What is Menstruation?
Menstruation or menstrual period is 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. Premenstrual syndrome (PMS for short) is a group of symptoms that start before the period. PMS can include emotional and physical symptoms.
Common menstrual disorders
Menorrhagia (Brief Overview)
Menorrhagia is menstrual bleeding that is prolonged (more than 7 days) and abnormally heavy.
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 or naproxen during the period. 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 kidney risk factors.
Endometriosis (Brief Overview)
Endometriosis is when the lining of the uterus grows 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.
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
To be continued…I will discuss dysmenorrhoea in October in this health column
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