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Menstrual Cycle Disorders: Causes, Symptoms, and Treatment
The menstrual cycle is a complex physiological process regulated by hormones. Its regularity is an important indicator of a woman’s reproductive health. Deviations from the norm are called menstrual cycle disorders (MCDs).
Main Types of Menstrual Cycle Disorders:
1․ Amenorrhea: Absence of menstruation.
3․ Polymenorrhea: Too frequent menstruation (intervals shorter than 21 days).
4․ Dysmenorrhea: Painful menstruation.
6․ Metrorrhagia: Irregular, intermenstrual bleeding.
7․ Hypomenorrhea: Scanty menstrual bleeding.
8․ Premenstrual Syndrome (PMS): A complex of physical and emotional symptoms occurring in the luteal phase of the cycle (before menstruation).
- Primary: Menstruation has never occurred (by age 16).
- Secondary: Cessation of menstruation for 6 months or more in a woman who previously had periods.
3․ Polymenorrhea: Too frequent menstruation (intervals shorter than 21 days).
4․ Dysmenorrhea: Painful menstruation.
- Primary: Pain without underlying pelvic pathology.
- Secondary: Pain caused by diseases (endometriosis, fibroids, inflammation).
6․ Metrorrhagia: Irregular, intermenstrual bleeding.
7․ Hypomenorrhea: Scanty menstrual bleeding.
8․ Premenstrual Syndrome (PMS): A complex of physical and emotional symptoms occurring in the luteal phase of the cycle (before menstruation).
Causes of Menstrual Cycle Disorders:
The causes of MCDs are diverse and can be interrelated:
— Sudden weight loss or gain, obesity, eating disorders (anorexia, bulimia).
— Excessive physical activity.
— Climate change, time zone changes.
— Taking certain medications (hormones, anticoagulants, antipsychotics, antidepressants).
— Use of an intrauterine device (IUD).
— Chronic Diseases: Diabetes mellitus, liver disease, kidney disease, blood clotting disorders.
— Perimenopause: The period preceding menopause, characterized by hormonal fluctuations.
- Hormonal Imbalances: Dysfunction of the ovaries, thyroid gland (hypo- or hyperthyroidism), adrenal glands, pituitary gland, hypothalamus (e.g., polycystic ovary syndrome — PCOS, premature ovarian failure, hyperprolactinemia).
- Gynecological Diseases: Endometriosis, uterine fibroids, endometrial polyps, hyperplasia, pelvic inflammatory disease (PID), cervical pathology, malignant tumors.
- Complications of Pregnancy: Miscarriage, ectopic pregnancy.
- External Factors:
— Sudden weight loss or gain, obesity, eating disorders (anorexia, bulimia).
— Excessive physical activity.
— Climate change, time zone changes.
— Taking certain medications (hormones, anticoagulants, antipsychotics, antidepressants).
— Use of an intrauterine device (IUD).
— Chronic Diseases: Diabetes mellitus, liver disease, kidney disease, blood clotting disorders.
— Perimenopause: The period preceding menopause, characterized by hormonal fluctuations.
- Chronic Diseases: Diabetes mellitus, liver disease, kidney disease, blood clotting disorders.
- Perimenopause: The period preceding menopause, characterized by hormonal fluctuations.
Symptoms Requiring a Visit to a Doctor:
- Absence of menstruation (if pregnancy is excluded).
- Cycles shorter than 21 days or longer than 35 days.
- Menstruation lasting more than 7 days.
- Exceptionally heavy bleeding (changing pads/tampons every 1-2 hours, passing large clots).
- Severe pain during menstruation that interferes with daily life.
- Bleeding between periods or after sexual intercourse.
- Menstruation after menopause.
- Significant deterioration in general well-being before or during menstruation.
Diagnosis:
Diagnosis of MCDs includes:
1․ Detailed Medical History: Cycle characteristics, symptoms, past illnesses, medications, lifestyle.
2․ Gynecological Examination.
3․ Laboratory Tests:
4․ Ultrasound Examination (Ultrasound): Transvaginal and/or transabdominal ultrasound to assess the uterus, endometrium, and ovaries.
5․ Additional Examinations (as needed): Hysteroscopy, endometrial biopsy, MRI, CT scan, coagulogram.
1․ Detailed Medical History: Cycle characteristics, symptoms, past illnesses, medications, lifestyle.
2․ Gynecological Examination.
3․ Laboratory Tests:
- Blood tests: General blood count, hormones (FSH, LH, prolactin, estradiol, progesterone, testosterone, TSH, T4 free), biochemistry (if necessary).
- Tests for infections (if inflammation is suspected).
4․ Ultrasound Examination (Ultrasound): Transvaginal and/or transabdominal ultrasound to assess the uterus, endometrium, and ovaries.
5․ Additional Examinations (as needed): Hysteroscopy, endometrial biopsy, MRI, CT scan, coagulogram.
Treatment Principles:
Treatment depends entirely on the identified cause:
1․ Correction of Lifestyle: Normalization of weight, balanced nutrition, stress management, moderate physical activity, adequate sleep.
2․ Treatment of Underlying Diseases: Therapy for endocrine disorders (thyroid, adrenal glands), treatment of inflammatory processes, endometriosis, fibroids, etc.
3․ Hormonal Therapy:
4. Non-Hormonal Therapy:
5. Surgical Treatment: Hysteroscopy (removal of polyps, submucosal fibroids), endometrial ablation, uterine artery embolization, laparoscopy (for endometriosis, cysts), hysterectomy (removal of the uterus — in extreme cases).
1․ Correction of Lifestyle: Normalization of weight, balanced nutrition, stress management, moderate physical activity, adequate sleep.
2․ Treatment of Underlying Diseases: Therapy for endocrine disorders (thyroid, adrenal glands), treatment of inflammatory processes, endometriosis, fibroids, etc.
3․ Hormonal Therapy:
- Combined oral contraceptives (COCs) — to regulate the cycle, reduce bleeding and pain.
- Progestins (tablets, IUDs) — for bleeding disorders, endometrial hyperplasia.
- Other hormonal drugs (GnRH agonists, antiestrogens) — for severe endometriosis, fibroids, IVF protocols.
4. Non-Hormonal Therapy:
- NSAIDs (Ibuprofen, etc.) — to relieve pain and reduce bleeding.
- Tranexamic acid — to reduce heavy bleeding.
- Vitamins and minerals (especially if deficient).
5. Surgical Treatment: Hysteroscopy (removal of polyps, submucosal fibroids), endometrial ablation, uterine artery embolization, laparoscopy (for endometriosis, cysts), hysterectomy (removal of the uterus — in extreme cases).
Conclusion:
Menstrual cycle disorders are a common reason for women to seek medical attention. They can be both a symptom of serious diseases and a consequence of lifestyle factors. Timely diagnosis and identification of the cause are crucial for prescribing effective treatment and maintaining reproductive health. Any noticeable changes in the menstrual cycle require consultation with a gynecologist. Self-medication is unacceptable.
