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The female reproductive system is designed in such a way to prepare itself every month for pregnancy. The monthly cycle of menstruation or the menstrual cycle is the process by which the body gets ready for the ovum to get attached to the sperm when this not happens ovum is thrown out of the body with shreds of the endometrium as bleeding through the vagina.
Menstruation is no headache for some women while for some it is a matter of inconvenience and uneasiness. They may experience emotional distress and physical symptoms during menstruation. From pain in the pelvis and lumbar region, bloating, variable mood swings to heavy bleeding disturbs the routine activities and lifestyle of a female. Some females experience overwhelming emotional tranquil during and before menstruation.
On average, every 28 days menstrual period occurs as a part of a normal menstrual cycle. The menstrual cycle is a series of changes that occur in the female reproductive system including ovaries, uterus, vagina, and breasts. Sometimes the menstrual cycles can be a bit shorter or longer, varying in the respective female. The first day of bleeding/ menstruation is counted as day one of the menstrual cycles. The average menstruation lasts for 2-7 days. Menstruation (menarche) begins during puberty age and lasts till menopause at climacteric 45-55 years. During both stages of life, hormonal changes are fully-fledged along with the change of being.
Disorders of female:
Disorders of ovulation include oligoovulation and anovulation:
- Oligoovulation means infrequent/irregular ovulation (the menstrual cycle lasts ≥36 days or <8 cycles a year)
- Anovulation means the absence of ovulation when it is normally expected (in a post-menarchal, premenopausal woman). It manifests as irregularity of menstrual periods, with a variability of intervals, duration, or bleeding patterns. Anovulation can cause secondary amenorrhea or excessive uterine bleeding.
Disorders of the length of the menstrual cycle:
- Polymenorrhea: This the medical term is usually used for the menstrual cycles occurring at intervals of 21 days or less.
- Irregular menstruation: Metrorrhagia is the term used for irregular menstruation. The periods start occurring between the otherwise normal menstrual cycle. The variation in menstrual cycle length is more than eight days at most.
- Oligomenorrhea: It is the infrequent, scanty menstrual periods occurring at intervals exceeding 35 days or more.
- Amenorrhea is the complete absence of a menstrual period in a female of reproductive age. It can be physiologic (during pregnancy and lactation) or pathological(due to some medical illness).
- Primary amenorrhoea: The females after the age of 15 who have not started menstruating yet. It is associated with growth and hormonal problems.
- Secondary amenorrhoea: Absence of menstruation for at least 3 months in females who were previously having a normal menstrual cycle. It is associated with gonadotropin-releasing hormone, stress, anorexia, extreme weight loss, thyroid disorders, heavy exercise, birth control pills, and ovarian cysts
Disorder of excessive bleeding:
- Menorrhagia: It is the medical term used for excessive menstrual bleeding. Normally 30 ml of blood approximately is bled out for about 7 days of menstruation from a female body. If bleeding is profuse or exceeds 7 days over 80 ml of blood is lost in the process of menstruation. The primary cause of menorrhagia is an imbalance of female hormones estrogen and progesterone in the body. It may also be associated with fibroid, ectopic pregnancy, thyroid disorders, blood disease, inflammation/infection or tumor of the vagina or cervix.
- Abnormal Bleeding: Also called DUB i.e., dysfunctional uterine bleeding it includes bleeding between menstruation cycles. The bleeding may be contributed by uterine fibroids, polyps, ectopic pregnancy, miscarriage, cancer or blood clotting disorders such as Von Willebrand’s disease, idiopathic thrombocytopenic purpura (ITP). Liver or kidney disease, leukemia, medications, such as anticoagulant drugs heparin and some synthetic hormones can also cause abnormal uterine bleeding.
Disorder of pain and cramps interfering with routine life :
- Dysmenorrhea: Painful menstruation or cramps experienced during periods is referred to as dysmenorrhea. The pain usually occurs in the lower abdomen and can be referred to as the lumbar region, lower back, and thighs. In some cases, intense abdominal cramps are also experienced. Primary dysmenorrhea experienced by adolescents is generally idiopathic. Whereas Secondary dysmenorrhea in older females is caused due to diseases like fibroids, pelvic inflammation disease, endometriosis or ectopic pregnancy.
- Premenstrual syndrome (PMS): A group of physical, emotional, and behavioral symptoms occurring during the last week of the luteal phase (a week before menstruation). Symptoms usually do not occur before ovulation i.e. until 13-14 days before the cycle and are completed within 4 days after the bleeding begins. The symptoms of PMS are: Tenderness and swelling in the breasts, depressed irritable mood, anxiety or confusion, difficulty in concentration decreased libido, acne, bloating and cramps in the abdomen, headache or joint pains, disturbed sleep, clumsiness.
- Premenstrual Dysphoric Disorder (PMDD)It is severe than the typical PMS. During PMDD symptoms are intense with irritability heightened, severe mood swings and overwhelming emotional distress. PMS and PMDD are similarly different as a mild tension headache and a migraine. A female suffering from PMDD has a history of major depression, postpartum depression or mood disorders. The symptoms related to PMDD are cyclical subside within a few days after the beginning of the menstrual cycle. Sometimes therapy is required to tackle the intensified symptoms.
- To help the diagnosis a series of tests are ordered by the physician. These tests may include:
- Routine blood test and urine test to rule out infection, anemia, and pregnancy.
- Ultrasound: A pelvic ultrasound is done to rule out any abnormality in the pelvic organs. No anesthesia is necessary is required for these tests.
- Endometrial biopsy. A tissue lining of the uterus is scraped to be analyzed under a microscope. This helps to identify any possible problems causing female menstrual disorder, including cancer.
- Hysteroscopy: The uterine cavity is examined with a miniature telescope-like instrument called a hysteroscope. Local, or sometimes general, anesthesia is needed for this procedure to be carried out.
- Dilation and curettage (D&C): The cervix is dilated and the lining of the uterus is scraped away with the instruments. It is an OPD procedure performed under local anesthesia. It is otherwise a diagnostic technique. However, it is also used as a treatment technique used for excessive uterine bleeding when the patient is not responding to other medications.