Menstrual irregularities

Synonyms

Menstrual cramps, menstrual cycle disorder, bleeding abnormality, menstrual pain

English: menstruation disorder

definition

Menstrual disorders are a disorder in the menstrual cycle.

The menstrual cycle repeats itself approximately every 28 days between two menstrual periods and begins with the first menstrual period and ends with the next bleeding. In this phase the woman is sexually mature and this sexual maturity occurs in the time between menarche (first menstruation; Menstrual period; Period) between the ages of 10 and 16 and menopause (Phase after the last menstruation) from 40 to 55 years of age.
Reasons for menstrual disorders can lie in the duration, intensity and frequency of bleeding.

causes

The causes for Menstrual irregularities can be hormonal or genetic in nature be. Defects of the genital organs (e.g. insufficiency of the ovaries, polyps / myomas), defects of the internal organs (liver, kidney, thyroid)or diabetes lead to menstrual disorders.

During the menstrual cycle, the lining of the uterus is prepared and changed for a fertilized egg to implant. This change is hormonally dated Hypothalamus controlled. The hypothalamus releases the hormone GOnadotropinR.eleasingHormon (GnRH) from that production of the Hormones luteinizing Hormon (LH) and folliclestimulating Hormon (FSH) in the pituitary gland (Pituitary gland) stimulates. LH and FSH then stimulate the production of sex hormones Androgen and estrogen in the ovaries (Ovaries). These sex hormones in turn regulate the Menstrual bleeding or the menstrual cycles. If there are disturbances in this hormonal control, a menstrual disorder would be the result.

Mental causes, how stress or problems in the partnership / in family life can also lead to hormonal disorders and thus menstrual disorders.
In addition to thyroid diseases, Obesity (Obesity), Anorexia nervosa (anorexia) and Contraceptiveswhich can lead to menstrual disorders, polyps (tumor) and tumors in the area of ​​the genital organs can also be causes.

Causes of primary amenorrhoeae can be hormonal disorders, disorders of ovarian function, or chromosomal disorders Atresia (congenital closure of a body opening) the uterus (uterus) or the vagina be.

In the secondary amenorrhea can pregnancy and Lactation be a physiological cause. Pathological causes that can lead to menstrual disorders are ovarian tumors, psychological problems, anorexia and hormonal disorders.

Other symptoms and causes

The prämenstruelle S.syndrome (PMS) is a cycle-dependent symptom. For example, women suffer from days to weeks before menstrual bleeding depressed mood, migraine, Tension in the breasts and irritability. These symptoms usually subside when the menstrual period starts. But not all women suffer from one PMS.

Other symptoms can include painful menstrual bleeding (Dysmenorrhea), Tiredness, Loss of appetite, diarrhea (Diarrhea) and constipation (Constipation) be.

Menstrual irregularities from medication

The body's hormonal balance is up very susceptible to external influences and can thereby are subject to strong fluctuations. In addition to stress, smoking and alcohol consumption, the hormonal balance also increases significantly influenced by medication. Each person also reacts differently to different medications, so that influencing the menstrual cycle would in principle be conceivable for almost every medication. Medication that especially often Cause menstrual disorders are for example Psychotropic drugs, antihypertensive drugs, hormonal drugs and anti-cancer drugs.

Hormonal preparations

Hormonal drugs have a direct impact on the body's hormonal balance. These include on the one hand the hormonal contraceptives (such as the Birth control pills, the Hormonal IUD, the Three-month syringe) and on the other hand Hormone preparations for the treatment of menopausal symptoms. Hormonal contraceptives prevent the ovulation in the ovaries suppressed. In the preparations there are usually certain combinations Estrogens and Progestin that replace the female hormonal cycle. Since this does not correspond to the natural hormonal balance of the body, it can be especially in the early stages of use irregular bleeding and spotting between periods come.
Some women suffer from menstrual disorders or a complete absence of the menstrual period (amenorrhea) even after stopping hormonal contraceptives.
The same applies to hormone therapy during the menopause (postmenopause), which can also lead to intermenstrual bleeding.

Androgen therapy and anabolic steroids

The male sex hormones are known as androgens. They are also available as medicinal products and are also used therapeutically in women. This can also lead to menstrual disorders, especially if the hormonal balance contains more male than female sex hormones. In this case there is often a complete absence of the menstrual period.
The so-called anabolic steroids are similar to androgens. These are particularly known for their misuse in sports. Above all, they promote muscle building and can lead to masculinization in women. This is then noticeable through a deeper voice, increased body hair and disturbances / absence of menstruation.

Psychotropic drugs

In the case of psychotropic drugs, neuroleptics (especially risperidone) and tricyclic antidepressants, which are used, for example, to treat depression, cause menstrual disorders. Tricyclic antidepressants act on dopamine receptors in the brain and promote the release of the hormone prolactin. Prolactin promotes milk production in the mammary gland, usually for breastfeeding the offspring. It also suppresses ovulation. Therapy with the mentioned psychotropic drugs can lead to milk secretion from the breast and disorders of the menstrual cycle (secondary amenorrhea).

Read more on the topic: Psychotropic drugs

Cancer therapeutics

Especially when treating Breast cancer come often Chemotherapy used on a anti-hormonal mode of action are based. Many breast tumors show strong growth under the influence of female sex hormones, which is why one would like to switch off the promoting influence of the hormones on cancer. Medicines such as Tamoxifen, Aromatase inhibitors and GnRH analogs used. The production and function of the female sex hormones is suppressed for the duration of the chemotherapy, so that a No menstrual period results. Initially, this can manifest itself as menstrual irregularities until the bleeding no longer occurs. After the end of the therapy, the hormonal balance can normalize again, but sometimes the menstrual period does not start again.

Cytostatics and radiation In the context of cancer, the degenerated tumor cells are used to kill. Unfortunately, healthy cells are also damaged in the process. The germ cells in particular are susceptible to these therapeutic measures and often perish as a result of aggressive cancer therapy. A permanent infertility with the absence of menstruation result.

Cortisone therapy

Menstrual disorders can also occur during therapy with cortisone preparations. For example, there may be intermenstrual bleeding, especially if the therapy is continued over a longer period of time.

Menstrual irregularities from alcohol

Excessive alcohol consumption Has many harmful influences on the organism. The cardiovascular system, the gastrointestinal tract, the nervous system and the liver in particular can be permanently damaged.
However, alcohol also affects the body's hormonal balance. Women who have not yet gone through menopause notice this, among other things, from menstrual disorders (Oligomenorrhea) or the absence of a menstrual period (Amenorrhea).
This is because the Formation of female sex hormones (estrogen, progesterone) decreased with regular alcohol consumption can be.The ovaries, which are responsible for the production of these hormones, cease to function under excessive influence of alcohol, so that the hormone levels are lowered.
Since the female sex hormones control the monthly cycle, this is also disturbed secondarily.
Likewise, it can be caused by constant consumption of alcohol anovulatory menstrual bleeding come, that means that the menstrual period takes place, but without ovulation beforehand.
Women who drink a lot of alcohol are so common less fertilethan women who abstain from alcohol.
In addition, alcohol increases in case of pregnancy the Risk of deformities or developmental disorders of the child, as well as for one Miscarriage or premature birth.

In the case of menstrual disorders, it is advisable to to refrain from alcohol and nicotineso that the body's hormonal balance can regulate itself again. Especially in the case of one Desire to have children or one pregnancy you should definitely avoid alcohol and nicotine.

Menstrual disorders during puberty

With the beginning of the puberty sets the first menstrual period a. Of the The hormonal balance changes and the ovaries become active. The first menstrual period is usually very weak and the intervals between the bleeds are still very irregular. The next bleeding usually starts after 21-45 days. That's because the body does the Has yet to establish a balance in hormone productionuntil the monthly cycle can run smoothly. This takes longer for some girls and less for other girls. After about three years, most women have a regular cycle, but it can take up to six years for the cycle to follow a really stable rhythm.

The duration and regularity of the monthly cycle, however, also depends heavily on external factors. Girls during puberty severely underweight (anorexia) or overweight (obesity) have their first menstrual period much later and much more irregularly than girls of normal weight.
Girls who are taking hormonal contraceptives, can also suffer from menstrual irregularities. This occurs especially in the first few months of use, until the body has got used to the new hormonal situation. However, it can intermenstrual bleeding occurs for the first time even after prolonged use without complications. The same applies after stopping the hormone preparations. Also psychological stress has a major impact on the hormonal balance.
Last but not least, the female norm cycle is too influenced by vigorous exercise.
All of these factors can cause the onset of menstruation to be irregular.

However, it is extremely rare for the bleeding to stop for more than 90 days and usually has other causes. In this case, for example, a malfunction of the ovaries, other hormonal diseases and pregnancy must be excluded.

Menstrual disorder due to iron deficiency

A Iron deficiency is present in many women through the menstrual period. Women with a heavy menstrual period in particular can suffer from iron deficiency due to the loss of blood and the associated loss of iron. But can iron deficiency also be the cause of menstrual cramps? An iron deficiency can lead to a anemia (Anemia) lead. This manifests itself through symptoms such as tiredness, exhaustion, listlessness, headache and paleness. This can also result in increased brittleness of the nails and hair loss. These symptoms can be alleviated by increasing the iron intake. Depending on how severe the deficiency is, iron supplements may be necessary. The iron intake can, however, also be increased by consuming iron-containing foods.

Read our article on this: Consequences of iron deficiency.

Menstrual disorder caused by L-thyroxine

L-thyroxine is a medicine that is prescribed very often. It is used to treat an underactive thyroid (Hypothyroidism) prescribed. An underactive thyroid can be the trigger for what is known as secondary amenorrhea, which is the absence of menstrual bleeding. If the thyroid is underactive, TSH, an important hormone in the thyroid regulating system, is increased, which leads to an increase in prolactin. This increased prolactin causes the absence of menstrual bleeding. The administration of L-thyroxine ensures that the TSH reaches a normal level if the dosage is sufficient. If the dosage is too low, the TSH is increased, so that irregularities in the cycle can arise. Menstrual cramps can also occur as a side effect if the dose is irregular or incorrect.

Menstrual disorder in Hashimoto's thyroiditis

The Hashimoto's thyroiditis is an autoimmune disease that causes hypothyroidism in the late stages of the disease. This hypothyroidism has certain consequences, also for the female cycle. With hypothyroidism, there is an increase in TSH, which is an important hormone in the thyroid regulating system. This increase in TSH leads to an increase in the hormone Prolactin. The increased prolactin leads to an estrogen deficiency, the one secondary amenorrhea conditionally. Secondary amenorrhea is the absence of menstrual bleeding. After all, 20% of women who suffer from such secondary amenorrhea have an increase in their prolactin levels.

Menstrual disorder in menopause

The Menopause, also climacteric called, denote the period of transition from the fertile phase of a woman's life to the end of this fertility. The premenopause, the period before the last menstrual period in a woman's life, is characterized by irregularities in the cycle and menstrual cramps. During this phase, hormonal changes and adaptation processes occur in the female body, which is why irregular menstrual cycles are all too normal.

Diagnosis of menstrual disorders

In order to be able to diagnose menstrual disorders, the doctor uses the anamnesis as the first examination method (Patient survey).

By asking the patient, the doctor can determine how exactly the patient's menstrual period went. The doctor is interested in when the first menstrual period took place, how long the cycle and the bleeding lasted approx. The doctor also asks whether there are known hereditary diseases or previous illnesses. This is followed by the physical examination. Gynecological examinations, ultrasound (Sonography) and laboratory (hormone determination in the blood; androgen / LH / thyroid hormones) for clarification are used. The extent to which these examinations take place or in which direction the examinations are carried out mostly depends on the symptoms reported by the patient. It would be good if the patient kept a kind of diary for a certain time, which dates the cycle length, bleeding duration, bleeding intensity and any intermenstrual bleeding in order to find out exactly which menstrual disorder is present. If the menstrual disorders cannot be precisely named, the diagnosis can be made surgically (endoscopy / hysteroscopy, scraping / curettage).

Read more on the topic: Endoscopy

Therapy of menstrual disorders

What therapy at Menstrual irregularities used depends on the symptoms, causes and diagnoses. Depending on the cause and severity of the menstrual disorder, it is possible that the cycle levels off again on its own.

If the cause is in the area of ​​hormone production, then through Giving these missing hormones be treated. If organ damage is the cause of the lack of hormones, an attempt can be made to surgically treat this organ damage and thus get the hormone production going again. If stress or psychological problems are the cause, the stress can be alleviated Relaxation exercises, Vacation or psychotherapy.

Is this Contraceptives the cause of the menstrual disorder, it may be necessary to take another preparation with other active ingredients or to dispense with this type of contraception.

The therapy of Amenorrhea essentially lies in the administration of hormones. Here the bleeding is caused by the administration of medication.

In the Oligomenorrhea and polymenorrheaIn cases where the cycle is shortened or lengthened, but menstrual bleeding is present, therapy is usually not used here. Hormone therapy is induced if the patient still wants to have children.

Although the menstrual period in the Hypomenorrhea is too weak, is usually not treated unless there is a desire to have children. Otherwise you have to be treated with hormones here too.

The other menstrual disorders (Hypermenorrhea, metrorrhagia, menorrhagia) must be treated. Treatment of menstrual disorders usually aims to treat the causes. Causes how Fibroids (Uterine tumor), for example, can be removed surgically. Scraping or hormone therapy can also be another form of therapy. In the case of very severe menstrual disorders, it may be necessary to remove the uterus (hysterectomy) should be thought.

Also the therapy of the Dysmenorrhea aims at the causes. Preparations are used here that target the pain or the pain-causing one cramps to treat.

more on the subject Premenstrual syndrome at our partner

Home remedies for menstrual disorders

Some of the menstrual discomfort and symptoms can be relieved by using home remedies. In the following, some common home remedies are presented as examples that can provide relief from menstrual disorders.

Menstrual period pain: pain that occurs during menstruation is not uncommon. There are some effective period pain medications available, but home remedies are also a good alternative or effective supplement to relieve pain. Warm cherry stone or spelled pillows gently relieve cramps and relax the abdomen. Various types of tea can also help alleviate the symptoms. In general, you can drink any tea that tastes good and is good for you. Fresh herbal teas such as nettle tea, lemon balm or chamomile have a promising effect. Ginger is also said to have a beneficial effect. You can add these to your tea, for example.

In the week before menstruation: In the week before menstruation you can do a lot to prevent menstrual cramps. Avoid alcohol, nicotine and caffeine if possible. In this way you can prevent headaches and menstrual pain. Avoid stress and eat a healthy diet.

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Prophylaxis (prevention)

There a physiological course the menstrual cycle is predominantly dependent on hormones and a disruption of the hormonal balance too Menstrual irregularities factors that disrupt the hormonal balance should be prevented. These include, stress, unhealthy diet, smoking, inadequate physical activity, inadequate and irregular sleep.

Menstrual disorders in comparison

The normal one Menstrual bleeding becomes Eumenorrhea and has a cycle of 25 to 31 days. During the cycle, menstrual bleeding lasts approximately 3 to 6 days and the bleeding volume is approximately 50 to 150 ml per day.

Under disruption of the Bleeding duration counting Menorrhagia and Brachymenorrhea. Menorrhagia refers to the extended menstrual period. The menstrual cycle remains the same, but the bleeding lasts longer than seven days. The bleeding rate is also increased.

Brachymenorrhea is the shortened menstrual period. This means that the bleeding time will only last from hours to 2.5 hours. The bleeding intensity here is normal to reduced.

Under Disruption of Bleeding intensity (Type anomaly) counting Hypermenorrhea and hypomenorrhea. Excessive menstrual bleeding is called Hypermenorrhea designated. The menstrual cycle and the duration of the bleeding remain the same, although the bleeding intensity is more than 150 ml per day.

In the Hypomenorrhea there is slight bleeding. Here, too, the cycle and bleeding duration remain the same. But the bleeding strength is less than 50ml per day.

Under Disorders of the Bleeding frequency (Tempo anomalies) counting Polymenorrhea and oligomenorrhea.

Polymenorrhea denotes the irregular or often shortened menstrual cycles. The bleeding time remains the same, but the menstrual cycle is less than 25 days and the bleeding intensity is increased, normal or decreased. Occasionally there are two menstrual periods per month.

In the Oligomenorrhea the menstrual cycle is greatly extended (> 35 days). The bleeding time remains the same and the bleeding intensity is increased, normal or decreased here too.

Additional bleeding also counts, such as Metrorrhagia and post-coital bleeding to menstrual disorder. Here it is so that in the course of the cycle bleeding occurs outside of menstruation. In the Metrorrhagia (Intermenstrual bleeding; Spotting) there are additional Spottingwhich occurs either a day or two before or after your menstrual period. The bleeding rate is low. In the Post-coital bleeding there is bleeding after intercourse.

Another menstrual disorder is that Amenorrheawhere the menstrual period stops completely. Here we differentiate between primary and secondary Amenorrhea. In primary amenorrhea, a girl has still not started menstruating when she is 16 years old. And with secondary amenorrhea there is no menstrual period for more than three months, although a normal menstrual cycle has already started.