KEMENTERIAN PENDIDIKAN NASIONAL

UNIVERSITAS SRIWIJAYA
FAKULTAS KEDOKTERAN
UNIT PENDIDIKAN KEDOKTERAN (UPK)
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Skenario D Blok 9 2011
A 25-year-old housewife comes to doctor at clinics with chief complaint abdominal cramp
since 2 days ago. She also complains about breast discomfort and mild low back pain. She is
having this complain since she got her menarche at age 12. Her usual period is 2 days!
regular! and lasts for "-5 days. #his morning she noticed blood spotting on her underwear.
She has no history of chronic disease and surgical procedure before.
She told the doctor that she is afraid that her complaint will affect her fertility.
She has been married for 2 years and has no child yet.
Physical Examination:
Height $ 155 cm% &eight 5' kg%
() $ 11'*+' mmHg% )ulse $ ' ,*m% -- $ 2' ,*m.
.,ternal e,amination/
Abdomen% slight tenderness! rigidity 0-1
2aboratory e,amination/ 3rine 4-h56 0-1 negatif
Learning objectives:
7n this tutorial! students should be able to e,plain/
1. Anatomy 8 physiology of female reproduction system
2. Hormone role in menstrual cycle
". )hysiology! symptoms! clinical signs! physical e,amination and management of
menstruations 0cycle! blood loose! pain and dismenorrhea! prolong bleeding and
premenstrual syndrome 1
9. #erm in normal 8 abnormal menstrual cycle
5. :ifferential diagnosis of menstruations
;. 7nterpretation of laboratory findings 0blood and urine rutine 8 4-h561
erm !lari"ication:
1. Abdominal cramp
2. (reast discomfort
". <ild low back pain
9. <enarche
5. (lood spotting
;. 4-h56
+. =ertility
Problem #$enti"ication
1. A 25-year-old housewife comes to doctor at polyclinics with chief complain
abdominal cramp since 2 days ago.
2. She also complains about breast discomfort and mild low back pain.
". She has this complain since she got her menarche.
9. #his morning she noticed blood spot on her underwear.
5. She has no history of chronic disease and surgical procedure before.
Problem %nalysis
A 25-year-old housewife
o &hat is the definition of reproductive age>
Abdominal cramp! breast discomfort! mild low back pain
o &hat is the mechanism of the symptoms during menstruation>
(lood spotting
o &hat is the definition normal blood loss in menstruations >
0amount of blood and pads used1
<enstrual cycle
o &hat is the definition of normal and regular menstrual cycle>
o &hat factors that affect menstrual cycle>
o &hat are kinds of menstrual cycle disorder>
<enstruation.
o &hat are the classification of menstrual irregularities>
o How are the right and comprehensive management>
5onservative with medicamentous! laboratory screening! councelling!
documentation.
=ertility
o &hat kind of obsetetric and gynecologic e,amination need to be done to this
patient>
o &hat factors that affect the fertility>
o 7s there any relationship between menstrual disorder with fertility>
&y'othesis:
A 25-year-old housewife suffered from dismenorrhea due to normal menstruation.
Menstruation is the shedding of the uterine lining (endometrium).
(vervie)
-egular menstruation 0also called eumenorrhea1 lasts for a few days! usually " to 5 days! but
anywhere from 2 to days is considered normal.
?1@
#he average menstrual cycle is 2 days
long from the first day of one menstrual period to the first day of the ne,t. A normal
menstrual cycle is typically between 21 and "5 days between menstrual periods.
?2@
#he average blood loss during a monthly menstrual period is "5 milliliters 0or 9 to ;
tablespoons of menstrual fluid1 with 1'-' milliliters considered typical. <enstrual fluid is
the correct name for the menstrual flow! although many people refer to it as menstrual blood.
<enstrual fluid in fact contains some blood! as well as cervical mucus! vaginal secretions!
and endometrial tissue. <enstrual fluid is reddish-brown! a slightly darker colour than blood.
?"@
<any women also notice shedding of the uterusAs endometrium lining during menstruation.
#he shed endometrium lining appears as small pieces of tissue mi,ed with the blood. #hese
pieces of tissue are often called menstrual clots 0although they are pieces of the endometrium!
and are not true blood clots1 and are common% they more freBuently occur in women who
e,perience a heavier-than-average menstrual flow.
?9@
Sometimes this is incorrectly thought to
indicate an early-term miscarriage of an embryo. An enCyme called plasmin D contained in
the endometrium D tends to inhibit the blood from clotting. (ecause of this blood loss!
premenopausal women have higher dietary reBuirements for iron to prevent iron deficiency.
#he first e,perience of a menstrual period during puberty is called menarche. <enarche
typically occurs between ages 1' and 1+.
?5@
)erimenopause is when fertility in a woman
declines! and menstruation may occur infreBuently in the years leading up to menopause!
when a woman stops menstruating completely and is no longer fertile. <enopause typically
occurs between the late 9's and 5's
?;@
in &estern countries.
Physical ex'erience
7n most women! various physical changes are brought about by natural fluctuations in
hormone levels during the menstrual cycle! and by muscle contractions 0menstrual cramping1
involving the uterus that can precede or accompany menstruation. &omen may notice water
retention! changes in se, drive! fatigue! breast tenderness! or nausea. (reast swelling and
discomfort may be caused by premenstrual water retention. (inge eating occurs in a minority
of menstruating women.
?+@
3sually! such sensations are mild! and some women notice very
few physical changes associated with menstruation. A healthy diet! reduced consumption of
salt! caffeine and alcohol! and regular e,ercise are often effective in controlling these
physical changes.
?@
#ypical physical changes related to menstruation are not ordinarily
considered to be true )remenstrual Syndrome. However! it is common for non-medical
people to refer to these physical changes colloBuially as E)<S symptomsE. #he sensations
e,perienced vary from woman to woman and from cycle to cycle.
Painful menstrual cramps
<any women e,perience painful uterine cramps during menstruation. #he muscles of the
uterus! and abdominal muscles surrounding the uterus! contract spasmodically to push the
menstrual fluid out of the uterus. #he contractions are produced by the tissue lining the
uterus! which is believed to release an e,cess of fatty acids called prostaglandins that
stimulate the muscles! leading to contractions. #his is called primary dysmenorrhea. )rimary
dysmenorrhea usually begins within a year or two of menarche. 7t may continue until
menopause! but many women find that symptoms of dysmenorrhea gradually subside after
their mid-2's. 7f the pain occurs between menstrual periods! or lasts longer than the first few
days of the period! it is called secondary dysmenorrhea.
?F@
Symptoms of dysmenorrhea may become debilitating in some women. 7t is unknown why
this occurs in some women and not others. Severe symptoms may include pain spreading to
hips! lower back and thighs! nausea and freBuent diarrhea or constipation. #reatments target
e,cess prostaglandin! using anti-prostaglandin medications or oral contraceptives.
Gonsteroidal antiinflammatory drugs 0GSA7:S1! such as over-the-counter ibuprofen and
napro,en! may ease symptoms.
?1'@
Emotional an$ 'sychological ex'erience
Some women e,perience emotional disturbances associated with menstruation. #hese range
from the irritability! to tiredness! or EweepinessE 0i.e. easily-provoked tearfulness1. A similar
range of emotional effects and mood swings is associated with pregnancy.
?11@
#he prevalence
of )<S is estimated to be between "H
?12@
and "'H.
?1"@
<ore severe symptoms of an,iety or
depression may be signs of )remenstrual Syndrome. -arely! in individuals susceptible to
psychotic episodes! menstruation may be a trigger 0menstrual psychosis1.
Premenstr*al Syn$rome
7n some cases! stronger physical and emotional or psychological sensations may become
debilitating! and include significant menstrual pain 0dysmenorrhea1! migraine headaches! and
severe depression. :ysmenorrhea! or severe uterine pain! is particularly common for
adolescents and young women 0one study found that ;+.2H of girls aged 1"I1F suffer from
it1.
?19@
#his phenomenon is called )remenstrual Syndrome. <ore severe symptoms may be
classified as )remenstrual :ysphoric :isorder 0)<::1.
+enstr*al $isor$ers
7t should be noted that there is a wide spectrum of differences between how women may
e,perience menstruation. &hat may indicate a more serious physical problem for one
woman! may be Buite normal for another. #here are several ways that a womanAs menstrual
cycle can differ from the norm! any of which should be discussed with a doctor to identify the
underlying cause/
Sym'tom See article
7nfreBuent periods Jligomenorrhea
Short or e,tremely light periods Hypomenorrhea
#oo-freBuent periods 0defined as more freBuently than every 21 days1 )olymenorrhea
.,tremely heavy or long periods 0one guideline is soaking a sanitary napkin
or tampon every hour or so! or menstruating for longer than + days1
Hypermenorrhea
.,tremely painful periods :ysmenorrhea
(reakthrough bleeding 0also called spotting1 between periods% normal in
many women
<etrorrhagia
Absent periods Amenorrhea
:ysfunctional uterine bleeding is a hormonally caused bleeding abnormality. :ysfunctional
uterine bleeding typically occurs in premenopausal women who do not ovulate normally 0i.e.
are anovulatory1. All these bleeding abnormalities need medical attention% they may indicate
hormone imbalances! uterine fibroids! or other problems. As pregnant patients may bleed! a
pregnancy test forms part of the evaluation of abnormal bleeding.
Menstrual cycle
#he menstr*al cycle is the scientific term for the physiological changes that can occur in
fertile women. #his article focuses on the human menstrual cycle.
#he menstrual cycle! under the control of the endocrine system! is necessary for reproduction.
7t is commonly divided into three phases/ the follicular phase! ovulation! and the luteal phase%
although some sources use a different set of phases/ menstruation! proliferative phase! and
secretory phase.
?1@
<enstrual cycles are counted from the first day of menstrual bleeding.
Hormonal contraception interferes with the normal hormonal changes with the aim of
preventing reproduction.
Stimulated by gradually increasing amounts of estrogen in the follicular phase! discharges of
blood 0menses1 slow then stop! and the lining of the uterus thickens. =ollicles in the ovary
begin developing under the influence of a comple, interplay of hormones! and after several
days one or occasionally two become dominant 0non-dominant follicles atrophy and die1.
Appro,imately mid-cycle! 29I"; hours after the 2uteiniCing Hormone 02H1 surges! the
dominant follicle releases an ovum! or egg in an event called ovulation. After ovulation! the
egg only lives for 29 hours or less without fertiliCation while the remains of the dominant
follicle in the ovary become a corpus luteum% this body has a primary function of producing
large amounts of progesterone. 3nder the influence of progesterone! the endometrium
0uterine lining1 changes to prepare for potential implantation of an embryo to establish a
pregnancy. 7f implantation does not occur within appro,imately two weeks! the corpus
luteum will involute! causing sharp drops in levels of both progesterone and estrogen. #hese
hormone drops cause the uterus to shed its lining and egg in a process termed menstruation.
7n the menstrual cycle! changes occur in the female reproductive system as well as other
systems 0which lead to breast tenderness or mood changes! for e,ample1. A womanAs first
menstruation is termed menarche! and occurs typically around age 12-1". #he average age of
menarche is about 12.5 years in the 3nited States!
?2@
12.+2 in 5anada!
?"@
12.F in the 3K
?9@
and
1".'; L '.1' years in 7celand.
?5@
#he end of a womanAs reproductive phase is called the
menopause! which commonly occurs somewhere between the ages of 95 and 55.
erminology
#he menarche is one of the later stages of puberty in girls. #he average age of menarche in
humans is 12I1" years! but is normal anywhere between ages and 1;. =actors such as
heredity! diet and overall health can accelerate or delay menarche.
?;@
#he cessation of
menstrual cycles at the end of a womanAs reproductive period is termed menopause. #he
average age of menopause in women is 52 years in industrialised countries such as the 3K!
with anywhere between 95 and 55 being common. <enopause before age 95 is considered
premature in industrialised countries.
?+@
#he age of menopause is largely a result of genetics%
however! illnesses! certain surgeries! or medical treatments may cause menopause to occur
earlier.
?@
#he length of a womanAs menstrual cycle will typically vary! with some shorter cycles and
some longer cycles. A woman who e,periences variations of less than eight days between her
longest cycles and shortest cycles is considered to have regular menstrual cycles. 7t is unusual
for a woman to e,perience cycle length variations of less than four days. 2ength variation
between eight and 2' days is considered as moderately irregular cycles. Mariation of 21 days
or more between a womanAs shortest and longest cycle lengths is considered very irregular.
?F@
Phases
#he menstrual cycle can be divided into several different phases. #he average length of each
phase is shown below! the first three are related to changes in the lining of the uterus whereas
the final three are related to processes occurring in the ovary/
,ame o" 'hase
%verage start $ay
assuming a 2-day
cycle
%verage en$
$ay
<enstrual phase 0<enstruation1 1 9
)roliferative phase 0Some sources include <enstruation
in this phase1
5 1"
Jvulatory phase 0Jvulation1 1" 1;
2uteal phase 0also known as Secretory phase1 1; 2
7schemic phase 2+ 2
=ollicular phase 1 1"
Follicular phase
#his phase is also called the proliferative phase because a hormone causes the lining of the
uterus to grow! or proliferate! during this time.
?2'@
#hrough the influence of a rise in follicle stimulating hormone 0=SH1 during the first days of
the cycle! a few ovarian follicles are stimulated.
?2'@
#hese follicles! which were present at
birth
?2'@
and have been developing for the better part of a year in a process known as
folliculogenesis! compete with each other for dominance. 3nder the influence of several
hormones! all but one of these follicles will stop growing! while one dominant follicle in the
ovary will continue to maturity. #he follicle that reaches maturity is called a tertiary! or
6raafian! follicle! and it forms the ovum.
?2'@
As they mature! the follicles secrete increasing amounts of estradiol! an estrogen. #he
estrogens initiate the formation of a new layer of endometrium in the uterus! histologically
identified as the proliferative endometrium. #he estrogen also stimulates crypts in the cervi,
to produce fertile cervical mucus! which may be noticed by women practicing fertility
awareness.
?21@
Ovulation
:uring the follicular phase! estradiol suppresses production of luteiniCing hormone 02H1
from the anterior pituitary gland. &hen the egg has nearly matured! levels of estradiol reach a
threshold above which they stimulate production of 2H. #hese opposite responses of 2H to
estradiol may be enabled by the presence of two different estrogen receptors in the
hypothalamus/ estrogen receptor alpha! which is responsible for the negative feedback
estradiol-2H loop! and estrogen receptor beta! which is responsible for the positive estradiol-
2H relationship.
?22@
7n the average cycle this 2H surge starts around cycle day 12 and may last
9 hours.
#he release of 2H matures the egg and weakens the wall of the follicle in the ovary! causing
the fully developed follicle to release its secondary oocyte.
?2'@
#he secondary oocyte promptly
matures into an ootid and then becomes a mature ovum. #he mature ovum has a diameter of
about '.2 mm.
?2"@
&hich of the two ovariesDleft or rightDovulates appears essentially random% no known left
and right co-ordination e,ists.
?29@
Jccasionally! both ovaries will release an egg%
?29@
if both
eggs are fertiliCed! the result is fraternal twins.
?25@
After being released from the ovary and into the peritoneal space! the egg is swept into the
fallopian tube by the fimbria! which is a fringe of tissue at the end of each fallopian tube.
After about a day! an unfertiliCed egg will disintegrate or dissolve in the fallopian tube.
?2'@
=ertiliCation by a spermatoCoon! when it occurs! usually takes place in the ampulla! the
widest section of the fallopian tubes. A fertiliCed egg immediately begins the process of
embryogenesis! or development. #he developing embryo takes about three days to reach the
uterus and another three days to implant into the endometrium.
?2'@
7t has usually reached the
blastocyst stage at the time of implantation.
7n some women! ovulation features a characteristic pain called mittelschmerz 06erman term
meaning middle pain1.
?15@
#he sudden change in hormones at the time of ovulation sometimes
also causes light mid-cycle blood flow.
?2;@
Luteal phase
#he luteal phase is also called the secretory phase. An important role is played by the corpus
luteum! the solid body formed in an ovary after the egg has been released from the ovary into
the fallopian tube. #his body continues to grow for some time after ovulation and produces
significant amounts of hormones! particularly progesterone.
?2'@
)rogesterone plays a vital role
in making the endometrium receptive to implantation of the blastocyst and supportive of the
early pregnancy% it also has the side effect of raising the womanAs basal body temperature.
?2+@
#here is a noted secretion of prolactin towards the end of the secretory phase.
?citation needed@
After ovulation! the pituitary hormones =SH and 2H cause the remaining parts of the
dominant follicle to transform into the corpus luteum! which produces progesterone. #he
increased progesterone in the adrenals starts to induce the production of estrogen. #he
hormones produced by the corpus luteum also suppress production of the =SH and 2H that
the corpus luteum needs to maintain itself. 5onseBuently! the level of =SH and 2H fall
Buickly over time! and the corpus luteum subseBuently atrophies.
?2'@
=alling levels of
progesterone trigger menstruation and the beginning of the ne,t cycle. =rom the time of
ovulation until progesterone withdrawal has caused menstruation to begin! the process
typically takes about two weeks! with 19 days considered normal. =or an individual woman!
the follicular phase often varies in length from cycle to cycle% by contrast! the length of her
luteal phase will be fairly consistent from cycle to cycle.
?2@
#he loss of the corpus luteum can be prevented by fertiliCation of the egg% the resulting
embryo produces human chorionic gonadotropin 0h561! which is very similar to 2H and
which can preserve the corpus luteum. (ecause the hormone is uniBue to the embryo! most
pregnancy tests look for the presence of h56.
?2'@
Length
Although many people believe the average menstrual cycle takes 2 days! a large study of
more than "'!''' cycles from more than 2"'' women showed that the mean cycle length was
2F.1 with a standard deviation of +.5 days and a F5H prediction interval of between 15 and
95 days.
?2F@
7n that study! the subset of data with cycle lengths between 15 and 95 days had an
average length of 2.1 days with a standard deviation of 9 days. A smaller study of 19'
women performed in 2''; found a mean cycle length of 2.F days.
?"'@
#he variability of menstrual cycle lengths is highest for women under 25 years of age and is
lowest! that is! most regular! for ages "5 to "F.
?2F@
SubseBuently! the variability increases
slightly for women aged 9' to 99.
?2F@
3sually! length variation between eight and 2' days in a
woman is considered as moderately irregular menstrual cycles.
?F@
Mariation of 21 days or
more is considered very irregular.
?F@
7t has long been thought that cycle length is associated with the moon. A 1F+F study of "'5
women found that appro,imately one-third of the subNects had lunar period cycles! i.e.! a
mean cycle length of 2F.5 days plus or minus 1 day. Almost two-thirds of the subNects started
their cycle in the brighter half of the lunar cycle! significantly more than would be e,pected
by random distribution.
?"1@
Another study found a statistically significant number of
menstruations occurred around the new moon.
?"2@
!ycle abnormalities an$ $isor$ers
7nfreBuent or irregular ovulation is called oligoovulation.
?52@
#he absence of ovulation is
called anovulation. Gormal menstrual flow can occur without ovulation preceding it/ an
anovulatory cycle. 7n some cycles! follicular development may start but not be completed%
nevertheless! estrogens will form and will stimulate the uterine lining. Anovulatory flow
resulting from a very thick endometrium caused by prolonged! continued high estrogen levels
is called estrogen breakthrough bleeding. Anovulatory bleeding triggered by a sudden drop
in estrogen levels is called changes.
?5"@
Anovulatory cycles commonly occur before
menopause 0perimenopause1 and in women with polycystic ovary syndrome.
?59@
Mery little flow 0less than 1' ml1 is called hypomenorrhea. -egular cycles with intervals of
21 days or fewer are polymenorrhea% freBuent but irregular menstruation is known as
metrorrhagia. Sudden heavy flows or amounts greater than ' ml are termed menorrhagia.
?55@
Heavy menstruation that occurs freBuently and irregularly is menometrorrhagia. #he term for
cycles with intervals e,ceeding "5 days is oligomenorrhea.
?5;@
Amenorrhea refers to more
than three
?55@
to si,
?5;@
months without menses 0while not being pregnant1 during a womanAs
reproductive years.
Abnormal Menstruation
<ost women have menstrual periods that last four to seven days. A womanOs period usually
occurs every 2 days! but normal menstrual cycles can range from 21 days to "5 days.
.,amples of menstrual problems include/
Periods that occur less than 21 days or more than 35 days apart
Missing three or more periods in row
Menstrual flow that is much heavier or lighter than usual
Periods that last longer than seven days
Periods that are accompanied by pain cramping nausea or vomiting
!leeding or spotting that happens between periods after menopause or following
se"
.,amples of abnormal menstruation include the following/
#menorrhea is a condition in which a woman$s periods have stopped completely. %he
absence of a period for &' days or more is considered abnormal unless a woman is
pregnant breastfeeding or going through menopause. Menopause usually begins
when a woman is between the ages of (5 and 55. %he average age of menopause in
the )nited *tates is 51. %he transition into menopause can ta+e from two to eight
years.
Poung women who havenOt started menstruating by age 15 or 1; or within three years after
their breasts begin to develop are also regarded as having amenorrhea.
,ligomenorrhea refers to periods that occur infre-uently.
.ysmenorrhea refers to painful periods and severe menstrual cramps.
#bnormal uterine bleeding may apply to a variety of menstrual irregularities
including/ a heavier menstrual flow0 a period that lasts longer than seven days0 or
bleeding or spotting between periods after se" or after menopause.
Causes of abnormal menstruation?
#here are many causes of abnormal periods! ranging from stress to more serious underlying
medical conditions/
Stress. 1aining or losing a significant amount of weight dieting changes in e"ercise
routines travel illness or other disruptions in a woman$s daily routine can have an
impact on her menstrual cycle.
Birth control pills. Most birth control pills contain a combination of the hormones
estrogen and progestin (some contain progestin alone). %he pills prevent pregnancy
by +eeping the ovaries from releasing eggs. 1oing on or off birth control pills can
affect menstruation. *ome women have irregular or missed periods for up to si"
months after discontinuing birth control pills. %his is an important consideration when
you are planning on conception and becoming pregnant. 2omen who ta+e birth
control pills that contain progestin only may have bleeding between periods.
Uterine polyps or fibroids. )terine polyps are small benign (noncancerous) growths
in the lining of the uterus. )terine fibroids are tumors that attach to the wall of the
uterus. %here may be one or several fibroids that range from as small as an apple
seed to the si3e of a grapefruit. %hese tumors are usually benign but they may cause
heavy bleeding and pain during periods. 4f the fibroids are large they might put
pressure on the bladder or rectum causing discomfort.
Endometriosis. %he endometrial tissue that lines the uterus brea+s down every
month and is discharged with the menstrual flow. 5ndometriosis occurs when the
endometrial tissue starts to grow outside the uterus. ,ften the endometrial tissue
attaches itself to the ovaries or 6allopian tubes0 it sometimes grows on the intestines
or other organs in the lower digestive tract and in the area between your rectum and
uterus. 5ndometriosis may cause abnormal bleeding cramps or pain before and
during periods and painful intercourse.
Pelvic inflammatory disease. Pelvic inflammatory disease (P4.) is a bacterial
infection that affects the female reproductive system. !acteria may enter the vagina
via se"ual contact and then spread to the uterus and upper genital tract. !acteria
might also enter the reproductive tract through insertion of an intrauterine device
(4).) or through childbirth miscarriage or abortion. *ymptoms of P4. include a
heavy vaginal discharge with an unpleasant odor irregular periods pain in the pelvic
and lower abdominal areas fever nausea vomiting or diarrhea.
Polycystic ovary syndrome. 4n polycystic ovary syndrome (P7,*) the ovaries
ma+e large amounts of the male hormone androgen. *mall fluid8filled sacs (cysts)
may form in the ovaries. %hese can often been seen on ultrasound. %he high levels
of androgens prevent eggs from maturing and so ovulation does not ta+e place.
*ometimes a woman with polycystic ovary syndrome will have irregular periods or
stop menstruating completely. 4n addition the condition is associated with obesity
infertility and hirsutism (e"cessive hair growth). %his condition may be caused by a
hormonal imbalance although the e"act cause is un+nown. %reatment of P7,*
depends on whether a woman desires pregnancy. 4f pregnancy is not a goal then
weight loss oral contraceptive pills and the medication Metformin (an insulin
sensiti3er) can regulate a woman$s cycles. 4f pregnancy is desired ovulation8
stimulating medications can be tried.
Premature ovary failure. %his condition occurs in women under age (' whose
ovaries do not function normally. %he menstrual cycle may be irregular or absent.
%his can occur in patients who are being treated for cancer with chemotherapy and
radiation or if you have a family history of premature ovary failure or certain
chromosomal abnormalities. 4f this condition occurs see your physician.
Jther causes of abnormal menstruation include/
)terine cancer or cervical cancer
Medications such as steroids or anticoagulant drugs (blood thinners)
Medical conditions such as anemia other bleeding disorders an under8 or
overactive thyroid gland or pituitary disorders that affect hormonal balance
7omplications associated with pregnancy including miscarriage or an ectopic
pregnancy (the fertili3ed egg is implanted outside the uterus0 for e"ample within the
6allopian tube)
Supportive e,aminations*tests/
blood tests to rule out anemia or other medical disorders or infections0
a pelvic ultrasound e"am to chec+ for uterine fibroids polyps or an ovarian cyst0
an endometrial biopsy in which a sample of tissue is removed from the lining of the
uterus to diagnose endometriosis or cancerous cells. 5ndometriosis or other
conditions may also be diagnosed using a procedure called a laparoscopy in which
the doctor ma+es a tiny incision in the abdomen and then inserts a thin tube with a
light attached to view the uterus and ovaries.
hysterosalpingography an 98ray test that provides images of the inside of the uterus
and the 6allopian tubes. .uring the test a special dye (contrast material) is in:ected
through a thin fle"ible tube (catheter) that is inserted through the vagina and cervi"
into the uterus. 2hile the contrast material passes through the uterus and 6allopian
tubes continuous 98ray pictures are ta+en that can show any abnormalities.
Treatment
#he treatment of abnormal menstruation depends on the underlying cause/
Regulation of the menstrual cycle: ;ormones such as estrogen or progestin might
be prescribed to help control heavy bleeding.
Pain control: Mild to moderate pain or cramps might be lessened by ta+ing an over8
the8counter pain reliever such as ibuprofen or acetaminophen. #spirin is not
recommended because it might cause heavier bleeding. %a+ing a warm bath or
shower or using a heating pad might help to relieve cramps.
Uterine fibroids: %hese can be treated medically and<or surgically. 4nitially most
fibroids that are causing mild symptoms can be treated with over8the8counter pain
relievers. 4f you e"perience heavy bleeding an iron supplement might be helpful in
preventing or treating anemia. =ow8dose birth control pills or progestin in:ections
(.epo8Provera) may help to control heavy bleeding caused by fibroids. .rugs called
gonadotropin8releasing hormone agonists may be used to shrin+ the si3e of the
fibroids and control heavy bleeding. %hese drugs reduce the body$s production of
estrogen and stop menstruation for a while.
7f fibroids do not respond to medication! there are a variety of surgical options that can
remove them or decrease their actions. #he type of procedure will depend on the siCe! type!
and location of the fibroids. A myomectomy is the simple removal of a fibroid. 7n severe
cases where the fibroids are large or cause heavy bleeding or pain! a hysterectomy might be
necessary. :uring a hysterectomy! the fibroids are removed along with the uterus. Jther
options include/ uterine artery emboliCation! which cuts off the blood supply to the active
fibroid tissue% or! endometrial ablation! which uses electrocautery to destroy the lining of the
uterus.
Endometriosis: #lthough there is no cure for endometriosis over8the8counter or
prescription pain relievers may help to lessen the discomfort. ;ormone treatments
such as birth control pills may help prevent overgrowth of uterine tissue and reduce
the amount of blood loss during periods. 4n more severe cases a gonadotropin8
releasing hormone agonist or progestin may be used to temporarily stop menstrual
periods. 4n severe cases surgery may be necessary to remove e"cess endometrial
tissue growing in the pelvis or abdomen. # hysterectomy might be re-uired as a last
resort if the uterus has been severely damaged.
Some recommendations for self-care/
%ry to maintain a healthy lifestyle by e"ercising moderately and eating low8fat foods.
4f you have to lose weight do so gradually instead of turning to diets that drastically
limit your calorie and food inta+e.
Ma+e sure you get enough rest.
Practice stress reduction and rela"ation techni-ues.
4f you are an athlete cut bac+ on prolonged or intense e"ercise routines. 5"cessive
sports activities can cause irregular periods.
)se birth control pills or other contraceptive methods as directed.
7hange your tampons or sanitary nap+ins at least twice each day to avoid to"ic
shoc+ syndrome and prevent infections.
*ee a gynecologist for regular chec+8ups.
6rom/ 2i+ipedia