Menstrual irregularities: causes and treatment

Every girl or woman may experience menstrual irregularities.

At some point in her life, cycle disturbances probably occurred in every woman. Irregular periods, which many women are accustomed to considering as something ordinary, are actually a signal of problems with women’s health.

What is NMC in gynecology? This is a disrupted menstrual cycle that happens to women at different periods of their lives.

Irregular menstruation - delays or a shorter cycle, indicate disturbances in the physical or mental state of the woman. The monthly cycle is a kind of biological clock of the body. A disruption in their rhythm should alert you and cause you to consult a doctor so that diseases can be identified in a timely manner. Below we will talk about why the menstrual cycle fails and what a woman should do in such a situation.

A little about menstruation and the menstrual cycle

The first menstruation or menarche occurs in girls around 12–14 years old, and the further south the child lives, the earlier her periods begin. Menstruation ends around 45–55 years of age (this period is called premenopausal).

Menstruation is the shedding or desquamation of the functional layer of the uterine lining in response to decreased progesterone production. This is why gynecologists like to repeat that menstruation is the bloody tears of the uterus due to an unfulfilled pregnancy. To understand this definition, it is worth remembering the physiology of the menstrual cycle. As you know, a woman’s monthly cycle is divided into 3 phases:

• In the first, follicular phase, estrogens are produced, the action of which causes the maturation of follicles. From these follicles the main or dominant follicle is released, from which a mature egg is subsequently released.
• The second phase is the shortest (about a day), it is during this period that the main follicle ruptures, and the mature egg is released “free”, ready to meet the “live animals” and fertilize.
• In the third phase, the luteal phase, the synthesis of progesterone by the corpus luteum, which arose at the site of the ruptured follicle, begins. It is progesterone that prepares the endometrium for implantation of a fertilized egg. If conception does not occur, the corpus luteum slowly “dies” (regresses), progesterone production drops and endometrial rejection begins, that is, menstruation.

Then estrogen production gains strength again and the cycle repeats.

From all that has been said, it becomes clear that the menstrual cycle is called cyclic changes that occur in the body after a strictly defined time.

Causes of menstrual irregularities

The main reason for the disruption of the menstrual cycle is hormonal imbalance. This happens in various diseases and conditions. The hereditary factor also plays an important role - if ancestors on the female line had disruptions in the cycle or other disorders, it is quite possible that this will affect the nature of menstruation in women in subsequent generations.

Lack of sleep, stress, excessive physical activity, psychological fatigue, change in time zone or climatic conditions can lead to irregular periods. It is not uncommon to experience menstrual problems in those who regularly stay awake at night. Brain tumors and neuroviral infections can also lead to menstrual irregularities.

Disturbed hormonal cycles are also observed in many diseases. Most often this happens against the background of pathologies of the endocrine and genitourinary systems, such as:

• genetic and hormonal pathologies of the ovaries;
• inflammation of the uterus and appendages;
• infectious lesions of the pelvic organs;
• diabetes;
• diseases of the thyroid gland, adrenal glands;
• obesity, etc.

Functional disorders of the endocrine system, manifested in the accumulation of estrogen with a simultaneous deficiency of progesterone, also cause menstrual irregularities. The cycle can be disrupted due to any infectious and non-infectious diseases, acute or chronic.

How anesthesia and anesthesia work: myths, fears, side effects

An alternative to spinal anesthesia can be epidural, when a local anesthetic is injected into the epidural space located in the spine through a special catheter. Depending on the type of operation (chest, abdominal cavity), the anesthesiologist determines the place of its introduction. In this case, the doctor can inject not only a local anesthetic into the epidural space, but also opioid painkillers that enhance the effect. Sometimes the epidural catheter may be left in place temporarily to provide pain relief as required by the patient (called an extended epidural).

More complex and serious interventions are always associated with lengthy preparation on the part of the anesthesiologist - installation of a central venous catheter, administration of infusion therapy, correction of blood coagulation parameters and other important parameters. It is also important to consider whether the operation is an emergency or a planned one.

Can you tell me more about the difference between spinal and epidural pain relief?

During spinal anesthesia, the drug is injected at the lumbar level into the subarachnoid space (into the cavity between the pia mater and the arachnoid mater of the spinal cord, filled with cerebrospinal fluid). Usually everything is limited to a couple of injections. In this way, the soft tissues above the injection site are anesthetized and the drug is directly administered under the dura mater. This anesthesia lasts from two to six hours and is technically easier to administer.

During epidural anesthesia, the drug is injected into the space between the dura mater of the spinal cord and the periosteum of the vertebrae, which contains connective tissue and venous plexuses. It is located closer to the skin compared to the spinal one. Anesthesia is given at any level of the spinal column. It is considered a technically more complex manipulation.

I've read that epidurals can cause paralysis.

This is a common fear, but anesthesiologists say that today it is practically impossible. Such a complication could arise after surgery due to improper care of the catheter, as a result of which the patient developed purulent epiduritis, which caused neurological symptoms with loss of function of the lower extremities. Or due to incorrect actions of the anesthesiologist, when puncture of the epidural space occurs at high levels (there is a risk of unintentional damage to the spinal cord). But in most cases, epidural anesthesia does not threaten anything other than a headache for several days after surgery.

Can everyone have anesthesia?

In life-threatening situations when a person needs surgery, doctors almost always use anesthesia. For example, if there is a victim of an accident on the couch who urgently needs surgery, the risk of having it performed with anesthesia for any health condition will be less than the risk of refusing it.

If a patient comes for a planned operation, then the anesthesiologist is obliged, after collecting an anamnesis, to select the appropriate type of anesthesia taking into account the patient’s health. Doctors are guided by the rule: the volume and risk of anesthesia should not exceed the risks on the part of the surgeon. The patient's age cannot be a contraindication. Specialists take into account all severe chronic diseases that complicate the state of health, and allergic reactions to anesthesia components.

Is there a difference between old and new drugs?

Yes there is: in their consumption, efficiency and safety of use. However, it is invisible to patients; To appreciate the difference, you have to be an anesthesiologist.

How to prepare for anesthesia and how to survive recovery from it?

Preparation depends directly on the type of anesthesia and surgical intervention. The doctor will tell you what and how best to do before the operation. Just build a trusting relationship with your treating doctors, it will be much calmer.

Each patient experiences recovery from anesthesia individually; not everyone feels bad, but many feel nausea and drowsiness, and muscle tremors. It all depends on the characteristics of the body and the drugs that were administered during the operation. After waking up, it is important to listen to your body and report any deviations to your doctors.

Any woman can experience menstrual irregularities

Failures can be associated not only with diseases of the pelvic organs, but also with disorders in the endocrine, nervous, and immune systems. It should also be remembered that sometimes they signal the development of certain infectious diseases or pathological conditions:

• ectopic pregnancy;
• neoplasms in internal organs;
• malignant or benign neoplasm in the uterus or on its surface;
• STD;
• tuberculosis.

Some girls believe that tampons also provoke changes in the cyclicity of menstruation, but this opinion is incorrect. They are the same means of hygiene during menstruation as pads and menstrual cups.

Complications of anesthesia

Therapy is carried out taking into account the reasons that caused the pathological condition. In case of respiratory disorders, the composition and volume of the gas-air mixture is adjusted, and the endotracheal tube is sanitized using an electric suction. If it is not possible to completely clear the airways, call the endoscopic team on duty to perform emergency bronchoscopy. To relieve laryngospasm, narcotic analgesics, atropine, antispasmodics, and adrenergic agonists are used. To saturate the blood with O2, the device is set to enhanced oxygenation mode (100%). Maintaining a sleepy state is ensured by intravenous anesthetics.

Cardiac dysfunction is treated symptomatically. For bradycardia, administration of atropine and adrenaline is required. A decrease in blood pressure against the background of weakened cardiac activity is an indication for transferring the patient to the administration of pressor amines through a syringe pump. The dose of anesthetic may need to be reduced. Arrhythmias are stopped using cordarone, amiodarone, procainamide, lidocaine. Fibrillation that is not amenable to chemical treatment requires electrical defibrillation. When blood pressure increases, antihypertensive drugs are administered; when blood pressure decreases, hypotonic drugs, infusion solutions to replenish blood volume, and steroid hormones are administered.

Short-term postoperative psychosis cannot be relieved with medications. In case of severe psychomotor agitation, the prescription of neuroleptics and narcotic analgesics is allowed. Long-term disorders of the central nervous system require therapy with the use of nootropics, antioxidants, and general strengthening agents (multivitamin complexes, adaptogens). Intestinal tone usually recovers on its own within 1-2 days. In case of prolonged paresis, proserin is administered.

Malignant hyperthermia is an indication for the administration of datrolene, a muscle relaxant that can block ryanodine receptors. In addition, symptomatic treatment drugs and physical methods of reducing the temperature are prescribed (ice on large vessels, wetting the sheets and the patient’s body with cold water, ventilating the patient’s body). For allergic reactions, antihistamines, glucocorticosteroids, and symptomatic medications are infused. Severe manifestations require mandatory tracheal intubation and transfer to mechanical ventilation, if this has not been done previously.

What is considered a menstrual disorder?

• Delay of menstruation by more than 10 days.
• Shortening the cycle by 5-7 days.
• Increase or decrease in the volume of menstrual flow.
• Accompanying menstruation with deterioration of well-being and/or severe pain.
• Discharge of blood outside of menstruation (minor bleeding during ovulation is part of the norm).
• Complete cessation of menstruation before menopause.
• Uterine bleeding during menopause.

In order for a change in a cycle to be called a violation, it must be repeated over several cycles. Situational, that is, single changes (increasing or shortening the cycle by 5-7 days) are not violations and are considered a type of norm.

Symptoms of menstrual irregularities

Too scanty or, conversely, abnormally heavy periods have their own characteristic symptoms. It is well known that any disturbances in the human body never go away without a trace, and a disruption in the menstrual cycle can be recognized by the following signs:

• disturbance in the regulation of bleeding;
• copious discharge with the presence of clots;
• significant delay;
• very scanty menstruation;
• painful attacks of various types;
• premenstrual syndrome.

In the case of normal menstruation, the woman does not feel any significant symptoms. In some cases, a nagging pain in the lower abdomen may appear, which does not particularly disturb the general rhythm of life. If the menstrual cycle is disrupted, the pain syndrome can become too severe, the pain can radiate to the hip and lower back.

The intensity of the syndrome is determined by the following indicators:

• loss of ability to work – it’s hard to sit, do usual work, there is a constant desire to lie down;
• number of painkillers taken;
• In adolescents, menstrual irregularities are often caused by excessive emotional stress that arises from the expectation of bleeding.

About the period after anesthesia

Common adverse reactions and complications after anesthesia:

• Pain

After the end of general anesthesia, you may feel pain in the surgical area. If upon arrival in the recovery room you still feel it, then inform the medical staff about this - you will be given painkillers.

• Nausea

This is a very common consequence of anesthesia, occurring in approximately 30% of cases. Nausea is more common with general than with regional anesthesia. Here are some tips to help reduce your risk of nausea:

• During the first hours after surgery, you should not be active - sit down and get out of bed;
• Avoid drinking water and food immediately after surgery;
• good pain relief is also important as severe pain can cause nausea, so if you experience pain, tell your healthcare team;
• Deep breathing with slow inhalation of air can reduce the feeling of nausea.

• A sore throat

The endotracheal tube at the stage of awakening from anesthesia can cause an unpleasant feeling of discomfort and sore throat. You need to take this calmly, try to breathe evenly and, most importantly, follow all the instructions of your anesthesiologist. Discomfort, dry mouth, and pain when speaking or swallowing may also be felt for several hours after surgery, but may persist for two or more days. If the above symptoms do not go away within two days after surgery, contact your doctor. A sore throat is only a consequence of anesthesia.

• Shiver

Trembling, as a consequence of anesthesia, is a fairly common problem, as it causes great discomfort, although most often it does not pose a danger to the body and lasts about 20-30 minutes. Trembling can occur after general anesthesia and can also occur after epidural and spinal anesthesia.

• Sensory impairment

During anesthesia, there is a lack of muscle tone, which may result in positional compression of the nerve, which can cause sensory disturbances at the site of compression that last for several weeks. After an operation performed under spinal or epidural anesthesia, the legs become numb for several hours, and emptying the bladder may also be difficult; if necessary, a urinary catheter is installed.

• Dizziness and lightheadedness

The residual effect of anesthetics may manifest itself in the form of a slight decrease in blood pressure, in addition, dehydration, which is not so uncommon after surgery, can lead to the same effect. A decrease in pressure can cause dizziness, weakness, and faintness.

• Headache

There are many reasons that can cause a headache. These include the medications used for anesthesia, the surgery itself, dehydration, and patient anxiety. Most often, the headache goes away within a few hours after anesthesia and can be easily controlled with painkillers. Severe headaches may be a complication of spinal or epidural anesthesia, and treatment may require bed rest for several days.

• Itching

This is usually an adverse reaction to anesthesia medications, but itching can also be an allergic reaction, so be sure to tell your doctor if it occurs.

• Back and lower back pain

During surgery, the patient lies in one constant position on a hard operating table for quite a long time, which can cause the back to become “tired” and ultimately lead to lower back pain after surgery.

• Muscle pain

These pains are most common in young males and are most often associated with the use of drugs to relax muscles during anesthesia. Muscle pain is a consequence of anesthesia (general anesthesia), it is symmetrical, most often localized in the neck, shoulders, upper abdomen and lasts approximately 2-3 days after surgery.

After surgery in the intensive care unit

Depending on the severity of the surgery, postoperative monitoring in the intensive care unit may be necessary. As needed, you will be prescribed medications, possibly in the form of injections/drips. Unfortunately, it is inevitable that the wound after surgery will hurt for some time. If you feel severe pain, you must immediately inform the staff so that the necessary measures can be taken.

Depending on the operation performed, you may have a gastric tube, drainage and a urinary catheter installed.

• Gastric tube

Probes are used to evacuate the contents of the gastrointestinal tract. This is a necessary measure and it is necessary to understand the importance of this procedure. A gastric tube helps you avoid vomiting in the postoperative period, because... all gastric contents will flow through it into a special container. You may experience discomfort and sore throat.

If necessary, enteral nutrition is provided through a tube, i.e. introduction of balanced mixtures to provide your body with nutrients and vitamins. In the first day (and in some cases longer) after the operation, you should not drink or eat. You will receive all the fluid your body needs through an intravenous infusion and tube.

• Drains

Drainage is a treatment method that involves removing discharge from wounds, natural, purulent and other pathological cavities, and the contents of hollow organs.

Drainage - rubber or plastic tubes of various diameters, thin rubber strips, dry aseptic swabs.

• Urinary catheter

If you are unable to urinate on your own, a urinary catheter may be inserted into your bladder to make urination easier.

(See About the Intensive Care Unit) (Active link)

The department team wishes you a speedy recovery!

Irregular periods during adolescence

In teenage girls, menstrual irregularities are quite common. This is due to physiological reasons. That is, the hormonal background has not yet been established and the duration of both the cycle itself and menstruation may be different each time. The norm is considered to be the formation of a cycle over 1 – 2 years.

Pathological factors and causes of irregular periods include:

• traumatic brain injuries;
• infectious lesions of the brain and its membranes;
• tendency to colds;
• vegetative-vascular dystonia;
• obesity;
• sclerocystic ovaries and genital infections.

Of no less importance is the craze among girls for dieting, which leads not only to significant loss of body weight, but also to hypovitaminosis and menstrual irregularities. In addition, the regularity of the menstrual cycle is also affected by the girl’s character (too emotional, impulsive or aggressive).

The following also play a role in cycle disruption:

• early and promiscuous sexual intercourse;
• bad habits;
• malformations of the reproductive system.

An disrupted menstrual cycle in girls can result in a complication such as juvenile uterine bleeding. In this case, periods last more than a week and are heavy, which leads to anemia in the child (see iron supplements for anemia). Typically, juvenile bleeding is provoked either by an infectious process or by nervous strain.

How is endotracheal anesthesia performed?

Preparation for surgery consists of several stages. The preparatory stage is premedication. Before surgery, the patient is given sedatives - tranquilizers, drugs with anxiolytic effect. Taking sleeping pills the evening before surgery is also part of the preparatory phase. Thanks to premedication, a person approaches surgery in a calm and balanced state.

Immediately before the operation, induction anesthesia is performed - intravenous administration of sedatives, which ensures smooth falling asleep before intubation begins. The next stage is muscle relaxation. When the patient falls asleep, he is given a small dose of muscle relaxants - drugs that help relax the muscles. Thanks to muscle relaxants, the tone of the laryngeal muscles is reduced and optimal conditions are created for the insertion of an endotracheal tube.

The fourth stage is the direct insertion of the endotracheal tube and its connection to the ventilator. At this stage, the patient is already sleeping and dreaming, and nothing bothers him.

Diagnosis of a disrupted menstrual cycle

Many women who have problems with menstruation put off visiting the doctor because they are afraid of prescribing hormone therapy. In fact, hormones are indicated only in some cases, and careful diagnosis is necessary to select an adequate treatment regimen.

In addition to a gynecological examination, smear and general blood and urine tests, the following may be prescribed:

• Ultrasound of the pelvic organs and thyroid gland;
• hormone analysis;
• hysteroscopy;
• studies to identify chromosomal pathologies;
• PCR, etc.

The doctor decides exactly what tests are needed after a detailed questioning, in which he can find out the presence of a genetic predisposition, features of the patient’s lifestyle and other nuances that affect the frequency and intensity of menstruation. You may also need to consult doctors of other specialties (endocrinologist, therapist) and additional studies (computed tomography, skull radiography, etc.).

Advantages of endotracheal anesthesia

Maximum safety and complete control over the depth of drug-induced sleep are the main advantages of endotracheal anesthesia. The risk of “waking up during surgery” is eliminated, as is the slightest possibility of disruption of the respiratory and cardiovascular systems. In other words, this is the safest and most reliable type of general anesthesia, during which the anesthesiologist has everything under control!

The advantages of endotracheal anesthesia are explained by the fact that, thanks to intubation, continuous monitoring of respiratory function is carried out. The anesthesiologist constantly monitors adequate ventilation of the lungs, accurately doses the amount of oxygen entering the lungs, and carefully controls the carbon dioxide content in the exhaled air.

From a safety point of view, one more point is important - the risk of tongue retraction, which is present with intravenous and mask anesthesia techniques, is eliminated. In addition, the endotracheal tube completely isolates the respiratory tract from the esophagus, which eliminates the possibility of saliva and stomach contents entering the pulmonary system.

Other features and advantages of endotracheal anesthesia are the possibility of active use of muscle relaxants, the possibility of performing long-term operations with artificial ventilation, and minimizing the risk of postoperative complications from the respiratory and cardiovascular systems.

Treatment of menstruation disorders

Often the irregularity of the cycle is short-lived, but it is necessary to consult a doctor. He will conduct an examination, prescribe a list of tests and help determine the factor contributing to the development of this condition. A failure caused by hypothermia, stress, moving or overexertion does not require serious treatment or the use of medications.

During heavy workloads and sports, it is important to provide the body with rest, walk less, but also not lie down for several days in a row. When the climate changes, you can take vitamins; over time, the body will get used to the changes and will not react sharply to changes in temperature and humidity.

If the disturbances are caused by a diet, you must immediately stop it and start eating a balanced diet. Lack of nutrients provokes vitamin deficiency, the treatment of which begins with the use of vitamin and mineral complexes.

Indications for visiting a doctor if your menstrual cycle is irregular

For any irregularities in the menstrual cycle, it is advisable to consult a gynecologist. This will help you avoid serious consequences and not worry about your condition, thereby aggravating the situation. But in some cases it is necessary to undergo an examination:

• If a teenage girl did not have menarche until she was 15-16 years old.
• A year and a half passed after the first menstruation, and the monthly cycle was still not established.
• Your periods are too long and too heavy.
• The nature of menstrual flow, its color, and smell have changed (this may be a sign of endometrial disease).
• Ovulation is accompanied by painful sensations.
• The discharge is very scanty, and menstruation comes with a significant delay.
• Bleeding is a concern during the period between menstruation (even a single case requires examination).

Even if all these changes do not cause discomfort or cause complaints, you should not ignore them. Menstrual irregularities are often a sign of illness, and timely treatment can avoid complications and life-threatening conditions.