Amenorrhoea means the absence of the menstrual period. Apart from during childhood, pregnancy, breastfeeding or menopause, the absence of the menstrual period may indicate a problem with the reproductive system. One of the most common causes of amenorrhea is hormonal disturbance. The interplay of female sex hormones can be disrupted by a wide range of events, including diseases of the reproductive organs, weight loss, emotional stress or overexercising. Frequently, there is no worrying cause found.
This condition refers to the pain or discomfort associated with menstruation. About 80 percent of the time, cramps are part of the primary dysmenorrhea syndrome. Although not a serious medical problem, it’s usually meant to describe a woman with menstrual symptoms severe enough to keep her from functioning for a day or two each month. Symptoms may begin one to two days before menses, peak on the first day of flow, and subside during that day or over several days. The pain is typically described as dull, aching, cramping and often radiates to the lower back.
Leucorrhoea or leucorrea, vaginal discharge is a universal problem of all women. Most secretions are regarding life style physiological and warrant no medical interventions. But it is significant if it is blood stained, profuse, foul smelling or with changes in its colour. Usually the normal secretions are slimy and slightly sticky. It is something like nasal secretion. Normally the quantity of vaginal secretions varies throughout the menstrual cycle, peaking at ovulation and also increasing when under emotional stress.
LEUCORRHEA, VAGINAL DISCHARGE Causes
Unhygienic condition
Poor health
Chronic Illness
Anaemia
Birth control measures
Repeated intercourse
Cancer cervix/cervicitis
Excess tea or coffee
Constipation
Monilia or fungus infection
Gonorrhoea
Low estrogen levels are linked to some uncomfortable symptoms in many women. The most common and easy to recognize symptom is hot flashes ÷ sudden intense waves of heat and sweating. Some women find that these hot flashes disrupt their sleep, and others report mood changes. Other symptoms may include irregular periods, vaginal or urinary tract infections, urinary incontinence (leakage of urine or inability to control urine flow), and inflammation of the vagina. Because of the changes in the urinary tract and vagina, some women may have discomfort or pain during sexual intercourse. Many women also notice changes in their skin, digestive tract, and hair during menopause.
Signs & Symptoms of menopause
Decreased sex drive
Hot flashes and skin flushing
Insomnia
Irregular menstrual periods
Mood swings including irritability, depression, and anxiety
Night sweats
Spotting of blood in between periods
Urinary tract infections
Vaginal dryness and painful sexual intercourse
Vaginal infections
The long-term effects of menopause include:
Bone loss and eventual osteoporosis
Changes in cholesterol levels and greater risk of heart disease
Sometimes the symptoms are so severe that they interfere with their day-to-day lives. This type of PMS is called premenstrual dysphoric disorder, or PMDD.
Premenstrual syndrome involves a combination of physical, mental, and behavioral symptoms. PMS is a complex health concern. Up to 70-80% of women experience some symptoms of PMS during their childbearing years.
Etilogy of PMS:
Exactly what causes premenstrual syndrome is not known, but several factors may contribute to the condition. It is often linked with genetic factors because twins often suffer with it.
Current theory suggests that central nervous system neurotransmitter’s interaction with sex hormones may be responsible for PMS. It is also linked with activity of serotonin. Research points to the changes that occur in hormone levels before menstruation begins; when the ovaries are working to make both estrogen and progesterone. Women who do not ovulate do not have PMS. It is believed that change in progesterone level is responsible for woman’s mood, behavior, and physical changes during the luteal phase (or second half) of the menstrual cycle.
All women have both female and male hormones within the natural balance of the body. However, increased levels of male hormones as well as increased levels of prolactin can result in a delayed ovulation and low levels of progesterone, leading to PMS. Cyclic changes in hormones seem to be an important cause, because signs and symptoms of premenstrual syndrome change with hormonal fluctuations and also disappear with pregnancy and menopause.
Low levels of serotonin, an important chemical produced by the brain, may in fact be the major cause of PMS responses. Serotonin helps to regulate sleep cycles and carbohydrate metabolism and influences the regulation of estrogen and progesterone. There is a theory that the common PMS response of increased appetite with cravings for carbohydrates may be caused by low serotonin levels. Insufficient amounts of serotonin may contribute to other symptoms of PMS, such as depression, fatigue, food cravings and sleep problems.
According to another theory PMS involves inflammatory substances called prostaglandins. Prostaglandins are produced in the breast, brain, reproductive tract, kidney, and gastrointestinal tract where PMS symptoms originate; which is responsible to problems such as cramping, breast tenderness, gas, diarrhea, and constipation.
Another theory explaining PMS also linked to low levels of vitamins and minerals. Other possible contributors to PMS include eating a lot of salty foods, which may cause fluid retention, and drinking alcohol and caffeinated beverages, which may cause mood and energy level disturbances.
Endorphin levels drop during the luteal phase of the menstrual cycle; which may lead to nausea, jumpiness, and various types of pain in some women. Normal levels of this hormone lead to cheerful, happy moods and also make people less sensitive to pain.
However, it may be related to social, cultural, biological, and psychological factors.
Symptoms of PMS:
There are a number of symptoms that comes under this heading, the exact symptoms and severity may vary in different cases and with every menstrual period. The most common symptoms include:
Mood swings
Anxiety and stress
Irritability
Dizziness
Breast tenderness and swelling
Acne
Abdominal Bloating
Tiredness/ fatigue
Sex drive changes, loss of sex drive or disinterest in sex
Lack of control or impulsivity
Feel temporarily antisocial, avoiding friends and rejecting invitations
Low self-esteem, tend to have negative, sad thoughts and experience a transitory lack of enthusiasm and energy
Stiff neck
Headaches/migraines
Depression
Crying Spells
Sadness, feelings of “fogginess”
Difficulty concentrating
Indecisiveness
Forgetfulness
Weight gain from Water retention
Appetite changes and food cravings for carbohydrates and sweets
Insomnia or difficulty in falling asleep
Muscular and joint pain
Unable to concentrate
Mild fever
Social withdrawal
Allergic and infection problem may worse
Irregular heart beats, palpitations
Chest pains
Swelling of ankles, feet, and hands
Backache
Abdominal pain
Recurrent cold sores
Nausea
Constipation or diarrhea
Decreased coordination
Less tolerance for noises and lights
Painful menstruation
Confusion
Poor judgment
hostility, or aggressive behavior
Increased guilt feelings
Slow, sluggish, lethargic movement
Decreased self-image
Paranoia or increased fears
Low self-esteem
Although the list of potential signs and symptoms is long, most women with premenstrual syndrome experience only a few of these problems.
Diagnosis of PMS:
There is no special test to point out PMS. The following may help in making the diagnosis:
Complete history of the patient
Physical examination
Psychiatric evaluation in some cases
Mineral Analysis Test
Blood tests to rule out other illnesses
Conventional treatment of PMS:
Line of treatment depends upon symptoms present in PMS
Anti-inflammatory drugs
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen sodium can for cramps and breast discomfort. COX-2 inhibitors are a new type of NSAID. It is longer-acting NSAID’s. Administration of COX-2 inhibitor has risk of heart attacks and strokes. COX-2 inhibitors and traditional NSAIDs have risk of serious skin reactions, stroke, deep vein thrombosis, and pulmonary embolism.
Hormonal therapy
Oral contraceptives for stopping ovulation and stabilize hormonal swings; Progesterone support, Gonadotropin hormone agonists in severe PMS.
Antianxiety drugs and antidepressants – may help with mood, irritability, and concentration. Anti-anxiety drugs such as Benzodiazepines or Alprazolam. Antidepressants: Selective serotonin reuptake inhibitors (SSRIs), which include fluoxetine, paroxetine and sertraline for fatigue, food cravings and sleep problems.
Diuretics if weight gain, breast swelling, and bloating are associated with PMS. Diuretics such as Metolazone and spironolactone .
Medroxyprogesterone acetate- it temporarily stops ovulation. However, Depo-Provera may cause an increase in some signs and symptoms of PMS, such as increased appetite, weight gain, headache and depressed mood.
If psychological symptoms are present then tranquillizers or antidepressants are prescribed.
Supplements of Calcium, Magnesium, Vitamin B-6 and Vitamin E. Multivitamin and Mineral supplement programme may helpful in some cases.
In rare cases where PMS symptoms are severe and no relief with any medications or other therapies and when pregnancy is not the objective then surgical procedure involving a partial hysterectomy can be considered.