An Introduction to menstrual irregularities  PART 1:

1)Menorrhagia

What is the definition of Menorrhagia?

Menorrhagia is defined as abnormally excessive bleeding (>80ml) during menstruation. The menstrual cycle is regular, but the bleeding may be excessive, either in quantity or duration or both.

Since the frequency of the menstrual cycle remains unchanges ,the function of the hypothalmo-pitiutary-ovarian (H-P-O) axis is normal.

What are the common causes of Menorrhagia?

a)Gynaecological Causes:

i) Uterine fibroids (Submucosal or intramural)- The net surface area of the endometrium is increased by sub mucosal fibroids. Intramural fibroids prevent normal uterine contractions.

ii)Adenomyosis- This reduces the contractility of the uterus, while increasing the surface area of the endometrium and increases the vascularity of the uterus.

iii)Chronic Pelvic Inflammatory Disease (PID).

iv)Pelvic endometriosis.

v)Intrauterine Contraceptive Device (IUCD) in utero (Inside the uterus).

vi)Intrauterine structural abnormalities eg bicornuate uterus

b)Medical causes:

i) Hypothyroidism

ii)Bleeding disorders eg Idiopathic thrombocytopenic purpura (ITP), von willibrand factor deficiency (VWF- deficiency).

c) Dysfunctional :

Here the cause is not really known. But it is thought to be due to elevated endometrial PGE-2 levels and increased fibrinolytic activity.

2)Oligomenorrhoea:

What is the definition of oligomenorrhoea?

Oligomenorrhoea is defined as abnormally prolonged menstruation cycles, where the bleeding occurs with a cycle frequency of more than 35 days, or where the amount of bleeding is reduced either in quantity (<20ml) or duration (<2 days).

It must be noted that in oligomenorrhoea the function of the hypothalmo-pitiutary-ovarian (H-P-O) axis is disrupted (not normal).

What are the common causes of oligomenorrhoea?

i) It is commonly due to Polycystic ovarian disease (PCOD).

ii) Asherman syndrome- due to repeated endometrial curettage.

iii) Endometrial tuberculosis (This is now very rare.

3) Epimenorrhoea:

What is the definition of epimenorrhoea?

Epimenorrhoea is defined as menstrual bleeding which occurs with an abnormally short cycle frequency (<21 days).

It must be noted that in epimenorrhoea the function of the hypothalmo-pitiutary-ovarian (H-P-O) axis is disrupted (not normal).

In epimenorrhoea ,the quantity and duration of bleeding is normal.

What are the common causes of epimenorrhoea?

i) Chronic Pelvic Inflammatory Disease (PID).

ii)Salpingo-oophritis (infection of the uterine tubes and ovaries).

4) Metrorrhagia:

What is the definition of metrorrhagia?

Meteorrhagia is defined as bleeding which takes place between normal menstrual cycles (It is also known as intermenstrual bleeding).

Here the function of the hypothalmo-pitiutary-ovarian (H-P-O) axis is normal.

The menstrual cycles occur normally ,but are interrupted by bouts of bleeding in between.

What are the common causes of metrorrhagia?

This is due to surface lesions of the genital tract

i) Cervical erosion

ii)Endometrial polyps

iii)Carcinoma of the cervix

iv)Cervical polyps.

To be Continued in PART 2

References:

Introduction to Clinical Gynaecology and Obstetrics for Undergraduates. Compiled by Dr WDN De Alwis, Dr  .R Gnansekeram, Dr .N.Gunawansa. Edited by Dr C. Randeniya MBBS, MS, FRCOG. Senior Lecturer, Dept. of Obstetrics and Gynaecology, Faculty of Medicine, Colombo. Honorary Consultant, De Soysa Hospital for Women and the National Hospital of Sri Lanka.

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