Menstrual disorders
The menstrual cycle, while normally a smooth, regular process, is a complex phenomenon whose usual operation can break down at any point along the way. Menstrual disorders can be roughly divided into four categories: amenorrhea, dysfunctional uterine bleeding, dysmenorrhea, and oligomenorrhea.
The complete absence of menstrual periods is amenorrhea. There are twocategories within this disorder: (1) primary amenorrhea, the relatively rarefailure to start having a period by age 16 (the average age is 12), and (2)secondary amenorrhea, which is more common and refers to the temporary or permanent ending of periods in a woman who has menstruated normally in the past.Many women miss a period occasionally, but missing three or more periods ina row is considered amenorrhea. Prolonged amenorrhea can lead to infertilityand other medical problems such as osteoporosis (thinning of the bones).
The absence of menstrual periods is a symptom, not a disease. Primary amenorrhea can result from hormonal imbalances, psychiatric disorders, malnutrition,excessive thinness or heaviness, and rapid weight loss. Drugs such as antidepressants, tranquilizers, steroids, and heroin can induce amenorrhea, as canchronic illness and stress. However, the main reason for amenorrhea is a delay in the beginning of puberty--either from natural reasons (such as heredity,intense physical training, or poor nutrition) or because of a problem in theendocrine system, such as a pituitary tumor or hypothyroidism.
The most common cause of secondary amenorrhea is pregnancy. Also, a woman's periods may end temporarily after she stops taking birth control pills. Secondary amenorrhea may also result from hormonal problems related to stress, depression, anorexia nervosa, or drugs; any condition affecting the ovaries, suchas a tumor; or polycystic ovary syndrome (PCOS), which involves cysts in theegg-producing ovaries. The cessation of menstruation also occurs permanentlyafter menopause or a hysterectomy.
Dysfunctional uterine bleeding (DUB) is irregular, abnormal uterine bleeding not caused by a tumor, infection, or pregnancy. It often occurs when the endometrium, the lining of the uterus, receives too much stimulation fromthe hormone estrogen, overgrows, and then must be shed from the uterus more frequently than usual. DUB occurs most often in women at the beginning and endof their reproductive lives.
DUB is suspected after other causes of uterine bleeding have been eliminated.Some of DUB's causes are pelvic inflammatory disease (PID), adenomyosis (a benign condition involving endometrial growths), cancer, fibroid tumors, and hypothyroidism. DUB is common in women with PCOS, while women who are on kidney dialysis or who use an intrauterine device (IUD) for birth control may alsohave heavy or prolonged periods.
Generally, the first approach to controlling DUB is to use oral contraceptives that provide a balance between estrogen and progesterone. NSAIDs (nonsteroidal anti-inflammatory drugs) can also be helpful. When bleeding cannot be controlled by hormone treatment, surgery may be necessary. Iron supplements, vitamin C, bioflavonoids, and stiptic (blood vessel-tightening) herbs may also be beneficial, while phytoestrogens and phytoprogesterone (from plant-based substances such as soy) can address hormonal imbalances.
Dysmenorrhea is the occurrence of painful cramps during menstruation.More than half of all girls and women suffer from this dull or throbbing painthat usually centers in the lower mid-abdomen, radiating toward the lower back or thighs. Menstruating women of any age can experience cramps. The firstyear or two of a girl's periods are not usually very painful. However, once ovulation begins, blood levels of prostaglandins (hormone-like substances thattrigger strong muscle contractions in the uterus) rise, leading to strongercontractions. While the pain may be mild for some women, others suffer severediscomfort that can significantly interfere with everyday activities for several days each month. Some women may even experience nausea and vomiting, diarrhea, irritability, sweating, or dizziness. Dysmenorrhea often disappears after a woman's first childbirth, probably due to the stretching of the uterineopening or because the birth improves the uterine blood supply and muscle activity.
Dysmenorrhea is called "primary" when there is no specific abnormality and "secondary" when the pain is caused by an underlying gynecological problem. Experts believe that the presence and/or severity of cramps is also strongly influenced by genetics, whether a woman has PID, stress, higher caffeine intake,too little exercise, and certain body types. Secondary dysmenorrhea may be caused by endometriosis, fibroid tumors, or a pelvic infection.
If an NSAID is not available, acetaminophen and applying heat may help. Whilebirth control pills ease the pain of dysmenorrhea because they lead to lowerhormone levels, they are not usually prescribed for pain management unless the woman also wants to use them for birth control, because these pills may carry other, more significant side effects and risks. Likewise, several yoga postures and lying in the fetal position may bring relief. Dietary recommendations to ease cramps include increasing fiber, calcium, and complex carbohydrates and reducing or eliminating smoking, fat, red meat, dairy products, caffeine, salt, and sugar. Recent research suggests that vitamin B supplements, magnesium, and fish oil supplements (omega-3 fatty acids) may be beneficial.
Oligomenorrhea is a disorder characterized by light, infrequent menstrual periods in women whose periods were regularly established before they developed problems. Periods occur at intervals of greater than 35 days, with only four to nine periods in a year. Women who have oligomenorrhea often have difficulty conceiving children and may receive fertility drugs for this reason.The absence of adequate estrogen increases risk for bone loss, uterine cancer, and cardiovascular disease.
Women with PCOS are likely to suffer from oligomenorrhea, but other factors can also bring on the condition, including emotional stress, chronic illness,poor nutrition, eating disorders, excessive exercise, estrogen-secreting tumors, and using anabolic steriods to enhance athletic performance. Oligomenorrhea in adolescents is often caused by physical immaturity or lack of synchronization between the hypothalamus, pituitary gland, and ovaries. Adequate nutrition and moderate exercise usually prevent oligomenorrhea in healthy women.
In adolescents and women near menopause, oligomenorrhea usually needs no treatment. Most patients are treated with birth control pills. Other women, including those with PCOS, are treated with hormones. Glandular therapy can assistin bringing about the crucial balance involved in the normal reproductive cycle. Homeopathy and acupuncture may also be helpful, along with Western and Chinese traditional herbal medicines.
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