Menstrual Disorders

Menstrual Disorders Can include premenstrual syndrome, dysmenorrhea, amenorrhea, and excess bleeding , irregular bleeding, or bleeding between cycles or unrelated to cycles. PREMENSTRUAL SYNDROME: A cluster of physical emotional and behavioral s/s that are usually r/t the luteal phase of the menstrual cycle. PMS is COMMON. S/S: HA, fatigue, low back pain , painful breasts, feeling of abdominal fullness. General irritability, mood swings, fear of loosing control, binge eating and crying spells. Tx: no single tx or cure for PMS. Regular exercise may be helpful Pharmacologic tx includes SSRIS, protanglandin inhibitors, diuretics, antianxiety agents, CA supplements. DYSMENORRHEA: painful menstruation w no identifiable pelvic pathology. It occurs during time of menarche or shortly after. It’s a crampy like pain that begins before or after onset of menstrual flow and lasts 48-72 hrs *pelvic exam is NORMAL Usually results from excess production of prostaglandins which causses painful contraction of the uterus. MANAGEMENT: useful meds include prostaglandin antagonists such as NSAIDS . Continuous low level local heat such as a heating pad can be helpful. AMENORRHEA: absence of menstrual flow is a s/s of many disorders and dysfunctions. Primary amenorrhea- situation in which a young woman who by age 15yrs old has not begun developing secondary sex characteristics or who by age 16yrs or older has developed secondary sex characteristics but has not started menstruation. Reasons for primary amenorrhea- genetic and anatomical d/o, turner syndrome, anorexia and polycystic ovarian syndrome. Secondary amenorrhea- absence of menses for 3 cycles or 6 months after a normal menarche. Reasons for secondary amenorrhea- functional hypothalamic amenorrhea, pituitary disease, primary ovaria failure, pregnancy, breast feeding, menopause, too little body fat, eating disorder, thyroid disease or polycystic ovary syndrome. ABNORMAL UTERINE BLEEDING Defined as irregular painless bleeding of endometrial origin that may be excess, prolonged and w no pattern. Can occur at any age but most common at opp ends of the reproductive lifespan. Usually secondary to anovulation (lack of ovulation) MENORRHAGIA- prolonged excess bleeding at the time of the regular menstrual flow In young women usually due to endoncrine disturbances and in laster life it results d/t inflammatory disturbances , tumors of the uterus and/or hormonal balance. Women w menorrhagia – recommended to see primary provider and describe amt of bleeding by pad count and saturation. Ongoing bleeding → ANEMIA. Tx: can involve endometrial ablation and hysterectomy. METRORRHAGIA- Vaginal bleeding between regular menstrual periods is the most significant form of menstrual dysfunction bc it may signal cancer, benign tumors of the uterus or other OBGYN problems.