Menstrual Irregularities

Menstrual irregularities is defined by the changes in normal menstrual pattern-menstruation days, duration of menses (days), menstrual flow, blood loss and the cycle length gives rise to Menstrual irregularities.

Epidemiology:

Menstrual irregularities are commonly seen during puberty, reproductive, pre-menopausal agegroup.

Classification: They are broadly classified into 2 categories:

1. Amenorrhoea
2. Menorrhagia

Amennorrhoea: It has two subtypes: Primary amenorrhoea and Secondary amenorrhoea.

In primary amenorrhoea, there is absent menstruation up to 16yrs of age group but with well developed secondary sexual characters or 14 yrs in absence of secondary sexual development.

In secondary amenorrhoea, there are no periods for 90 consecutive days.

Menorrhagia is defined as excessive blood loss lasting for more than 10 consecutive days.

Etiology:

1. Hormonal factors
2. Iatrogenic
3. Blood disorders
4. Infection

Investigations

1. Hormonal blood test – Thyroid function test, Prolactin , Leutinising hormone ,follicular stimulating hormone, Glycosylated hemoglobin.
2. In amenorrhoea cases, following tests are to be done

Serum testosterone, DHEAS, serum cortisol. It is mandatory to perform serum B HCG test.

Radiological tests

Abdomino-Pelvic sonography is to be performed to detect reproductive organ anomalies.

Treatment

Medical management

1. Symptomatic treatment for pain relief
2. Cylical hormones for regularization of menstrual cycle. Pure progestogen hormone use is reserved for specific conditions.
3. Hormonal intrauterine device reduces bleeding in adenomyotic uterus.

Surgical management

1. Hysteroscopic management of menorrhagia is the best diagnostic and therapeutic option in these cases.
2. Laparoscopic hysterectomy is performed if medical line of management gives no symptomatic relief and or in cases when the underlying disease demands surgical intervention..

CASE :

Premenopausal 45 yr old lady had irregular menstruation for 6 months. She did not respond to hormonal treatment and sonography hormonal blood test were normal. She was disturbed by her irregularity of menses and was subsequently posted for diagnostic hysteroscopy with endometrial biopsy. On hysteroscopy her uterine cavity had normal appearance and histopathology report was suggestive of cystic endometrial hyperplasia , benign type. Fat women with hypertension and diabetes are risk factor for malignant change with this kind of histopathology report. This lady was obese and had family history of diabetes but no hypertension at present.

The procedure helped educate the lady about the disease process and was relieved.