesions of uterus
- Sexually transmitted infections (STIs)
- Polycystic ovary syndrome- cysts on the ovaries
- Medications- Anticoagulants
Symptoms may include:
- Abnormal menstrual bleeding-which may include heavy menstrual bleeding, no menstrual bleeding (amenorrhea) or bleeding between periods (irregular menstrual bleeding)
Bleeding is considered heavy if it starts to interferes with normal activities
- Dysmenorrhea-Pain or cramping
- Emotional distress
- Bloating or fullness in the abdomen
It starts with a detailed medical history and physical exam, including pelvic exam and Pap smear. You should keep a diary of your menstrual cycles, including dates, amount of flow, pain and any other symptoms.
Additional testing may include:
- Blood tests
- Hormonal tests
- Ultrasound. To detect conditions those are causing menstrual disorders.
- Hysterosonography. An ultrasound using sterile saline for better imaging of uterine cavity.
- Magnetic resonance imaging (MRI). For detailed pictures of the uterus and surrounding organs.
- Hysteroscopy. An office procedure that uses a small hysteroscope inserted through the vagina and cervix to examine the uterus for fibroids, polyps, or other areas of concerns.
- Laparoscopy. Looks for abnormalities of the reproductive organs using a laparoscope inserted through a small incision in the abdomen.
- Endometrial biopsy is an office procedure in which a small sample of the lining of the uterus is removed to examine for abnormal cells.
- Dilation and Curettage (D&C). The inner lining of the uterus and cervix is scraped to take tissue samples or relieve heavy bleeding.
Treatment for menstrual disorders depends on multiple factors like underlying cause, the woman’s desire to have children, and other factors. Treatment options ranges from lifestyle changes to medical options to surgery, including:
Dietary changes.Reduce salt, caffeine, sugar, and alcohol intake before a woman’s period to reduce cramping and other symptoms.
Medical treatment. Medication therapy is often successful as first option. The benefits last only till the time medication is taken.
Low-dose birth control pills, progestins and nonsteroidal anti-inflammatory drugs (NSAIDs) helps control heavy or irregular bleeding caused by hormonal imbalances. If your periods have stopped then oral contraceptives and contraceptive patches are highly effective in restoring regular bleeding, although they will not correct the reason you stopped bleeding. These can also help to reduce menstrual flow, improve and control menstrual patterns and relieve pelvic pain during menstruation.
These are considered for PMS treatment if your symptoms are mostly physical, but may not be effective if your primary symptom is mood changes. A newer brand of oral contraceptive containing a form of progesterone called drospirenone and marketed under the names YAZ, Yasmin, Ocella, Gianvi and Zarah, may reduce some mood-related symptoms such as anxiety, irritability, tearfulness and tension. And Yaz is FDA-approved for the treatment of PMDD.
Progestins are also used to manage heavy bleeding, particularly that resulting from a lack of ovulation. Although they are less effective compared to estrogen, they are good for long-term management.
The levonorgestrel intrauterine system (Mirena) is used to treat heavy menstrual bleeding in women who use intrauterine contraception as their method of birth control prevention.
Nonsteroidal anti-inflammatory drugs are available over the counter and with a prescription and can help reduce menstrual bleeding and cramping. These medications include ibuprofen and naproxen. Mefenamic acid (Ponstel) is a prescription-only NSAID. Common side effects are stomach upset, headaches, dizziness and drowsiness.
Tranexamic acid, has been used successfully to decrease heavy menstrual bleeding.These tablets are only taken on the days you expect to have heavy bleeding.
Surgical treatment. Surgery can be performed:
- Hysteroscopy, a minimally invasive approach to examine and treat areas of concern inside the uterus
- Laparoscopy, using a scope inserted in small incisions in the abdomen
- Through traditional abdominal techniques
- Procedures include endometrial ablation, which destroys the inner lining of the uterus to stop periods, and hysterectomy, the surgical removal of the uterus.
- Myomectomy- if cause of heavy bleeding is uterine fibroids