Menstruation Disorders - Research Paper Example

MENSTRUATION DISORDERS Lecturer’s Menstruation disorders are conditions that affect women with a normalmenstrual cycle. Menstrual cycles in a woman are experienced every month, come like a clock starting and stopping at nearly the same time every month, and will cause little inconvenience to the reproductive woman. These disorders will be present from the start of menopause during adolescence to the normal end of the menstrual cycle i.e. menopause. Some women get through their menstrual cycles easily with few or no concerns will others experience disorders in their cycles regularly. A number of conditions contribute to these disorders. To better understand these menstrual disorders, the research paper will discuss the menstrual cycle; the features involved in the menstrual cycle, the risk factors to the disorders and discuss the disorders in menstruation as well as their management and complications involved. Keywords: menstruation, menstrual cycle, disorder, complications, dysmenorrhea, menorrhagia, Amenorrhea, Oligomenorrhea Introduction A menstrual disorder will affect the woman normal menstrual cycle, and the disorders include painful menses, abnormally heavy bleeding and lack of menses. Normal menstruation is bound to occur during the years of puberty and menopause. Also referred to as “period” entails a process where blood flow from the uterus to the cervix and out of the vagina. Some women will experience emotional and physical symptoms during the time of menstruation while another will not and such factors may disrupt a woman’s normal life in a number of ways. It is essential for the reproductive-aged woman to understand their menstrual cycles and some of the orders that are bound to occur to be able to prevent, manage them and seek medical attention. Most of these disorders have straightforward explanations, and treatments options that exist to help in relieving the symptoms. It is essential for a woman experiencing irregularity in their cycle to seek medical attention from a healthcare profession (Peacock, Alvi, & Mushtaq, 2012). Major topics in the research paper include the menstrual cycle and its features, the menstrual disorders and their risk factors and the management and complications of the underlying disorders. The Menstrual Cycle The menstrual cycle is prepared and regulated by a complex surge of reproductive hormones that work together to prepare the woman body and systems ready for pregnancy. The regions of the body that control these hormones are the hypothalamus in the brain and the pituitary gland that all control six important hormones in the body. This includes the Gonadotropin realizing hormone (GnRH) that is released by the hypothalamus, the follicle stimulating hormone (FSH) and the luteinizing hormone (LH). The two are produced under the command of the Gonadotropin realizing hormone. The ovaries under luteinizing hormone and follicle stimulating hormone command production of other reproductive hormones estrogen, progesterone and testosterone (Hawkins & Matzuk, 2008). The menstrual cycle starts with the first day of menses, and it is divided to the follicular phase that starts with menstrual bleeding. The hypothalamus releases GnRH that stimulates the production of the follicle-stimulating hormone and the luteinizing hormone. As levels of follicle-stimulating hormone increases, they signal production of the follicle by the ovaries. The eggs will continue to grow as follicle-stimulating hormone decline. When it is fully grown and mature it now ready for egg release. The ovulation phase follows that involves the release of a matured egg. It occurs 12 to 36 hours after decline of the LH. The mature egg travels to the down the fallopian tube to the uterus and women at this time are bound to experience some pain “middle pain” as it occurs at the middle of the month. The woman will likely get pregnant three to five days before ovulation or in the day of ovulation as the egg lives for up to 24 hours after it is released (Hickey & Balen, 2003). The luteal phase is the last phase where the ruptured follicle that released the egg closes to form a yellow mass of cells called the corpus luteum. This is the source of estrogen and progesterone at the time of pregnancy, and the hormones are important in thickening the uterine wall in preparation of fertilization (Oertelt-Prigione, 2012). Pregnancy will begin upon fertilization of the egg and if it does not occur, the egg breaks apart, corpus luteum degenerates and the levels of estrogen and progesterone will drop. The uterine lining sheds off together will the unfertilized egg leading to menstruation, and the cycle will begin again. Features of Menstruation Menarche- it is the start or onset of the menstrual cycle. It typically starts from 12 to 13 years, but it can emerge either early or late depending with the individual. It will generally occur after two or three years after breast budding i.e. start of breast development. It is affected by environmental and nutritional factors of the individual. Length of the cycle- an average menstrual cycle period is 28 days, but a 21 to 35 days cycle period is considered as normal. However, the cycle will start early or late depending on the individual as the cycles will tend to be longer during teenage and lengthen more when a woman reaches 40 years. At that period, the cycle also tends to be more irregular (Hawkins & Matzuk, 2008). Normal stop of menstruation- these are instances, where the menstruation is absent normally and not abnormally. During pregnancy, menstruation stops. If menstruation continues, it is an indication of a miscarriage, and the woman should seek medical attention. During breastfeeding, a woman is unlikely to ovulate but the woman will later on gain their fertility. Menopause is the last instance of normal absence of menses, and it occurs at about 51 years although it depends with the personal factors (Silberstein & Merriam, 2000). Risk Factors of menstrual disorders A number of factors predispose individuals to menstrual disorders. Age will play the greatest role in menstrual disorders. Girls who have their menarche at 11 years of age or even younger ages are at a greater risk of these disorders. They are at a higher risk of longer periods, severe menstrual pain and longer cycles. Before cycles become regular, Amenorrhea (absence of menses) may be experienced. Peri-menopause women are also at risk of developing menopausal disorders, as episodes of heavy bleeding are common as a woman approaches menopause. Weight is another risk factor as being over or underweight increases the risks (Slap, 2003). Heavier and longer cycles are also associated with painful periods (crumps). Smoking increases the risk of having heavy periods while emotional or physical stress acts as a hindrance to production of luteinizing hormone causing amenorrhea. A woman with no child has increased the risk of dysmenorrhea whereas a woman who has a greater number of pregnancies is predisposed to menorrhagia (Williams & Creighton, 2012). Menstrual Disorders Dysmenorrhea (Painful Cramps) It is severe pain frequent cramping that occurs during menstruation. The pain is felt on the lower abdominal area but will as well spread on the lower thighs and back region. Dysmenorrhea is classified as either to be secondary or primary depending on the presentation. Primary dysmenorrhea is pain cramping resulting from menstruation and the cramps will occur from the contractions of the uterus and are severe during heavy bleeding (Morrow & Naumburg, 2009). On the other hand, secondary related dysmenorrhea is pain accompanying another physical or medical condition i.e. uterine fibroids and endometriosis. Causes Primary dysmenorrhea is as a result of hormones that are produced in the uterus “prostaglandins” that causes the uterine muscle to contract. They play an essential role in the heavy menstruation causing the painful menses. On the other hand, secondary type of dysmenorrhea is as a result of several factors. Among the common medical conditions include endometriosis a chronic condition that results when the endometrium grows on abnormal areas such as the bowel, bladder, ovaries rather than the uterus leading to chronic pelvic pain. Another contributing factor is fibroids that are noncancerous growth growing on the uterine wall. They cause the clamping pain as well as heavy bleeding (Lee, Chen, Lee, & Kaur, 2006). Other medical causes include ovarian cysts, ectopic pregnancy, and pelvic inflammatory disease. An intrauterine contraceptive device used for family planning (IUCD) can also be a causative agent (Harel, 2008). Menorrhagia (Heavy Bleeding) It is a menstrual disorder where the menstrual flow last longer and is usually heavier than the normal. Bleeding will occur at regular intervals during the periods and will usually last for more than seven days, and the woman loses more than 80 mL of blood. It will often be accompanied by dysmenorrhea, as passing the large clots is a painful experience to a woman. Women will often underestimate the amount of blood lost during menses. A woman is expected to loss 30 mL of blood and change their pads or tampons 3-5 times a day (Wolfe, 2005). Clot formation noticed during menses is a cause of concern as it is a sign of heavy bleeding and the woman needs to seek medical attention. However, other types of bleeding should not be confused with menorrhagia. This includes bleeding after sex, metrorrhagia (spotting) that occurs at irregular intervals in variable amounts, menometrorrhagia that is prolonged and heavy bleeding occurring at irregular periods that combines both the features of menorrhagia and metrorrhagia as it can occur during menstruation or in between the periods and dysfunctional uterine bleeding (DUB). DUB occurs as a result of hormonal problems when girls begin their menses or when they approach menopause (Rao, 2011). Causes A number of factors are attributed to causing heavy bleeding. This entails hormonal imbalances in progesterone and estrogen levels common at the time of menopause or menarche. This may result from anovulation. If ovulation does not occur, the body produces progesterone causing heavy bleeding. Another cause of heavy bleeding is fibroids that will result to the heavy and prolonged bleeding (Duckitt & Collins, 2008). Uterine polyps that are noncancerous growth in the uterus result to profuse uterine bleeding. Endometriosis that causes painful menses also results to heavy and profuse bleeding. Other causes include medications and contraceptives that include IUCD, anti-inflammatory and anticoagulant medications. Bleeding disorders such as Von Willebrand disease will lead to heavy bleeding, ovarian and cervical cancers, cervical infections and miscarriages are other causes (Hickey & Balen, 2003). Amenorrhea (Absence of Menstruation) This refers to the absence of menstrual flow and there are two types of secondary and primary amenorrhea. Primary amenorrhea will occur to a girl who has not begun their menstrual cycle by 16 years of age. A healthcare provider should evaluate any girl who has not shown signs of sexual development such as breast development. However, secondary amenorrhea will occur to a woman who had regular periods and they stop for more than three months (Heiman, 2009). Oligomenorrhea (Light or Infrequent Menstruation) It is a condition where the cycle in infrequent and greater than 35 days. It is very common among the adolescents and is an indication of a medical problem to women who had regular flows. A healthy cycle in an adult is bound to vary from month to month by a few days. The flow can also vary from light to heavy flow and skipping a period then having a heavy flow may also occur. Causes of Amenorrhea and Oligomenorrhea A common cause of absent menses is delayed puberty as a result of genetic factors causing failure of ovarian development. Hormonal changes and puberty itself results to Oligomenorrhea as is often experienced among young teens. Eating disorders, as well as weight loss, causes hormonal changes and increased stress hormone levels that results in a reduction of the reproductive hormones and may result to the menstrual disorders. Endometriosis is another major cause as well as Polycystic Ovarian Syndrome (PCOS) where ovaries produce high amounts of androgens that cause the abnormalities. Elevated prolactin levels a condition referred to as hyperprolactinemia in pregnant breastfeeding women reduces the production of gonadotropin hormones thus inhibiting ovulation (Master-Hunter & Heiman, 2006). This results to absence of menses. Premature menopause cause amenorrhea and infertility and can be due to premature ovarian failure. Physical and emotional stress is a causative factor due to blockage of LH. Amenorrhea or Oligomenorrhea is also associated with weight loss and vigorous activity such as athletic training therefore it is more common among athletes. Interventions and Management of menstruation disorders Treatment of the disorders depends on the cause. There are a number of methodologies and medications used for management of these disorders. This entails the use of pain relievers such as NSAIDs that are no steroidal inflammatory drugs. They act by blocking the prostaglandins that increase uterine contractions therefore; they are effective in treating painful cramps (Dysmenorrhea). Oral contraceptives that include estrogen and progesterone pills are used for regulating periods in women with menstrual disorders such as dysmenorrhea, menorrhagia, and amenorrhea (Tapanainen, 2004). Pills are also effective in the treatment of pelvic pain from endometriosis and protect against endometrial and ovarian cancers. GnRH agonist is effective in treating menorrhagia. The agonist block release of reproductive hormones FSH and LH and the ovaries will stop ovulating and will no longer produce estrogen. Danazol a synthetic substance resembling a male hormone is used for suppressing estrogen used in combination with oral contraceptives to prevent heavy bleeding. However, it is not suitable for long-term treatment due to its masculinizing side effects thus it is used rarely. Tranexamic acid is a recently approved non-hormonal drug for the treatment of menstrual bleeding (Gordon, 2010). Surgery has been used in the management of the menstrual abnormalities i.e. heavy menstrual bleeding and painful cramps. Hysterectomy is used to remove the uterus and ablation of the endometrial destroys the lining of the uterus and stops menstrual flow as well as reducing the flow.hysterectomy is used in cases of heavy bleeding from fibroids and pelvic pain. However, with new medications and interventions available, it is less common. Removal of IUCD’s is also a surgical intervention to reduce progesterone levels. In dysmenorrhea, cutting of the pain conducting nerve fibers has been proven effective for pain management (Hickey & Balen, 2003). Complications of menstrual disorders Anemia is a common complication resulting from profuse loss of blood. Menorrhagia results to anemia as a blood loss more than 80mL per menstrual cycle will eventually result to anemia. This reduces oxygen transport in blood causing fatigue and a reduced physical capacity. Heart problems will also result when prolonged anemia persists and remains untreated. Osteoporosis characterized by loss of bone density progressively increased vulnerability and thinning of bone tissues is a complication resulting from hormonal deficiency, dietary deficiency and advanced age (Deligeoroglou & Creatsas, 2012). Amenorrhea that results from reduced levels of estrogen is linked with osteoporosis. Other conditions linked to the disease include premature ovarian failure and eating disorders. Infertility is another complication as conditions associated with profuse bleeding such as fibroids; endometriosis and ovulation abnormalities are important contributors to infertility. The irregular periods resulting from menstrual abnormalities may it difficult for a woman to conceive, therefore, treating these abnormalities is essential. Moreover, these abnormalities affect the quality of life of the individual. Pain and heavy bleeding will affect school and productivity as well as social activities of a woman or girl (Hawkins & Matzuk, 2008). Conclusion A menstrual disorder will affect the woman normal menstrual cycle and the disorders include painful menses, abnormally heavy bleeding and lack of menses. It is crucial for the woman to understand their menstrual cycles and the orders that are bound to occur to be able to prevent, manage them, seek medical attention and prevent complications such as anemia that may even cause death to the reproductive woman. References Deligeoroglou, E., & Creatsas, G. (2012). Menstrual disorders. Endocrine Development, 22, 160–170. doi:10.1159/000331697 Duckitt, K., & Collins, S. (2008). Menorrhagia. Clinical Evidence, 2008. pp. 110–128 Gordon, C. M. (2010). Clinical practice. Functional hypothalamic amenorrhea. The New England Journal of Medicine, 363, 365–371. doi:10.1056/NEJMcp0912024 Harel, Z. (2008). Dysmenorrhea in adolescents. In Annals of the New York Academy of Sciences (Vol. 1135, pp. 185–195). Hawkins, S. M., & Matzuk, M. M. (2008). The menstrual cycle: Basic biology. In Annals of the New York Academy of Sciences (Vol. 1135, pp. 10–18). doi:10.1196/annals.1429.018 Heiman, D. L. (2009). Amenorrhea. Primary Care, 36, 1–17, vii. doi:10.1016/j.pop.2008.10.005 Hickey, M., & Balen, A. (2003). Menstrual disorders in adolescence: Investigation and management. Human Reproduction Update. Lee, L. K., Chen, P. C. Y., Lee, K. K., & Kaur, J. (2006). Menstruation among adolescent girls in Malaysia: A cross-sectional school survey. Singapore Medical Journal. Master-Hunter, T., & Heiman, D. L. (2006). Amenorrhea: Evaluation and treatment. American Family Physician. Morrow, C., & Naumburg, E. H. (2009). Dysmenorrhea. Primary Care, 36, 19–32, vii. doi:10.1016/j.pop.2008.10.004 Oertelt-Prigione, S. (2012). Immunology and the menstrual cycle. Autoimmunity Reviews. doi:10.1016/j.autrev.2011.11.023 Peacock, A., Alvi, N. S., & Mushtaq, T. (2012). Period problems: disorders of menstruation in adolescents. Archives of Disease in Childhood. Rao, S. (2011). Menorrhagia. Obstetrics, Gynaecology & Reproductive Medicine. doi:10.1016/j.ogrm.2011.06.003 Silberstein, S. D., & Merriam, G. R. (2000). Physiology of the menstrual cycle. Cephalalgia, 20, 148–154. doi:10.1046/j.1468-2982.2000.00034.x Slap, G. B. (2003). Menstrual disorders in adolescence. Best Practice and Research: Clinical Obstetrics and Gynaecology. Tapanainen, J. S. (2004). Medical management of menstrual disorders. International Congress Series. doi:10.1016/j.ics.2004.01.106 Williams, C. E., & Creighton, S. M. (2012). Menstrual disorders in adolescents: review of current practice. 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