Heavy, frequent, or irregular menstrual bleeding is irregular menstrual bleeding. Approximately 25% of menstrual irregularities are caused by diseases related to the reproductive organs, while in the remaining 75% hormonal irregularities are the cause of irregular menstrual bleeding. Pre-pubertal or post-menopausal vaginal bleeding is a serious condition that must be investigated.
Among the non-hormonal causes of irregular vaginal bleeding; bleeding due to trauma in the genitals, uterine or cervical inflammation, uterine myomas, adenomyosis disease, benign or cancer-type diseases of the inner lining of the uterus. Age is important for women with irregular vaginal bleeding. Irregular bleeding before the age of 40 is mostly due to hormonal reasons, while after the age of 40, it is more likely to occur for non-hormonal reasons.
Use of intrauterine devices (spirals), birth control pills, or monthly contraceptives may also cause irregular vaginal bleeding. Early complications of pregnancy (for example; miscarriage, ectopic pregnancy, molar pregnancy) may also complain of bleeding.
Irregular menstrual bleeding must be evaluated by a gynecologist. Factors that may cause bleeding are reviewed one by one during the examination. Vagina, uterus, and ovaries are evaluated. The presence of tumors in the uterus and ovaries is investigated with ultrasound. With the same method, the thickness of the uterine lining is measured. If an obvious cause of bleeding cannot be determined after the age of 40, a biopsy should be performed from the inner lining of the uterus. In this way, the structure of the uterine lining is evaluated microscopically, and uterine cancer is investigated.
If the reason for the bleeding is from the reproductive organs, that is, if it is not a hormone disorder, the treatment is done for the cause. For example, if there are uterine fibroids, surgical treatment is applied. As a result of all these studies, if a disease that may cause bleeding is not detected, menstrual irregularity is due to hormonal imbalance. In this case, bleeding is tried to be regulated with menstrual regulating drugs. Although birth control drugs are mostly used in this treatment, alternative drug treatments are also available.
As menstrual bleeding approaches, some complaints occur in 75% of women due to the changing hormone levels. In half of these women, complaints are mild and do not affect the daily life of the person. In the other half, much more serious complaints occur, including depression. (Premenstrual Syndrome, PMS)
As menstrual bleeding approaches, some complaints occur in 75% of women due to the changing hormone levels. In half of these women, complaints are mild and do not affect the daily life of the person. In the other half, much more serious complaints occur, including depression. Premenstrual complaints can be physiological or psychological and may be affected by cultural differences. PMS is the combination of both physiological and psychological events. Studies show that different complaints occur in women from different cultures. While the most common complaint in women from the Far East is pain, depression is the most common finding in developed western societies. Complaints that negatively affect the social life of the person and are seen every month may even cause the woman to lose her self-confidence.
Almost all women with PMS symptoms have breast tenderness and slight temporary weight gain. Other symptoms include digestive system disorders, headache, rashes, muscle and joint pain, weakness, bleeding gums, palpitations, balance disorders, hot flashes, voices, and smells. These include hypersensitivity, agitation, and insomnia. Painful or excessive menstrual bleeding, that is, dysmenorrhea is not considered PMS.
Emotional hypersensitivity is very common in PMS. There are many different moods, from depression to anxiety to extreme irritability. Some women may experience mild memory loss. Concentration impairment is not uncommon in PMS. The depression, restlessness, and tension that are seen in some women are called premenstrual dysphoric disorder (PMDD).
Studies to find the causes of PMS have not been able to fully reveal the underlying factors of this picture, but there are some theories. If some hormones that suppress ovulation are given, PMS symptoms regress. Accordingly, reproductive hormones can cause PMS, but this role has not been explained. There are strong findings that PMS is the result of the joint action of these hormones and some substances that provide transmission in the nerves. The most blamed substances are those called GABA and serotonin. Some researchers believe that the disturbance in calcium and magnesium balance causes the PMS picture. The distribution of these two minerals in the body can affect the communication between nerve cells and cause the picture. These researchers argue that women with PMS cause complaints of magnesium deficiency or excess calcium. Another reason suggested in the etiology of PMS is stress hormones. The excess of these hormones may cause more intense complaints. Almost all hormones and substances secreted in the body are blamed for the etiology of PMS. However, no proven cause has been found.
Who can be seen
PMS is a condition encountered in all cultures all over the world. In one study, different levels of PMS findings were found in 88% of women. As the age increases, the severity of the complaints decreases, but with the number of children, the violence increases. Women with PMS in their mothers have more complaints. PMS can also increase the severity of some diseases. For example, most of the attacks in women with migraines coincide with the premenstrual period. Again, in diabetic patients, blood sugar levels and insulin need vary in the premenstrual period. Asthma attacks are more common and many chronic illnesses show exacerbations. During this period, the person’s harmony with his environment deteriorates and the people he/she has relationships with and their children may deteriorate. Suicidal tendencies may increase in adolescent girls. Eating disorders may be encountered.
The diagnosis of PMS is not based on positive findings. The most reliable way for diagnosis is to record the complaints for 2-3 months and score their severity. Complaints should be separated physically and mentally and when they started and when they ended should be recorded regularly.
Since the cause of PMS is not known exactly, its treatment is not certain. There are many different treatment approaches in this regard.
Diet: Some report eating little and often reduces complaints. It may sometimes be beneficial to consume fresh fruits and vegetables, avoid red meat and frozen fats, and not consume foods containing additives in the pre-menstrual period. Likewise, it may be beneficial to reduce caffeine and alcohol consumption.
Exercise: A study found that PMS is more common in women who do not exercise. A 30-minute daily walk can be helpful.
Calcium and Magnesium: There is a study reporting that a daily calcium intake of 1200 mg reduces the complaints by half at the end of 3 months. Some women have benefited from magnesium supplements, but there is no definitive evidence yet.
Vitamins: Although it has been suggested that vitamins A, E, and B6 cause PMS, there is no definite proven finding.
Other treatment options include drugs related to serotonin metabolism, hormone drugs, antidepressants, and psychiatric drugs such as anxiety, diuretics, male hormones, but none of them have definite benefits.
Other rare treatment approaches include psychotherapy and acupuncture.