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Irregular or extra-long menstruation may portend shorter lifespan (2) by Prof. Oladapo Ashiru OFR

Other causes of abnormal menstruation are:

Pelvic inflammatory disease(PID): This is a bacterial infection that affects the female reproductive system. Infection may result via the vagina during sexual contact and then spread to the uterus and upper genital tract. Gynecologic procedures, childbirth, miscarriage, or abortion can also predispose to PID. Symptoms of PID include a heavy vaginal discharge with an unpleasant odor, irregular periods, pelvic and lower abdominal pains, fever, nausea, vomiting, or diarrhea.

Polycystic Ovarian Syndrome: The ovaries make large amounts of androgens, which are male hormones. Small fluid-filled sacs (cysts) may form in the ovaries. The hormonal changes can prevent eggs from maturing and so, ovulation may not take place consistently. Sometimes a woman with polycystic ovary syndrome will have irregular periods or stop menstruating altogether. Besides, the condition is associated with obesity, infertility, and hirsutism (excessive hair growth and acne). This condition may be caused by a hormonal imbalance, although the exact cause is unknown.

Premature ovarian insufficiency: This condition occurs in women who are less than 40 years with a malfunction in the ovaries. Their menstrual cycle usually stops like menopause. Women who are being treated for cancer with chemotherapy and radiation, family history of premature ovarian insufficiency, or specific chromosomal abnormalities may have it.

Thyroid abnormality: Overactive thyroid or underactive thyroid can cause anovulation and coagulation disorders with associated menstrual irregularities.

Other causes of abnormal menstruation include:

  • Cancers of the uterus, cervix, ovary or vagina
  • Blood thinners such as steroids or anticoagulant drugs
  • Bleeding disorders such as low platelets count
  • Pregnancy complications, including miscarriage or an ectopic pregnancy (the fertilized egg is implanted outside the uterus; for example, within the fallopian tube).

 

Management of abnormal menstrual periods

Management is patient-specific, coupled with a proper history and physical examination to find the possible causes.

  1. Pregnancy test- urine or blood test.
  2. Blood test- full blood count, coagulation profile, thyroid function test, platelet count, PCV, blood group.
  3. Ultrasound- abdominal or transvaginal for ovarian or uterine diseases (fibroids/polyps), PCOS
  4. Endometrial biopsy- to rule out cancers
  5. Diagnostic hysteroscopy, sonohysteroscopy
  6. Vagina swab to exclude infections
  7. History of trauma

 

Treatment options

Treatment can also depend on the age of the woman, how heavy the bleeding is, thickened endometrial lining, and whether the woman plans to have children. It might not be safe to get pregnant after some treatments, while others can make it impossible. For perimenopausal women, a wait-and-see approach may be adopted because the symptoms may get better on its own. It’s also advisable to rule out chronic illnesses or a blood disorder.

Medical treatment – Drugs are the first line of treatment.

  • Hormones. Birth control pills and other hormone treatments may be able to give you regular menstrual cycles and lighter periods.
  • Gonadotropin-releasing hormone agonists. These stop your body from making specific hormones. They can shrink fibroids for a while, but they’re usually used along with other treatments.
  • NSAIDs-ibuprofen or naproxen taken for a few days before the period starts may help lighten the bleeding.
  • Tranexamic acid- This is a pill that helps with blood clotting and can control heavy uterine bleeding.
  • For some women, an intrauterine device system that releases a hormone called progestin can stop heavy bleeding. Some women may not get their period at all.
  • Antibiotics to treat infections, if any.

 

Surgical management

Sometimes surgery can be needed to stop the bleeding

  • Endometrial ablation –The procedure uses heat, cold, electricity, or a laser to destroy the lining of the uterus. It may end the periods entirely and reduce the chances of pregnancy, birth control pills recommended until menopause.
  • Myomectomy or uterine artery embolisation–doctor may take the fibroids out or cut off the vessels that supply them with blood.
  • Hysterectomy– taking out the uterus This may be needed for huge fibroids, endometrial or uterine cancer. Otherwise, it’s the last resort when other treatments haven’t worked

 

Patient education

Abnormal menses can impact women negatively because of its unpredictability, and the anxiety it causes, it may also limit her daily activities or prevent her from leaving the house for particularly heavy menses.

The women goes a long way in rehabilitating them and adopting some lifestyle modifications.

  • Gradual Weight loss is encouraged- 5-10 per cent can help with menstrual regulations.
  • Instruct patients to continue prescribed medications, although bleeding may still be occurring during the early part of the cycle.
  • Also, patients should be told to expect menses after cessation of the regimen.
  • Young patients with small amounts of irregular bleeding need reassurance and observation before starting their drug regimen. It’s important to note that using drugs will not be necessary once menstrual cycles become regular.

 

Complications

  • Anemia – low blood volume
  • Fertility problems, such as miscarriages, implantation problems, and difficulty in achieving spontaneous pregnancy.
  • Malignant changes- transforming into cancers.
  • Some women may have severe, acute abnormal menses that necessitate hospital admissions or leads to death if a patient is in shock resulting from uncontrolled blood loss and delayed presentation.

Women are counseled to keep track of their menses – the regularity, the cycle length to detect an abnormality, and present early to their gynecologist.

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