Gynaecology

Menstrual Disorders

Menstrual Disorders

Premenstrual Syndrome

Premenstrual Syndrome (PMS) describes the collection of physical and behavioural symptoms experienced by women prior to menstruation. The effect of PMS varies from woman to woman.  Management of PMS can involve medication, natural therapies and other treatments.

Mild PMS is a common problem and effect up t 75% of women with regular menstrual cycles. The severe form called Premenstrual Dysphoric disorder (PMDD) effect only 3-8% of women.

Common Symptoms:

  • Abdominal Bloating
  • Food Cravings
  • Anger, irritability and conflict with family, co-workers and friends
  • Anxiety and tension
  • Difficulty concentrating
  • Fatigue, lethargy, or lack of energy
  • Headaches and Migraines
  • Changes in Sexual Desire
  • Mood Swings
  • Swollen and Tender Breasts
  • Sadness, hopelessness, or Depression

Symptoms should be relieved within the first 4 days of menses and recurrence happens in the 2nd half of the cycles.

Treatment:

  • Life style changes: Exercise, diet low in salt and high in fruit and vegetables
  • Natural therapies: Vit B6 doses up to 100 mg daily, Elemental calcium and magnesium, Premular
  • Drug therapies: OCP like Yaz, Antidepressant “SSRIs” like Prozac from days 19 till menstruation start.
  • Surgical treatments: rarely required

Dysmenorrhea

Dysmenorrhea refers to painful periods and may indicate either a menstruation related disorder or it could be related to an underlying problem like endometriosis, fibroid or bladder/ bowel problem.

A proper examination is necessary to determine the specific cause of the period pain and hence decide on the most appropriate course of treatment.  Pelvic ultrasound may be required to investigate the cause of he dysmenorrhea.

Common Symptoms

  • Aching Pain: Low in the abdomen and sometimes the lower back and legs
  • Headaches
  • Nausea and Vomiting
  • Digestive Problems
  • Premenstrual Symptoms

For more information related to dysmenorrhea, refer to ‘Pelvic Pain’.

A number of treatments available including:

  • Conservative approach: like heat pack, diet, vitamins and herbs, exercise.
  • Complementary and alternative medicine: like Yoga and acupuncture
  • Non steroidal anti-inflammatory drugs (NSAIDs)
  • Hormonal birth control like the pills, vaginal ring, injections and hormone releasing intrauterine device).
  • Surgical treatment: laparoscopy for the diagnosis and management of endometriosis.

Menorrhagia

Menorrhagia refers to heavy menstrual bleeding or bleeding between periods. It is important to make an appointment with Dr Farjo if affected by menorrhagia, as if it is left untreated, it may lead to anemia.

Common methods of diagnosing menorrhagia include a general examination, and analysis of medical history and menstrual history. Blood test, pap smear and pelvic ultrasound may also be required for the diagnosis of the cause of the menorrhagia.

In addition a hysteroscopy, which uses a small telescope to look inside the uterus and take a biopsy of the tissue inside may be used to diagnose and treat menorrhagia in some cases.

Common Symptoms

  • Heavy Blood Loss: during menstrual period
  • Spotting/Bleeding between periods
  • Cramps
  • Fatigue

Refer to Abnormal Vaginal Bleeding for more information related to Menorrhagia.

Most common Gynaecological causes:
Endometrial polyps, fibroids, adenomyosis, bleeding disorders, endometritis, PID, endometrial hyperplasia or carcinoma, arterio-venous malformation.

Based on the results of the examination and the investigations, Dr Farjo will develop a treatment plan and discuss this with you on your next appointment.

The treatment will depend on the cause of the bleeding, your preference, whether you need to prevent pregnancy and your desire to have children in the future.

Treatment options:

  • Non steroidal anti-inflammatory drugs
  • Hormone birth control pills and device.
  • Surgery like endometrial ablation or hysterectomy

Oligomenorrhea

Oligomenorrhea refers to light or infrequent periods. A range of factors, including the use of birth control pills, may lead to oligomenorrhea.

Oligomenorrhea or light periods in themselves may not be a cause of concern however it can be an indicator of Polycystic Ovarian Syndrome (PCOS) and as such it is wise to seek medical advice as soon as possible.

Common Symptoms

  • 35 days or more without a period
  • Skipping periods
  • Light periods
  • Not beginning period after 15 years of age

Ovarian Syndrome

Polycystic Ovarian Syndrome (PCOS) is a hormonal disorder associated with higher than normal levels of insulin or androgen (male hormones). Between 12-21 % of Australian women of reproductive age may be affected by PCOS (Medical Journal of Australia).

Common signs and Symptoms

Presence of a large number cysts or follicles on the ovaries (ie polycystic ovaries)

  • Irregular menstrual cycles
  • Amenorrhoea (absence of periods)
  • Excessive hair growth and acne
  • Hair loss