HORMONAL IMBALANCE ASSOCIATED MENSTUAL DISODERS

Hormones are the chemical messengers of the body . Hormones  control many of your body’s major processes, including metabolism , menstruation and reproduction.

An imbalance in the hormones can alter normal physiology of the body . Miner imbalance can cause significant effect , especially with menstrual cycle. Main hormone that regulate  menstrual cycle include GnRH , Progesterone, Estrogen , LH, FSH, TSH  . Any alteration in these hormone can cause menstrual disorders. Commonly seen Menstrual disorders associated with hormonal imbalance are

THYROID DYSFUNCTIONING

 Thyroid gland plays an important role in reproductive health , directly affecting ovaries and indirectly interacting with sex hormone binding globulin (a protein that binds sex hormones). 

Both disorders Hypothyroidism and hyperthyroidism can affect the normal physiology of menstrual cycle.

Hypothyroid women more like to experience oligomenorrhea and menorrhagia and in hyperthyroid women experience hypo menorrhea.  Both conditions can cause menstrual disturbance or irregularities and also affect the fertility of female.

Diagnosis is done taking history of patient and blood investigations like TSH or other hormonal investigations.

Treatment is done according to underlying cause.

PCOD (Polycystic Ovarian Disease)-

PCOD known as polycystic ovarian disease which is principally a  hormonal disorder causing enlarged ovaries with small cysts on the outer edges. 

In Polycystic ovarian disease there is an imbalance in the sex hormones due to which  females start making slightly more androgens. This causes them to prevent  ovulating, due to which females get liable to pimples and grow extra facial and body hair.

In PCOD , the eggs in the follicles don’t mature and  not released from the ovaries, but they form very small cysts with in the ovary, hence ovaries become polycystic.

Common symptoms  include:

• Acne and blemishes on face
• Weight gain  and trouble losing fat around belly
• Extra hair growth on the face and body. 
• Thinning hair on the scalp.
• Irregular periods 
• Fertility concern

Diagnosis – Diagnosis of patient is done by taking history of patient . Investigations like blood glucose level , ultrasound of the abdomen and pelvis are done. Sometimes serum androgens, LH  and other hormone estimations may be checked.

Treatment

The medical treatment of PCOD/PCOS focuses on managing your individual concerns like  infertility, hirsuitism, acne or obesity. Thus mainly symptomatic treatment is given like –

• Lowering of  glucose levels in body
• Restoration of fertility
• Treatment of hirsutism or acne
• Restoration of regular menstruation, and prevention of endometrial hyperplasia and endometrial carcinoma.

AMENORRHEA

Amenorrhea is the absence of the menstrual periods in a women during her reproductive years i.e. after the age of puberty and before the age of menopause.

What causes Amenorrhea ?

It is important to note that amenorrhea is normal before puberty , during pregnancy and after menopause .

 Amenorrhea  may be caused by many factors includes

• Defects in one or more areas of reproductive system , such as hypothalamus and pituitary gland , ovaries , uterus 
• As side effect of cancer
• As a symptom of endometrial cancer
• One of the most common type of amenorrhea is functional hypothalamic amenorrhea. This is where the onset of amenorrhea can be linked with the factors like stress , change in weight, excessive dieting , exercise.

Symptoms may include

• Headache and tiredness caused by disease affecting pituitary gland
• Acne and excess body hair growth in male pattern distribution caused by polycystic ovarian syndrome
• Symptoms of premature menopause like hot fluhes , vaginal dryness , poor sleep , reduce libido

Diagnosis of amenorrhea

Amenorrhea is diagnosed from history of lack of menstrual cycle . Pregnancy test must always be carried to rule out pregnancy. Some blood investigations has to be done to find out cause of amenorrhea these include FSH , TSH , prolactin and androgen levels.

USG will be done to look out the uterus and anatomy of the vagina.

Treatment 

Treatment of amenorrhea is done according to the cause. Mainly treatment include some lifestyle changes and hormonal replacement therapy.

DYSMENORRHEA

Dysmenorrhea is the occurrence of severe lower abdominal pain in women during her menstrual cycle . The pain often has cramping in nature and may radiate to the thighs and lower spine . Lower abdominal pain may be accompanied by vomiting , headache back pain , diarrhea, fatigue etc.

Dysmenorrhea is classifies as primary and secondary.

 Cause of dysmenorrhea – 

 One of the factors contributing to dysmenorrhea may be an increase in prostaglandin concentration before menstruation .

 Prostaglandins cause narrowing of the blood vessels supplying the uterus and abnormal contractile activity of the uterus, that cause  ischemia, hypoxia of the uterus and which leads to pain.

Treatment 

Treatment of dysmenorrhea include use of NSAIDS , calcium channel blockers to reduce pain . Physiotherapy is also good option .

MENORRHAGIA

Menorrhagia is a condition that is characterized by heavy and prolonged menstrual bleeding.  It is the most common type of abdominal uterine bleeding.

Causes 

• Hormonal imbalance is the major cause of menorrhagia
• Pelvic inflammatory disease
• Uterine fibroid
• High levels of prostaglandins
• Diseases of liver, Kidney , Thyroid
• Infection , tumor or polyps in uterine cavity

Diagnostic procedure may include blood test , USG , MRI, laproscopy , hysterocopy

Treatment include Prostaglandin inhibitors , Hormone supplements , Oral contraceptives , dietary modifications , lifestyle changes.