Menstrual-Related Conditions

Aria Health Center for Gynecology & Women's Health

Monthly or longer-term hormonal changes and fluctuations have physical and emotional effects on women. The degree of significance of these effects runs a broad range among individuals and thus can vary significantly from one women to the next, as well as from one menstrual cycle or stage of life to the next.  Some amount of hormonal-related change –– from week to week, month to month, year to year, or decade to decade –– is normal and natural for all women. But for some women, these changes can be severe enough to cause disruption in their lives.

The center's staff can help to confirm if changes related to the menstrual cycle are unusually severe.  They can offer the most up-to-date counseling and appropriate treatment.

The most common and best-known condition accounting for these types of problematic physical and emotional changes is premenstrual syndrome (PMS).  This condition corresponds to the menstrual cycle.  Women with PMS experience especially noticeable changes in their bodies or in their psychological state, or both, in the days leading up to and surrounding menstruation, in each cycle.  For some women, PMS can be such a challenging monthly set of altered feelings and manifestations of both mind and body that it becomes a life-compromising condition.  The staff at Aria's Center for Gynecology & Women's Health is experienced in helping to determine if the changes a woman is experiencing each month constitute PMS.

PMS can be largely or partly treatable for many women, through both counseling and lifestyle adjustments as well as medical care.  Aria's staff can help women track and evaluate their monthly experience and can place them on a regimen of care, if they suffer from PMS.  This may include referral to or consultation with other specialists, including those in endocrinology, behavioral medicine, and other areas.  Care can also include intervention through natural or alternative (complimentary) medicine.

A smaller percentage of women experience emotional changes so severe that their psychological affect is dramatically altered during the premenstrual period.  These women may have a mood disorder called premenstrual dysphoric disorder (PMDD).

This condition is often considered a severe form of PMS.  Like PMS, PMDD must be taken seriously, as brief cycles of significant depression typify this malady and, again, the condition can have a vast impact on the quality of life of a woman and those close to her.

The women's center staff can help patients determine if they fall into this group with menstrual-related dysphoric disorder.  As with PMS, the center's providers can deliver, manage, and refer for all of the most up-to-date approaches to treating PMDD.

Polycystic ovarian syndrome (PCOS) derives its name from the multiple, small, benign, fluid-filled, sac-like structures present in the ovaries of some women with this condition.  The hormonal imbalance that also defines this common syndrome causes physical and appearance changes in women, and can create problems with their periods.  Overproduction of androgen by the ovaries in PCOS, for example, can cause women to stop ovulating. In addition to the physical changes and other symptoms that accompany this disrupted hormonal balance, women with PCOS may have fewer periods and heavy bleeding, or no periods.

If PCOS is not addressed, it can lead to more serious health problems, such as heart disease or diabetes.  It is also a common cause of fertility problems in women.

If a woman has symptoms indicating possible PCOS, Aria's staff will take her medical history, perform a physical examination, check her blood pressure, calculate her body mass index, and order blood tests.  They may also perform a pelvic ultrasound.

If lifestyle changes, and drug or hormonal therapy, at not effective in restoring ovulation in women with PCOS, specialists may –– in a small number of patients –– perform laparoscopic surgery to inspect the ovaries, remove part of the ovaries, or to puncture enlarged follicles on these organs, with the goal of stimulating ovulation.  Ovarian surgery can be effective in some women and is thought to work through reducing levels of production of some hormones.

Abnormal menstruation
Almost all women in their lifetimes will have a period that is missed, comes too quickly after the previous one, is unusually light or heavy, or brings more severe symptoms.  However, significant and chronic disturbance or irregularity in menstruation is also common and can take these forms:

  • menorrhagia (heavy and prolonged menstrual bleeding, also called hypermenorrhea).  Women who have this condition experience bleeding for several days or more longer than normal for a cycle, or have heavy bleeding (sometimes to the point of needing to change protection almost hourly).  These symptoms can be disruptive and restricting. Fatigue and anemia may also accompany them.

Noninvasive approaches to caring for this condition include use of nonsteroidal anti-inflammatory medications or hormonal therapy.  While drug treatment or other conservative care for this condition help some women, others do not improve with these treatments or may not be eligible for them because of other medical factors.  In these cases, specialists have had increasing success with techniques that remove the lining of the uterus nonsurgically.  Treatment by endometrial ablation is highly effective and can be performed using a variety of methods for removing the tissue.

Hysterectomy is an additional option that definitively treats the problem when other forms of care have not worked.  Aria's gynecologic surgeons can offer this procedure via laparoscopy, for suitable candidates, to minimize the invasiveness of the operation and the length of time needed for recovery.

Hormone therapies directed at excessive menstrual bleeding may have side affects or risk factors.  For these reasons, the specialists have given increasing emphasis to the endometrial ablation technique.  They can evaluate each patient's condition and review the options for treatment, if they confirm menorrhagia as the diagnosis.

  • amenorrhea (absence of menstrual bleeding).
  • dysmenorrhea (severe cramping and pain).
  • polymenorrhea (too many periods, i.e., at intervals of two to three weeks, including with excessive bleeding or periods that start and stop).
  • oligomenorrhea (less than nine periods per year or periods that are too light).

Each of these conditions can have a variety of causes, relating to physical or mental stress, uterine abnormalities, endocrine disorders, and other conditions.  The staff can help patients determine the pattern of any significant disturbances in menstruation and work to determine the cause.  While changes in menstrual patterns are not usually, in themselves, serious, they may signal underlying conditions that require treatment.  Causes of abnormal uterine bleeding are many, including harmless or benign conditions as well ones requiring more concerted medical attention. The list of possible causes includes cancer, fibroids,problems with birth control methods, physical or mental stress, infections, and chronic medical conditions such as thyroid disorders, diabetes, or blood clotting disorders. Early menopause or perimenopause can also cause unexpected menstrual changes.

Treatment for abnormal uterine bleeding can include anti-inflammatory drugs, hormone therapy, or surgery.  Surgery can take the form of endometrial ablation or hysterectomy.

The staff members are skilled at determining what, if any, hormonal-related syndrome or disorder a woman may be experiencing.  Their gentle, understanding, knowledgeable approach assists women in addressing such conditions.  These staff members can also refer to an endocrinologist, reproductive endocrinologist, fertility specialist, behavioral health specialist or therapist, or other medical professionals as needed for menstrual-related symptoms.

The radiology and other diagnostic services at Aria Health ths offer the highest quality studies.  As a patient at Aria's women's center, a woman will know that results of her screening studies or other tests, including those involving biopsy, will be sent directly to her providers.  The staff can also directly provide certain diagnostic procedures that may be helpful in diagnosing menstrual disorders, such as dilation and curettage (D&C), hysteroscopy, colposcopy, laparoscopy, pelvic ultrasound, or endometrial biopsy.