Menstrual Cycle Disorder

The Menstrual Cycle

The menstrual cycle is defined as the period from the first day of menstruation to the day before the next period begins. It typically lasts about 28 days. Although individual variations may occur, the duration and intensity of bleeding, as well as the interval between two periods, should remain consistent.

Irregular, Too Strong, Too Early, Too Late – Simple Diagnostics

The regularity of menstrual bleeding can be disrupted by various factors, including hormonal imbalances, psychological stress, physical exertion, poor nutrition, dieting, as well as being underweight or overweight. Sometimes pathological causes such as fibroids, endometriosis, infections, or cysts are responsible. If menstruation ceases entirely, it may indicate pregnancy or disorders of the uterus or ovaries. In any case, irregular bleeding or spotting should be examined by a doctor. A gynecologist will conduct three diagnostic steps:

1. Check for anatomical abnormalities
2. Evaluate for hormonal imbalances
3. Assess for regulatory fluctuations

In most cases, irregular bleeding results from hormonal irregularities since the buildup and breakdown of the uterine lining are controlled by three ovarian hormones.

Diagnosing Irregular Bleeding Primarily Focuses on Two Questions:

1. How Can I Rule Out an Anatomical Disorder?

This fundamental question is primarily addressed through hysteroscopy, a modern and increasingly established diagnostic method in which the uterus is examined using an optical rod inserted through the cervix into the uterine cavity. This examination can be performed on an outpatient basis, either under local anesthesia or light sedation. Hysteroscopy allows inspection of the uterine interior, identifying benign or malignant changes. In some cases, tissue samples may be required for histological examination. If no abnormalities are found in the uterus, anatomical causes for irregular bleeding can likely be ruled out.

2. Is the Cause of the Irregular Bleeding Hormonal?

Hormonal causes are far more commonly responsible for irregular bleeding. Common situations include:

• Premenstrual Bleeding: Bleeding before the scheduled period can indicate progesterone deficiency. Progesterone is a hormone dominant in the premenstrual phase, maintaining the uterine lining and offering protection against pregnancy. A deficiency can trigger early menstruation. This can be corrected by taking a progestogen to raise progesterone levels.

• Postmenstrual Bleeding: Bleeding that continues after the regular menstrual period may be due to estrogen deficiency. Treatment involves balancing estrogen levels.

• Random, Irregular Bleeding: Sometimes cycle disturbances occur irregularly, almost randomly. This may be due to an imbalance between estrogen and progesterone. Therapeutically, correcting this issue is more complex, often requiring the entire menstrual cycle to be artificially replicated and regulated.

Surgical Treatment for Irregular Bleeding

Surgical treatments for irregular bleeding include curettage, a procedure used for both diagnosis and therapy:

Diagnostic and Therapeutic Curettage

Known as a "scraping," this procedure is used for specific gynecological issues such as unclear or irregular bleeding, miscarriages, fibroids, or endometrial carcinomas. During diagnostic curettage, tissue is removed from the uterine cavity to diagnose or rule out certain conditions. The removed tissue is then histologically examined. Therapeutic curettage removes tissue from the uterine cavity that could affect health, such as fibroids or uterine lining remnants after a miscarriage. The procedure is typically performed on an outpatient basis, under local anesthesia or light sedation, and lasts about an hour. Post-procedure, mild pain, bleeding, and nausea for a few days are normal, but symptoms should subside quickly. It is essential to rest and follow the doctor's post-procedure care instructions for optimal healing.

Diagnostic and Operative Hysteroscopy

Hysteroscopy is a method for examining female reproductive organs. Using a hysteroscopic instrument, a thin rod inserted through the cervix into the uterine cavity, the inner surface of the uterus is inspected. During diagnostic hysteroscopy, the examination is used to detect potential changes or conditions such as fibroids, polyps, or adhesions. Tissue samples for histological analysis may be taken during the exam if necessary. Operative hysteroscopy also allows therapeutic measures, including the removal of polyps or fibroids and treatment for adhesions or anatomical anomalies. Both procedures can be performed under local anesthesia or light sedation, usually lasting about five to ten minutes.

Endometrial Ablation

Endometrial ablation is a surgical method used to treat irregular or excessive menstrual bleeding. During this procedure, the inner uterine lining (the endometrium) is removed or damaged to reduce or stop bleeding. Ablation can be performed using several techniques, including hysteroscopy, thermal coagulation, laser ablation, or hydrothermal coagulation. It is essential to note that endometrial ablation does not act as sterilization, so women who choose this procedure should use alternative contraceptive methods. Pathological structures can also be removed with the same device. Small scissors can be inserted into the uterus to remove polyps or small fibroids during the procedure. If no polyps or fibroids are present, the uterine lining can be cauterized to prevent heavy bleeding. This method has become an alternative to hysterectomy (removal of the uterus), allowing women to stop excessive bleeding without the need for uterine removal.