A review of different types of menstrual disorders and their treatment options

Menstrual Disorders

What is Menstruation?

Menstruation or menstrual period (period) is normal vaginal bleeding that occurs as part of the monthly cycle in women of reproductive age. Every month the woman’s body prepares for pregnancy. If no pregnancy occurs, the uterus (womb) sheds its lining. The menstrual discharge contains both blood and tissue from inside the uterus that passes out of the body.

Periods usually start between age 11 and 14. Periods continue until menopause which occurs for most women in their late forties or early fifties. Periods last between three to five days per month. In addition to bleeding from the vagina, women may experience:

• Abdominal or pelvic cramping type pain
• Tender and sore breasts
• Lower back pain
• Mood swings and irritability
• Headache and fatigue
• Food cravings

Premenstrual syndrome (PMS for short) is a group of symptoms that start before the period. PMS can include emotional and physical symptoms.

Menstrual disorders can include:

• Menorrhagia
• Endometriosis
• Postponement of menstruation
• Dysmenorrhoea

Common menstrual disorders

Menorrhagia (Brief Overview)

Menorrhagia is menstrual bleeding that is prolonged (more than 7 days) and abnormally heavy.

Treatment

To stop acute bleeding: Norethisterone 5mg, orally, three times a day for 10 days

For long-term control: if contraception required

• First choice Combined oral contraceptive, orally, daily
• Second choice Progesterone intra-uterine system (Mirena®)

For long-term control: if contraception NOT required

• First choice Tranexamic acid 1,000mg, orally, three times a day for up to four days after period has begun
• Second choice: NSAID such as ibuprofen, mefenamic acid or naproxen during the period. Trial lower doses of NSAIDs initially only increasing to higher doses if more relief required. NSAIDs should be prescribed for the shortest possible duration (e.g.) 3 or 4 days. NSAIDs are best avoided if the patient has cardiovascular, gastrointestinal, or renal risk factors.

Endometriosis (Brief Overview)

Endometriosis is a condition caused by tissue that normally only lines the uterus starting to grow in other places including the ovaries, fallopian tubes, and stomach.

Endometriosis can lead to symptoms including:

• Painful periods.
• Pain at time of ovulation.
• Dyspareunia (pain during or after sex)
• Heavy or irregular bleeding.
• Pain in the pelvic area, lower back, or legs.
• Pain during bowel movements or urination.
• Nausea
• Fatigue

Treatment

Where endometriosis requires drug treatment, a progestogen (e.g., Norethisterone) administered on a continuous basis is an option. For severe endometriosis, progestogen and or a synthetic progestogen (e.g., dydrogesterone) can be given alone, in a cyclical basis or in conjunction with an oestrogen.

If contraceptive required: Treatment option is an oral combined oral contraceptive daily

If contraception NOT required:

• First choice: Norethisterone 10mg, orally, daily for 4 to 6 months; start on day 5 of menstrual cycle; increase dose to 20 to 25mg daily (in divided doses) if spotting occurs then reduce once bleeding has stopped.
• Second choice: Dydrogesterone 10mg, orally, two or three times a day; take continuously

Postponement of Menstruation (Brief Overview)

While postponement of menstruation is not a “menstrual disorder” like menorrhagia, endometriosis or dysmenorrhoea, many women at some stage decide to postpone periods on a temporary basis for reasons like life events such as getting married or going on holidays or for medical reasons such as period pain.

Options to postpone period:

• Norethisterone 5mg, orally, three times a day. Start 3 days before anticipated onset of period. Menstruation will occur 48 hours after treatment finishes.
• Or Medroxyprogesterone 10mg, orally, daily for 7–10 days.

I discussed dysmenorrhoea, a common reason for pains and cramps experienced during menstruation in the Westmeath Examiner in April, if you wish to read this article, check www.whelehans.ie

For comprehensive and free health advice and information call in to Whelehans, log on to www.whelehans.ie or dial 04493 34591 (Pearse St) or 04493 10266 (Clonmore). Email queries to info@whelehans.ie. Find us on Facebook.