MENSTRUAL IRREGULARITIES

Sometimes women have problems in their menstrual cycle—called menstrual irregularities.  They may
not get periods, get periods too frequently, have unpredictable menstrual bleeding, or they may have
painful periods.

There are many conditions that can cause menstrual irregularities.

1. AMENORRHOEA– Amenorrhoea occurs when a woman does not get her period by age 16, or
when she stops getting her period for at least three months and is not pregnant.
It is a symptom of another condition.  Possible causes can include moderate or excessive
exercising, physical or psychological stress, hormonal problems and so on.  Polycystic ovary
syndrome (PCOS) patient also experience amenorrhoea

2. OLIGOMENORRHOEA – Infrequent menstrual periods. Oligomenorrhoea is not a disease but is a

symptom of a larger condition.  For example, many polycystic ovary syndromes (PCOS) patient
have oligomenorrhoea.

3. PREMATURE OVARIAN FAILURE (POF) - POF describes a stop in the normal functioning of the
ovaries in a woman younger than age 40.  Women with POF may not have periods or get them
irregularly.

4. UTERINE FIBROIDS – Non cancerous tumours in women of childbearing age.  Some women with
fibroids have heavy menstrual periods, and some may bleed in between periods

5. DYSMENORRHEA

Background
The term dysmenorrhea is derived from the Greek words dys, meaning difficult /painful/
abnormal, meno, meaning month, and rrhea, meaning flow (Holder, 2009). Dysmenorrhea refers
to the syndrome of painful menstruation. Dysmenorrhea is one of the most common
gynecologic complaints in young women who present to clinicians. Dysmenorrhea can be
divided into 2 broad categories: primary dysmenorrhea and secondary dysmenorrhea.

Primary Dysmenorrhea
It occurs without pelvic pathology. The onset is 6 months to 2 years after menarche. It occurs
more frequently in unmarried woman. Pregnancy and vaginal delivery may improve discomfort.

Clinical Manifestations
Primary dysmenorrhea is occurrence of a physiologic alteration in some women. The pain begins
a few hours prior to or with the onset of menses, lasting 48 to 72 hours. The pain, located in
suprapubic region, can be sharp, gripping, cramping, or dull and aching. There is pelvic fullness
or bearing down sensations that radiate to the inner thighs and lumbosacral area. Premenstrual
syndrome will be experienced by some women during this time.
 Pathophysiology
Increased prostaglandin production and release by the endometrium (mainly PGF 2a) during
menstruation produce uncoordinated, spasmodic uterine contractions that cause pain. Women
with dysmenorrhea have higher intrauterine pressure during the menstrual period and twice as
much prostaglandin in their menstrual flow as women without pain. Uterine contractions are
more frequent and become uncoordinated or dysrhythmic. With this increased abnormal
uterine activity, blood flow is reduced, resulting in uterine ischemia and contributing to pain.
Another mechanism of pain is caused by prostaglandin (PGE 2) and other hormones, which
hypersensitize sensory pain fibers in the uterus to the action of bradykinin and other chemical
and physical pain stimuli (Dawood, 1990).

Secondary Dysmenorrhea
It is acquired menstrual pain that develops in life than primary dysmenorrhea, typically after age
25 years. This condition is associated with pelvic pathology, such as adenomyosis,
endometriosis, PID and uterine myomas so the symptoms may suggest as underlying cause. The
pain of secondary menorrhea is often characterized by dull, lower abdominal aching radiating to
the back or thighs. Often women experience feelings of bloating or pelvic fullness (Lowdermilk &
Perry, 2004).

Treatments & Medications

Medications are used to treat primary dysmenorrhea in women not desiring contraception
include prostaglandin synthesis inhibitors, primarily nonsteroidal anti-inflammatory drugs
(NSAIDs) (Parent-Stevens & Burns, 2000).
Oral contraceptive pills (OCPs) are for women who want a contraceptive agent. The
benefits of OCP use to decrease prostaglandin synthesis associated with an atrophic
decidualized endometrium (Speroff et al., 1999).

6. ENDOMETRIOSIS

Background
A condition in which multiple, small usually benign implantations of endometrial tissue develop
most commonly in the pelvic cavity, but may also be found in other areas of the body such as
lungs. Risk factors for endometriosis include early menarche, regular periods with a cycle of less
than 27 days, menses lasting more than 7 days, heavier flow, increased menstrual pain, and a
history of the condition in first-degree female relatives (Porth, 2005).

Etiology
The cause of endometriosis is unclear, but several theories have been proposed. The metaplasia
theory asserts the endometrial tissue develops from embryonic epithelial cells as a result of
hormonal or inflammatory changes. The theory of retrograde menstruation suggests that
menstrual tissue backs up through the fallopian tissue during menses, implants on various pelvic
structures, and survives. The transplantation theory asserts that the endometrial implants
spread via lymphatic or vascular route.

Clinical manifestations
Symptoms are varied and change over time. Often the severity of symptoms is in inverse
proportion to the extent and location of endometriosis

Diagnosis
Diagnostic test is done to rule out other medical conditions and endometrial implants. The tests
include the pelvic ultrasound and laparoscopy as well as CBCs to rule out pelvic abscesses and
infectious process. A low hemoglobin and hematocrit may be noted if menorrhagia also occurs.

Treatment & Medications

Nonsteroidal anti-inflammatory drugs or NSAIDs (such as ibuprofen or naproxen sodium) are
commonly prescribed to help relieve pelvic pain and menstrual cramping. These medications
have no effect on the endometrial implants but they do decrease prostaglandin production.
Many available medical treatments rely on interruption of the normal cyclical hormone
production by the ovaries which include Gonadotrophi analogs, oral contraceptive pills, and
progestins.