Abnormal Menstruation

August 7, 2009 at 5:48 pm

I. The Absence of Menstruation (Medical term: Amenorrhoea)

We will use the term “amenorrhoea” on the rest of this page when referring to the absence of a menstrual period. There are to subgroups, primary and secondary amenorrhoea. The two most common causes of amenorrhoea, pregnancy and menopause, will be discussed elsewhere.

Secondary amenorrhoea is usually define as the absence of a cycle for more than 90 days in a previously normal individual. ( Three missed cycles). If periods are absent for more than three months it should always be investigated

Primary amenorrhoea occurs when menstruation is still absent at a age when a girl should be menstruating. The onset of the first menstruation varies in different populations but should be present in most populations at the age of sixteen. If a young girl’s peers are all menstruating and she is not , she should be examined.

The conditions that cause primary amenorrhoea will be discussed later.

    The following organs are involved in the occurrence of a normal menstrual cycle

  1. The endometrium.
  2. The ovaries
  3. The pituitary gland
  4. The hypothalamus (special area of the brain)

1. The Endometrium
The endometrium is usually either thick (stimulated by estrogen) or thin (estrogen stimulation absent). Also see “The Female Reproductive Organs” and “Normal Menstruation“.

2. The Ovaries

Menstruation depends on the secretion of hormones by the ovaries. In the absence of menstruation there is usually anovulation (the ovary is not releasing any egg cells). Also see “The Normal Ovary”.

    There are a few possibilities

  1. The follicles do not develop and no estrogen are produced. In this case the endometrium will be thin.
  2. The follicles might developed but they do not rupture. Estrogen is produced but it is not opposed by progesterone and the endometrium becomes thick. In the latter case there is usually one or many estrogen producing follicles present.

Sonar examinations might show the presence of follicles and blood tests will determine the estrogen levels in the blood. Refer to this page and this one for more information.

3. The Pituitary Gland

The pituitary gland secrete many hormones that control the function of our bodies. Three of these hormones are important as far as menstrual function is concerned. They are FSH (Follicle Stimulating Hormone), LH (Luteinizing Hormone) and Prolactin. It is possible to determine the levels of these hormones via a blood test. Also see “The Pituitary and Menstrual Cycle”.

If the FSH and LH levels are high and the estrogen levels low, than the problem is usually in the ovary. The ovary is not responding to FSH and LH and the FSH and LH levels keep on increasing trying to get the ovaries to respond.

If the FSH is normal but the estrogen and LH are high , polycystic ovarian disease must be excluded. (See polycystic ovaries .

If the FSH , LH and Estrogen are all low , a problem in the pituitary or in the hypothalamus must be excluded.

A high prolactin level should also be investigated further.

The information obtained from blood tests combined with the microscopic diagnosis of the endometrium will give the medical practitioner a clear indication about the cause of the amenorrhoea.

Treatment will depend on the desirability of pregnancy. It a pregnancy is required ovulation induction treatment will be given else hormonal treatment will be given to normalize the cycle. It is very important in cases with a thick endometrium that the cycle should be normalized to prevent endometrial cancer later in life. ( please remember if your endometrium is thick , you do not have cancer, but it can develop into cancer over a period of years (more than ten years) if it is not treated.).

Highly effected medicines are now available to treat high prolactin levels. In many instances these drugs are able to shrink tumors (growths) of the pituitary gland. It is also important to remember that it is only a minority of persons with high prolactin levels that will develop pituitary tumors.

II. Heavy Menstruation(Medical term: Menorrhagia)

There are three kinds of heavy menstruation. The volume of the bleeding is increase, the duration of the bleeding is increased or both the volume and duration are increased.

The causes of heavy menstruations are:

  1. Hormonal
  2. Abnormalities in the genital tract
  3. Other hormonal problems (eg. diseases of the thyroid gland)
  4. General diseases.

III. Acyclic Bleeding. (Medical term Metorrhagia)

This is bleeding that occurs at any time and the duration of the bleeding is unpredictable. Sometimes it lasts for weeks and than on other occasions only for a few days. without a cyclic pattern.

Source:  Abnormal Menstruation

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