Your Guide to Menstrual Disorders

Ever see your gynecologist write something down and wondered what it meant? Here are the top 6 menstrual disorders, their symptoms and causes explained… What is Premenstrual Syndrome/ Premenstrual Dysphoric Disorder? Premenstrual syndrome (PMS), a combination of both physical and behavioral symptoms that interfere with daily functioning, usually occurs during the second half of the menstrual cycle. Symptoms typically resolve within 4 days from the onset of menses. The more commonly experienced symptoms are: Abdominal bloating Fatigue Irritability/anxiety Acne Increased appetite Breast tenderness Mood changes For a diagnosis to be made, these symptoms must occur during at least two consecutive cycles. Treatment Treatment of PMS includes both pharmacologic and nonpharmacologic therapies. For mild cases, behavioral changes, patient education and support, dietary changes and exercise should be attempted. If there is no improvement, medications can be prescribed to address the specific symptom. PMDD Premenstrual dysphoric disorder (PMDD), considered to be a severe form of PMS, is often a medical condition that requires attention and treatment. Selective serotonin reuptake inhibitors (SSRIs) are generally the first-line therapy. There are strict diagnostic criteria for PMDD, and women must meet five of the 11 defined criteria during the second half of their menstrual cycles for at least two consecutive cycles. The symptoms must not be an exacerbation of a pre-existing disorder, such as depression or psychosis. These criteria are: Feelings of sadness or hopelessness, possible suicidal thoughts Feelings of tension or anxiety Mood swings marked by periods of teariness Persistent irritability or anger that affects other people Disinterest in daily activities and relationships Trouble concentrating Fatigue or low energy Food cravings or binge eating Sleep disturbances Feeling out of control Physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain What is Polycystic Ovarian Syndrome? Polycystic ovarian syndrome (PCOS) is a disorder in which the ovaries produce excessive amounts of male hormones (androgens) and develop multiple small cysts. The criteria necessary to make a diagnosis of PCOS have been a topic of heated debate for many years. In 2003, a group of European and American researchers and physicians revised the diagnostic criteria, which now state that women must have two of the following: Clinical or biochemical evidence of hyperandrogenism Menstrual irregularity due to oligo- or anovulatory cycles Polycystic appearing ovaries on ultrasound Clinically, PCOS manifests as: Fewer menstrual periods or none at all (oligo- or amenorrhea) Hirsutism (excess body hair following a male pattern) Male-pattern balding Acne Infertility Insulin resistance Obesity Diagnosis Hirsutism, male-pattern balding and acne are clinical signs of hyperandrogenism; however, other causes must be ruled out before making a diagnosis of MCOS. The menstrual irregularities of PCOS usually begin following puberty. Women with PCOS should be screened for impaired glucose tolerance and type 2 diabetes because of the association with insulin resistance. Treatment Treatment of PCOS depends on the symptoms. Hirsutism is generally treated with laser hair removal, electrolysis, waxing, depilatories or shaving. Oral contraceptives can be used to decrease acne and slow hair growth and can also prevent endometrial hyperplasia in those women without menstrual periods. Treatment for type 2 diabetes in PCOS patients is the same as treatment in patients without the condition. What is Dysmenorrhea? Dysmenorrhea, or menstrual pain, affects approximately 50% of premenopausal women. There are two types of dysmenorrhea: primary (menstrual pain without pelvic disease) and secondary (when menstrual pain is accompanied with pelvic disease). Primary dysmenorrhea is the most common gynecologic complaint among adolescent females. It is related to prostaglandin release in the uterus resulting in increased uterine tone and contractions. It usually begins 1-2 years after the onset of menstruation, when ovulatory cycles begin. The pain can have a significant impact on daily activities and is frequently the cause of many missed school days. Symptoms include recurrent crampy, lower abdominal pain. Primary dysmenorrhea may be associated with nausea, vomiting, diarrhea and headache. It typically begins several hours before the onset of menstrual bleeding and may last up to three days. After ruling out any underlying pelvic disorders, diagnosis is made by a pelvic exam and by confirming the cyclic nature of the pain. Treating Primary Dysmenorrhea Nonsteroidal anti-inflammatory drugs (for example, ibuprofen or naproxen) are the most effective treatment in 80% of primary dysmenorrhea cases. They are typically taken at the onset of pain and continued every 6-8 hours while the pain lasts. In those cases where NSAIDs do not provide relief or there is a contraindication to taking the medication, combined oral contraceptive pills may be used. These pills may be considered a first choice in those women who desire contraception in addition to the relief of dysmenorrhea. Treating Secondary Dysmenorrhea Secondary dysmenorrhea may be caused by endometriosis, uterine fibroids, abnormalities of the uterus, or adenomyosis, among other conditions. Symptoms usually start years after the onset of menstruation. The pain may begin up to two weeks before menses, and diagnosis typically is made during a pelvic exam, ultrasound, or laparoscopy. Treatment depends upon the type of disease. What is Adenomyosis? Adenomyosis occurs when glands and the supporting endometrial lining of the uterus grow into the muscle layer of the uterus (called the myometrium). It may cause pelvic pain one week before menses that can last throughout menstrual bleeding. Other symptoms associated with adenomyosis are heavy or prolonged menstrual blood flow and diffusely enlarged uterus. One-third of the women affected have no symptoms. Although adenomyosis may be present for years, symptoms tend to begin after the age of 40. Diagnosis Clinical diagnosis is often made when a women has a diffusely enlarged uterus, pain during menses, and heavy menstrual bleeding in the absence of fibroids or endometriosis. However, a confirmatory diagnosis can be made only after a hysterectomy by examining the uterine tissue under the microscope. MRI is the most accurate imaging study for diagnosing adenomyosis. Treatment Treatment of adenomyosis depends on many factors, including age, future fertility, and desire for medical versus surgical therapy. The definitive treatment of adenomyosis is hysterectomy, or surgical removal of the uterus. Other options include: Endometrial ablation (surgical removal) Hormonal therapy Nonsteroidal anti-inflammatory drugs What Is Endometriosis? About 5 million American women and female adolescents have endometriosis, a sometimes painful and disabling condition in which tissue that lines the uterus is found outside it, most commonly in the pelvis. As many as 30% of women who report infertility problems have endometriosis. Risk Factors The exact cause of endometriosis is unclear; however, there are several theories, including: Reverse flow of menstrual blood and tissue through the fallopian tubes into the pelvis Inability of the body’s immune system to destroy endometrial tissue outside of the uterus Transport of endometrial tissue outside of the uterus by blood and lymphatic vessels With stimulation, certain cells in the abdominal cavity develop into endometrial cells There is a genetic component to endometriosis with an occurrence rate of 7% in first-degree relatives. Recent research indicates that women who have endometriosis are more likely than other women to have diseases such as chronic fatigue syndrome and fibromyalgia, as well as other painful conditions, such as irritable bowel disorder, interstitial cystitis, vulvodynia, temporary mandibular disorder and migraine headaches. Symptoms Endometriosis is not always symptomatic. When symptoms are present, they vary from patient to patient and do not necessarily correspond to the amount of endometriosis present. Clinical signs include: Chronic pelvic pain Severe menstrual cramps (dysmenorrhea) Pain during sexual intercourse (dyspareunia) Infertility Ovarian mass If the endometrial tissue affects the bladder or intestines, there can be painful urination or bowel movement and, sometimes, blood in the urine or stool. Diagnosis Diagnosis is made by direct visualization during surgery, preferably by laparoscopy. At the time of surgical evaluation, any endometriosis implants should be removed. Treatment Treatment depends on the ultimate goal of therapy: relief of pain, fertility or removal of ovarian mass. Treatment options include: Hormonal therapy Pain medication Laser ablation (removal) Surgery Excerpted from The Savvy Woman Patient: How and Why Sex Differences Affect Your Health (Capital Books) by the Society for Women’s Health Research. Do You Have Endometriosis? Has your period always been troublesome? You may have endometriosis, a common gynecological condition in women that occurs during their reproductive years.