Abnormalities of the Menstrual Cycle

The word breaks into three parts: absence | menstrual | discharge.

• Absence of the menstrual cycle.
• It is a symptom, not a disease.
• There are two types.

Physiological amenorrhoea

Absence of the menstrual cycle due to a normal condition.

Pathological amenorrhoea

Absence of the menstrual cycle due to an abnormal condition. It divides in two.

Concealed, hidden or false → cryptomenorrhoea (hidden):

For example: vaginal agenesis, obstruction, imperforate hymen.

Real or true pathological amenorrhoea:

• Primary pathological amenorrhoea — absence of the menstrual cycle due to any abnormal condition, with history of menarche absent. For example, after 16 years.
• Secondary pathological amenorrhoea — history of menarche present.

Difficulty in the menstrual cycle — pain during the menstrual cycle (M.C. के दौरान pain).

Primary dysmenorrhoea

• Pain without any pelvic pathology.
• Severe pain.
• Secondary symptoms present — nausea, vomiting.
• Radiating pain — lower abdomen → back → thigh.
• Prostaglandin is the cause (कारण) of the pain:

Treatment:

• Meftal (mefenamic acid) — a PST, prostaglandin synthetase inhibitor
• Ibuprofen (NSAID)
• OCP — oral contraceptive pills
• Tab Danazol, to stop the menstrual cycle

Secondary dysmenorrhoea

• Any pelvic pathology.
• Pain is dull in nature.
• Secondary symptoms absent.
• Non-radiating pain — it stays where it starts.

Treatment: according to the cause.

The word breaks into: increase | menstrual | discharge.

• Also known as menorrhagia.
• Excessive bleeding, either in amount more than 80 ml, or bleeding days more than 7.

Causes:

• Any pelvic pathology
• Disturbance of the HPO axis
• IUD — intrauterine device
• Uterine polyp
• Hypothyroidism

• Scanty bleeding, either in amount less than 20 ml, or bleeding days less than 2.

Causes:

• Under-activation of the HPO axis
• Malnutrition and anaemia
• Endometrial tuberculosis
• Hyperprolactinaemia
• PCOD — polycystic ovarian disease

• Also known as epimenorrhoea.
• The menstrual cycle is reduced to less than 21 days and remains constant at that frequency.

Causes:

• Hyperstimulation of the ovary
• Stress
• STD
• Menopause-related issues

• The menstrual cycle extends to more than 35 days and remains constant at that frequency.
• Decreased number of menses in a year.

Causes:

• Hyperprolactinaemia
• Under-activation of the HPO axis
• PCOD
• Obesity
• Stress

• Inter-menstrual bleeding (IMB).
• Vaginal bleeding between expected periods.
• Irregular, acyclic bleeding.

Taking the largest cycle minus the smallest cycle against a normal cycle of 28 days:

Menometrorrhagia

Menorrhagia + metrorrhagia — irregular, acyclic, excessive bleeding, so heavy that the menses cannot be counted.

Causes: carcinoma, uterine polyp, tumours, trauma, infection.

The word breaks into: before | menstrual | group of symptoms.

It is a psychosomatic disorder of unknown aetiology, characterised by symptoms that appear in the luteal phase (day 20–28) and subside during the bleeding phase.

• Also known as premenstrual tension (PMT).

Criteria of PMS

• No pelvic pathology
• Symptoms must appear in the luteal phase (day 20–28)
• The rest of the cycle is symptom free
• Symptoms severe enough to disturb activities of daily living

Symptoms

• Breast tenderness
• Abdominal pain and distension
• Headache
• Insomnia
• Irritability
• Anorexia

Treatment

• Psychological support
• Anti-anxiety — Tab Alprax
• Antidepressant — Tab Sertraline, Fluoxetine
• OCP
• Tab Danazol