The health care provider uses the laparoscope to view the uterus, ovaries, tubes, and peritoneum lining of the pelvis. Dietary adjustments, starting about 14 days before a period may help some women with certain mild menstrual disorders, such as cramping. Limiting salt sodium may help reduce bloating. Limiting caffeine, sugar, and alcohol intake may also be beneficial.
Women who have heavy menstrual bleeding can sometimes become anemic. Eating iron-rich foods can help prevent anemia. Iron found in foods is either in the form of heme or non-heme iron. Heme iron is better absorbed than non-heme iron. There are two forms of supplemental iron: Ferrous iron is better absorbed and is the preferred form of iron tablets.
Ferrous iron is available in three forms: Depending on the severity of your anemia , as well as your age and weight, your doctor will recommend a dosage of 60 to mg of elemental iron per day. This means taking 1 iron pill 2 to 3 times each day. Applying a heating pad to the abdominal area, or soaking in a hot bath, can help relieve the pain of menstrual cramps.
Change tampons every 4 to 6 hours. Avoid scented pads and tampons; feminine deodorants can irritate the genital area. Douching is not recommended because it can destroy the natural bacteria normally present in the vagina. Bathing regularly is sufficient. NSAIDs block prostaglandins, the substances that increase uterine contractions. They are effective painkillers that also help control the inflammatory factors that may be responsible for heavy menstrual bleeding. Long-term daily use of any NSAID can increase the risk for gastrointestinal bleeding and ulcers, so it is best to just use these drugs for a few days during the menstrual cycle.
Some products Pamprin, Premsyn combine acetaminophen with other drugs, such as a diuretic, to reduce bloating. Oral contraceptives OCs , commonly called birth control pills or "the Pill," contain combinations of an estrogen and a progesterone in a synthetic form called progestin. The estrogen compound used in most combination OCs is estradiol. There are many different progestins, but common types include levonorgestrel, drospirenone, and norgestrel.
A newer, four-phasic OC that contains estradiol and the progesterone dienogest, has been shown in small trials as effective for treatment of heavy menstrual bleeding. OCs are often used to regulate periods in women with menstrual disorders, including menorrhagia heavy bleeding , dysmenorrhea severe pain , and amenorrhea absence of periods. Oral contraceptives are as effective for treating pelvic pain from endometriosis as the more potent gonadotropin releasing hormone agonists.
They also protect against ovarian and endometrial cancers. Standard OCs usually comes in a pill pack with 21 days of "active" hormone pills and 7 days of "inactive" placebo pills. Extended-cycle also called "continuous-use" or "continuous-dosing" oral contraceptives aim to reduce or eliminate monthly menstrual periods. These OCs contain a combination of estradiol and the progestin levonorgestrel, but they use extending dosing of active pills with 81 to 84 days of active pills followed by 7 days of inactive or low-dose pills. Some types of continuous-dosing OCs use only active pills, which are taken days a year.
Common side effects of combination OCs include headache, nausea, bloating, breast tenderness, and bleeding between periods. The estrogen component in combination OCs is usually responsible for these side effects. In general, today's OCs are much safer than OCs of the past because they contain much lower dosages of estrogen. However, all OCs may increase the risk for migraine, stroke, heart attack, and blood clots. The risk is highest for women who smoke, who are over age 35, or who have a history of heart disease risk factors such as high blood pressure or diabetes or past cardiac events.
Women who have certain metabolic disorders, such as polycystic ovary syndrome PCOS , are also at higher risk for the heart-related complications associated with these pills. Some types of combination OCs contain progestins, such as drospirenone, which have a much higher risk for causing blood clots than levonorgestrel. Progestins synthetic progesterone are used by women with irregular or skipped periods to restore regular cycles. They also reduce heavy bleeding and menstrual pain, and may protect against uterine and ovarian cancers. Progestin-only contraceptives may be a good option for women who are not candidates for estrogen-containing OCs, such as smokers over the age of Short-term treatment of anovulatory bleeding bleeding caused by lack of ovulation may involve a day course of an oral progestin on days 5 to Medroxyprogesterone Provera is commonly used.
An intrauterine device IUD that releases progestin can be very beneficial for menstrual disorders, regardless of its contraceptive effects. The LNG-IUS remains in place in the uterus and releases the progestin levonorgestrel for up to 5 years, therefore being considered as a good long-term options.
However, periods become short eventually with little to no blood flow. Common side effects may include cramping, acne, back pain, breast tenderness, headache, mood changes, and nausea. The LNG-IUS may increase the risk for ovarian cysts, but such cysts usually cause no symptoms and resolve on their own. Women who have a history of pelvic inflammatory disease or who have had a serious pelvic infection should not use the LNG-IUS. Depo-Provera also called Depo or DMPA uses the progestin medroxyprogesterone acetate, which is administered by injection once every 3 months.
Most women who use Depo-Provera stop menstruating altogether after a year. Depo-Provera may be beneficial for women with heavy bleeding, or pain due to endometriosis. Women who eventually want to have children should be aware that Depo-Provera can cause persistent infertility for up to 22 months after the last injection, although the average is 10 months.
Weight gain can be a problem, particularly in women who are already overweight. Women should not use Depo-Provera if they have a history of liver disease, blood clots, stroke, or cancer of the reproductive organs. Depo-Provera should not be used for longer than 2 years because it can cause loss of bone density. Gonadotropin releasing hormone GnRH agonists are sometimes used to treat severe menorrhagia. As a result, the ovaries stop ovulating and no longer produce estrogen.
GnRH agonists include the implant goserelin Zoladex , a monthly injection of leuprolide Lupron Depot , and the nasal spray nafarelin Synarel. Such drugs may be used alone or in preparation for procedures used to destroy the uterine lining. They are not generally suitable for long-term use. Commonly reported side effects, which can be severe in some women, include menopausal-like symptoms.
These symptoms include hot flashes, night sweats, changes in the vagina, weight change, and depression. The side effects vary in intensity depending on the GnRH agonist. They may be more intense with leuprolide and persist after the drug has been stopped. The most important concern is possible osteoporosis from estrogen loss. Women should not take these drugs for more than 6 months. Add-back therapy, which provides doses of estrogen and progestin that are high enough to maintain bone density but are too low to offset the beneficial effects of the GnRH agonist, may be used.
GnRH treatments may increase the risk for birth defects. Women who are taking GnRH agonists should use non-hormonal birth control methods, such as the diaphragm, cervical cap, or condoms. Danazol Danocrine is a synthetic substance that resembles a male hormone. It suppresses estrogen, and therefore menstruation, and is occasionally used sometimes in combination with an oral contraceptive to help prevent heavy bleeding.
It is not suitable for long-term use, and due to its masculinizing side effects it is only used in rare cases. GnRH agonists have largely replaced the use of danazol. Adverse side effects include facial hair, deepening of the voice, weight gain, acne, and reduced breast size. Danazol may also increase the risk for unhealthy cholesterol levels and it may cause birth defects. Tranexamic acid Lysteda is a newer medication for treating heavy menstrual bleeding and the first non-hormonal drug for menorrhagia treatment. Tranexamic acid is given as a pill. It is an anti-fibrinolytic drug that helps blood to clot.
The FDA warns that use of this medication by women who take hormonal contraceptives may increase the risk of blood clots, stroke, or heart attacks. This drug should not be taken by women who have a history of blood clots. Women with heavy menstrual bleeding, painful cramps, or both have surgical options available to them.
Most procedures eliminate or significantly affect the possibility for childbearing, however. Hysterectomy removes the entire uterus while endometrial ablation destroys the uterine lining. Women should be sure to ask their doctors about all medical options before undergoing surgical procedures.
In endometrial ablation, the entire lining of the uterus the endometrium is removed or destroyed. For most women, this procedure stops the monthly menstrual flow. In some women, menstrual flow is not stopped but is significantly reduced.
Menstrual disorders - TriHealth: Discover the Power of Unity
Endometrial ablation significantly decreases the likelihood a woman will become pregnant. However, pregnancy can still occur and this procedure increases the risks of complications, including miscarriage. Women who have this procedure must be committed to not becoming pregnant and to using birth control.
Sterilization after ablation is another option. A main concern of endometrial ablation is that it may delay or make it more difficult to diagnose uterine cancer in the future. Postmenopausal bleeding or irregular vaginal bleeding can be warning signs of uterine cancer. Women who have endometrial ablation still have a uterus and cervix, and should continue to have regular Pap smears and pelvic exams.
Endometrial ablation used to be performed in an operating room using electrosurgery with a resectoscope a hysteroscope with a heated wire loop or roller ball. Laser ablation was another older procedure. These types of endometrial ablation have largely been replaced by newer types of procedure that do not use a resectoscope.
The newer procedures can be performed either in an operating room or a doctor's office. In preparing for the ablation procedure, the doctor will perform an endometrial biopsy to make sure that cancer is not present. If the woman has an intrauterine device IUD , it must be removed before the procedure. In some cases, hormonal drugs, such as GnRH analogs, may be given a few weeks before ablation to help thin the endometrial lining.
Endometrial ablation is an outpatient procedure. The doctor usually applies a local anesthetic around the cervix. The woman also receives medication for pain and to help her relax.
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The doctor will dilate the cervix before starting the procedure. Women may feel some mild cramping or discomfort, but many of the newer types of endometrial procedures can be performed in less than 10 minutes. Women may experience menstrual-like cramping for several days and frequent urination during the first 24 hours.
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The main side effect is watery or bloody discharge that can last for several weeks. This discharge is especially heavy in the first few days following ablation. Women need to wear pads, not tampons during this time, and to wait to have sex until the discharge has stopped.
They are generally able to return to work or normal activities within a few days after the procedure. Complications of endometrial ablation may include perforation of the uterus, injury to the intestine, hemorrhage, or infection. If heated fluid is used in the procedure, it may leak and cause burns. However, in general, the risk of complications is very low.
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Nearly all women have reduced menstrual flow after endometrial ablation, and nearly half of women have their periods stop. Some women, however, may continue to have bleeding problems and ultimately decide to have second ablation procedure or a hysterectomy. Heavy bleeding, often from fibroids , and pelvic pain are the reasons for many hysterectomies.
However, with newer medical and surgical treatments available, hysterectomies are performed less often than in the past. In its support, hysterectomy, unlike drug treatments and less invasive procedures, cures menorrhagia completely, and most women are satisfied with the procedure. Less invasive ways of performing hysterectomy procedures such as vaginal approach, laparoscopic approach with or without robotic assistance, are also improving recovery rates and increasing satisfaction afterward.
Still, any woman who is uncertain about a recommendation for a hysterectomy to treat fibroids or heavy bleeding should certainly seek a second opinion. Some women who have hysterectomies have their ovaries removed along with their uterus. Surgical removal of the ovaries is called an oophorectomy. A hysterectomy does not cause menopause but removal of both ovaries bilateral oophorectomy does cause immediate menopause. Doctors may recommend hormone therapy for certain women. Hormone therapy for a woman who has her uterus uses a combination of estrogen and progestin because estrogen alone increases the risk for endometrial uterine cancer.
However, women who have had their uteruses removed do not have this risk and can take estrogen alone, without the progestin. Some evidence suggests that surgically cutting the pain-conducting nerve fibers leading from the uterus diminishes the pain from dysmenorrhea. Some small studies have shown benefits from these procedures, but stronger evidence is needed before they can be recommended for women with severe primary dysmenorrhea or the chronic pelvic pain associated with endometriosis.
American College of Obstetricians and Gynecologists. Rates of subsequent surgery following endometrial ablation among English women with menorrhagia: Laparoscopic uterosacral nerve ablation for alleviating chronic pelvic pain: Davies J, Kadir RA. An update on management. Levonorgestrel intrauterine system--first-line therapy for heavy menstrual bleeding. N Engl J Med.
Associations between Psychiatric Disorders and Menstrual Cycle Characteristics
Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding. Cochrane Database Syst Rev. A randomized controlled trial of the clinical effectiveness and cost-effectiveness of the levonorgestrel-releasing intrauterine system in primary care against standard treatment for menorrhagia: Levonorgestrel-releasing intrauterine system 52 mg for idiopathic heavy menstrual bleeding: Ont Health Technol Assess Ser.
Disorders of menstruation in adolescent girls. Pediatr Clin North Am. Non-steroidal anti-inflammatory drugs for heavy menstrual bleeding. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Endometrial resection and ablation techniques for heavy menstrual bleeding.
Literature Review
Primary and secondary amenorrhea and precocious puberty: Monoamines and serotonin are known to cause altered physiologic and behavioral states. Serotonin mediates mood and behavioral disorders in which depression and irritability are prominent; monoamines are implicated in anxiety disorders. Estrogen and progesterone are known to modulate levels of both serotonin and monoamines.
The complexity and relevance of hormones in human behavior is not well understood. It is not simply a matter of an excess or a deficiency of hormones, since studies on premenstrual syndrome PMS demonstrate that women with severe PMS respond differently to normal hormone levels. Although anecdotal evidence links mental health and menstrual cycles, little research has focused on specific psychiatric disorders and comorbid menstrual symptoms, despite its importance in guiding the assessment and treatment of women. Similarly, Joffe and others found that early-onset within 5 years of menarche menstrual dysfunction prior the onset of psychiatric illness is reported more commonly by women with BPD than by women with unipolar depression and healthy controls, possibly reflecting abnormalities in the HPG axis associated with BPD.
The prevalence of one of the most common mood states, depression, increases with reproductive developmental events: Bisaga and colleagues examined the association between menstrual functioning and psychopathology in high school girls. Irregular cycles, late menarche, and being in the first gynecologic year post menarche were each differentially associated with depressive disorder, obsessive-compulsive disorder, and eating disorder.
Harlow and colleagues explored the relationship between depression and the onset of perimenopause. Compared with nondepressed women, depressed women had twice the risk of an earlier perimenopausal transition. Lower estrogen levels have been found in women who are depressed Harlow et al.
Rasgon and colleagues reported the case of a woman whose treatment-resistant depressive symptoms resolved only after her polycystic ovarian syndrome was treated and regular menstrual cycles were restored. In sum, a better understanding of the observed link between psychiatric illness and menstrual cycle characteristics is critical to the provision of quality nursing care for women, since there is little evidence to guide the assessment and proper treatment of women in this area. Little empirical evidence documents this important link. Thus, the purpose of this study is to investigate the association between current and lifetime psychiatric disorders with menstrual cycle length and regularity.
Data from a prospective cohort study of prenatal mental health and its impact on birth outcomes, health care utilization, and costs were used to investigate the relationship between psychiatric disorder and menstrual cycle regularity and length. The original data were collected between February and August Louis City and in five rural southeastern Missouri counties. Subjects were 13 years or older and spoke English. The participants underwent a 2—3 hour in-person interview with a trained research assistant using the Diagnostic Interview Schedule, IV DIS-IV and a pregnancy questionnaire once during her pregnancy either at the WIC site or in her home.
Electronic files containing WIC intake, pregnancy information, and birth certificate data were obtained for each subject from the Missouri Department of Health and Senior Services. The sample, after exclusions described below, included African-Americans One in five was currently married. Mean age was Of the women in the sample, The mean cycle length was Thus, a total of subjects had complete data for the cycle length variable.
Sociodemographics characteristics were drawn from the Diagnostic Interview Schedule Version IV Robins, Cotler, Bucholz, et al, , and from the WIC certificate data recorded by WIC staff upon enrollment [maternal age, race, residence, height, and prepregnancy weight]. The interview assessed symptom counts, onset, recency, and duration of symptoms; periods of remission: Good to excellent reliability with the DIS for most diagnoses kappa. Grouped diagnoses affective disorders, anxiety disorders, substance use or dependence disorders was based on the categories within the DSM-IV and were assigned when subjects met criteria for one of the individual diagnoses within the respective diagnostic category.
For the current study, subjects using hormonal contraceptives were excluded. These exclusions reduced the total sample for these analyses consisted of women. That is, is the length of time between your periods about the same each cycle? Subsequently, a new variable was developed that reflected interviewer comments. Subjects were divided into three groups by age: Smoking is associated with short cycles Rowland et al, The DIS nicotine dependence module was used to assess onset, recency, quantity and frequency of tobacco product use as well as the criteria for dependence.
A variable indicating any tobacco use in the last 12 months, a period that coincides with the period assessed for cycle regularity and length was created. The influence of body mass index on menstrual function has been studied for decades. Symons, Sowers, and Harlow studied women aged 24—35 who generated menstrual cycles. At the initial WIC pregnancy visit in this study women were measured for height and they reported their prepregnancy weight. Data were available for of the cases. Subjects were classified into four BMI groups: These four categories were collapsed into two categories underweight and average; overweight and obese due to low numbers in the underweight and overweight group see Table 1.
Researchers have consistently found that patients with diabetes are approximately twice as likely to experience depression as those without diabetes Brown, Women were asked in the DIS-IV pregnancy interview for age of onset for diabetes as well as the date of last symptom. Diabetic status was evaluated by cross-checking diabetes onset on the DIS with birth certificate data indicating diabetes during pregnancy to differentiate those with pre-existing and gestational diabetes.
If the woman had developed diabetes the same year she conceived or during the target pregnancy, the diabetes was considered gestational. If onset was prior to conception and duration was ongoing, diabetes was considered pre-existing. Univariate binary logistic regression analyses were conducted to examine the simple associations between menstrual cycle variables cycle length and regularity and each of the co-variates: Univariate logistic regression was then used to determine the relationship of the 13 diagnostic categories lifetime and current with menstrual cycle variables.
Because the purpose of the analyses was to produce the best estimate of the association between the menstrual cycle variables and likelihood of having a psychiatric disorder, multivariate binary logistic regression was used to test study hypotheses while adjusting for effects of potentially confounding variables.
Covariates were included in these models if they were significantly associated with the dependent variable in the earlier univariate analyses with the exception of race, which was included in all models because it was used in sample selection.
Menstrual Problems
All possible two variable interactions were examined as a batch and dropped if non-significant. The prevalence of these disorders have been reported elsewhere Cook et al. When comparing rates of psychiatric disorders between Caucasian and African-American subjects, Caucasians were significantly more likely to have a current disorder and a lifetime psychiatric disorder prevalence of current disorder for Caucasians was There were no significant differences when comparing menstrual length and regularity by age, residence, marital status, BMI, smoking status, and pre-existing diabetes.
Table 2 reports the prevalence of each disorder by menstrual cycle regularity with odds ratios indicating whether irregular cycles were associated with an increased or decreased risk for each disorder. Those with irregular cycles were twice as likely to have lifetime Bipolar I disorder. While none of the other individual diagnoses included in this analysis achieved statistical significance, all of those tested showed a lower prevalence of disorders among those with irregular cycles compared to those with regular cycles.
Categories of grouped diagnoses: Individual diagnoses of too low prevalence to analyze include: Table 3 reports the prevalence of each current and lifetime psychiatric disorder by menstrual cycle length with the unadjusted odds ratios indicating whether shorter or longer cycle lengths were associated with an increased or decreased risk for each disorder.
Among the lifetime substance abuse disorders, tobacco dependence was not significantly associated with shorter cycle length. Multiple logistic regression analyses were used to test for effects of menstrual cycle length and regularity on the likelihood of a psychiatric disorder diagnosis while adjusting for race. None of the other sociodemographic variables were included because they were not significantly associated with the menstrual cycle variables.
Women with irregular cycles were less than one-half as likely to have a current anxiety disorder and almost three times more likely to have ADHD compared to women with regular cycles. However, the interaction between menstrual cycle length and race proved significant. The results indicated that the association between cycle length and having at least one lifetime psychiatric disorder was accounted for primarily by an association for Caucasian women.
Among African-American women, there was no association between cycle length and having a psychiatric lifetime diagnosis; among Caucasian women, women with short cycles are 2. Women with shorter cycles were twice as likely to report lifetime drug abuse or dependence. Independent of cycle length, Caucasian women were nearly five times as likely to report substance abuse and two-and-half times more likely to report drug abuse or dependence. This was not surprising because there is a social stigma about alcohol intake during pregnancy.
Neither cycle length nor regularity was associated with current or lifetime major depression. Harlow and colleagues found that women with a history of depression experienced perimenopause earlier, which is consistent with lower estrogen levels. The finding that shorter cycles are associated with current and lifetime affective disorders in this study may also be consistent with lower estrogen levels but this possible relationship requires further study. That African-American women were less likely than Caucasian women to have an affective disorder is consistent with national findings on the mental health of minority women USDHHS, However, these figures may represent under diagnosis.
However, an ethnographic study comparing African American and Caucasian respondents who had participated in a large DIS-based prevalence study found differences in how anxiety symptoms were described by education but not by ethnicity Heurtin-Roberts et al. Our finding that women reporting irregular cycles had less than one-half the risk of a current anxiety disorder is new information since there is no known published data on anxiety and cycle regularity.
Because depression and anxiety often occur together, one might expect they have similar patterns of cycle regularity. However, the dissimilarity found in this study may be explained by differing neuroendocrine pathways that vary in substantial, yet unknown ways. Another consideration is that earlier studies had few women of lower socioeconomic or multiethnic backgrounds in their samples Breitkopf et al.
Reporting an irregular cycle was also associated with a higher prevalence of ADHD in the unadjusted analysis but adjustment for race reduced this to non-significance, suggesting the apparent relationship between ADHD and cycle irregularity was confounded by race. This investigation has several limitations.
All women were pregnant when recruited thus eliminating any potential subjects with menstrual abnormalities severe enough to prevent conception. Subjects were minimally questioned about the character of their menses and providing a definition of regularity to subjects may have affected the results. Common lay wisdom and numerous illustrations give 28 days as the normal length of menstrual cycle. The extent to which women in this cohort, if prospectively recorded, would vary from the expectation of a 28 cycle is not known. Women with psychiatric disorder also may be less able to accurately recall their last menstrual cycle prior to conception than women without a disorder.
Due to strong societal disapproval of substance and alcohol use during pregnancy, participants may have underestimated their current use. However, evaluating lifetime substance use is more likely to evoke an accurate response since this removes the stigma of pregnancy use. Despite these limitations, strengths of this study include the large population based sample, representative of poor women enrolled in WIC, which is inclusive of rural African American subjects.
Twenty-three lifetime and current psychiatric disorders were assessed simultaneously based on self-reported symptoms so the diagnoses were not dependent on subjects having sought care or identifying their symptoms as indicating psychiatric disorder. This study affirms that shorter cycle lengths are associated with mood disorders and introduces new findings about anxiety disorder and menstrual cycle irregularity. Advances in our understanding of women's health, including the recognition and treatment of psychiatric disorders, will increase the ability of nurses to comprehensively care for women.
Our findings suggest the importance of assessing women presenting with psychiatric illness for menstrual cycle disturbances and for gynecologic problems often associated with menstrual irregularities. The first step is to make sure that the gynecologic history is on the assessment tool used to screen the patient. Gynecologic assessment of the woman should include:. Re-screening the woman for menstrual cycle characteristics should also be performed when other labs are ordered such as the CBC and Thyroid profile.
Additionally, if the woman is taking psychotropic medications e. The nurse can refer the patient to or encourage her to follow up with a gynecology practice should abnormalities be suspected. In conclusion, this study is a step toward understanding the relationship between menstrual cycle characteristics and specific psychiatric disorders. Common factors may underlie the pathophysiology of menstrual disturbances and psychiatric disorder such that successful treatment of psychiatric disorder may improve menstrual cycle disturbances and vice versa.