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Menstrual disorders

Menstrual disorders

Menstrual disorders can include infrequent, heavy or painful periods as well as those associated with mood disorders. A period is made up of blood and the womb lining. The first day of woman’s period is day one of the menstrual cycle. Periods last between 2-7 days and women lose about 3-5 tablespoons of blood in a period.

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If you have any questions or concerns about your health, please book a consultation.

Don’t worry alone, we’re here to help.

Why are you attending?

If you are experiencing menstrual concerns, our clinic is here to help. Attend our specialised clinic if you are dealing with any of the following menstrual issues:

  • Painful Periods
  • Irregular Menstruation
  • Absent Menstruation (No Period)
  • Breakthrough Bleeding (Bleeding Between Periods)
  • Bleeding During or After Intercourse

Our expert team is dedicated to addressing and managing a variety of menstrual health issues.

Irregular periods:

You have irregular periods if the length of your menstrual cycle keeps changing. The average menstrual cycle is 28 days, however, it’s normal for it to be a bit shorter or longer than this.

Irregular periods may occur at puberty, the perimenopause or with weight loss or gain, excessive exercise or stress.  Medical conditions such as polycystic ovaries or syndrome (PCOS) or a problem with your thyroid may also cause irregular periods.  Contraceptive pills are often used to regulate your bleeding as the womb lining can over thicken if the lining is not shed at least at six monthly intervals.

Irregular periods – NHS (www.nhs.uk)

Sexually transmitted infections, early pregnancy and changes to your cervix (neck of the womb) can also cause irregular bleeding.

Heavy periods (Menorrhagia)

You may have heavy periods if you:

  • Need to change your pad or tampon every 1-2 hours, or empty your menstrual cup more often than is recommended.
  • Need to use two types of sanitary protection simultaneously such as a tampon and a pad or bleed through your clothes or bedding.
  • Pass blood clots larger than 2.5cms, a 2p coin.

Taking medications such as blood thinners or being overweight can also contribute to heavier periods, as can fibroids; growths in the wall of the womb. Rarely it can be a sign of womb cancer so it should be taken seriously and reported to your Doctor who will arrange an ultrasound scan. Dr Summerhill can refer for ultrasound scans at Starlight Ultrasound, 8 Crown Passages, Hale, WA15 9GN.

Heavy periods can be treated with a variety of medications such as contraceptive pills or a Mirena ® coil. Gynaecologists may offer a procedure such as an endometrial ablation or even a hysterectomy where the above methods have failed or are not tolerated.

Painful periods (Dysmenorrhoea)

Period pain is common and sadly a normal part of your menstrual cycle when the womb contracts to release the blood. It’s usually felt as pelvic cramps which can radiate to the back and thighs and lasts from 48-72 hours. It’s unknown why some women experience more period pain that others, it may be due to a buildup of pain-producing chemicals known as prostaglandins or less commonly can be caused by an underlying medical condition. These include endometriosis where cells that normally line the womb grow externally and bleed at menstruation causing pain and scarring. Similarly adenomyosis where the same tissue migrates within the muscular wall of the womb and also bleeds, stretching the cavity. Fibroids can also make your periods heavier and more painful.

Primary care treatments for period pains may include anti-inflammatory prescriptions, contraceptive pills or coils. Dr Summerhill can refer you to our partners, Starlight Ultrasound.

Pre-menstrual syndrome (PMS)

Many women experience mild physical and emotional symptoms premenstrually which are manageable. However, when severe these symptoms can lead to a breakdown in interpersonal relationships and to an interference with one’s normal daily activities. The cause of PMS remains unknown but is felt to be due to fluctuating levels of hormones throughout the menstrual cycles. Symptoms can include tension, irritability, tiredness, low mood, anxiety and tearfulness. Physical symptoms may be breast swelling or pain, bloating, swelling of the hands and/or feet and headaches.

In order to diagnose PMS, symptoms must be logged, ideally over two cycles. Please take a look at the menstrual diary below to enable you to record your symptoms;

NAPS-MENSTRUAL-DIARY.docx (live.com)

 

Various herbal products, vitamins and minerals are sold for the treatment of PMS. The ones which have been studied most include magnesium, vitamin B6 (pyridoxine), calcium, and agnus castus. The evidence is mixed and it is not clear yet if they have any effect. Some studies suggest some of them are helpful, whereas others suggest they are not. There is not enough evidence yet to know if they can be recommended, and if so, in what dose. They are unlikely to do much harm as long as you do not exceed the dose suggested on the label, so you may wish to give one or more of these treatments a try.1

Evening primrose oil or simple painkillers such as ibuprofen or paracetamol may help with breast tenderness.1

Dr Summerhill is able to advise on the initial treatment options for PMS sufferers such as the newer contraceptive pills and hormonal patches/coils as well as some antidepressants.

Pre-menstrual dysphoric disorder (PMDD)

PMDD, or Premenstrual Dysphoric Disorder, is a clinical condition characterized by profound psychological and physical symptoms manifesting several days to two weeks before menstruation, with symptomatic relief occurring during menstrual periods. In milder forms, PMDD is colloquially referred to as PMS (premenstrual syndrome) or PMT (premenstrual tension).

Prevalence: The prevalence of PMDD is estimated to affect 5-8% of menstruating women. Notably, during the premenstrual two-week phase, approximately 20-30% of women experience noteworthy PMS symptoms.

Symptoms of PMDD: Common manifestations of PMDD encompass:

  • Mood swings characterized by extreme anxiety, sadness, and heightened irritability
  • Depression leading to feelings of hopelessness
  • Aggressive and angry emotional states
  • Impaired work and sports performance
  • Difficulty concentrating and failure to meet usual standards
  • Disrupted sleep patterns
  • Physical symptoms, including abdominal cramps, headaches, breast tenderness, and hot flushes

Distinguishing PMDD from PMS: PMDD represents the most severe manifestation of PMS, characterized by pronounced mood symptoms. The intensity of anxiety and depression may be severe, potentially leading to suicidal thoughts. Behavioral changes associated with PMDD can significantly impact both professional and personal relationships.

Menstrual Cycle Timing of PMDD Symptoms: PMDD symptoms typically arise up to two weeks before the onset of menstruation, coinciding with ovulation. Symptoms exhibit improvement with the onset of menstruation. Maintaining a symptoms diary, illustrating the cyclical nature of symptoms concerning menstrual cycles, is integral to the diagnostic process.

Causes of PMDD: Hormonal fluctuations, particularly those induced by ovarian function, are considered the primary contributors to PMDD. Ovulation triggers increased progesterone levels, accompanied by a decline in estrogen levels, impacting the serotonergic pathway in the brain and giving rise to mood-related symptoms.

Risk Factors: Risk factors associated with PMDD include:

  • Stressful lifestyle
  • History of depression and anxiety
  • Obesity (BMI exceeding 30)
  • Smoking
  • Age (Women between 20 to 35 years exhibit stronger ovulation and more pronounced symptoms)
  • Genetic predisposition

Self-Care Strategies: Effective self-care strategies involve stress reduction through lifestyle modifications, incorporating mindfulness, yoga, and meditation. Avoiding caffeine, sugar, smoking, and alcohol can be beneficial. Adequate sleep, regular exercise, a balanced diet, and managing physical symptoms with painkillers contribute to symptom alleviation. Additionally, B-6 Pyridoxine vitamin and Evening Primrose Oil supplementation during the symptomatic window may prove helpful.

Seeking Medical Advice: Medical consultation is warranted if symptoms significantly impact well-being, quality of life, work, or relationships. Maintaining a symptom diary aids healthcare professionals in assessing severity and cyclic patterns.

Medical Interventions and Support: Medical professionals may recommend hormonal interventions, such as contraceptive pills, to regulate hormonal levels by blocking ovulation. Cognitive Behavioral Therapy (CBT) may be suggested for its potential benefits. In cases of severe mood-related symptoms, Selective Serotonin Re-uptake Inhibitor (SSRI) medications, acting as antidepressants, may be prescribed for symptom management.

Polycystic ovary syndrome (PCOS

Polycystic Ovary Syndrome (PCOS) presents as a hormonal imbalance occurring during the reproductive years, impacting menstrual regularity and hormone levels, particularly androgens. Women with PCOS may experience infrequent or prolonged periods due to the development of numerous small fluid-filled cysts, known as follicles, along the outer edge of the ovaries.

Clinical Features of PCOS: In PCOS, the failure of these follicles to regularly release eggs contributes to reproductive challenges. The precise etiology of PCOS remains unknown, emphasizing the importance of early detection and intervention. Timely management, including weight loss, can mitigate the risk of long-term complications such as type 2 diabetes and heart disease.

Diagnostic Procedures: While there isn’t a singular test for diagnosing PCOS, we can employ a combination of methods to assess and confirm the condition:

  1. Pelvic Exam:
    • A pelvic exam enables the examination of reproductive organs for any masses, growths, or notable changes.
  2. Blood Tests:
    • Hormone levels are assessed through blood tests to identify irregularities. These tests help rule out other potential causes of menstrual irregularities or androgen excess resembling PCOS. Additional blood tests may include evaluations of fasting cholesterol, triglyceride levels, and a glucose tolerance test to gauge the body’s response to glucose.
  3. Ultrasound:
    • An ultrasound provides a visual assessment of the ovaries and the uterine lining thickness. This involves using a transducer placed in the vagina, emitting sound waves translated into images on a computer screen. Dr Summerhill can refer you to our partners, Starlight Ultrasound.

Optimising Health and Well-being: Early diagnosis facilitates prompt intervention, promoting overall health and reducing the risk of associated complications. Management strategies often include lifestyle modifications, weight loss, and, when necessary, pharmaceutical interventions tailored to individual needs.

 

Consultations

Service Cost (£)
Menstrual Disorder Consultation £275

 

 

 

References:

  1. Premenstrual Syndrome (PMS, PMT) | Symptoms and Treatment | Patient
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