Menstruation and women's cycles have always been cloaked in some mystery. Often referred to as the "curse," many women experience physical and emotional symptoms before and during menstruation that make it appear aptly named. For some women who experience few symptoms and whose periods are always regular, their periods are only minor inconveniences that they must cope with once a month for 3 to 7 days. Some women, however, experience symptoms that are so overwhelming that their lives are severely disrupted during their menstruation.
The menstrual cycle begins with the first day of bleeding in your cycle and ends just before the beginning of your next menstrual period. Menstruation is the cyclic shedding of the lining of the uterus which is defined as the bleeding that a woman experiences on a monthly basis throughout her reproductive life.
Menstrual periods usually start somewhere between the ages of 11 and 14 and end at menopause, the average age of which is 50. Menstrual cycles usually last from 25 to 36 days, however a normal cycle for a teenager can last as long as 45 days. As women age, cycles also tend to become longer.
Menstrual cycle disorders can occur as a result of conditions that affect the hypothalamus, pituitary gland, ovaries, uterus, cervix or vagina. Problems can range from painful periods to periods with heavy bleeding and even missed periods. If any of the symptoms that you experience during your cycle are troublesome, you likely have a menstrual cycle disorder. Some of these disorders include: amenorrhea, abnormal uterine bleeding (AUB), dysmenorrhea, premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). A brief discussion of each of the menstrual disorders follows.
Amenorrhea
Amenorrhea is the absence of menses and is differentiated as either primary or secondary amenorrhea. Primary amenorrhea is the absence of menses by the time a young girl has reached the age of 16. It is also defined as the absence of menses, and normal growth and signs of secondary sexual characteristics (such as breast development) by the age of 14. Primary amenorrhea is usually the result of an endocrine system problem (your hormone-regulating system). Delayed maturation of the pituitary gland is one of the most common reasons for primary amenorrhea. Other causes include: hypothalamic problems, problems with the ovaries or genetic abnormalities, low body weight, like that associated with eating disorders and excessive exercise, and medications. All possible reasons must be explored.
Secondary amenorrhea occurs when you have had regular periods but they have suddenly stopped for at least three months or longer. Secondary amenorrhea is associated with low body weight, low body fat percentage, very low calorie or fat intake, emotional stress, strenuous exercise and some medical conditions and illnesses. Other common causes include ovarian conditions, hypothalamic amenorrhea or prolactin secreting pituitary tumors. Hypothalamic amenorrhea occurs when the hypothalamus slows down or stops the production of gonadotropin releasing hormone (GnRH). GnRH is the hormone primarily responsible for influencing a woman's menstrual period.
The most likely causes for amenorrhea include pregnancy, lactation or age-appropriate menopause. However, it is important to notify your health care provider if you experience amenorrhea. The evaluation of amenorrhea will include a complete medical history and physical examination. Your provider may or may not order blood tests. The goal of treatment plan for amenorrhea is to correct the underlying condition. If an assessment is suspicious for a blockage in the reproductive tract, surgery is often an effective treatment for amenorrhea.
Abnormal Uterine Bleeding (AUB)
Abnormal uterine bleeding (AUB) is caused by a disruption in normal ovarian function causing a failure to ovulate. The incidence of AUB is attributed to anovulation in about 90 percent of cases. It frequently occurs during puberty and the perimenopausal years as a result of hormonal changes.
Abnormal uterine bleeding is different from normal menstrual periods in that it includes: "bleeding between periods, bleeding after sex, spotting anytime in the menstrual cycle, bleeding heavier or for more days than normal, and bleeding after menopause" (American College of Obstetricians and Gynecologists, 2008).
Causes of abnormal uterine bleeding include: hormonal imbalances, structural abnormalities or medical conditions. Medical conditions causing abnormal uterine bleeding include: thyroid problems, blood clotting disorders, liver or kidney disease or leukemia. Medications such as the anticoagulant drugs Plavix or heparin and some synthetic hormones may also be responsible.
Complications from the copper T intrauterine device, miscarriage or ectopic pregnancies also cause heavy bleeding. An ectopic pregnancy occurs when the fertilized egg grows outside of the uterus, usually in a fallopian tube. Fibroids, infection and precancerous conditions are other causes for excessive bleeding.
Treatment for abnormal or dysfunctional uterine bleeding depends on the cause for the bleeding. Once your health care provider has diagnosed the cause, treatment can begin. Options may include medications, dilation and curettage (D and C), hysterectomy, or other surgical procedures as warranted.
Dysmenorrhea
While many women experience minor menstrual cramping before or during their periods, approximately 10 percent of those women are incapacitated by severe cramps or dysmenorrhea for 1 to 3 days each month. Dysmenorrhea is designated as primary or secondary. Primary dysmenorrhea occurs without pelvic pathology, while secondary dysmenorrhea is strictly accompanied by some type of pelvic pathology.
When menstrual cramping occurs in teens, it is caused by too much of a chemical called prostaglandin. Most teens with dysmenorrhea, even though cramps may be severe, do not have any serious disease. It may be accompanied by fatigue, headaches, abdominal bloating, nausea and vomiting, or dizziness.
Primary dysmenorrhea occurs once a woman's ovulatory cycles have become established. It is the result of excessive prostaglandin release.
The most frequent causes for secondary dysmenorrhea include endometriosis, intrauterine devices (IUDs) or pelvic infection, with endometriosis thought to cause approximately half of all cases. Secondary dysmenorrhea occurs in women with a history of menstrual cramping which becomes more intense or severe. It is frequently seen in women in their 30s and 40s. Obstructive defects are indicated as causes if dysmenorrhea begins at menarche rather than after the establishment of a regular menstrual pattern.
For some women, using a heating pad or taking a warm bath helps to ease the cramping pain. Many over-the-counter medications are available to relieve symptoms. If your cramping is not relieved by medication or other interventions, or if the pain begins to interfere with work or school, you should make an appointment to see your health care provider. Treatment will depend on the cause of the problem and how severe the cramping is.
Premenstrual Syndrome (PMS)
Premenstrual syndrome is a range of symptoms that cause distressing changes during the luteal (ovulatory) phase of the menstrual cycle. The symptoms are cyclic and are a combination of physical, psychological and behavioral changes. Although estimates vary, it is believed that approximately 30 to 40 percent of menstruating women experience symptoms that have become severe enough to disrupt their normal lifestyles.
Symptoms occur approximately 5 to 7 days before your period and disappear once your period begins or soon after. There are more than 150 documented symptoms of PMS. The most common symptom is depression.
Typical physical symptoms include breast tenderness, fluid retention, abdominal bloating, increased appetite and weight gain, craving for salty or sweet foods, acne, fatigue, heart palpitations, dizziness, faintness and headaches. Although women may present to their health care provider with the above symptoms, symptoms that are truly distressing the client are usually more behavioral and emotional in nature. This symptomatology may include mood swings, irritability, anxiety, hostility, depression, crying spells, suicidal thoughts, relationship conflicts, guilt over yelling at or battering children, feelings of inadequacy, and inability to cope with the recurring symptoms.
Several theories have been put forth as to the etiology of PMS. These include hormonal imbalances, nutritional deficiencies, endocrine imbalances and lifestyle factors. Although research is inconclusive, PMS is a complex disorder. It is generally agreed to be linked to the cyclic activity of the hypothalamus--pituitary--ovarian axis. Treatment will be based on a complete physical examination in order to rule out other causes of the signs and symptoms.
Premenstrual Dysphoric Disorder (PMDD)
Approximately 3 to 8 percent of women experience premenstrual dysphoric disorder (PMDD), which is a much more severe condition than PMS. These women state that symptoms significantly interfere with their lives. The difference between PMS and PMDD has been equated to the difference between a mild tension headache and a migraine. Premenstrual dysphoric disorder has been included in the Diagnostic and Statistical Manual of Mental Disorder (DSM-IV). It is a rare condition.
The most common symptoms of PMDD are those of heightened irritability, anxiety and mood swings. Women with a history of major depression or postpartum depression are at a greater risk of developing PMDD. Symptoms are cyclical and subside within a few days of your period.
When to See Your Healthcare Provider
If you notice any changes in your cycle, you should notify your health care provider. Also, notify her if you have three or more cycles lasting longer than seven days, heavy periods, bleeding between your periods or pelvic pain not associated with your period.
Notify your health care provider for any of the following as well: if you have not started menstruating by age 15, or three years after breast growth begins, or if breast growth have not started by age 13; if your periods stopped suddenly for more than 90 days; if your periods have become very irregular after having had regular monthly cycles; if your periods occur more often than every 21 days or less frequently than every 45 days; or if you suddenly develop a high fever after using tampons (U.S Department of Health and Human Services, 2007).
Any woman who is past menopause and develops any type of vaginal bleeding should discuss her symptoms with her health care provider immediately. Your health care provider is the best source of information for any questions or concerns related to your medical problem and should always be consulted.
Tags: care provider, health care, health care provider, symptoms that, women experience, your health, uterine bleeding
