Menstrual Disorders

Definition

Anything that interferes with the normal menstrual cycle, causing pain, unusually heavy or light bleeding, or missed periods.

Description

Typically, a woman of childbearing age should menstruate every 28 days or so unless she's pregnant or moving into menopause. But numerous things can wrong with the normal menstrual cycle, some the result of physical causes, others emotional. These include amenorrhea, or the cessation of menstruation, menorrhagia, or heavy bleeding, and dysmenorrhea, or severe menstrual cramps. Nearly every woman will experience one or more of these menstrual irregularities at some time in her life.

Amenorrhea

Simply following a healthy exercise and nutritional program can help prevent amenorrhia, as can reducing stress and learning relaxation techniques. Also, avoiding excessive alcohol intake and quitting smoking may prevent missed periods.

Dysmenorrhea

Prevention includes certain dietary supplements and vitamins described above. Exercise may also help.

Menorrhagia

There's little women can do to prevent this menstrual irregularity other than discovering the root cause. One thing they can do, however, is stop using an IUD, which can often cause heavier bleeding.

Diagnosis

Women should seek care from a gynecologist, family practitioner or internist for menstrual irregularities. Depending on the problem, various tests and procedures will be performed, but the one common to any menstrual problem is a pelvic exam. This should be scheduled when women are not menstruating, simply for convenience sake.

Male doctors typically have a female nurse or assistant in the room. The exam begins by checking the external genitalia for any sores or irregularities. Then the doctor inserts a speculum (a metal duckbill-shaped device that holds open the vagina) into the vagina and peers throughout the opening to evaluate the health of the cervix (opening of the uterus), and inside the vagina, looking for growths or any other abnormalities.

The doctor will also manually examine the woman, inserting two fingers into the vagina while pressing on the abdomen, again feeling for any lumps or other abnormalities, checking the size and shape of the reproductive organs, and watching for any signs of infection, such as tenderness or pain. The exam is typically covered by insurance and takes about 10 minutes.

Other tests that will be done for menstrual irregularities include:

• A pregnancy test. The nurse takes some blood from a woman's arm and it is tested for the presence of certain hormones that indicate a pregnancy has occurred.
• Ultrasound. Typically performed by a trained ultrasound technician, it involves using sound waves to get an image of the reproductive system. It is used to look for fibroids and other ovarian abnormalities that may cause heavy bleeding or cramps. Typically, the technician will smear a jelly over the woman's stomach, then place a probe on her stomach and watch the images appear on a computer screen. It is painless. Women may be asked not to urinate for several hours prior to the test, as a full bladder makes it easier to see the other internal organs. The test takes about 20 minutes.
• Endometrial biopsy. Used to check the health of uterine tissue in women who have unusually heavy bleeding, this test should be performed by the physician. Women should take a pain reliever like Motrin or Aleve prior to the procedure, as there may be some cramping. The woman lies back on the table with her feet in stirrups and the doctor inserts a speculum, then opens the cervix slightly with an instrument called a tenaculum. Then the doctor slides a small, hollow catheter into the uterus and sucks a small piece of tissue from the uterine lining out. The tissue is then examined for any abnormalities in a laboratory. The test takes about 30 minutes and is typically covered by insurance. Some bleeding may result afterwards.
• Blood, stool and urine tests may also be conducted to check for levels of various hormones, blood cells, and other chemicals.
• Dilation and curettage (D&C): During this minor surgical procedure, the cervix is opened and the lining of the uterus scraped for a tissue sample.
• Laparascopy and hysteroscopy: in some instances, these surgical procedures, in which a small camera is inserted into the woman to view the inside of the pelvis, abdomen or uterus.

Prognosis

The prognosis for all menstrual irregularities is good once treatment is initiated.

BOOKS

Dan, Alice J. (Editor), Linda L. Lewis (Editor) Menstrual Health in Women's Lives Univ of Illinois Press, 1991.

Flaws, Robert S. Honora L. Wolfe A Handbook of Menstrual Diseases in Chinese Medicine Blue Poppy Press, 1999.

Francis-Cheung, Theresa. A Break in Your Cycle : The Medical and Emotional Causes and Effects of Amenorrhea John Wiley & Sons, 1998.

Owen, Lara. Honoring Menstruation : A Time of Self-Renewal Crossing Press, 1998.

Trickey, Ruth. Women Hormones and the Menstrual Cycle : Herbal and Medical Solutions from Adolescence to Menopause Allen & Unwin, 1998.

ORGANIZATIONS

Advancement of Women's Health Research, 1828 L Street, N.W., Suite 625 Washington, D.C. 20036, 202-223-8224 <www.womens-health.org>.

National Women's Health Resource Center, 120 Albany Street Suite 820 New Brunswick, NJ 08901, 877-986-9472 <www.healthywomen.org>.

Debra Gordon

KEY TERMS

Adenomyosis—Uterine thickening caused when endometrial tissue, which normally lines the uterus, extends outward into the fibrous and muscular tissue of the uterus.

Cervical polyps—Growths originating from the surface of the cervix or endocervical canal. These small, fragile growths hang from a stalk and protrude through the cervical opening (the os).

Cushing's Syndrome—A group of conditions caused by increased production of cortisol hormones or by the administration of glucocorticoid hormones (cortisone-like hormones).

Endometriosis—A condition in which the tissue that normally lines the uterus (endometrium) grows in other areas of the body, causing pain, irregular bleeding, and frequently, infertility.

Fibroids—Benign tumors of muscle and connective tissue that develop within or are attached to the uterine wall.

Hyperthyroidism—An imbalance in metabolism that occurs from overproduction of thyroid hormone.

Inflammatory bowel disease—A chronic inflammatory disease that can affect any part of the gastrointestinal tract but most commonly affects the ileium.

Lupus—A chronic inflammatory autoimmune disorder that may affect many organ systems including the skin, joints, and internal organs.

Pelvic inflammatory disease (PID)—A general term referring to infection involving the lining of the uterus, the Fallopian tubes, or the ovaries.

Turner's Syndrome—A disorder in women caused by an inherited chromosomal defect. This disorder inhibits sexual development and causes infertility. A symptom is absence of menstruation.