MENSTRUAL DISORDERS


Menstrual disorders are cyclical, hormonally-based health issues that are linked to, or have an effect on, a woman’s natural menstrual cycle. Some of the most common menstrual disorders include:

  • Endometriosis
  • Premenstrual syndrome (PMS) or Premenstrual dysphoric disorder (PMDD)
  • Menorrhagia (abnormally heavy bleeding during periods)
  • Dysmenorrhea (painful cramps during menstruation)
  • Amenorrhea (the absence of menstruation)
  • Polycystic ovarian syndrome (PCOS)

At the Women’s Medical Center, PC, located in Mt. Pleasant, Michigan, our highly regarded and board certified Obstetricians/Gynecologists understand the potentially debilitating impact a menstrual disorder can have on a woman’s life. During your office visit, your treatment provider will conduct a thorough medical evaluation before performing the appropriate diagnostic tests to accurately determine the root cause of your menstrual disorder symptoms. He/she will then provide clear recommendations as to the optimal course of treatment, taking into consideration your medical history, general health, personal preferences, severity of current symptoms, and plans to become pregnant in the future.

ENDOMETRIOSIS

During the course of a normal menstrual cycle, the tissue lining the uterus (endometrium) builds up to prepare for implantation of a fertilized egg, and is then shed by the body (menstruation) if the woman has not become pregnant. Patients suffering from endometriosis experience growth of endometrial tissue outside of the uterus. As this misplaced tissue accumulates and subsequently breaks down over the course of the menstrual cycle, internal bleeding and inflammation of the tissues surrounding the endometriosis may occur. Over time, this menstrual disorder may lead to the progressive development of lesions, scar tissue, growths and/or fibrous cysts in the affected area.

Endometriosis symptoms may include:

  • Pain in the pelvic or back area
  • Heavy or irregular menstrual flow
  • Discomfort during sexual intercourse
  • Infertility
  • Spotting, pain, or cramping prior to onset of menses each month
  • Gastrointestinal upset (diarrhea, constipation, and/or nausea)

When attempting to diagnose the condition of endometriosis, your gynecologist will likely perform one or more of the following tests: laparoscopy, ultrasound, or an MRI. If these tests confirm the presence of endometriosis, there are a number of treatment options available, such as:

  • Hormone therapy
  • OTC analgesics, NSAIDs , or other pain medications
  • Surgical Corrective Measures
    • Laparoscopy
    • Laparotomy
    • Hysterectomy

PREMENSTRUAL SYNDROME (PMS)/PREMENSTRUAL DYSPHORIC DISORDER (PMDD)

Premenstrual Syndrome (PMS) refers to the collective set of physical and emotional symptoms that occur 7-10 days prior to the onset of a woman’s menstrual cycle, and typically subside when the menstrual period begins. The symptoms of PMS may present differently among women, and can shift and change from month to month. Some of the most common emotional/behavioral issues associated with PMS include: crying spells, tension, anxiety, irritability/anger, insomnia, food craving, depressed mood, social withdrawal, appetite changes, inability to concentrate, and mood swings. These emotional symptoms are often accompanied by physical maladies, such as: bloating (fluid retention), constipation, headache, breast swelling/tenderness, acne, joint or muscle pain, and diarrhea.

A diagnosis of Premenstrual Dysphoric Disorder (PMDD) is given when the severity of PMS symptoms reach a truly debilitating level, and begin to impede a woman’s normal functioning and participation in daily life. In addition to heightened levels of the aforementioned PMS symptoms, patients suffering from PMDD may also experience: rage, hopelessness, significant depression, low self-esteem, tendency to isolate, and suicidal ideations.

Your treatment provider will evaluate the severity and scope of your PMS/PMDD symptoms before recommending a course of treatment, which may include one or more of the following lifestyle changes or medications:

  • Antidepressants (typically from the category of SSRIs) –
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) to ease breast tenderness, cramping, and muscle pain
  • Diuretics to minimize water retention and bloating
  • Oral contraceptives to regulate hormonal shifts related to ovulation
  • Dietary/Lifestyle changes—limiting caffeine/alcohol/salty foods; drinking ample water; eating a high fiber diet and small, frequent meals; increasing exercise; and getting adequate sleep
  • Increasing calcium, magnesium, B-6, and Vitamin E intake to reach levels necessary to ease PMS symptoms (400mg magnesium, 1200mg calcium, 50-100mg vitamin B-6, 400 international units vitamin E)

MENORRHAGIA (HEAVY PERIODS)

The condition of having chronically extended and/or heavy menstrual periods is referred to as menorrhagia, and may present with some (or all) of the symptoms listed below:

  • Menstruation lasting longer than 7 days each month
  • Needing to change one or more sanitary pads/tampons each hour for several consecutive hours during menstruation
  • Needing to miss work, restrict daily activities, or avoid sex because of heavy periods
  • Passing large blood clots during menstruation
  • Experiencing anemic symptoms(fatigue, shortness of breath, exhaustion)
  • Severe cramping, headaches, and/or nausea during menstruation
  • Depression/anxiety,  mood swings, or a lack of confidence during your period
  • Needing to wake up to change sanitary protection during the night

Treatment options for heavy periods (menorrhagia) include:

  • The hormonal intra-uterine device (IUD) Mirena has been FDA-approved for the treatment of heavy periods
  • Endometrial Ablation (EA): employs the use of radiofrequency energy to remove the uterine lining (endometrium), thereby reducing or stopping menstruation. During this 5-10 minute outpatient procedure, your treatment provider will insert a triangular mesh device into the uterus, and will deliver carefully measured radio frequency energy through the mesh for approximately 90 seconds. Patients may resume their normal daily activities immediately after the EA procedure concludes—there are no hormonal side effects, and 90% of women experience a significant reduction or complete stoppage of menstrual bleeding after endometrial ablation.
  • Iron supplements
  • Oral contraceptives
  • Oral progesterone
  • Nonsteroidal anti-inflammatory drugs (i.e. ibuprofen, naproxen)
  • Depo Provera
  • Lysteda

DYSMENORRHEA

Dysmenorrhea describes painful cramps that may occur immediately before or during a woman’s menstrual period. Primary dysmenorrhea is the term for common menstrual cramps, and secondary dysmenorrhea is the term for pain caused by a disorder originating in the patient’s reproductive organs.  Mild cases of dysmenorrhea can often be treated with lifestyle changes, heating pads, pain relievers, and birth control pills, while more severe cases may require further testing to screen for gynecological or reproductive disorders (i.e. endometriosis, uterine fibroids).

 

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