2.
Menstrual Disorders
While some women experience their periods with minimal issues, where they arrive and end consistently each month with only minor inconvenience, others face a range of symptoms that can severely impact their daily lives. These symptoms can include heavy bleeding, irregular periods, and intense mood swings.
Fortunately, many menstrual cycle issues have clear causes, and a variety of treatments are available to manage symptoms effectively. If your menstrual cycle is overwhelming, it’s important to consult with ya specialist. An accurate diagnosis of your symptoms will enable your doctor to recommend the best treatment to help you manage your menstrual cycle more comfortably.
How Common Are Menstrual Disorders?
1 in 4 Women
Experiences A Menstrual Disorder During Their Childbearing Years
Did you know that menstrual disorders can put you at a higher risk for the following health conditions?
Anemia
Heavy menstrual bleeding can lead to anemia. Anemia means your blood doesn’t have enough red blood cells, so your body doesn’t receive enough oxygen.
Endometrial Cancer
Diabetes, obesity and other risk factors for menstrual disorders also increase your risk of endometrial cancer.
Depression & Anxiety
Many with PCOS also have depression and anxiety. Mental health conditions can also get worse during PMS or if you have premenstrual dysphoric disorder.
Osteoporosis
Women with amenorrhea (absent of menstrual period) or those who are in menopause have low estrogen levels. Low estrogen weakens your bones and puts you at risk for osteoporosis and fractures.
Diabetes
More than half of people with female hormone imbalances such as PCOS or irregular menstrual cycles develop prediabetes or Type 2 diabetes.
Infertility
Conditions leading to menstrual disorders, such as PCOS and uterine fibroids, are common reasons for difficulty getting pregnant.
Reference: How many women are affected by menstrual irregularities? in National Institute of Child Health and Human Development: https://www.nichd.nih.gov/health/topics/menstruation/conditioninfo/affected
Just because menstrual disorders are common, doesn't mean they are normal
Conditions We Treat
1
Absent of Menstrual Period (Amenorrhea)
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Hormone Replacement Therapy (HRT): Offering HRT to manage menopausal symptoms and support overall health. This may include estrogen alone or a combination of estrogen and progesterone, depending on individual needs.
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Non-Hormonal Treatments: Providing alternatives such as selective serotonin reuptake inhibitors (SSRIs) for mood changes or medications to address specific symptoms like hot flashes or vaginal dryness.
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Lifestyle and Dietary Recommendations:
• Bone Health: Advising on calcium and vitamin D supplements and recommending weight-bearing exercises to support bone health.
• Diet and Exercise: Encouraging a balanced diet and regular physical activity to maintain overall well-being.
2
Irregular Menstrual Period
(Oligomenorrhea)
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Hormonal Therapy:
• Birth Control Pills or Hormonal IUDs: Prescribing hormonal contraceptives to regulate menstrual cycles and manage symptoms.
• Progesterone Therapy: Providing progesterone or other hormone treatments to help regulate irregular cycles. -
Treatment of Underlying Conditions: Addressing specific causes such as PCOS, thyroid disorders, or uterine fibroids with targeted therapies or medications.
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Lifestyle and Dietary Recommendations:
• Weight Management: Advising on healthy weight management, as weight fluctuations can impact menstrual regularity.
• Diet and Exercise: Encouraging a balanced diet and regular exercise to support overall hormonal health.
3
Painful Menstrual Period
(Dysmenorrhea)
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Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Prescribing NSAIDs like ibuprofen or naproxen to reduce menstrual pain and inflammation.
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Hormonal Treatments: Offering hormonal contraceptives (e.g., birth control pills, hormonal IUDs) to regulate menstrual cycles and reduce pain by controlling hormone levels.
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Other Medications: Considering medications such as acetaminophen or, in more severe cases, stronger pain relievers if necessary.
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Lifestyle Modifications: Suggesting dietary changes, regular exercise, and stress management techniques to help reduce menstrual pain.
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Physical Therapy: Offering pelvic floor physical therapy if muscular or structural issues are contributing to dysmenorrhea.
4
Heavy Menstrual Period
(Menorrhagia)
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Medications:
• Hormonal Therapies: Prescribing birth control pills, hormonal IUDs, or other hormonal treatments to regulate the menstrual cycle and reduce bleeding.
• Non-Hormonal Medications: Offering options such as tranexamic acid or desmopressin to reduce bleeding, especially if a bleeding disorder is identified.
• NSAIDs: Nonsteroidal anti-inflammatory drugs like ibuprofen can help reduce menstrual flow and alleviate pain. -
D&C (Dilation and Curettage): A procedure to remove abnormal uterine lining and reduce bleeding.
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Endometrial Ablation: A technique to destroy the endometrial lining to reduce or stop menstrual bleeding.
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Uterine Fibroid Embolization: For fibroid-related menorrhagia, this minimally invasive procedure blocks blood flow to fibroids, reducing their size and bleeding.
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Myomectomy: Surgical removal of fibroids if they are causing heavy bleeding.
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Hysterectomy: In severe cases or when other treatments are ineffective, a hysterectomy (removal of the uterus) may be considered.
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Nutritional Support: Advising on iron-rich foods or supplements to address anemia associated with heavy bleeding.
5
Polycystic Ovary Syndrome
(Heavy, Irregular
Menstrual Period)
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Hormonal Therapy:
• Oral Contraceptives: Prescribing birth control pills to regulate menstrual cycles, reduce heavy bleeding, and manage acne and hirsutism.
• Progestin Therapy: Offering progestin-only pills or other hormonal treatments to induce regular periods and control heavy bleeding. -
Medications for Metabolic Issues:
• Insulin Sensitizers: Prescribing medications like metformin to improve insulin sensitivity and manage associated conditions like prediabetes or type 2 diabetes.
• Anti-Androgens: Using medications like spironolactone to reduce excessive hair growth and acne. -
Lifestyle and Dietary Recommendations:
• Weight Management: Advising on a balanced diet and regular exercise to help manage weight, which can improve menstrual regularity and reduce insulin resistance.
• Dietary Changes: Recommending a diet low in refined carbohydrates and high in fiber to support metabolic health and reduce symptoms. -
Fertility Treatments:
• Ovulation Induction: For patients trying to conceive, using medications such as clomiphene citrate or letrozole to stimulate ovulation.
• Assisted Reproductive Technologies (ART): Offering options like in vitro fertilization (IVF) if other fertility treatments are unsuccessful.
6
Uterine Fibroid
(Benign Growth of
Uterine Muscle)
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Medications:
• Hormonal Treatments: Prescribing hormonal therapies such as birth control pills, hormonal IUDs, or GnRH agonists to help manage symptoms by reducing menstrual bleeding and controlling fibroid growth.
• Non-Hormonal Medications: Using medications like tranexamic acid to reduce bleeding or pain relief medications to manage symptoms. -
Procedures:
• Myomectomy: Surgical removal of fibroids while preserving the uterus. This can be done through various methods:
↳ Hysteroscopic Myomectomy: For fibroids located inside the uterine cavity.
↳ Laparoscopic Myomectomy: A minimally invasive approach for fibroids located within or on the outer surface of the uterus.
↳ Abdominal Myomectomy: An open surgical approach for large or numerous fibroids.
• Uterine Artery Embolization (UAE): A minimally invasive procedure that involves blocking the blood supply to the fibroids, causing them to shrink and alleviate symptoms.
• Endometrial Ablation: A procedure to destroy the uterine lining, which may help reduce menstrual bleeding caused by fibroids. -
Surgical Options:
• Hysterectomy: In cases where fibroids are severe or other treatments are ineffective, a hysterectomy (removal of the uterus) may be considered. This is a definitive treatment that resolves the symptoms by removing the source of fibroids.
7
Endometrial Polyps
(Benign Overgrowth of Uterine Lining)
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Hysteroscopic Removal: Performing a hysteroscopic polypectomy, where polyps are removed using a hysteroscope, often done as an outpatient procedure. This is the most common and effective method for treating endometrial polyps.
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Hormonal Therapy: In some cases, hormonal treatments such as progestins or hormonal IUDs may be used to manage symptoms, especially if polyps are associated with abnormal bleeding. However, surgery is typically required for definitive treatment.
8
Pregnancy Complications
(Miscarriage)
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Medical Management:
Prescribing medications such as misoprostol to help expel the pregnancy tissue if the miscarriage does not occur naturally or if there is an incomplete miscarriage. -
Surgical Management:
• D&C (Dilation and Curettage): Performing a surgical procedure to remove remaining pregnancy tissue from the uterus if the miscarriage is incomplete or if there are complications such as heavy bleeding.
• Surgical Evacuation: In cases where D&C is not suitable, other surgical methods may be considered to clear the uterine contents.
9
Endometriosis
(Uterine lining growing outside of uterus)
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Medications:
• Pain Relief: Prescribing nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen to manage pain.
• Hormonal Therapies: Using hormonal treatments such as birth control pills, hormonal IUDs, or GnRH agonists to reduce estrogen levels and slow the growth of endometrial tissue.
• Other Medications: Offering progestins or Danazol to manage symptoms by altering hormone levels and reducing endometrial tissue. -
Surgical Management:
• Laparoscopic Surgery: Performing laparoscopic surgery to remove or destroy endometrial tissue while preserving the uterus and ovaries. This can help relieve pain and improve fertility.
• Excision of Endometriosis: Removing endometriotic lesions and scar tissue from the pelvic organs during surgery to alleviate symptoms and improve function.
Endometrial Cancer
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Total Hysterectomy: Performing a surgical procedure to remove the uterus, cervix, and usually the ovaries and fallopian tubes. This is the primary treatment for localized endometrial cancer.
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Lymphadenectomy: Removing nearby lymph nodes for examination to determine if cancer has spread.
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