What can be considered heavy periods. Heavy periods. Endometrial ablation for uterine menstrual bleeding. Possible causes of heavy periods

The group of rhythm disorders includes metrorrhagia, which is acyclic bleeding that occurs irregularly between normal menstrual periods. The myometrium regulates the amount of blood in each menstruation because when it contracts, it causes vasoconstriction and reduces the blood supply to the endometrium, as well as the proliferation of the basal layer, which allows re-epithelialization of the endometrium. When there is a change in either of these two functions, hypomenorrhea can occur, which is a deficient menstruation that occurs in drops and lasts two days or less.

Dysfunctional uterine bleeding is abnormal uterine bleeding, that is, any type of menstrual disorder in the absence of any structural or underlying disease; therefore, this condition is considered a diagnosis of exclusion. In adolescence, its prevalence is about 20%.

Should I agree to endometrial ablation if I have heavy periods?

When circulating estrogen levels fluctuate, endometrial growth is interrupted. In these patients, a history of bleeding elsewhere leads to the diagnosis in approximately 80% of cases. Pregnancy cases such as incomplete abortion or ectopic pregnancy should also be considered as a differential diagnosis. Immunological pregnancy testing should be requested as part of laboratory testing. On the other hand, endocrine disorders such as thyroid problems, polycystic ovary syndrome or adrenal disorders should also be ruled out.

Infections such as cervicitis or pelvic inflammatory disease can cause irregular bleeding, so agents that cause sexually transmitted infections and bacterial or trichomonal vaginosis should be looked for. 1, 12. As part of the research, ultrasound examination of the pelvic organs will determine whether there are congenital or acquired anomalies. 4, 30.

In addition, adolescent conditions such as eating disorders or the use of medications such as contraceptives, antipsychotics, or antiplatelet drugs must also be taken into account. 20. Other alternatives are medroxyprogesterone acetate 150 mg intramuscularly every three months or a levonorgestrel intrauterine device. In cases of no response to contraception the presence of an underlying disease should be taken into account. In approximately 10% of cases, surgical treatment under anesthesia is necessary to perform a revision of the uterine cavity.

With secondary dysmenorrhea, pain characteristics are not as predictable. Physiology. In the uterus, after ovulation, the formation of fatty acids in stem cells of membrane stem phospholipids increases with the predominance of omega fatty acids. After the degradation of progesterone begins and before menstruation, omega-6 fatty acids and under the action of the enzyme cyclooxygenase form leukotrienes and endoperoxidase. In turn, thromboxane A2, prostacyclins and prostaglandins will produce arteriolar vasoconstriction and myometrial hypercontraction, which cause ischemia and pain in the endometrium.

Most of these adolescents require monitoring only with assessment of their menstrual calendar, support with ferrous sulfate and hematocrit determinations. When evolution is not favourable, new controls must be carried out to rule out any specific entity, such as chronic anovulation, for the risk of developing endometrial carcinoma in the long term.

Finally, it is important to mention that part of treatment is to establish effective communication with the adolescent and her family by providing sufficient information about the variability of menstrual cycles on at this stage development. 4, 12. Amenorrhea is called absence of menstruation or abnormal interruption of menstruation; teenagers have the most common reason amenorrhea - pregnancy. For this reason, once pregnancy has been ruled out, the doctor should direct his efforts to finding the causes and their possible treatment. 34.

In adolescents and in practical terms, it is first necessary to determine whether amenorrhea is primary or secondary. Primary amenorrhea is defined as the absence of menstruation at age 16 years in adolescents who exhibit normal sexual development, as assessed by the development of secondary sexual characteristics, or the absence of menstruation at age 14 years in those who do not develop secondary sexual characteristics. On the other hand, the diagnosis of secondary amenorrhea is made when a patient who previously had menstrual cycles no longer presents them.

There are several causes of amenorrhea, and various classifications have been proposed internationally. To facilitate the diagnostic process of adolescents with amenorrhea, from a clinical perspective, several steps have been proposed over the years to establish a possible etiology. The main steps are described in Figure 2; As it is observed, due to the frequency of this phenomenon, the first action is to determine whether pregnancy is the cause of the amenorrhea. Subsequently, taking into account the previously described definitions and according to the medical history, the second step determines whether the patient has primary or secondary amenorrhea.

Primary amenorrhea. When primary amenorrhea is suspected, evaluation of breast and genital Tanner staging should determine whether the patient's sexual development is normal or delayed pubertal development. Following the algorithm in Fig. 2, one of the main causes of primary amenorrhea in patients with normal pubertal development is anatomical changes that cause obstruction of menstrual flow. Therefore, both physical examination and ultrasound examination should always check the permeability of the hymen and rule out obstructions such as transverse vaginal septum, cervical atresia or even more complex malformations such as uterovaginal atresia or Müllerian malformations.

Which periods are considered heavy?

In these cases, the diagnosis is confirmed when the accumulation of menstrual product is detected above the obstruction using pelvic ultrasound. The most common disorder of these conditions is Turner syndrome, so it is also necessary to determine whether these patients have other changes such as short stature, winged neck, etc.

On the other hand, amenorrhea due to ovarian damage, which is known as ovarian failure, is another cause that should be considered in cases of hypergonadotropic hypogonadism. Damage to the ovaries results from chemotherapy, pelvic radiation therapy, infection, trauma, or surgery. Given that this condition is acquired and given the age at which ovarian damage occurs, these patients may or may not have altered pubertal development and may even menstruate.

What to do if your periods are very heavy

It is important to note that although the latter conditions cause primary amenorrhea, most adolescents experience secondary amenorrhea. High levels of prolactin also cause secondary amenorrhea. Hyperprolactinemia is a relatively common condition, as it affects approximately 1% of women; of these, about 30% may also represent galactorrhea. The severity of menstrual disorders correlates with prolactin levels.

This disorder is considered functional and may be reversible. Treatment. Because the causes of amenorrhea are numerous, a fundamental part of treatment depends on achieving an accurate diagnostic conclusion. For example, the goal of treating hyperprolactinemic conditions is to normalize prolactin levels, since amenorrhea will persist as long as concentrations remain high. Thus, when it comes to pituitary tumors, dopamine receptor agonists, in addition to reducing the size of the adenoma, may also reduce prolactin levels.

However, this type of treatment should not be used for hyperprolactinemia secondary to antipsychotic use. Similarly, in the treatment of hypothalamic amenorrhea, restoration of menstrual function should not be the goal, but a consequence of improving the mental and physical condition of adolescents. 52.

Finally, from a pediatric perspective, aspects related to the implications that a definitive diagnosis of the cause of amenorrhea may have on the mental health of adolescents and their families should not be forgotten; timely consultations can help resolve doubts regarding infertility or loss of femininity.

It is classified into primary dysmenorrhea and secondary dysmenorrhea. In terms of age, primary dysmenorrhea occurs during the second or third decade of life, decreasing in frequency as age advances. On the contrary, the incidence of secondary dysmenorrhea increases at older ages. In adolescents, up to 10% of cases correspond to secondary dysmenorrhea. 61.

The degree of symptoms associated with dysmenorrhea varies and is different if the dysmenorrhea is primary or secondary. Typical pain occurs in the lower abdomen or suprapubic region; usually described as a cramp of varying intensity and which may radiate to the lower back or inner thighs. In half of these patients, dysmenorrhea is accompanied by other symptoms such as nausea, vomiting, diarrhea, headache, irritability or fatigue.

With secondary dysmenorrhea, pain characteristics are not as predictable. Physiology. In the uterus, after ovulation, the formation of fatty acids in stem cells of membrane stem phospholipids increases with the predominance of omega fatty acids. After the degradation of progesterone begins and before menstruation, omega-6 fatty acids and under the action of the enzyme cyclooxygenase form leukotrienes and endoperoxidase. In turn, thromboxane A2, prostacyclins and prostaglandins will produce arteriolar vasoconstriction and myometrial hypercontraction, which cause ischemia and pain in the endometrium.

Most of these adolescents require monitoring only with assessment of their menstrual calendar, support with ferrous sulfate and hematocrit determinations. When evolution is not favourable, new controls must be carried out to rule out any specific entity, such as chronic anovulation, for the risk of developing endometrial carcinoma in the long term.

Finally, it is important to mention that part of treatment is to establish effective communication with the adolescent and her family by providing sufficient information about the variability of menstrual cycles at this stage of development. 4, 12. Amenorrhea is called absence of menstruation or abnormal interruption of menstruation; In adolescents, the most common cause of amenorrhea is pregnancy. For this reason, once pregnancy has been ruled out, the doctor should direct his efforts to finding the causes and their possible treatment. 34.

It has also been noted that oxytocin and vasopressin also play an important role as they increase uterine contractility. Diagnosis. Assessment of the type of dysmenorrhea is based primarily on history and physical examination. In primary dysmenorrhea, the abdominal and pelvic examination is normal, so if pelvic structures are found, pain on delivery, pelvic congestion, or signs of cervical problems, the most likely diagnosis is secondary dysmenorrhea. 59.

Ultrasound helps identify structural abnormalities of the uterus, such as a bicornuate uterus or cecum uterus, while laparoscopy may be useful when dysmenorrhea is severe and does not respond to various therapies used. In these cases, endometriosis, salpingitis, ectopic pregnancy or pelvic inflammatory disease. Of these, the most common diagnoses in adolescents are endometriosis, accompanied by pelvic inflammatory disease.