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Menstrual Miseries
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The commonest cause for irregular cycles is polycystic ovarian disease, or PCOD. These women produce excess amounts of male hormones (androgens), are often overweight, and usually have either acne or hirsutism (excessive facial hair). This diagnosis can be confirmed by vaginal ultrasound, which shows that both the ovaries are enlarged; the bright central stroma is increased, and there are multiple small cysts in the ovaries.
Another common cause of menstrual irregularity is a major change in body weight. Women who lose a great deal of weight for whatever reason will frequently develop some abnormality of menstruation. Women who are overweight commonly have irregular periods. These women often produce increased amounts of androgen because of their excess fat cells.
Other reasons for anovulation (which can cause irregular cycles) include: thyroid disorders; hyperprolactinemia (increased prolactin levels in the blood); stress; and premature ovarian failure.
The diagnostic approach to a woman with abnormal menstrual cycles depends upon her age, the degree of menstrual abnormality, and her desire for pregnancy.
Recent advances in technology have totally changed the diagnostic approach to women with irregular cycles. Up to about 5 years ago, a D&C (dilatation and curettage) was the standard approach to a woman with irregular periods. However, all D&C does is to remove a small percentage of the endometrium from inside the uterus. A D&C rarely, if ever, permanently corrects irregular bleeding.
Today, the first two steps in the diagnosis of a woman with irregular bleeding are: the measurement of various hormone levels in the blood - namely FSH, LH, PRL and TSH (usually done on the third day of the cycle); and a vaginal ultrasound, when the thickness of the lining of the uterus (the endometrium) is measured and the uterus is carefully examined for possible causes of abnormal bleeding such as fibroids or adenomyosis.
If a specific cause for the irregular cycles is found, it is treated. If the woman is producing excess amounts of androgen, her androgen production is suppressed .If the woman has some abnormality in her thyroid gland, this is easily treated and usually will completely correct the menstrual abnormality. If a woman has an elevated prolactin, the drug used is bromocriptine. Reducing the elevated prolactin level back to normal almost always corrects the menstrual abnormality. For women who wish to conceive, ovulation is induced, usually with clomiphene. For women with irregular cycles who do not wish to conceive, regular cycles can be induced with cyclical birth control pills. Rarely, surgical intervention may be needed for organic diseases, such as uterine polyps.
Given the fact that all women have experienced menstrual cycles, it is not surprising that many myths about menstruation have arisen over the centuries, which need to be exploded. A common myth is that a woman has to menstruate in order to be healthy. It was commonly believed that the menstrual blood allowed the body to get rid of various "toxins", and that not menstruating would lead to all sorts of medical problems, such as obesity, backache and vaginal discharge. However, in reality there is nothing healthy about having a menstrual period, just as there is nothing unhealthy about not having one.
Another common question, which I hear, is "If I am not having a period where does the blood go?" You bleed only when the uterine lining sheds, and this occurs only when your hormone levels change. In the absence of these changes, the lining of the uterus remains relatively stable and, therefore, does not bleed. Therefore, the blood is really not going anywhere, because the lining is not being shed.
Another common myth involves a woman with blocked fallopian tubes. Many believe that your tubes have to be open in order for you to menstruate. Menstrual bleeding is controlled by hormonal changes from the ovary and whether or not the tubes are open has nothing to do with the hormones and, therefore, has nothing to do with irregular bleeding.
The more you understand about what is happening to your own body, the easier it will be for you to find the best medical care to solve your problem!
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