Menstrual Problems Treatment

WHAT IS THE MENSTRUAL CYCLE?

Menstrual cycle refers to ovulation, changes in the uterine wall and menstrual bleeding depending on the hormones secreted by the ovaries under the control of the hypothalamus and pituitary gland in the brain.

The average menstrual cycle (the period between the first day of menstrual bleeding and the first day of the next menstrual bleeding) is every 28 days.

Day one is considered the first day of bleeding.

The period from ovulation to the day menstruation starts varies between 12-16 days. The time between menstruation and the next ovulation can vary.

The normal menstrual bleeding period is 3-10 days. Bleeding lasting less than 3 days and more than 10 days is considered abnormal. Intense and prolonged bleeding can cause anemia and should be investigated for an underlying cause such as fibroids. Bleeding is usually heavy in the first 2-3 days of menstruation. The average blood loss during each menstrual period is 30 ml.

The average age at menarche (age at first menstruation) is 13 years (limit 11-15 years).

The average age of menopause (the age of the last menstrual period) is 47-48 years. In the first few years of menstruation and in the few years close to menopause, menstrual cycles are anovulatory, that is, there is no ovulation because the egg quality is not good.

MENSTRUAL PROBLEMS

Menstrual problems (menstrual problems) are various problems that women may experience during or related to their menstrual cycle.

Menstrual Delay (Amenorrhea):

• Primary amenorrhea: When a woman does not menstruate until the age of 16.
• Secondary amenorrhea: When a woman who menstruates regularly does not menstruate for 3 months or longer.
• Irregular Menstruation (Oligomenorrhea or Polymenorrhea):
• Oligomenorrhea: The period between two periods is longer than 40 days.
• Polymenorrhea: The period between two menstrual periods is shorter than 21 days.
• Painful periods (dysmenorrhea):
• Primary dysmenorrhea: Pelvic pain associated with the menstrual cycle, usually starting at a young age and may decrease with age.
• Secondary dysmenorrhea: Menstrual pain caused by an underlying medical condition (e.g.
• endometriosis).
• Excessive Bleeding (Menorrhagia): Menstrual bleeding that is heavier and lasts longer than normal.
• Intermittent bleeding (Metrorrhagia): Irregular vaginal bleeding that occurs outside the menstrual period.
• Premenstrual Syndrome (PMS): Physical and emotional symptoms that occur before menstruation (bloating, headache, breast tenderness, irritability, depression).
• Premenstrual Dysphoric Disorder (PMDD): A more severe form of PMS, characterized by severe emotional and physical symptoms.
• Menstrual problems can have many causes:

Hormonal imbalances,

Stress

Weight changes,

Polycystic ovary syndrome (PCOS),

Thyroid problems and other health conditions.

If changes in the menstrual cycle persist for several cycles, a gynecologist should be consulted.

MENORAJI

Menorrhagia is defined as an abnormally high amount of menstrual flow in several consecutive menstrual cycles.

In terms of quantity, the definition of menorrhagia (heavy menstrual bleeding) is a blood loss of more than 80 ml per menstrual period.

In practice, the total blood loss can rarely be calculated and is more often done by pad calculation.

Menorrhagia can also be described as a condition in which a woman finds that she is bleeding a lot and has to use more pads during her menstrual cycle than before.

Dysfunctional uterine bleeding is defined as bleeding that is profuse, prolonged or frequent, but for which pregnancy or significant systemic or pelvic disease cannot be ruled out as the cause.

One in 3 women may have heavy menstrual bleeding.

Menorrhagia can occur at any age.

However, it is especially common before menopause.

Every year, one in 20 women between the ages of 30-49 consult a doctor with the complaint of heavy bleeding.

CAUSES OF MENORRHAGIA

Fibroids that occupy space in the uterus (especially submucosal fibroids)

Anovulatory bleeding, e.g. at menarche, perimenopausal period, polycystic ovary syndrome (PCOS)

Endometrial polyp or hyperplasia

Coagulation disorders, e.g. von-Willebrand disease or anticoagulant therapy.

Intrauterine device use (IUD) (spiral)

Thyroid Diseases

Patients usually present with severe bleeding or are referred by another physician for iron deficiency anemia.

If there are clinical signs and symptoms of hypothyroidism, thyroid function tests should be checked.

Coagulation tests should be checked in patients on warfarin or in patients with signs of coagulopathy (easy bruising).

Transvaginal pelvic ultrasound evaluation should be performed to detect fibroids, ovarian cysts and endometrial thickness.

In cases where bleeding cannot be stopped with medical treatment, both diagnosis and treatment can be performed with endometrial biopsy or hysteroscopy.

Treatment

Estrogen or progesterone therapy in case of hormonal imbalance

Myomectomy if fibroids are present,

Removal of endometrial polyps if endometrial polyps are present,

Removal of the IUD if there is bleeding due to the presence of an IUD (spiral)

In patients on warfarin, INR should be regulated as rate correction.