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Menstrual disruptions

By Bjarne Lühr Hansen PhD, MD and Philipp Skafte-Holm MD, Mentor Institute

Most women experience that their menstruations varies in strength and do not arrive regularly every time. This is normal and should not cause worry or closer examination. However, some menstrual disruptions can be sign of infection or cancer. Women who experience spotting and older women who after menopause start bleeding again should therefore quickly seek a doctor. All women with continuously troublesome menstruations can seek a doctor and receive treatment for their menstrual disruptions.

Menstrual disruptions with women are divided into regular but very powerful menstruations (menorrhagia) and completely irregular menstruations (metrorrhagia).

Powerful menstruations (menorrhagia). In the case of menorrhagia, the time interval between the bleedings are regular but the bleeding are lengthy and powerful. Menorrhagia is common and is seen with 20% of women in the age of 30-50 years. With the majority of the women, there is no explanation for the powerful bleedings. Fibroids in the uterus and the use of coil (but not IUS) can lead to menorrhagia.

Irregular menstruations (metrorrhagia). In the case of metrorrhagia, the time interval between the bleedings are completely irregular or the women experience spotting between regular bleedings. Metrorrhagia is common and is seen with 20% of women in the age of 15-20 years. The most common causes are hormonal disturbances, use of contraceptives, infections and pregnancy. Hormonal disturbances are seen with very young and not yet fully developed women or with older women approaching menopause. Use of contraceptives or hormones in menopause can cause metrorrhagia as a side effect. A more rare but serious cause or metrorrhagia is abdominal cancer.

What can you do?

It is a good idea to keep a table of your menstruations where you write date and strength of your bleedings and note down any spotting. This makes it easier for the doctor to find the cause of your menstrual disruptions.

What can your doctor do?

Powerful menstruations (menorrhagia). If you suffer from very powerful men regular bleedings, it is ok to wait and see for a few months. If you are in pain or develop symptoms of low blood count (exhaustion, headache, tinnitus, dizziness and reduced physical strength) you should contact your doctor at your earliest convenience.

Your general practitioner will ask about strength and duration of your menstruations, take some blood samples and perform a gynaecological examination. If the general practitioner finds perfectly normal conditions during the examinations, he/she can choose to prescribe hormone therapy to reduce the strength of your menstruations. Hormone therapy can be administered as tablets or as an IUS.

Irregular menstruations (metrorrhagia). Very young women with irregular bleedings and who have not yet had their sexual debut do not need to seek a doctor. They have to wait for their hormones to adjust so that the menstruations become regular.

Women who start taking the contraceptive pill often have irregular bleedings the first 3-4 months. This is just a side effect of the contraceptive pills that may disappear again. You should therefore wait and see for 3-4 months before contacting the doctor.

All women who experience spotting (small bleedings between menstruations) or contacts bleedings (bleeding following intercourse) should seek a doctor at their earliest convenience since spotting can be a sign of infection or cancer.

Practically all women have irregular menstruations when they approach menopause. This is because the production of the sex hormones becomes diminishes and finally stops. In the case of continuously troublesome irregular menstruations, women in menopause can seek a doctor.

All women who have passed menopause with the end of menstruation and who starts bleeding anew should immediately contact a doctor since it can be a sign of cancer.

Your general practitioner will ask about your menstruations, take a blood sample and perform a gynaecological examination. During the examinations, the doctor looks for sign of infection, pregnancy and cancer.

If the doctor finds and infection, it will be treated with antibiotics. With women with a coil, the doctor may choose to remove it. With women who takes the contraceptive pill, the doctor can choose to change to another contraceptive pill.

What can a specialist doctor do?

Powerful menstruations (menorrhagia). If your general practitioner finds any abnormal conditions during the gynaecological examination or your menstruations continue to be powerful in spite of treatment, the doctor refers you to a gynaecologist.

The gynaecologist can perform an ultrasound and check for abnormal conditions in your uterus. Depending on what the ultrasound shows, the gynaecologist can perform different surgical procedures. The gynaecologist can remove a possible polypus, perform curettage or remove the uterus completely to normalise your menstruations.

Irregular menstruations (metrorrhagia). If your general practitioner finds any abnormal conditions during the gynaecological examination or your menstruations continue to be irregular in spite of treatment, the doctor refers you to a gynaecologist.

The gynaecologist can perform an ultrasound and look for signs of cancer in your uterus. If the gynaecologist finds no signs of cancer, the treatment will often consist of hormone therapy. If there is signs of cancer in the uterus, you will be treated according to established guidelines.