Treatment of Menstrual Disorder, Menstrual Disorders Diagnosis & Test

Treatment of Menstrual Disorder

PCOS Treatment at Nest Hospital, Thane

A menstrual disorder refers to any condition that affects a woman's normal menstrual cycle. The menstrual cycle is a monthly process in which the female body prepares for a potential pregnancy, typically involving the shedding of the uterine lining if pregnancy does not occur, which results in menstruation (a period). Menstrual disorders encompass a range of issues related to a woman's menstrual cycle, including heavy bleeding, painful periods, irregular periods, and the absence of menstruation.

Treatment varies depending on the specific disorder, its underlying cause, and the individual's health and lifestyle.

Dysmenorrhea (Painful periods) : This may include severe cramps, back pain, and other discomforts.

Menorrhagia (Heavy Menstrual Bleeding) : Abnormally heavy or prolonged menstrual bleeding.

Oligomenorrhea (Infrequent menstrual periods): Usually defined as cycles longer than 35 days.

Amenorrhea (Absence of Menstruation) : The absence of menstruation, either primary (no menstruation by age 15) or secondary (absence of menstruation for three months or more in someone who previously had regular periods).

Premenstrual Syndrome (PMS): A group of symptoms that occur before the onset of menstruation, including mood swings, bloating, and fatigue.

Premenstrual Dysphoric Disorder (PMDD): A severe form of PMS with more intense emotional and physical symptoms.

Polycystic Ovary Syndrome (PCOS): A hormonal disorder that can cause irregular periods, excessive hair growth, acne, and infertility.

The purpose of the monthly menstrual cycle is to prepare for pregnancy. Menstrual cycles vary in length and intensity. During each menstrual cycle, an egg develops and is released from the ovaries. The lining of the uterus builds up. If a pregnancy doesn’t happen, the uterine lining sheds during a menstrual period. Then the cycle starts again.

The menstrual cycle is divided into four phases:

Menstrual phase
Follicular phase
Ovulation phase
Luteal phase

The length of each phase can vary and change over time.

Menstrual phase:

The menstrual phase is the first stage of the menstrual cycle. It’s also when you get your period. This phase starts when an egg from the previous cycle isn’t fertilized. Because pregnancy hasn’t taken place, levels of the hormones estrogen and progesterone drop.

The thickened lining of your uterus, which would support a pregnancy, is no longer needed, so it sheds through your vagina. During your period, you release a combination of blood, mucus, and tissue from your uterus.

You may have period symptoms like these:

Cramps
Tender breasts
Bloating
Mood swings
Irritability
Headaches
Tiredness
Low back pain

Follicular phase:

The follicular phase starts on the first day of your period (so there is some overlap with the menstrual phase) and ends when you ovulate. It starts when the hypothalamus signals your pituitary gland to release follicle-stimulating hormone (FSH). This hormone stimulates your ovaries to produce around 5 to 20 small sacs called follicles. Each follicle contains an immature egg. Only the healthiest egg will eventually mature. (On rare occasions, a female may have two eggs mature.) The rest of the follicles will be reabsorbed into your body. The maturing follicle sets off a surge in estrogen that thickens the lining of your uterus. This creates a nutrient-rich environment for an embryo to grow. The average follicular phase Trusted Source lasts for about 16 days. It can range from 11 to 27 days, depending on your cycle.

Ovulation phase:

Rising estrogen levels during the follicular phase trigger your pituitary gland to release luteinizing hormone (LH). This is what starts the process of ovulation.
Ovulation is when your ovary releases a mature egg. The egg travels down the fallopian tube toward the uterus to be fertilized by sperm.
The ovulation phase is the time during your menstrual cycle when you can get pregnant. You can tell that you’re ovulating by symptoms like these:

A slight rise in basal body temperature
Thicker discharge that has the texture of egg whites

Ovulation happens around day 14 if you have a 28-day cycle — right in the middle of your menstrual cycle. It lasts about 24 hours. After a day, the egg will die or dissolve if it isn’t fertilized.

Luteal phase:

After the follicle releases its egg, it changes into the corpus luteum. This structure releases hormones, mainly progesterone and some estrogen. The rise in hormones keeps your uterine lining thick and ready for a fertilized egg to implant.
If you do get pregnant, your body will produce human chorionic gonadotropin (hCG). This is the hormone pregnancy tests detect. It helps maintain the corpus luteum and keeps the uterine lining thick.
If you don’t get pregnant, the corpus luteum will shrink away and be resorbed. This leads to decreased levels of estrogen and progesterone, which causes the onset of your period. The uterine lining will shed during your period.
During this phase, if you don’t get pregnant, you may experience symptoms of premenstrual syndrome (PMS). These include:

Bloating
Breast swelling, pain, or tenderness
Mood changes
Headache
Weight gain
Changes in sexual desire
Food cravings
Trouble sleeping

The luteal phase lasts for 11 to 17 days. The average length Trusted Source is 14 days.

Menstrual disorders can be caused by various factors, including hormonal imbalances, underlying health conditions (like thyroid disorders or PCOS), stress, significant weight changes, and certain medications.
Certain health conditions are associated with missed menstrual periods. They include:

Endometriosis: Endometriosis occurs when endometrial tissue grows outside of your uterus. The tissue often attaches itself to your ovaries or fallopian tubes. Endometriosis may cause abnormal bleeding, cramps or severe pain before and during your period.
Pelvic inflammatory disease: Pelvic inflammatory disease (PID) is a bacterial infection that affects the female reproductive system. It’s typically caused by an untreated sexually transmitted infection (STI). Bacteria enter your vagina and spread to your uterus and upper genital tract. Symptoms of PID include a heavy vaginal discharge with an unpleasant odor, irregular periods and pelvic pain.
Polycystic ovary syndrome: In polycystic ovary syndrome (PCOS), your ovaries make large amounts of androgens, which are a type of hormone. This hormone prevents or delays ovulation, causing irregular periods. People with PCOS may stop menstruating completely.
Primary ovarian insufficiency: This condition occurs in cisgender women under age 40 whose ovaries don’t function as they should, causing missed or irregular periods. It can occur during treatment for cancer with chemotherapy and radiation or if you have certain autoimmune conditions.
Thyroid or pituitary gland disorders: Hypothyroidism (underactive thyroid), hyperthyroidism (overactive thyroid) and other thyroid or pituitary gland disorders affect your hormones. This causes your period to be irregular.
Bleeding disorders: You may experience heavy menstrual bleeding if you develop a bleeding or blood clotting disorder.
Uterine cancer or ovarian cancer: Certain cancers can affect a person’s menstrual period. Changes may include bleeding that’s heavier than usual or missed periods.
Birth control pills: Most birth control pills contain a combination of hormones. The pills prevent pregnancy by keeping your ovaries from releasing eggs. Going on or off birth control pills can affect menstruation. You may have irregular or missed periods for up to six months after discontinuing birth control pills.
Medications, such as steroids or anticoagulant drugs (blood thinners).
Miscarriage or an ectopic pregnancy (the fertilized egg implants outside your uterus).
Surgery, scarring or blockages in your uterus, ovaries or fallopian tubes.

Menstrual disorders encompass a variety of conditions that affect a woman's menstrual cycle, such as irregular periods, heavy bleeding, painful periods, and absence of periods. Diagnosing these conditions involves a combination of patient history, physical examinations, and various diagnostic tests.
The diagnosis of menstrual disorders is complex and involves a combination of detailed patient history, physical exams, and a variety of diagnostic tests. The specific tests selected will depend on the individual’s symptoms and clinical findings. After diagnosis, appropriate treatment can be planned based on the underlying cause.

Patient History
- Menstrual History: Details about the menstrual cycle, including age at menarche, cycle regularity, duration, flow amount, and presence of pain.
- Medical History: Information on past medical conditions, surgeries, medications, and any family history of menstrual disorders.
- Lifestyle Factors: Diet, exercise, stress levels, and sexual activity.

Physical Examination
- General Examination: Assessment of overall health, including weight, BMI, signs of hirsutism, acne, or other conditions linked to hormonal imbalances.
- Pelvic Examination: Examination of the reproductive organs to detect any abnormalities such as fibroids, ovarian cysts, or signs of infection.

Diagnostic Tests
- Hormone Levels: Blood tests to measure levels of key hormones, including:
  1. Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH): To assess ovarian function.
  2. Estrogen and Progesterone: To evaluate the menstrual cycle phase.
  3. Thyroid-Stimulating Hormone (TSH): To check for thyroid disorders, which can affect menstruation.
  4. Prolactin: Elevated levels can indicate a pituitary gland issue.
  5. Androgens (Testosterone, DHEAS): Elevated levels can be a sign of polycystic ovary syndrome (PCOS) or other androgen-excess disorders.
- Involves taking a small sample of the uterine lining to be examined under a microscope. This can help diagnose conditions like endometrial hyperplasia or cancer, especially in cases of abnormal uterine bleeding.
- A procedure where a thin, lighted tube is inserted through the cervix to examine the inside of the uterus. This is useful for diagnosing uterine abnormalities like polyps or fibroids.
- An ultrasound technique enhanced with saline infusion to get a clearer view of the uterine cavity and endometrial lining.
- A minimally invasive surgical procedure where a camera is inserted into the abdomen to directly visualize the pelvic organs. It is particularly useful for diagnosing endometriosis, pelvic adhesions, or other pelvic pathologies.

Additional Tests:
- Pap Smear: To check for cervical dysplasia or cancer.
- Cervical Cultures: To rule out sexually transmitted infections (STIs) that could affect menstrual health.
- Pregnancy Test: To rule out pregnancy as a cause of missed periods (amenorrhea).

Specialized Tests:
- Ovulation Testing: May involve tracking basal body temperature, luteal phase progesterone levels, or home ovulation predictor kits.
- Genetic Testing: In cases where a genetic condition like Turner syndrome or Fragile X syndrome is suspected, genetic testing may be indicated.

Dysmenorrhea (Painful Periods) : Treatment Options:
- Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Ibuprofen or naproxen can help reduce menstrual cramps.
- Hormonal Birth Control: Birth control pills, patches, or intrauterine devices (IUDs) can regulate or lighten periods, reducing pain.
- Heat Therapy: Applying a heating pad to the lower abdomen can alleviate cramps.
- Lifestyle Changes: Regular exercise, adequate sleep, and stress management can help reduce symptoms.
- Alternative Therapies: Acupuncture, yoga, and herbal remedies like ginger or magnesium supplements may offer relief.

Menorrhagia (Heavy Menstrual Bleeding) Treatment Options:
- Hormonal Therapy: Birth control pills, hormonal IUDs, or progesterone can reduce heavy bleeding.
- Tranexamic Acid: A medication that helps reduce blood loss during menstruation.
- Iron Supplements: To treat or prevent anemia due to heavy bleeding.
- Surgical Options: In severe cases, procedures like endometrial ablation (removal of the uterine lining) or hysterectomy (removal of the uterus) may be considered.

Amenorrhea (Absence of Menstruation) Treatment Options:
- Addressing Underlying Conditions: Treating conditions like polycystic ovary syndrome (PCOS), thyroid disorders, or pituitary issues.
- Lifestyle Changes: Weight management, reducing excessive exercise, or managing stress.
- Nutritional Support: For cases related to eating disorders or malnutrition, proper nutrition and weight restoration are key.

Oligomenorrhea (Infrequent Periods) Treatment Options:
- Hormonal Therapy: Birth control pills or hormone therapy to regulate the cycle.
- Lifestyle Changes: Addressing factors like stress, excessive exercise, or underweight/overweight issues.
- Treatment of Underlying Conditions: Managing conditions like polycystic ovary syndrome (PCOS) or thyroid disorders can restore regular cycles.

Polycystic Ovary Syndrome (PCOS) Treatment Options:
- Weight Management: Diet and exercise to help regulate the menstrual cycle.
- Hormonal Birth Control: Birth control pills or other hormonal treatments to stabilize hormone levels.
- Metformin: medication used to manage insulin resistance, commonly associated with PCOS.
- Fertility Treatments: For women trying to conceive.

Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) Treatment Options:
- Lifestyle Changes: Regular exercise, a balanced diet, and adequate sleep.
- Medications: NSAIDs for pain, antidepressants for severe PMS or PMDD, hormonal birth control to regulate mood swings.
- Supplements: Calcium, magnesium, and vitamin B6 might help alleviate symptoms.

Endometriosis Treatment Options:
- Pain Relief: NSAIDs or stronger pain medications as needed.
- Hormonal Therapy: Birth control pills, GnRH agonists, or progestins to reduce or stop menstruation.
- Surgery: Laparoscopy to remove endometrial tissue outside the uterus.

Fibroids Treatment Options:
- Hormonal Therapy: Birth control pills, progestins, or GnRH agonists to manage symptoms.
- Non-surgical Procedures: Uterine artery embolization (cuts off blood supply to fibroids) or MRI-guided focused ultrasound.
- Surgery: Myomectomy (removal of fibroids) or hysterectomy in severe cases.

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Treatment of Menstrual Disorder

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