What are the common causes of heavy and irregular menstrual bleeding. How is heavy and irregular menstrual bleeding evaluated. What treatment options are available for heavy and irregular menstrual bleeding. Can lifestyle factors affect menstrual bleeding patterns. What role do hormones play in menstrual irregularities. When should you seek medical attention for abnormal menstrual bleeding.

Common Causes of Heavy and Irregular Menstrual Bleeding

Heavy and irregular menstrual bleeding can be caused by various factors. Understanding these causes is crucial for proper diagnosis and treatment. Here are some of the most common reasons:

• Irregular ovulation
• Weight issues (underweight or overweight)
• Excessive exercise, particularly running
• Abnormal pregnancies (miscarriage or ectopic pregnancy)
• Uterine fibroids or endometrial polyps
• Thyroid gland dysfunction
• Elevated prolactin levels
• Sexually transmitted infections (gonorrhea and chlamydia)
• Cancerous or pre-cancerous conditions of the cervix or uterus
• Endometriosis

Is irregular ovulation the most common cause of heavy and irregular bleeding? Indeed, irregular ovulation is the most frequent culprit behind these menstrual irregularities. When ovulation doesn’t occur as expected, it can lead to delayed periods that may be unusually long or heavy when they do arrive.

The Impact of Weight on Menstrual Health

Body weight plays a significant role in menstrual health. Both being underweight and overweight can contribute to menstrual irregularities:

Overweight and Menstrual Issues

Excess weight increases the risk of heavy and irregular periods. Over time, this condition may elevate the risk of uterine cancer. How can overweight individuals improve their menstrual health? Adopting a low-sugar, low-calorie diet, losing weight, and engaging in at least 30 minutes of daily exercise can be beneficial.

Underweight and Menstrual Irregularities

Being underweight, especially when combined with excessive exercise, can lead to anovulation (lack of ovulation). This condition, if prolonged, may increase the risk of osteoporosis. To restore regular menstruation, maintaining a normal body weight and limiting exercise to 30 minutes a day is recommended.

Hormonal Imbalances and Menstrual Disorders

Hormonal imbalances can significantly impact menstrual patterns. Two key hormones that can affect menstruation are:

1. Thyroid hormones: A malfunctioning thyroid gland can cause heavy or absent periods.
2. Prolactin: Elevated levels may lead to absent or irregular bleeding, often due to a microscopic tumor producing this hormone.

Can hormonal imbalances be treated? Yes, thyroid abnormalities are easily treated medically, while prolactin issues can be addressed through medical or surgical interventions.

Reproductive System Abnormalities and Menstrual Bleeding

Several conditions affecting the reproductive system can lead to heavy or irregular bleeding:

• Uterine fibroids: Benign tumors that may require surgical removal
• Endometrial polyps: Small, benign growths that may need to be surgically removed
• Endometriosis: A condition where uterine lining tissue grows outside the uterus, causing heavy periods and pelvic pain
• Cancerous or pre-cancerous conditions of the cervix or uterus

Why is early diagnosis important for these conditions? Early detection of these reproductive system abnormalities often leads to easier and more effective treatment options.

Evaluation Process for Heavy and Irregular Menstrual Bleeding

When experiencing heavy or irregular bleeding, a comprehensive evaluation is necessary. This process typically includes:

1. Complete medical and menstrual history
2. Thorough physical examination
3. Blood tests for anemia, thyroid disease, pregnancy, and prolactin levels
4. Cervical culture for infections like gonorrhea or chlamydia
5. Pap smear
6. Endometrial biopsy or D&C (Dilation and Curettage) to diagnose uterine conditions
7. Ultrasound to detect small uterine or ovarian tumors
8. Laparoscopy if periods or intercourse are painful, to diagnose endometriosis

Why are multiple tests often necessary? Multiple tests help healthcare providers identify the underlying cause of the bleeding, which is crucial for determining the most appropriate treatment plan.

Treatment Options for Heavy and Irregular Menstrual Bleeding

Treatment for heavy and irregular menstrual bleeding depends on the underlying cause and the patient’s future family planning goals. Here are some available options:

Hormonal Treatments

• Birth control pills
• Injectable hormones (e.g., Depo-Provera®)
• Mirena® IUD (Intrauterine Device)

Non-Hormonal Options

• Naproxen Sodium (Aleve®) for lighter, less painful periods
• Endometrial ablation (for women done with childbearing)
• Uterine artery embolization (for women with fibroids who are done with childbearing)

Surgical Interventions

• Hysterectomy (as a last resort for women done with childbearing)

How does the choice of treatment depend on a woman’s reproductive plans? The selected treatment often varies based on whether a woman is trying to conceive, wants to maintain fertility for future pregnancies, or has completed her family planning.

Lifestyle Modifications to Manage Menstrual Irregularities

In addition to medical treatments, certain lifestyle changes can help manage menstrual irregularities:

• Maintaining a healthy weight
• Regular exercise (30 minutes daily, avoiding excessive workouts)
• Balanced diet low in sugar and calories
• Stress management techniques
• Adequate sleep

Can lifestyle changes alone regulate menstrual cycles? In some cases, particularly when weight or extreme exercise are factors, lifestyle modifications can significantly improve menstrual regularity. However, it’s essential to consult with a healthcare provider to determine if additional treatments are necessary.

When to Seek Medical Attention for Abnormal Menstrual Bleeding

While some variation in menstrual patterns is normal, certain symptoms warrant medical attention:

• Bleeding lasting longer than 7 days
• Extremely heavy bleeding (soaking through a pad or tampon every hour for several consecutive hours)
• Bleeding between periods
• Severe pain accompanying menstruation
• Sudden changes in menstrual patterns
• Bleeding after menopause

Why is it important not to ignore these symptoms? Prompt medical attention for these symptoms can lead to early detection and treatment of underlying conditions, potentially preventing more serious health issues.

Heavy and irregular menstrual bleeding can significantly impact a woman’s quality of life. However, with proper evaluation and treatment, most cases can be effectively managed. It’s crucial to work closely with healthcare providers to determine the underlying cause and develop an appropriate treatment plan. Remember, menstrual health is an important aspect of overall well-being, and there’s no need to restrict your life to suit your periods. With the right approach, you can control your periods to suit your life.

Heavy and Irregular Menstrual Bleeding

Possible Causes

The most common cause of irregular or heavy bleeding is irregular ovulation. If there is no ovulation your period may be late and when it comes it may last a long time or be unusually heavy. Irregular ovulation is more common if you are underweight or very overweight. If you are overweight, this increases your risk of heavy and irregular periods. If this goes on for many years it may increase your risk of uterine cancer later in life. If you are overweight you may benefit from a low-sugar, low-calorie diet, weight loss and exercise for at least 30 minutes per day.

The combination of excessive exercising – particularly running – and very low body weight increases your risk of anovulation. If this goes on for a long period of time you may increase your risk of osteoporosis. If you are underweight regular menses may resume if you maintain a normal body weight and limit exercise to 30 minutes a day.

Irregular and heavy periods can be successfully treated with hormonal therapy in the setting of overweight, underweight or normal weight women.

Heavy and irregular bleeding may also be the result of an abnormal pregnancy. A miscarriage or a pregnancy outside of the uterus may cause abnormal or heavy bleeding.

Heavy and irregular bleeding may also be the result of benign tumors of the uterus such as fibroid tumors or endometrial polyps. These may require surgical removal.

A malfunctioning thyroid gland can cause heavy or absent periods. Thyroid abnormalities are easily treated medically. Elevated prolactin may cause absent or irregular bleeding. An abnormal prolactin level can be the result of a microscopic tumor that produces this hormone. This may be medically or surgically treated.

Heavy and irregular bleeding may also be the result of gonorrhea and chlamydia infections. These are readily treated with antibiotics.

Abnormal bleeding may also be caused by cancerous or pre-cancerous conditions of the cervix or uterus. The earlier they are diagnosed the easier they are to treat.

Endometriosis can cause heavy periods as well as pelvic pain.

Evaluation

Heavy and/or irregular bleeding in a young woman requires a complete medical and menstrual history as well as a complete physical exam. A complete list of medications is important. Blood tests should be performed for anemia, thyroid disease, pregnancy and prolactin level. Sometimes more hormonal tests are necessary to rule out other rare causes of absent or erratic periods. A cervical culture for infections like gonorrhea or chlamydia and a Pap smear may need to be done. An endometrial biopsy or a D&C diagnose pre-cancerous and cancerous lesions of the uterus. Ultrasound may be needed to look for uterine or ovarian tumors that are too small to be felt on an examination. If periods and/or intercourse are painful, a laparoscopy may be needed to diagnose endometriosis.

Treatment

Treatment depends on what cause for the irregular or heavy bleeding was found. It also matters what your plans for a future family are.  If there is no obvious cause, there are many options including birth control pills, injectable hormones, the Mirena® IUD, endometrial ablation, and uterine artery embolization.

If you are actively trying to get pregnant, taking Naproxen Sodium (Aleve®) during your period can make them lighter and less painful. If your periods are irregular and heavy due to polycystic ovarian syndrome there is medication available to make your periods more regular and lighter. If you are not trying to get pregnant there are other options.  Depo-Provera® is a long-acting injectable hormone that stops your periods and provides birth control for 3 months.  The Mirena IUD is an intrauterine device containing a small amount of hormone that gives you lighter periods and provides birth control for up to 5 years.  Endometrial ablation is a procedure for women who are done with childbearing that cauterizes the inside of the uterus to give you lighter periods.  Uterine artery embolization is a procedure done at the hospital by an interventional radiologist that reduces blood flow to the uterus and makes fibroids smaller. It is also recommended only for women done with childbearing.   If you are done with childbearing and all other treatments have failed or are not for you, there is hysterectomy.  A hysterectomy can often be done through the vagina or by laparoscopy with the da Vinci® Robot, making it less painful and shortening hospitalization.

If you have heavy and irregular periods there is help available.  Don’t restrict your life to suit your periods.  Let us help you control your periods to suit your life.

Why am I Bleeding 2 Weeks After My Period? – Knix

Most people experience a menstrual cycle that is on average 28 days long, which means (roughly) monthly periods. The first day of your cycle is counted from the first day of your period. 

If you’re bleeding 14 days after your last period it could be that you have a shorter menstrual cycle. Or, it could be non-period bleeding. Let’s explore! 

What Could Cause 2 Periods in One Month?

The average menstrual cycle is 28 days long. But that doesn’t mean that everybody’s cycle runs like clockwork. Some of us have shorter or longer cycles. And some women have very irregular periods.

Also, it’s worth noting that even if your cycle is around the average 28 days, most months are slightly longer. This means your period won’t begin on the same date every month and, over time, will shift to an entirely different time of month. 

The combination of:

• A slightly shorter menstrual cycle, plus 
• A period that falls at the start of one month could result in two periods occurring within the same calendar month.

A shorter or irregular menstrual cycle may be caused by:

• Anovulation: The lack of ovulation in a menstrual cycle.
• Hyperthyroidism: An overactive thyroid may cause an irregular cycle.
• Hypothyroidism: An underactive thyroid may also cause irregular bleeding.

Is it Really a Second Period?

But if you’re bleeding 14 days after your last period, don’t jump to the conclusion that it’s necessarily a second period. There are many possible causes of bleeding between periods or intermenstrual bleeding. 

It’s definitely worth noting just how much bleeding is occurring and understanding whether you’re spotting or bleeding. In general, spotting would mean a few drops of blood on your underwear or toilet paper. You might want to wear a panty liner or Leakproof Underwear, but odds are you wouldn’t require a tampon or pad.

If you’re bleeding more heavily, to the point where you need a pad or tampon, it’s worth consulting a doctor to understand whether the bleeding is menses (a period) or has another cause. Unusual blood loss is a cause for concern, and could result in, or exacerbate, anemia. 

But what could those causes be? Given the specific timing of the question, there is one very likely cause: Ovulation.

The Likeliest Cause: Ovulation

You ovulate about day 14 of your cycle. For many women, the day around ovulation goes completely unnoticed. But for some, ovulation is an event they may feel and notice other symptoms around. Those symptoms can include light spotting.

During reproductive ages, the ovary releases an egg every month. This event occurs when the ovary follicles rupture and release the oocyte which travels to the fallopian tube and becomes an ovum or egg. The rupture of the ovary follicles can cause some light spotting and some women can even feel it happen.

That feeling usually manifests as a slight twinge or pain on one side of your abdomen. This pain is called Mittelschmerz. It translates literally as “middle pain”. It’s the name for the slight twinge or cramp that some women experience when the follicle releases the egg.

Learn more about what happens when you ovulate.

The best way to understand whether your bleeding corresponds with ovulation is to track your cycle using an app or diary. If you’re experiencing bleeding that does not coincide with ovulation, there are many other possible causes.  

Other Causes of Bleeding and Spotting Between Periods

Below is a list of the most common reasons you might be bleeding or spotting between periods. While this list is not exhaustive, it does cover the most likely explanations.

Birth Control Causes

• Birth Control Pills: According to Medical News Today, irregular bleeding between periods often occurs in the first 6 months of taking a new birth control pill. Doctors sometimes refer to this as breakthrough bleeding.
• Morning-After Pill: According to the Mayo Clinic, the morning-after pill can cause bleeding between periods or heavier menstrual bleeding.
• Intrauterine Device (IUD): Some women with an IUD for birth control may also experience non-period bleeding.

External Causes

• Trauma or Medical Examination: If you’ve experienced rough sex or a medical exam, like a Pap test, you may also experience vaginal bleeding.
• Medications: Certain medications may cause abnormal vaginal bleeding. Your pharmacist should advise you of any side-effects of medication.
• Stress: Increased stress may trigger many reactions.

Common Infections

The following infections may cause bleeding between periods. It’s worth noting that most infections are treatable. However, infections can become more serious if symptoms are ignored.

• Sexually Transmitted Infection (STI), including chlamydia, gonorrhea, and genital warts.
• Pelvic Inflammatory Disease (PID), an infection of the upper part of the female reproductive system.

Pregnancy-Related Causes

• Implantation bleeding: After a sperm fertilizes an egg, the fertilized egg implants in the womb. Sometimes, implantation may cause spotting known as implantation bleeding.
• Ectopic Pregnancy: Signs and symptoms of an ectopic pregnancy include abdominal pain and vaginal bleeding.
• Pregnancy: According to the American Pregnancy Association, 20% of women experience spotting during the first 12 weeks of being pregnant.
• Miscarriage: Heavy spotting is one of the symptoms of miscarriage.
• Breastfeeding: Depending on the frequency of breastfeeding and your own individual hormone levels, spotting may occur before full periods return.

Other Causes

• Fibroids or Polyps: Symptoms of these benign tumours can include irregular or heavy periods and heavy bleeding between periods.
• Endometriosis: According to the Mayo Clinic, women with endometriosis may experience occasional heavy menstrual periods or bleeding between periods (intermenstrual bleeding).
• Polycystic ovary syndrome (PCOS): PCOS can cause cysts in the ovaries and make it difficult to get pregnant. It can also cause irregular vaginal bleeding.
• Blood clotting disorders, like von Willebrand disease.
• Other health conditions, like hypothyroidism, liver disease, or chronic kidney disease.
• Cancer: Cancer or pre-cancer of the cervix, uterus, or (very rarely) fallopian tube can cause spotting or abnormal bleeding.

Perimenopause & Menopause

• Perimenopause: The time before menopause is known as perimenopause. During perimenopause, hormone levels fluctuate greatly. These hormonal shifts can have an effect on ovulation and your entire menstrual cycle. Some women notice irregular or skipped periods and abnormal bleeding between periods during perimenopause. 

• Vaginal dryness: Especially due to lack of estrogen after menopause, can cause bleeding.
• Cancer: According to the Dana-Farber Cancer Institute, spotting in post-menopausal women can, in some cases, be an early sign of cancer and should always be investigated further.

Risks

Depending on the cause of intermenstrual bleeding, the risks to your health will be different.

However, anemia is one risk that is common to all causes, especially those that result in heavy bleeding and particularly when paired with heavy periods.

Anemia is a condition in which you lack enough healthy red blood cells to carry adequate oxygen to your body’s tissues. It can have many causes, including heavier menstrual bleeding (menorrhagia) or by bleeding between periods (metrorrhagia).

Anemia doesn’t always have symptoms. But, according to the Mayo Clinic, some signs and symptoms of anemia include:

• Fatigue
• Weakness
• Pale or yellowish skin
• Dizziness or lightheadedness

When to Seek Medical Advice

If bleeding is accompanied by any of the following symptoms, it warrants getting some medical advice.

• Heavy periods with a lot of clotting
• Irregular periods
• Abdominal pain or cramping
• Pain or a burning sensation when peeing
• Unusual vaginal discharge and/or redness and itchiness

Even if you don’t have any of the above symptoms, don’t ever ignore abnormal vaginal bleeding or abnormal uterine bleeding in the following situations:

• If you think you’re pregnant: You should always see a doctor as soon as you think you may be pregnant to be administered a pregnancy test.
• When it happens inconsistently: If spotting seems to happen frequently and randomly, you should definitely look into it.
• It begins after unprotected sex: Unprotected sex can put you at risk for STI’s and other infections so if you notice spotting after unprotected sex, it’s wise to visit a doctor.
• You are on medication: If spotting can be a side-effect of any medication you are on, you should seek out professional help.
• Spotting occurs post-menopause: It is never considered normal for anybody post-menopause to experience spotting or vaginal bleeding.

Track Your Cycle in a Journal or App

If you suspect you’re bleeding at regular intervals, it’s a really good idea to start tracking your cycle in a journal or app. This can help you understand the rhythms of your own body. Remember, everybody has their own cycle and flow and it may be affected by many factors, both internal and external.

When you’re tracking, pay attention to bleeding, but also other symptoms, including:

• Vaginal discharge
• Cramps or abdominal pain
• Breast tenderness 

You can even make notes about sudden increases in libido or mood changes. Remember that bleeding may be a symptom of many different causes.

If bleeding continues, seek medical advice. Have  the information you’ve tracked in your diary medically reviewed by your doctor. This will help you speak to your doctor with more certainty and provide them valuable information to help with a diagnosis.

Abnormal Vaginal Bleeding – Clinical Methods

Definition

Normal vaginal bleeding occurs with the female ovulatory cycle beginning with the menarche, or onset of menses, which generally occurs at 10 to 15 years of age. It ends with the menopause, or cessation of menses, generally between age 45 and 50 years.

Abnormal vaginal bleeding may occur in association with or independent from menstruation. Bleeding related to the cycle may be abnormal in timing, duration, or quantity. Polymenorrhea (frequent menses) refers to a menstrual interval of less than 21 days. In oligomenorrhea (infrequent menses) the interval is greater than 37 days but less than 90. Amenorrhea (absence of menses) refers to failure to menstruate for 90 days or longer. Metrorrhagia is an increased duration of menstrual flow beyond 7 days and continuous with the cycle. Intermenstrual bleeding occurs between menses, discontinuous with the cycle. Hypomenorrhea is the term for abnormally low bleeding, substantially less than 30 ml per menstrual cycle, and hypermenorrhea refers to excessive bleeding, over 90 ml, in a cycle of normal duration.

The history should determine the following information:

• Premenarchal bleeding, which may be associated with precocious puberty (bleeding before the age of 9 years)

• Onset and cessation of menses

• The characteristics of the menstrual cycle: interval, duration, amount of flow, last monthly period

• Postcoital bleeding (any bleeding after intercourse or in association with douching)

• Postmenopausal bleeding (any bleeding occurring in the postmenopausal female)

Technique

Many associated findings in the history and physical examination must be evaluated in order to determine the etiology of abnormal bleeding. The basic general complete gynecologic history and physical examination will be extremely helpful. Ask about associated pain, discharge, bladder symptoms, nausea and vomiting, fever, infertility, and other history points. During the physical examination look for such conditions as abnormal phenotype breast development, abnormal hair distribution, thyroid enlargement, abdominal distention and tenderness, and hepatomegaly. Look for pelvic tumor, cervical lesions, polyps, and tenderness on the pelvic examination. Special diagnostic procedures such as hormonal assays, visual field tests, chest x-rays, laparoscopy, vaginal cytology, colposcopy, ultrasonography, culdocentesis, endometrial curettage, pelvic examination under anesthesia, and many others are helpful.

Menstruation usually begins at age 10 to 15. Young girls who have not menstruated before age 15 or who have vaginal bleeding before age 10 should be suspected of having gynecologic disease. Menarche usually appears 1 or 2 years after thelarche, or breast development.

The menopause with associated symptoms and cessation of menses usually occurs at age 45 to 50. A patient who is still menstruating regularly at age 52 should undergo dilation and curettage (D and C) even if she is asymptomatic. A patient who has stopped her menses for 6 to 12 months, then begins again to have vaginal bleeding, should have a careful examination. If the examination does not reveal a gross neoplasm of the cervix, then a D and C must be done.

Begin the evaluation by asking the patient about the onset of menses, then determine if the patient has ceased menstruation. Three clinical characteristics of cyclic menstruation should be recorded for the adult patient:

1. The menstrual interval (length of cycle). The menstrual interval is counted from the first day of one flow to the first day of the next flow (ordinarily 26 to 30 days). The definition of a normal menstrual interval is 21 to 37 days. Therefore menstruation occurring more frequently than 21 days is considered abnormal (polymenorrhea), and menstruation occurring less frequently than every 37 days is considered abnormal (oligomenorrhea). If menses has been absent for 90 days, the patient is said to have amenorrhea.

2. The duration of flow. This is usually 3 to 5 days, but a duration of 7 days is still considered normal. If the duration of flow is greater than 7 days, the patient is said to have metrorrhagia (bleeding beyond the normal duration of flow and into the intermenstrual period). The intermenstrual period is counted from the last day of one flow to the first day of the next flow. Therefore metrorrhagia and intermenstrual bleeding are synonymous. In practical usage these terms are distinguished from each other depending on whether the bleeding is continuous into the intermenstrual period (metrorrhagia) or discontinuous into the intermenstrual period (intermenstrual bleeding). This is explained in .

3. The amount of flow. This is more difficult to define. The normal amount of blood lost with each menstrual flow is 30 to 50 ml. There is no practical way to measure the amount of flow, however, and its evaluation is therefore rather subjective. Menorrhagia and hypermenorrhea refer to an increase in the amount of menstrual flow to 90 ml or more. Hypomenorrhea refers to a decrease in the amount of menstrual flow to substantially less than 30 ml per cycle.

It is important to ask the patient specifically about her last period. Many patients will assume that the occurrence of any bleeding episode is a “period.” Failure to make this distinction can result in misleading information.

The date of the last menstrual period should be included in the database of all female patients. Record the date that the menstrual flow began. Therefore, simply asking a patient, “When was your last menstrual period?” is not sufficient. Ask instead, “When was the first day of your last menstrual period?” Also record the duration of flow in the number of days. The date of the previous menstrual period should be recorded with the duration of flow. Then ask the patient if these periods were normal. Any deviation from normal should be recorded. Whenever the database is updated, the date of the last menstrual period should also be updated.

Ask the patient if there is any evidence of bleeding after intercourse or in association with douching.

The significance of a variety of gynecologic complaints and findings changes tremendously with menopause. Any complaint of vaginal bleeding after menopause is considered abnormal. No matter how slight the bleeding, always consider this abnormal and investigate.

Basic Science

The inception of menses (menarche) depends on the previous development of normal puberty. Menarche is the latest event in puberty. The mechanisms responsible for the start of puberty, and for the resulting menarche, are to a great extent unknown. Puberty is associated with an increased secretion of gonadotropin-releasing hormone (GnRH) from the hypothalamus, and consequent increased secretion of the gonadotropins follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the adenohypophysis. This results in increased secretion of estrogens (mostly estradiol-17β some estrone) from the ovary. Finally, cyclic secretion of GnRH, FSH, and LH is established, and in consequence cyclic secretion of estrogens and progesterone by the ovaries occurs. As a result of this, the endometrium undergoes cyclic stimulation and menses start.

On the first day of the normal menstrual cycle, plasma levels of FSH, LH, estrogens, and progesterone are relatively low. Plasma estrogens rise slowly during the first 12 days and then more abruptly around the thirteenth to fifteenth day, producing a midcycle peak. The level then diminishes somewhat, to rise again about the twenty-second day to form a second (luteal) peak, and fall finally to low levels as the menstrual flow starts again. Plasma FSH and LH are also low during the menstrual flow and remain low until the thirteenth to fifteenth day of the cycle, when there is a sharp and abrupt rise in concentration which rapidly subsides (midcycle peak). This peak appears to follow the midcycle estrogen peak by some hours. There is a single peak for both FSH and LH. Plasma progesterone remains low until after the midcycle. The concentration then rises to form a broad luteal peak corresponding to the luteal estrogen peak, and falls to low levels as the menstrual flow starts. The midcycle peak of gonadotropins appears to be responsible for ovulation, and the luteal estrogen and progesterone peaks correspond to the formation of and secretion by the corpus luteum. The elevation of plasma estrogens during the first part of the midcycle estrogen peak is thought to trigger the gonadotropin peak, with subsequent ovulation.

The menopause can be regarded as physiologic ovarian failure. For reasons unknown, the ovary ceases to respond to gonadotropin stimulation at around the age of 45. Plasma estradiol-17β is low, and since there is no ovulation, plasma progesterone remains low. The endometrium is, therefore, not stimulated and there are no menses. Plasma FSH and LH are greatly elevated and remain so for many years.

Clinical Significance

A variety of gynecologic problems is associated with abnormal menstruation. Invasive cervical cancer may cause menometrorrhagia or postcoital bleeding, or both. Tubal pregnancy may cause oligomenorrhea followed by metrorrhagia. Uterine myomas, pelvic endometriosis, pelvic inflammatory disease, adenomyosis, and dysfunctional uterine bleeding may cause menorrhagia. Adenomatous endometrial hyperplasia and endometrial adenocarcinoma may cause postmenopausal bleeding. Functioning ovarian tumors may cause a variety of menstrual abnormalities, depending on the hormone produced by the tumor. Normal intrauterine pregnancy is the most frequent explanation for oligomenorrhea followed by amenorrhea.

If bleeding occurs before the other signs of puberty, one must include the possibility of malignancy, foreign body in the vagina, or other trauma.

Healthy adult females usually menstruate normally. However, a patient cannot be guaranteed a complete state of health simply because her menstruation is normal, even though women who menstruate normally usually feel better and think of themselves as healthy. On the other hand, the patient is likely to consider abnormal menstruation a sign of ill health. It may be a manifestation of either a general medical disease or a specific gynecologic problem. For example, oligomenorrhea and amenorrhea may be associated with hypothyroidism, or the same menstrual problem may be associated with tuberculosis. Thrombocytopenia may be associated with menorrhagia or metrorrhagia, or both.

The amount of flow is very important to determine. When measured accurately, the average seems to be around 30 ml per menstrual cycle but varies among otherwise normal patients up through 90 ml. A careful history must be obtained for the flow to be properly evaluated. It is important to ask specifically about the patient’s last menstrual period. The patient may not understand whether or not her flow is normal because she has no basis for comparison. Her impression of her flow and whether it is light, normal, or heavy is important from the standpoint of knowing how she feels about herself, however. Additional helpful questions are: How many tampons or pads do you use on the heaviest day of your flow? How well soaked are these tampons or pads? A patient who is very fastidious about her menstrual flow may change pads when there is just the slightest sign of staining. She may actually use as many as 10 or 12 tampons or pads per day but lose less blood than another patient who uses only 4 pads per day but does not change pads until they are soaked from corner to corner. Patients who bleed very heavily may also state the necessity for using two tampons or pads at a time or sheets or towels. The passage of definite aggregates of red blood cells, or “clots”, is significant and indicates heavy bleeding. Ordinarily if the menstrual flow can be controlled with the use of vaginal tampons alone, one can assume that the menstrual flow is not too heavy.

A patient may have a heavy menstrual flow with a normal hemoglobin and hematocrit value. Excess menstruation may result in iron deficiency, but iron deficiency anemia is a late manifestation of excessive menstrual flow. Therefore, a history of excessive menstrual flow should be not discounted simply on the basis of a normal hematocrit value.

Reference

1. Kistner RE, ed. Gynecology principles and practice. 3rd ed. Chicago: Year Book Medical Publishers, 1979.

Period problems | Office on Women’s Health

Period problem: Menstrual pain (dysmenorrhea)

Pain that you get with your menstrual period is called dysmenorrhea (dis-men-uh-REE-uh). Pain is the most common problem women have with their periods. More than half of women who have periods get some pain around their period.² Some women may get just a feeling of heaviness in the abdomen or tugging in the pelvic area. Other women experience severe cramps different from premenstrual syndrome (PMS) pain.

A majority of period pain can be relieved by over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen, ibuprofen, or aspirin.³ Starting an over-the-counter NSAID medicine when your period first starts may also lessen heavy menstrual bleeding⁴ and help control the pain better.

There are two types of dysmenorrhea:

• Primary dysmenorrhea. This is the most common type of dysmenorrhea. The pain is usually caused by contractions of the uterus (womb). The uterus contracts during your period to help the uterine lining leave the body. Teens may get dysmenorrhea soon after they get their first period. For most women, primary dysmenorrhea gets less painful as they get older. But some women get severe menstrual pain. Your risk for dysmenorrhea may be higher if you:⁵
  • Got your first period before age 11
  • Have longer or heavier periods
  • Smoke
  • Have high levels of stress^6,7

• Secondary dysmenorrhea. This type of dysmenorrhea is usually caused by another health problem. Pain from secondary dysmenorrhea usually gets worse as you get older. It also lasts longer than normal menstrual cramps. Problems that cause secondary dysmenorrhea include:
  • Endometriosis. This condition happens when the lining of the uterus grows outside of the uterus where it does not belong. In response to monthly changes in levels of the hormone estrogen, this lining breaks down and bleeds outside of the uterus and can cause swelling and pain.
  • Uterine fibroids. Fibroids are tumors that grow in or on the wall of the uterus. They are almost always not cancerous. Some women with fibroids experience pelvic pain and vaginal bleeding at times when they do not have their period.
  • Ovarian cysts. Cysts are fluid-filled sacs on the ovary. Ovarian cysts usually don’t cause any symptoms, but some can cause pain during your period or at ovulation.

When to see your doctor

Talk to your doctor or nurse if over-the-counter pain medicine, such as ibuprofen or naproxen, does not help or if the pain interferes with daily activities like work or school. Your doctor or nurse will ask you questions and do some tests, including possibly a physical exam, to rule out any other health problem. Keeping track of your symptoms and periods in a diary or calendar can help your doctor or nurse diagnose any health problems.

See your doctor to rule out other health problems if:

• You have blood clots in your menstrual flow that are larger than a quarter.
• Your pain happens at times other than just before your period or during your period.

Treatment depends on what is causing your pain. Your doctor may prescribe hormonal birth control, such as a hormonal intrauterine device (IUD),⁸ the pill, shot, or vaginal ring,⁹ to help with pain from endometriosis, fibroids, or ovarian cysts. Hormonal birth control is sometimes prescribed by doctors for women’s health concerns other than preventing pregnancy. You may also need surgery, as a last resort, if one of these conditions is causing your pain.

Painful Periods and Heavy Bleeding | Condition

Symptoms of Painful Periods and Heavy Bleeding

Signs and symptoms of heavy menstrual bleeding include:

• Bleeding for more than seven days
• Bleeding that soaks through one or more tampons or pads every hour for several hours in a row
• Need to use multiple pads to control menstrual flow
• Need to change pads or tampons during the night
• Menstrual flow with blood clots larger than a quarter
• Flooding of clothing and bedsheets with menstrual bleeding
• Symptoms of anemia, such as fatigue and shortness of breath

Symptoms of menstrual pain include:

• Diarrhea
• Headaches
• Lower back pain
• Nausea
• Pain that starts a few days before the period, worsens during the period, and lasts two to three days after the period ends
• Throbbing or cramping pain in the lower abdomen that can be intense
• Lower back pain during menses

Patients should see their doctors if:

• Their periods stop for more than 60 days
• Their periods become erratic
• Their periods are less than 21 days or more than 35 days apart
• They bleed between periods
• They bleed after sex
• They have any vaginal bleeding after menopause
• They suddenly get a fever and feel sick after using tampons

Diagnosis of Painful Periods and Heavy Bleeding

UT Southwestern’s experienced gynecologists conduct a thorough evaluation, which includes a:

• Physical exam
• Review of personal medical history, including details of the patient’s menstrual cycle
• Discussion of symptoms

Patients should bring information about the dates and lengths of their last several periods. For sexually active patients, a pelvic exam will be performed to check for infections and to examine the cervix.

To diagnose heavy bleeding and painful periods, our doctors usually recommend one or more tests, such as:

• Blood tests to look for signs of iron deficiency, thyroid disorders, or blood-clotting abnormalities
• Ultrasound: Diagnostic tools that use sound waves to produce images of the pelvic organs. Used to look for any abnormalities  
• Pap smear: Sample of cells from the cervix that are examined under a microscope for infection or changes that can lead to cancer or already are cancerous
• Endometrial biopsy: A test that samples a small amount of endometrial tissue for examination under a microscope
• Magnetic resonance imaging (MRI) scans: Equipment that uses a large magnet and radio waves to produce detailed images of pelvic organs

Based on the results of these tests, we might recommend further testing, such as:

• Hysteroscopy: Examination of the inside of the uterus using a hysteroscope, a slender, lighted device inserted through the vagina and cervix. This allows direct visualization of the inside of the uterus
• Sonohysterography: Test that involves injecting fluid into the uterus via a thin tube through the vagina and cervix and then taking ultrasound images of the uterus

Treatment for Painful Periods and Heavy Bleeding

Painful Periods

If the painful periods are not relieved with over-the-counter medications or start to interfere with daily activities, our physicians might be able to offer relief.

Our doctors might recommend:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). If over-the-counter NSAIDs such as ibuprofen (Advil or Motrin) or naproxen (Aleve) don’t relieve symptoms, prescription NSAIDs might be prescribed.
• Hormonal birth control. Birth control prescriptions contain hormones that can help regulate hormone levels throughout the month and reduce the severity of menstrual cramps. In addition to pills, these hormones also can be delivered by an injection, a patch, an implant placed under the skin of the arm, or a flexible ring that is inserted into the vagina. Another good option, even in teens, is an intrauterine device (IUD) that contains a hormone called progesterone. These methods can be very effective in managing symptoms, even if patients are not sexually active.
• Surgery. If painful periods are caused by polyps or fibroids, surgical removal of the abnormal tissue can help reduce the symptoms. Many uterine-sparing, fertility-sparing, and definitive surgical options exist to help with these symptoms.

Heavy Bleeding

Our treatment for heavy bleeding is based on the amount of bleeding. Many approaches involve hormone therapy and other nonhormonal medical therapies. If there is a reason estrogen should not be prescribed, an oral progestin might be recommended. Over-the-counter treatments such as ibuprofen can help decrease the amount of bleeding and pain, as well.

Clinical Trials

As one of the nation’s top academic medical centers, UT Southwestern offers a number of clinical trials aimed at improving screening, diagnosis, and treatment of painful periods and heavy bleeding.

Clinical trials often give patients access to leading-edge treatments that are not yet widely available. Eligible patients who choose to participate in one of UT Southwestern’s clinical trials might receive treatments years before they are available to the public.

11 reasons why your period is suddenly lasting forever

Let’s not be coy here: Bleeding out of your vagina every single month is already kind of a pain, so when your period decides to extend its visit a little longer than usual, it can be downright infuriating – and concerning.

Honestly, there’s a pretty big range of normal when it comes to your period’s length (a typical one can last between two to seven days). If your period is a day or two more or less than your usual, and you don’t see any other issues (like extreme menstrual pain or very heavy bleeding), you likely don’t need to be concerned.

But – and there’s always a but, isn’t there? – if your period lasts 10 days or more, or suddenly changes significantly in length for three or more cycles in a row, that warrants a call to your gynae, says Dr Tom Toth, a reproductive endocrinologist at Boston IVF.

Still, there’s no need to panic – most causes of prolonged menstrual bleeding (like most of the ones below) aren’t a big deal and can be fixed or improved with the help of your doctor, says Dr Toth.

1. You have an IUD.

One of the most common causes of long periods in younger women are intrauterine devices (IUDs), a type of birth control placed directly into your cervix. There are two main types: a non-hormonal, copper-based IUD (like Paraguard), and a hormonal, progestin-based IUD (like Mirena and Skyla).

It turns out that both can cause abnormally long bleeding, especially right after insertion, Dr Toth says. Longer, heavier periods are a known side effect of the copper IUD. The progestin IUD, however, is often marketed to women as a way to reduce or even eliminate their periods. And while it typically does have that effect over time, the first few cycles may have more or longer bleeding than usual, he says.

With either IUD, if the prolonged periods don’t settle down after three cycles, it’s time to go back to your doctor, as it’s possible the IUD moved out of position or simply doesn’t play nice with your body.

Read more: 6 times your period blood looks different – and what it means about your health

2. You’re actually ovulating.

Menstruation is your body’s way of getting rid of the extra blood and tissue it saved up in case your egg got fertilised and there’s a baby, but sometimes the hormonal signals get crossed and you can bleed when you release the egg too, says Dr Sherry Ross, an obstetrician and gynae and author of She-ology.

That’s called “intermenstrual bleeding”, and it occurs when the slight dip in oestrogen that happens around ovulation causes some spotting. If the bleeding lasts a few days or happens close to the end of your last cycle, it may seem like your period is continuing forever. It’s not normally something to worry about, but if it changes suddenly or if you have serious pain, it’s time to see your doctor.

3. You’re pregnant (yes, really).

Wait just a second: Isn’t the tell-tale sign of pregnancy no periods? Yes, but not all the time, Dr Toth says. “A common cause for abnormal menses, including longer bleeding, is pregnancy,” he explains, adding that typical symptoms of pregnancy, like nausea, may be absent. “Any time a woman has unusual bleeding, it’s always best to eliminate possibility of pregnancy with a blood test for pregnancy for reassurance,” he says.

Read more: Can you really get pregnant while on your period?

4. You’re on hormonal birth control.

Anything that manipulates your hormones has the potential to make your periods longer, says Dr Toth. This includes all types of hormonal birth control like the pill, patches, rings, shots and implants. The good news is that there are lots of options with varying levels and types of hormones, so if your body doesn’t respond well to one type or dosage, there’s a good chance you can find a different one that will work.

The length of your period is just one factor your doctor will use to help you determine which type of birth control works best for you.

5. You had an early miscarriage.

Early miscarriages are much more common than you may realise. Up to half of all pregnancies end in miscarriage, often before the woman even realises she was pregnant, according to the March of Dimes.

The only sign? An extra-heavy or long period. Your menstrual cycle length should return to normal within one to two cycles – if it stays abnormally long after three cycles, call your doctor, Dr Toth says. About one in 100 women suffer from repeat miscarriages, so it’s important to rule out a condition that affects fertility like endometriosis.

6. You have PCOS.

Polycystic ovary syndrome (PCOS) affects about 10% of women of childbearing age, per the OWH. It’s named for the cysts that grow on the ovaries, preventing eggs from maturing, and often making the woman infertile.

PCOS also wreaks havoc on hormone levels, causing weight gain, excess hair growth and prolonged periods, Dr Toth says. You’d think that not ovulating would give you a free pass on bleeding, but the opposite is often true, he adds – no egg means long, wacky cycles.

If you’re experiencing super-long periods along with other signs of PCOS, like migraines, facial hair growth and weight gain, talk to your obstetrician or gynaecologist about getting tested for the condition.

7. You have thyroid issues.

One in eight women will suffer from low thyroid function, or hypothyroidism, at some point in their lives, according to the Office on Women’s Health (OWH).

Your thyroid is a little butterfly-shaped gland that controls the hormones that regulate many systems in your body, including how fast you burn kilojoules, how fast your heart beats, and yes, menstruation. Having too little thyroid hormone can cause your period to be super long and heavy, they explain.

Other symptoms of hypothyroidism include weight gain, fatigue and hair loss, so if you’re experiencing any of those, along with longer-than-normal periods, bring it up to your doctor, says Ross.

8. You have an underlying blood disorder.

It’s rare, but it’s possible that extra-long periods are a sign of an underlying illness, like a haematologic (blood) disease, says Dr Toth. Some of these, like haemophilia or Von Willebrand disease, are genetic, so if you have this you likely already know about it.

Still, if your periods are lasting a super-long time, and you’ve already been cleared for other conditions, it’s worth checking in with your doctor about tests to rule out a blood disorder that you might not be aware of.

9. You have uterine polyps or fibroids.

“Uterine abnormalities, such as polyps or fibroids, can cause prolonged periods because they distort the endometrial cavity which can lead to increased blood flow,” Dr Toth explains. Basically, your body senses something in your uterus that isn’t supposed to be there, and tries extra hard to get rid of it.

Polyps and fibroids sound scary, but they’re pretty common – up to 80% of women will have at least one before they’re 50, per the OWH. On their own, they don’t indicate a serious disease, like cancer.

These benign growths often don’t have any symptoms, and if they do, it’s usually prolonged periods, says Dr Toth. Most likely your doctor will just recommend keeping an eye on them, but if they cause pain or grow very large they can be surgically removed.

Read more: Would you recognise these 8 uterine fibroid symptoms?

10. You have undiagnosed cervical cancer.

Abnormal vaginal bleeding – such as bleeding after vaginal sex, bleeding and spotting between periods can be a sign of cervical cancer. (Yet another reason to check in with your doctor if you notice something strange going on with your period.)

Because cervical abnormalities can be detected through Pap smears and HPV tests, make sure you stay on top of those, and always tell your doctor about your family history of female cancers.

Read more: 7 cervical cancer symptoms you should absolutely never ignore

11. Your body’s gearing up for menopause.

Oh yes, simply getting older can mess with your period. Menopause, which technically means you’ve gone 12 or more months without a period, hits women around age 50. However, your body starts the natural decline in hormones that leads up to menopause (a.k.a. perimenopause) as early as 35, says Dr Christiane Northrup, author of Women’s Bodies, Women’s Wisdom.

When this happens, you may notice your periods getting longer or shorter, your cycle becoming more random, and other slight changes in your menstruation.

If you’ve ruled out everything else, and you’re in your mid- to late-thirties, your prolonged periods might simply be due to the natural process of ageing. There is, however, such a thing as early menopause, which can affect women even in their twenties, so talk to your doctor if this runs in your family or if you’re showing other signs of menopause, like a low sex drive or insomnia.

^{This article was originally published on www.womenshealthmag.com}

^{Image credit: iStock}

Depo-Provera User Reviews for Abnormal Uterine Bleeding

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Menstrual irregularities and uterine bleeding

Menstrual migraine

What is a menstrual migraine?

This is a migraine in which attacks occur in women two days before the onset of menstruation and within three days after the onset.At least two out of three cycles. So menstrual migraine is defined by the III International Classification of Headaches.

Menstrual migraines are of several types. With “pure” menstrual migraine attacks occur exclusively at the beginning of menstruation, and no more in any other phase of the cycle.
At menstrual-associated migraine attacks occur during other phases.

According to the classification, a “pure” menstrual migraine is a migraine without an aura, although this is not an exceptional rule, a menstrual migraine can be a migraine with an aura [1, 7].

What is a migraine in general?

Migraine is a disease of the brain (often hereditary) that causes a very severe headache. The pain lasts 4 to 72 hours. It is accompanied by nausea or increased sensitivity to light and sound. The pain is such that it interferes with daily activities.

Are menstrual migraines common?

Yes. Menstrual migraines are very common. This is a significant medical problem.Two-thirds of women with migraines report that their attacks are more severe during their period. At the beginning of the cycle, the likelihood of an attack is 2-3 times higher than usual. The attacks that occurred during this period are more severe and prolonged [2].

Why does your period make your migraine worse?

Migraine is very sensitive to fluctuations in the level of female sex hormones. Before the onset of menstruation, estrogen levels drop sharply. This triggers the development of the seizure.
Proof of this is the fact that most women do not experience migraine attacks until adolescence.In childhood, the ratio of boys and girls with migraine is the same. And in adulthood, the prevalence of migraine among women is already three times higher than among men [3].

How are menstrual migraines treated

Two ways [6]:

1. relieve an attack that has already arisen;
2. prevent new attacks.

How to relieve an attack menstrual migraine

It is most effective to relieve (stop) seizures with specific anti-migraine drugs – triptans (read the article about them: Triptans).Non-steroidal anti-inflammatory drugs (NSAIDs) can also be effective, you can read about them here: Non-steroidal anti-inflammatory drugs) and ergotamine preparations.

How to prevent a menstrual migraine attack

Drugs for prophylaxis are prescribed 1-2 days before the most likely day of the attack. This type of prophylactic treatment is called mini prophylaxis. For her, triptans, NSAIDs and magnesium preparations are used. All of them are effective if they are prescribed just before the onset of the attack, and treatment continues for 5-7 days.

Hormone therapy gives conflicting results. Some women note that when menstruation is stopped with the help of oral contraceptives or modern intrauterine systems, migraines also go away [4]. Preventing a drop in estrogen levels with estrogen-containing gels and patches has been shown to be beneficial in preventing menstrual migraines in several small studies [5].

Menstrual migraine may reflect hormonal dysregulation.This disease is very common and greatly reduces the quality of life, but there are always solutions. Do not tolerate pain, see a doctor!

Literature:

1. International classification of headaches, 2nd edition (full Russian version) “. , 2006, 380 p.
2. Tabeeva G. R. “Menstrual migraine”. // Ros. honey. zhurn. 2008, vol. 16, no. 4, p. 195-199.
3. Tabeeva G. R. Gromova S. A. “Estrogens and migraine.” // Neurological journal.2009. No. 5, p. 45-53
4. Allais G., Castagnoli Gabellari I., et al. Oral contraceptives in migraine therapy. // Neurol Sci. – 2011. – v.32. – Suppl 1. – S135-139.
5. Almén-Christensson A., Hammar M., Lindh-Åstrand L., et al. “Prevention of menstrual migraine with perimenstrual transdermal 17-β-estradiol: a randomized, placebo-controlled, double-blind crossover study.” // Fertil Steril. – 2011. – v.96. – p. 498-500
6. MacGregor E.A. “Prevention and treatment of menstrual migraine”. // Drugs. – 2010. – v.70. – p. 1799-818.

Rothrock J.F. Oral triptan therapy. // Headache. – 2009. – v.49. – p. 1399-1400

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Menstrual cycle and ovulation – Nikamed Clinic

If your period is painful, there is no reason to suffer in silence. By contacting our clinic, women with dysmenorrhea, irregular or painful periods will be able to receive qualified specialist assistance and access to a range of treatment options.

In case of problems with ovulation, the doctor assesses the patient’s condition to identify the cause of infertility. He will prescribe the appropriate treatment to help the family conceive. Female infertility can be caused by a variety of factors, including ovarian dysfunction.

Menstrual cycle is a series of monthly changes that take place in a woman’s body in preparation for a possible pregnancy. Each month, one of the ovaries forms a follicle from which an egg is released – a process called ovulation.At the same time, cyclical hormonal changes prepare the uterus for possible pregnancy. If ovulation occurs, but the egg is not fertilized, the lining of the uterus is rejected and menstruation occurs.

What is the norm?

The menstrual cycle is counted from the first day of the beginning of one period until the first day of the next. It is different for every woman. Menses can normally occur between 21 and 35 days and last from two to seven days. During the first few years after your period starts, long periods are normal.However, the menstrual cycle tends to shorten and become more regular within 1 year of the onset of your period.

Your menstrual cycle is considered regular if the intervals between your periods are approximately the same length each month or differ by 1-2 days. Normally, menstruation should be painless, not abundant and complete within 3-5 days.

Be aware that using certain types of contraception, such as the continuous contraceptive pill, changes your menstrual cycle.Talk with your doctor about what to expect while taking the drug and how it might affect your future fertility. This is an important aspect to consider when planning a pregnancy and managing a pregnancy.

How can I track my menstrual cycle?

To find out what is normal for you, start keeping track of your menstrual cycle on a calendar or mobile app. Start by tracking the start date of each month for several months in a row to determine if your period is regular.

• If you have anxiety about your period, look for the following factors every month:
• End date. How long does your period usually last? Are they longer or shorter than usual?
• Intensity of menstruation. Record the intensity of your period. Does it seem lighter or heavier than usual? How often do you need new personal care products?
• Abnormal bleeding. Have you seen bleeding between periods?
• Pain.Describe any pain associated with your period. Does the pain get worse over time?
• Other changes. Have you felt a change in mood or behavior?

What causes menstrual irregularities?

Menstrual irregularities can be caused by a number of reasons, including:

Pregnancy or breastfeeding. A delayed or missed cycle can be an early sign of pregnancy. In addition, breastfeeding before a certain period of time often blocks the return of menstruation after pregnancy.

Eating disorders, severe weight loss or excessive exercise. Eating disorders – such as anorexia nervosa, sudden weight loss, and dramatic increases in physical activity – can lead to menstrual irregularities.

Polycystic ovary syndrome (PCOS). This common hormonal disorder can cause small cysts to form on the ovaries and cause irregular periods.

Premature ovarian failure. Premature ovarian failure refers to the loss of normal ovarian function before the age of 40.Women who experience premature ovarian failure (also known as primary ovarian failure) have irregular or infrequent menstrual cycles for many years.

Pelvic inflammatory disease. These genital infections also cause irregular menstrual bleeding.

Myoma of the uterus. A uterine fibroid is a benign growth of the uterus that can cause heavy periods and bleeding between cycles.

What can I do to prevent menstrual irregularities?

For some women, using the contraceptive pill prescribed by a doctor can help regulate the menstrual cycle.However, some menstrual irregularities cannot be resolved with medication alone.

Regular check-ups are the best guarantee that women’s health problems are diagnosed as soon as possible.

Also, see your doctor if:

• Your periods suddenly stopped for more than 90 days and you are not pregnant
• Your periods become irregular
• Bleeding continues for more than seven days
• Bleeding has changed towards profuse, forcing more frequent changes in personal hygiene products.
• Your period occurs in less than 21 days or more than 35 days
• You have bleeding between periods
• You have severe pain during your period
• You feel feverish and nauseous after using tampons

Remember: Monitoring your menstrual cycle helps you know what is normal and what is not normal for you. If you have questions or concerns about your menstrual cycle, check with your doctor.

About menstruation after childbirth | Clinic.kg

Healthy pregnancy and childbirth of a healthy baby are a reason for a woman to be proud of herself and her health. An important topic that worries many women after childbirth is menstruation: when to wait for it, why is the cycle irregular, is it possible to get pregnant while breastfeeding, and much more. Let’s analyze the main issues in our article.

Postpartum discharge

Postpartum abundant discharge in a woman has nothing to do with menstruation – these are lochia, which become bloody from bloody, and then transparent, completely disappearing.After about two months, the uterus and ovaries return to their physiological state and size, and therefore, it is quite possible that menstrual cycles begin with the maturation of eggs and menstruation. Thus, a woman can expect her first menstruation from 2-3 months after childbirth.

When should your period start after childbirth?

This period depends on the type of feeding of the child: natural or artificial. Breast milk is produced by the pituitary hormone prolactin.The level of estrogen does not increase, therefore, when breastfeeding, menstruation begins, on average, 2 months after childbirth, more often when feeding “by the hour”. But there are times when some lactating women do not have their periods within a year, and for some they can recover within a month and a half after giving birth. On average, the onset of menstruation with breastfeeding varies from 3 months to six months.

How long are your periods in the postpartum period?

Often the first menstrual period is quite heavy.There may be strong discharge, menstruation with blood clots. If you have to change the gasket every hour, you should seek help from a doctor: this may be a symptom of bleeding that has begun. Subsequent periods are usually normal. In other cases, irregular spotting appears in women in the first months. This is typical for breastfeeding, when prolactin synthesis gradually decreases.

Reasons for slow recovery of the regular cycle

Each woman has its own individual period of recovery of the menstrual cycle.This is determined by the activity of the production of hormones of the gonads, the pituitary gland, the state of the immune and reproductive system as a whole. For this, there are a number of reasons that affect the body in the postpartum period:

• peculiarities of the individual hormonal background;
• hereditary factors;
• the nature of the generic process;
• Features of the reconstruction of the uterus.

What to do if your menstrual cycle becomes irregular:

• In the first months of the postpartum recovery period, do not panic.In most cases, this is a variant of the norm. For each woman, the normalization of the cycle occurs individually, usually during the first months of the resumption of menstrual bleeding. Irregularity is more common in nursing mothers.

• It takes about 2 months to restore the normal function of all organs and systems. The balance in the endocrine system comes later, especially if breastfeeding is used. Therefore, a woman may feel quite healthy, but at the same time she will not have a period.

• Pay attention to irregular cycle only after 3 cycles. It may be due to inflammation, endometriosis, or a tumor of the genitals. A delay in the second period is not dangerous, unless it is associated with a second pregnancy.

Menstruation after cesarean section

Menstruation after cesarean section is restored in the same way as after normal childbirth.During lactation, menstruation does not come for six months. Against the background of artificial feeding from the hospital due to the lack of stimulation of the nipples (in which the synthesis of oxytocin, which contracts the uterus, is activated), recovery may proceed somewhat slower, plus there is still a scar on the uterus. Therefore, the restoration of menstrual function may occur a little later, for several weeks.

Cycle after a pathological course of pregnancy or childbirth

After termination of a frozen pregnancy or abortion, the first menstruation occurs within 45 days.If this does not happen, the woman should seek help from a gynecologist. To exclude such causes of amenorrhea as the remainder of the ovum in the uterus or inflammation, an ultrasound scan is necessary 10 days after the termination of a frozen or normal pregnancy.

Menstruation pathologies, what to look for and immediately contact a specialist:

• Sudden cessation of postpartum discharge is a sign of uterine bending or endometritis, accumulation of lochia in the uterine cavity – lochiometers.
• Lean periods for 3 cycles or more. Perhaps they are a symptom of hormonal disorders, Sheehan’s syndrome or endometritis.
• Irregularity of menstruation six months after its recovery, the break between bloody discharge for more than 3 months. Most often, it is accompanied by ovarian pathology.
• Excessive bleeding for 2 or more cycles, especially after surgical delivery or termination of pregnancy. They are often caused by the tissues of the membranes remaining on the walls of the uterus.
• The duration of menstruation is more than a week, which is accompanied by weakness, dizziness.
• Abdominal pain, fever, foul odor, discoloration of vaginal discharge are signs of a tumor or infection.
• Spotting before and after menstruation is a likely symptom of endometriosis or inflammatory disease.
• Itching in the vagina, an admixture of cheesy discharge – a sign of thrush.
• Bleeding twice a month for more than 3 cycles.

Is it possible to get pregnant?

The most common myth is that a woman cannot get pregnant if she is breastfeeding her baby. The fact is that the process of ovulation, the first after childbirth, is formed before the onset of the first bloody discharge, and it is she who, with unprotected intercourse, can lead to an unplanned pregnancy, and the woman will give birth to the weather. If a woman does not feed, you need to think about protection after childbirth immediately, from the very first sexual contact, since the dynamics of restoration of reproductive functions is different for everyone, after 6-8 weeks from the moment of birth, the first ovulation is already possible.

Remember that a long delay in menstruation after childbirth or a failure of the cycle are not always symptoms of dangerous disorders, but in any case it is undesirable to self-medicate. For any questions and problems arising with the reproductive system, please contact our specialists for advice.

Disorders and Reasonable Correction uMEDp

This article discusses strategies for the prevention and treatment of menstrual dysfunction in the late reproductive period.Particular attention is paid to the possibilities of hormone therapy during the menopausal transition. Observational data demonstrate a positive result of the use of combined oral contraceptives for painful menstruation and abnormal uterine bleeding. The use of combined oral contraceptives to regulate the menstrual cycle is also a method of preventing proliferative endometrial diseases.

The late reproductive period is one of those periods in a woman’s life when the restructuring of homeostatic mechanisms against the background of changing hormonal levels requires coordinated work of adaptation systems.Adaptation disorders at this stage of the life cycle more often than ever are manifested by disorders of menstrual function and numerous psychovegetative symptoms [1]. It should be understood that the parameters of the normal menstrual cycle for young women are not acceptable for women in the late reproductive period, which is characterized by a different ratio of “norm / pathology”. An underestimation of the age-related characteristics of the functioning of the reproductive system can lead to both overdiagnosis and unjustified therapeutic interventions, as well as to untimely detection of latent gynecological pathology.This determines the relevance of adequate observation of women in the late reproductive period.

A woman enters the late reproductive period after age 35. From the age of 40, the state of her reproductive system is often referred to as “premenopause”. If the late reproductive period and premenopause are determined by age criterion, then the menopausal transition and perimenopause reflect the functional characteristics of the state of the reproductive system of women. The concepts of “menopausal transition” and “perimenopause” are not identical, but very close.Menopausal transition begins when menstrual cycles lose their stable duration against the background of an isolated increase in follicle-stimulating hormone (FSH) levels, and ends with the last menstrual period. Perimenopause is counted from the same moment as the menopausal transition, but extends another 12 months after the last menstrual period. However, it is possible to establish the time of menopause (the last menstruation) only after 12 months, so the annual difference in the concepts of “perimenopause” and “menopausal transition” has a purely terminological meaning.

According to the modified PENN-5 classification of climacteric stages (a 5-group staging system for more accurate identification of cycle length changes), the menopausal transition has three stages, two of which occur during premenopause [2]. In the early phase of the menopausal transition, the menstrual cycle loses its regularity and becomes variable in the duration of the intermenstrual intervals with deviations from 7 days or more. The late phase of the menopausal transition is characterized by the “skipping” of two or more menstruation, the appearance of intermenstrual intervals lasting up to 60 days with an increase in FSH levels up to 40 IU / L or more [3], and its onset allows predicting the time of expected menopause in the range from 2.6 to 3.3 years [4].The absence of menstruation during the year in a woman over 45 years in 90% of cases means the onset of menopause.

In defiance of the early concept of a linear decrease in ovarian secretion, the current view of endocrine features in women of an older reproductive period suggests significant fluctuations in hormone levels. Extinction of ovarian function due to a decrease in the follicular pool, impaired folliculogenesis, increased apoptosis and follicular atresia begin long before perimenopause.The age-related decrease in the number of follicles is biexponential and accelerates more than 2 times when their number falls below 25 thousand (this occurs on average at 37.5 years). The time interval from the beginning of the decrease in the follicular pool to menopause is about 13 years [5]. The concentration of circulating FSH during the late reproductive period and the subsequent menopausal transition progressively increases [6, 7], which is associated, rather, with a decrease in the production of inhibin, rather than estradiol [7, 8].The level of estradiol in perimenopause fluctuates along with the level of FSH, sometimes reaching the values ​​characteristic of women under 35 years of age, and significantly decreases only towards the end of the menopausal transition. The level of progesterone, meanwhile, already in the early phase of the menopausal transition is lower than in the average reproductive age, despite monthly menstruation, and varies depending on body mass index, reflecting an inverse correlation with this anthropometric indicator [7]. In the late phase of the menopausal transition, along with a decrease in folliculogenesis, the frequency of anovulation increases, which is accompanied by a significant persistent decrease in progesterone secretion [8].Testosterone levels do not change significantly during the menopausal transition [6].

Proteins produced by granulosa cells, inhibin and activin, also play an important role in the process of changes in hormonal homeostasis. Depending on the presence of a particular subunit, two inhibin heterodimers are distinguished – inhibin A, a product of the corpus luteum, and inhibin B secreted by antral and dominant follicles. Accordingly, the level of inhibin A increases in the luteal phase, inhibin B in the follicular phase, but both of them suppress the pituitary secretion of FSH.Activins, on the other hand, stimulate the pituitary release of FSH and are derivatives of inhibin A and inhibin B.

In the late reproductive period and further during the menopausal transition, the levels of inhibin B in the early follicular phase and inhibin A in the luteal phase decrease simultaneously with an increase in FSH concentration [8]. Concentration of activin A in perimenopause, on the contrary, increases. Activin A affects FSH secretion to a lesser extent than inhibins, but the combined effect of these proteins on pituitary secretion provides an increase in FSH concentration even in the absence of a decrease in ovarian estradiol synthesis.

Another marker of ovarian reserve – anti-Müllerian hormone (AMH) – is secreted by granulosa cells of secondary and preantral follicles, its circulating concentration remains relatively stable during the menstrual cycle and correlates with the number of early antral follicles. The AMH level decreases significantly and progressively throughout the menopausal transition [9].

Thus, during perimenopause, the variety of endocrine changes determines the existence of numerous clinical variants of menopause, each of which can become the basis of a pathological condition and must be assessed from the standpoint of compliance with the physiological norm.

Diagnosis of menopausal transition is based on clinical findings. Measurement of hormone concentrations does not allow identifying the stage of the menopausal transition and accurately predicting the time of menopause. An isolated increase in FSH in the early follicular phase becomes evident in many women over 40 years of age and is associated with a prognosis of decreased fertility, but significant cycle-to-cycle variation determines its low predictive value as a marker of cessation of menstruation [3].Consequently, from a clinical point of view, it is possible to assume that a woman will enter the menopausal transition when she begins to have deviations in the regular menstrual cycle after the age of 40 years.

Diagnosis of these deviations is based primarily on the individual rhythm of menstruation formed in the reproductive period and, secondly, on ideas about the parameters of the normal menstrual cycle characteristic of mature reproductive age. In individual cases, these parameters can be varied within the following limits:

1.The duration of the menstrual cycle from the first day of menstruation to the first day of the next menstruation ranges from 21 to 42 days. Clinical diagnosis of the menopausal transition implies the variability of the cycle duration, which goes by a week or more, not beyond the specified limits, but beyond the stable cycle characteristic of a particular woman. Reduction of the menstrual cycle less than 21 days is denoted by the term “polymenorrhea”, lengthening more than 42 days – oligomenorrhea, absence of menstruation for 6 months or more – amenorrhea.

2. The number of days of menstrual bleeding is from 3 to 7 and the amount of lost blood is up to 80 ml. Menstrual bleeding is understood to mean bleeding that cannot be controlled by one standard hygiene product during the day. A bleeding of less intensity is referred to as bleeding. The number of days of bleeding in a normal menstrual cycle is 3 to 7; bleeding is not counted. Decrease in the duration of menstrual bleeding – hypomenorrhea; increase – menorrhagia.Menorrhagias also include menstrual bleeding, accompanied by increased blood loss, which is assessed by the subjective sensation of increased menstrual flow or by an objective criterion for a decrease in hemoglobin levels after menstruation (you can also focus on the number of hygiene products used by a woman: if one hygiene product with the maximum ability to control bleeding enough for no more than 2 hours, it is legitimate to talk about menorrhagia).

3.Lack of bleeding and blood smearing, in addition to cyclic menstruation. Acyclic bleeding or bleeding is referred to as metrorrhagia. Premenstrual and postmenstrual bleeding is considered pathological if the total number of days of menstruation exceeds a week. Acyclic bleeding can occur on any day of the menstrual cycle if the rhythm of menstruation is maintained, but it can also be a form of irregularity in the absence of a normal menstrual rhythm (for example, metrorrhagia – prolonged, non-abundant bleeding / bleeding after a delay in menstruation).In the presence of heavy acyclic bleeding, the term “menometrorrhagia” is used (the above example with heavy bleeding that exceeds the normal menstrual flow typical of a woman). Menometrorrhagia is also understood as a combination of menorrhagias (heavy regular menstruation) and metrorrhagias (acyclic bleeding).

4. Absence of complaints related to menstruation. A healthy woman should feel neither the approach of menstruation, nor any painful or other unpleasant symptoms during menstrual bleeding.Slight discomfort, however, is permissible, but if premenstrual / menstrual symptoms disrupt the quality of life of a woman or her environment and force her to change her usual lifestyle, then it is necessary to consider them as pathologies, identify their causes (not always functional!) And resort to treatment. In the absence of an organic or extragenital substrate of disorders, complaints associated with the luteal phase of the menstrual cycle are classified as premenstrual syndrome, and pain during menstruation alone or in combination with autonomic disorders is classified as dysmenorrhea.

5. End of menstrual function not earlier than 40–45 years. Menopause usually occurs between the ages of 50 and 53. Cessation of menstruation before the age of 40 is referred to as premature menopause, and in the interval from 40 to 45 years – early menopause.

In addition to menstrual irregularities, symptoms of perimenopause include the appearance of vasomotor and psychovegetative disorders. The classic examples of vasomotor disorders – hot flashes and night sweats – are usually associated with a persistent decrease in estradiol secretion below the level of the early follicular phase of the normal menstrual cycle (

Menstrual irregularities associated with its variable duration are naturally the norm for perimenopause.But simultaneously with the formation of oligomenorrhea – amenorrhea in a woman, the nature of the menstruation itself may change, acquiring the features of abnormal uterine bleeding. Abnormal uterine bleeding results from relatively high acyclic estrogen production with relatively low progesterone production during the menopausal transition. But it is this physiological endocrine feature of perimenopause that can increase the risk of developing endometrial hyperplasia and cancer.Among women with abnormal uterine bleeding in the premenopausal age group of 45 years or more, there is a threefold increase in the risk of proliferative endometrial diseases. This is especially clearly seen in the dynamics of the prevalence of simple endometrial hyperplasia in different age groups [10]. Simple endometrial hyperplasia in perimenopause can be considered as a natural reaction of the mucous membrane of the uterine body to overt estrogenic stimulation, that is, it can be considered a normal variant if it is not accompanied by abnormal uterine bleeding.

Most often during the menopausal transition, abnormal uterine bleeding is represented by disorders that do not have an organic substrate and are called dysfunctional uterine bleeding. The reason for the development of dysfunctional uterine bleeding remains unknown. Disorders of ovulatory function of the ovaries are an inevitable component of the menopausal transition, but only a small part of anovulatory cycles ends in bleeding. The revealed relationship between the development of dysfunctional uterine bleeding and aggravated premorbid background, stressful situations, disorders in the reproductive system suggests that dysfunctional uterine bleeding is the result of a breakdown of the adaptive mechanisms of the reproductive system, allowing, under normal conditions, to “complete” menstrual-like bleeding of the anovulatory cycle at normal times and with normal blood loss.

Due to the real difficulties of separating the norm and pathology of the menstrual cycle in perimenopause, the strategy for the prevention and treatment of menstrual dysfunction in this period of a woman’s life consists of several components:

1. Symptoms that disrupt the quality of life of patients are subject to elimination, namely: menorrhagia, menometrorrhagia, dysmenorrhea, manifestations of premenstrual syndrome, as well as various symptoms of hypothalamic and autonomic dysfunction.

2.Anovulation, characteristic of the menopausal transition, is associated with a high risk of hyperplastic processes of the reproductive system, due to constant estrogenic stimulation. Consequently, perimenopausal women should undergo regular screening for early detection of proliferative diseases and receive timely medical and preventive care.

3. Disorders of menstrual function are often combined with various disorders, especially autonomic dysfunction and metabolic disorders, which should also be corrected even in the absence of complaints in order to avoid the formation of a pathological relationship between hormonal and metabolic abnormalities that support each other.

Supervision of women during the menopausal transition should be active, but not aggressive. Screening programs are adopted only in the practice of preventive measures to reduce the incidence of diseases of the cervix and mammary glands. There is no need to conduct any additional examination, including a gynecological examination, ultrasound examination of the pelvic organs, a healthy woman during the menopausal transition who does not present complaints and is not at risk for endometrial cancer.Delayed menstruation, shortening of the menstrual cycle, episodes of oligomenorrhea and amenorrhea are not regarded as complaints or pathological symptoms. When forming risk groups for endometrial diseases, it should be remembered that risk factors for atypical hyperplasia coincide with risk factors for endometrial cancer [11]. In premenopausal women, these include obesity, type 2 diabetes mellitus, polycystic ovary syndrome, prolonged menstrual irregularities in the reproductive period (chronic anovulation), and absence of childbirth (provided that progestin-containing drugs are not taken).The structure of risk factors for simple hyperplasia is somewhat different. This fully fits into the concept put forward by A. Ferenczy and M. Gelfand and implying the presence of two “pathways for the endometrium”: the path of hyperplasia or neoplasia. This concept does not recognize a gradual increase in hyperplastic changes, but postulates cytological atypia as the only morphological discrete factor that distinguishes benign endometrial lesions from potentially malignant processes.

Despite the relative rarity of detecting atypical hyperplasia and endometrial cancer in premenopausal women, menstrual irregularities in the form of abnormal uterine bleeding require examination due to oncological alertness. With polymenorrhea and menorrhagia, it is permissible to limit oneself to a gynecological examination and ultrasound on the 5-8th day from the onset of menstrual bleeding and to plan further tactics for managing a woman, depending on the results obtained. Metrorrhagias and menometrorrhagias deserve a more radical approach, as they often reflect severe endometrial pathology.Regardless of the results of ultrasound, patients with these forms of disorders are recommended morphological examination of the endometrium obtained by biopsy or curettage.

Therapeutic and prophylactic measures aimed at controlling the menstrual cycle and preventing endometrial diseases should also not be carried out for all perimenopausal women without exception. Healthy women who are not at risk of endometrial cancer, whose only complaint is an irregular cycle, can receive advice on a healthy lifestyle and explanations about the features of the menopause and symptoms that require medical attention.As part of the recommendations for maintaining a healthy lifestyle, the doctor can provide information about vitamin and mineral complexes and dietary supplements that can increase the body’s adaptive capabilities and avoid the pathological course of menopause. The presence of abnormal uterine bleeding requires monitoring of the menstrual cycle, taking into account the organic or functional substrate of the bleeding and additional goals of the woman.

For women who are sexually active, regardless of the frequency and regularity of intercourse, hormonal contraception is the best choice for regulating the menstrual cycle.It is fundamentally important that this type of drug can be recommended for those women in whom the menopausal transition proceeds relatively well, accompanied only by delays in menstruation. Control of the menstrual cycle can be effectively carried out using combined oral contraceptives (COCs), provided that the patient does not smoke and has no other contraindications to the use of this group of drugs. The use of COCs to prevent pregnancy is relevant until the end of perimenopause.A natural decline in fertility after 37 years does not mean a decrease in the need for contraception, especially since pregnancy in women over 40 is accompanied by an increased risk of congenital and chromosomal fetal malformations, spontaneous abortions, pregnancy complications, as well as an increase in maternal morbidity and mortality [12].

The choice of a contraceptive method in the age group over 40 is dictated by many circumstances: frequency of sexual intercourse, sexual problems, concomitant somatic diseases and the need for additional non-contraceptive effects, among which the task of regulating the disturbed menstrual cycle is in the first place [13].According to the Cochrane Reviews, randomized controlled trials provide some evidence for the effectiveness of COCs for the treatment of dysmenorrhea or the reduction of menstrual blood loss [14, 15] compared with other therapies. Observational data demonstrate a positive result of COC use in relation to painful menstruation and abnormal uterine bleeding [16, 17]. Based on these data, current clinical guidelines suggest the use of COCs as a treatment for severe uterine bleeding [18].At the same time, the use of COCs for the regulation of the menstrual cycle is simultaneously becoming a method for the prevention of proliferative endometrial diseases. It is known that combined hormonal contraceptives reduce the risk of endometrial cancer [19, 20] in direct proportion to the duration of their use.

The benefits of regulating menstrual irregularities and preventing endometrial hyperplasia and cancer, while achieving a contraceptive effect, should be weighed against the possible risks of COC use, which naturally increase with age.

If there are contraindications to the use of estrogen-containing contraceptives, control of abnormal uterine bleeding and endometrial hyperplasia in sexually active women can be achieved using purely progestogenic contraceptives. Purely progestogenic contraceptives include a large group of drugs, among them injection, oral drugs, hormone-releasing intrauterine systems and implants. Continuous administration of progestogens in an adequate dose leads to decidualization of the stroma and atrophy of the glandular epithelium of the endometrium.The acceptability of a particular contraceptive is largely determined by the way it is administered.

The choice of a specific hormonal agent within these two groups is usually not regulated, although it is obvious that different drugs have different potential both in the regulation of the menstrual cycle and in terms of safety of use. To date, two contraceptives are recognized as leaders in the program for correcting the menstrual cycle in perimenopausal women: a combined oral contraceptive containing estradiol valerate and dienogest (Claira ^® ), and a levonorgestrel-containing intrauterine system (LNG-IUD) (Mirena ^® ) [21].

The combination of estradiol valerate and dienogest is registered in many countries as a treatment for menorrhagia [22]. The advantages of COC Klayra ^® in the control of the menstrual cycle and excessive proliferation of the endometrium are the strong progestogenic potential of dienogest [23, 24], a dynamic four-phase dosing regimen that ensures estrogen dominance in the early phase of administration and progestin dominance in the middle and final phases of the cycle, as well as prolongation admission up to 26 days of a 28-day cycle.Comparison of Claira ^® with low-dose COCs containing levonorgestrel used in a standard regimen demonstrated the best contraceptive profile Claira ^® in terms of the number of days of bleeding and blood loss over monitored time intervals [25]. Placebo-controlled studies have shown a significantly greater reduction in menstrual blood loss by 353–373 ml over a 90-day observation interval compared with placebo (130 ml), accompanied by a significant increase in hemoglobin and ferritin concentration [26, 27].

For the period of menopausal transition, when choosing a drug, it is extremely important to observe the principle of safety. Age-related metabolic disorders, which begin to progressively increase in a woman as menopause approaches, should not be additionally provoked with medications. From the standpoint of safety, Klayra ^® has advantages over COCs containing ethinyl estradiol. Unlike ethinyl estradiol, which is resistant to hepatic metabolism, estradiol valerate is rapidly metabolized, turning into hormones identical to natural estrogens: 17-beta-estradiol, estrone and estriol.The effect of 2–3 mg of 17-beta-estradiol on the synthesis of liver proteins is several times lower than the activity of 20–30 μg of ethinyl estradiol, which entails several times less pronounced activation of blood coagulation and the renin-angiotensin-aldosterone system and, therefore , less likelihood of adverse reactions and complications. At the same time, the replenishment of the positive effects of endogenous hormones lost due to the suppression of folliculogenesis is achieved better than when using ethinylestradiol-containing drugs.This is due to two circumstances. Firstly, taking the drug Klayra ^® compensates for the decrease in the production of all three fractions of estrogen. Secondly, bioidentical metabolites of estradiol valerate realize their action not only through type 1 estrogen receptors (alpha type), like ethinyl estradiol, but also through type 2 receptors (type beta), prevailing in the vessels and the central nervous system. The non-proliferative effects transmitted by type 2 receptors improve vascular function and positively affect the metabolism of neurotransmitters in the brain.As a result, the tolerability of the drug Claira ^® increases, which was noted in clinical studies [28].

It is possible that further studies of the safety profile of contraceptives containing an analogue of natural estradiol will reduce the number of contraindications to their use in comparison with ethinyl estradiol-containing COCs. But while there is an accumulation of data, when prescribing any combined hormonal contraceptives, clinicians should use the same acceptance criteria [29] and, if there are contraindications to the use of COCs, choose progestogen contraceptives to prevent pregnancy and control bleeding.

Among progestogenic contraceptives, the levonorgestrel-containing intrauterine system has a therapeutic indication for use in patients with profuse uterine bleeding in many countries [30]. According to the literature, the use of the LNG-IUD in women with menorrhagia leads to a decrease in menstrual blood loss by 80% within 3 months after administration, and within 12 months – by 95% or more [31]. Reduction in the volume and duration of menstrual bleeding while using the LNG-IUD Mirena ^® is accompanied by an increase in hemoglobin and ferritin levels.The indicated properties of the LNG-IUS make it possible to consider it as an alternative to medical oral and surgical treatment of menorrhagia [30, 31].

For women who are not sexually active, prevention of recurrent episodes of abnormal uterine bleeding is generally recommended with cyclic progestins. There is no consensus regarding the ability of progestins to control the menstrual cycle with a tendency to bleeding. Thus, the effectiveness of the oral form of medroxyprogesterone acetate, often prescribed in the United States in a cyclic regimen, has not been confirmed in clinical trials.Nevertheless, progestins remain one of the most popular methods of preventing endometrial hyperplasia and regulating the menstrual cycle [32] in perimenopause. Compliance with the principle of maximum safety of therapy implies the predominant appointment of those progestins that have the most selective effect on the endometrium and a minimum effect on metabolism.

Hormone therapy does not exhaust all the possibilities of drug and non-drug therapy during the menopausal transition.Of course, in the process of monitoring patients, it is necessary to correct the lifestyle, eliminate the risk factors for diseases associated with menopause. However, hormone therapy should not be neglected in the presence of gynecological indications for its appointment, since it is a powerful means of preventing many chronic diseases and contributes to improving the quality of life.

22 things to know before going to the gynecologist

Why get tested for HPV if it is untreated? Should I worry about erosion or irregular cycles? Why can’t emergency contraceptives be taken all the time? They come to the gynecologist with many of these questions.We will answer the basic ones in this article.

About examination by a gynecologist

Many questions are devoted to when and how often to go to the doctor for examination.

1. What days of the cycle come?

The best period is the first 3-5 days after menstruation. This is usually 5-10 days of the cycle.

2. How often should you visit a gynecologist?

At least once a year, ideal for ultrasound OMT and breast ultrasound.

3. How is a doctor’s examination going?

First, the doctor takes anamnesis:

• are there any complaints,
• what is the nature of menstruation,
• what is your sex life,
• how you are using contraception or planning a pregnancy,
• are there any chronic diseases.

On the gynecological chair, the doctor examines the condition of the mucous membrane of the vulva, vagina and cervix. As a rule, he takes two smears: a smear for flora and cytology.

After swabs are taken, the doctor performs a bimanual vaginal examination. At the end of the examination, the doctor must examine the mammary glands with regional lymph nodes. According to the indications, an ultrasound of the OMT, and an ultrasound of the breast (mammography of the breast) are performed.

4. How to read the menstrual cycle correctly?

The first day of menstruation is the beginning of the menstrual cycle, the first day of the menstrual cycle. The duration of the menstrual cycle is the interval from the first day of menstruation to the first day of the next menstrual period and is normally 24 to 38 days.

5. Do I need to go to a gynecologist before having sex?

It is necessary to see a doctor once a year. Especially if something bothers you: an irregular cycle, painful periods, aching pains in the lower abdomen. If you have not had sexual intercourse, your doctor will not use a mirror.

6. When is an urgent need to go to the gynecologist?

If you feel a sharp growing pain in the lower abdomen, in which you cannot straighten up, you need to call an ambulance.But there are other symptoms, the appearance of which requires an urgent visit to the gynecologist:

• foul-smelling vaginal discharge, discoloration of the discharge, possibly mixed with blood;
• aching pains in the lower abdomen;
• violation of the menstrual cycle – a strong delay or early onset of menstruation, even if pregnancy is excluded;
• long periods – 8 days or more;
• severe pain during or after intercourse.

There is no need to panic with such symptoms, but it is worth making an appointment with a gynecologist.Pain and discharge can be signs of infection.

Menstruation

If your cycle is irregular, consult your doctor.

1. Should I go to the doctor if the delay in menstruation is definitely not caused by pregnancy?

If pregnancy is ruled out, a delay in menstruation can be caused by stress, a change in diet, lack of sleep, or illness. If you suspect that your lifestyle has affected your cycle, give yourself 1–1.5 weeks to swing, if the situation does not change, go to the doctor.

2. What is an irregular cycle?

Fluctuations in the menstrual cycle of 3-5 days are normal. If the cycle fluctuates by more than 10 days (the difference between the shortest and the longest) – it can be considered irregular.

3. Are your painful periods due to infections?

Painful periods are common. The cause may be endometriosis, features of the anatomical structure, neoplasms, and infections.An examination by a gynecologist with an in-depth instrumental and laboratory examination will help to deal with the problem.

About contraception

The topic about which there are the most myths.

1. How do emergency contraceptives like Postinor and its analogues work?

Two tablets contain a monthly dose of hormonal contraceptive. They cause the transformation and rejection of the endometrium, so the egg “has nothing to cling to” – pregnancy does not occur.Many girls have a discharge resembling menstruation after taking it.

Caution must be exercised with this method. Taking such pills is strictly prohibited at all times.

If after taking the contraceptive you do not experience a severe cycle failure or other inconvenience, you can postpone the visit to the gynecologist until planned. But at the examination, be sure to tell the doctor that you have taken the pills.

2. Why can’t you buy any contraceptive?

Each person is different, as is his hormonal background, so hormonal contraceptives that fit your girlfriend may not suit you: cause weight gain or loss, change in hair, libido.

Before prescribing contraceptives, the doctor collects anamnesis, examines and examines the whole body, takes into account the presence of concomitant diseases and determines the absence of contraindications to the use of contraceptives. If indicated, he will refer you to additional examinations of the liver and kidneys, hormonal tests. After that, he prescribes contraceptives and gives recommendations: he tells in what case to stop taking pills and come to an appointment.

About STIs and other diseases

Let’s talk about sexually transmitted infections, HPV, erosion.

1. C How often should you be screened for genital infections?

It is better to take tests once a year. Most diseases are asymptomatic and discovered by chance.

2. Who needs to be tested for human papillomavirus?

It is worth being examined for human papillomavirus infection if:

• you are sexually active, have early sexual intercourse and have multiple sexual partners;
• you have complaints of leucorrhoea, itching;
• you have identified risk factors for papillomavirus infection, chronic genital infections, vaginitis, cervicitis;
• you have any mass on the cervix;
• you have genital warts;
• you are over 30 years old and have a cytological smear taken; they should be tested for high-risk HPV for screening purposes.In the presence of the virus, include in the risk group for cervical cancer.

HPV test significantly increases the efficiency of detecting precancerous conditions and cervical cancer along with a cytological smear.

HPV of high oncogenic risk is a significant etiological factor in the development of cervical cancer.

Timely gynecological services will help prevent the development of life-threatening diseases.

3. How is HPV transmitted?

Mainly through sexual contact.More than 80% of the world’s sexually active population will contract HPV during their lifetime. HPV infection does not always lead to the development of a clinically determined disease. With a normal state of immunity and the absence of additional risk factors, in the overwhelming majority of cases, the body manages to eliminate the virus on its own.

4. Do I need to go to the doctor every time with candidiasis, or can I drink medications that were prescribed before?

It is worth finding out if you have candidiasis.Discharge can be a symptom of another process, so you need to go to the doctor.

5. Should I go to the gynecologist with a decrease in libido?

It is best to consult a doctor, as a lack of libido can be a symptom of an illness.

6. Should I go to the gynecologist for cystitis?

Yes, consultation with a gynecologist is necessary. This is the situation when 2 doctors: a urologist and a gynecologist are trying to understand the causes of the disease and choose the right treatment.

7. What is cervical erosion and should it be treated

Most often, girls under the age of 24-26 have ectopia of the columnar epithelium on the surface of the cervix. This is when the columnar epithelium lining the cervical canal comes out to the surface of the cervix. This is a physiological condition that does not require treatment.

An extended colposcopy is used to assess the condition of the cervix. The need for further in-depth examination with subsequent treatment or observation is determined by the doctor.

About pregnancy

Pregnancy is a crucial period in a woman’s life. It is advisable to prepare well for it and go through the necessary doctors, as well as follow the doctor’s recommendations while carrying a child. Then the risk of complications is minimal.

1. How long before conception is it better to visit a gynecologist?

It is advisable to conduct a primary examination by a gynecologist at least 3 months before the intended conception.It is necessary to pass smears for STIs, flora, cytology.

2. What other specialists should you visit if you are planning a pregnancy?

Before pregnancy, you need to heal all chronic sores so that there are no complications during gestation. Be sure to check your abdominal organs and thyroid gland. If you have ever had heart pathologies, high blood pressure – this should also be checked.

3. Consultations of a dentist, otorhinolaryngologist (ENT) are required.

Additional examinations, as well as the need for additional consultations of related specialists, the gynecologist determines individually, focusing on the results of the basic examination and the history data. It will not be superfluous to assess the level of vitamin D, iron reserve, the state of the thyroid gland.

4. What recommendations can be given to men in couples planning a pregnancy

Men should give up smoking, alcohol, including beer, and certain medications.It is desirable to normalize weight. It is necessary to limit the impact of harmful physical factors, especially the reproductive organs should not be overheated: give up hot baths, trips to baths, heated car seats.

The optimal regimen of regular sexual activity for conception is 2-3 times a week without using contraception.

5. What vitamins should you take when planning a pregnancy?

For all, without exception, women planning pregnancy, it is mandatory to take folate in a daily dose of 400-800 mcg per day (optimally as part of folate-containing complexes) at least 3 months before pregnancy and at least throughout the first trimester of pregnancy (up to 12 weeks of pregnancy) for the prevention of fetal malformations and complicated pregnancy.

6. When to see a doctor if a pregnancy test is positive?

If nothing bothers you, and the pregnancy test is positive, have patience — wait until your period is 2-3 weeks — make an appointment with your gynecologist.

On the “D” pregnancy registration it is necessary to get up before 12 weeks of pregnancy in the antenatal clinic at the place of residence.

In our country, pregnant women are monitored in accordance with the clinical protocols of the Ministry of Health of the Republic of Belarus “Medical observation and provision of medical care to women in obstetrics and gynecology”, approved by the decree of the Ministry of Health of the Republic of Belarus 19.02.2018 No. 17.

A gynecologist’s examination is not scary. It is important to understand that the doctor cares about your health, and if you are worried about something, you need to contact him in time.

6 interesting facts about menstruation and menstruation myths

You probably have a general idea of ​​why women have periods. However, do you really know about the menstrual cycle beyond the basics? A complete understanding of how the menstrual cycle works can help you stay healthy throughout your life.You can also avoid future health problems. That’s why our experts have come up with six fun facts about menstruation and menstruation myths to help you understand what’s normal and what’s not. Here are the facts:

• The menstrual cycle does not last 28 days.
• The timing of menstruation depends on ovulation
• Menses may be irregular due to stress or illness.
• Weight fluctuations can affect your period
• Abnormal bleeding may indicate a more serious health problem.
• Irregular periods can often be treated with birth control pills or other hormonal medications.

1. The menstrual cycle does not last 28 days.

There are many different menstruation facts that have different cycle averages. In addition, many menstruation myths claim that menstruation lasts 28 days. However, a woman’s menstrual cycle can range from 21 to 35 days, depending on her age and various other health factors.The average menstrual cycle is 28 days, but a shorter or longer cycle does not necessarily mean your health is at risk. Health care providers consider a cycle that differs from the 28-day average to be normal and healthy as long as it is regular and reasonably predictable.

2. The timing of menstruation depends on ovulation.

The menstrual cycle usually occurs 14 days after ovulation. The first part of a cycle can range from 7 to 20 days, which can lead to shorter or longer cycles, depending on when you ovulate.For example, if you ovulate on the 14th day, you may have your period on the 28th day. On the other hand, if you ovulate on day 10, your period should occur on day 24.

3. Menses may be irregular due to stress or illness.

One of the reasons menstruation can be irregular on our list of menstruation facts is because of stress. Any stress on the body, physical or mental, can disrupt the natural balance of other hormones. This can lead to a late or early period.Stressful life events can cause irregular menstrual periods, as can thyroid problems, illnesses such as the flu, taking certain medications, and switching contraception.

4. Weight fluctuations can affect the menstrual cycle.

Because your body requires a certain amount of fat to store and release estrogen and other hormones, your menstrual cycle may become irregular if you lose or gain weight during your cycle.In many cases, women with a high percentage of body fat are more likely to experience irregular menstrual cycles due to excess estrogen production.

5. Abnormal bleeding may indicate more serious health problems.

Abnormal bleeding and spotting during a cycle can signal other health problems, such as cancer, polyps, infection, or menopause. See your gynecologist right away if you experience abnormal bleeding so that you can be screened for other health problems.

6. Irregular periods can often be treated with birth control pills or other hormonal medications.

Birth control pills often help regulate your menstrual cycle so you have easier and more regular periods. Talk to your gynecologist about your birth control pill options to help you manage your period more effectively based on your unique health condition.

Tracking your menstrual cycle and identifying specific symptoms can help you stay fertile, healthy, and happy for years to come. A better understanding of your body can also help you prevent and treat health problems in women. Together, you and your gynecologist can work to eliminate menstrual problems and myths so you can live a longer, more fulfilling life.

Contact WCF to schedule an appointment with one of our board-certified gynecologists or for more menstrual cycle resources.

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