Answer:
Dear
Helen,
Metrorrhagia
is menstrual bleeding that is irregular in quantity, acyclical in
nature and often prolonged in nature.
The condition
is usually due to a pathological condition in the uterus or other
internal genital organs.
A wide
variety of factors can be responsible for irregular periods, among
them:
-Significant
weight gain or loss
-Over-exercise
-Poor nutrition (or a diet too high in carbohydrates)
-Smoking
-Drug use
-Caffeine
-Excessive alcohol use (interfering with how the liver metabolizes
estrogen and progesterone)
-Eating disorders
-Increased stress
-Polycystic ovarian syndrome/estrogen dominance
-Uterine abnormalities (fibroids/cysts/polyps/endometriosis)
-Hormonal imbalance related to perimenopause
-Medications
-Chemotherapy
-Recent childbirth, miscarriage, or D&C
-Breastfeeding
It's
a good idea to do the following:
-Have
a complete physical, including evaluations of thyroid function and
blood pressure. Also, a complete blood count (CBC) test is quite important
for the diagnosis of anemia.
-A pelvic
exam is critical to rule out any uterine abnormality, a cervical polyp
or fibroid, or a uterine infection. These are less common causes but
should be considered. Often an ultrasound will be required to evaluate
the uterus, the ovaries and the fallopian tubes. Ultrasound of the
uterus is useful and painless - you may already be familiar with this
technique from pregnancy. If infection is a concern, antibiotics will
be prescribed.
The
best non-prescription treatments
to make menses more regular are:
For a
low estrogen, irregular menstrual problem, the key treatments are:
-Stress
reduction and/or relaxation techniques
-Elimination of overly strenuous physical exercise
-Eliminate any eating disorders such as purging, bulimia, or anorexia
-Take supplemental, measured estrogens such as phytoestrogens in soy
or clover products.
For a
high estrogen irregular menses pattern such as that found in PCOS,
weight reduction using a low carbohydrate diet is essential.
Even
a 10% weight loss will help restore normal menstrual patterns in obese
women who are anovulatory .
The
best prescription treatments
for menstrual irregularities are:
Oral
contraceptives (OCPs) are the most commonly used hormonal treatment
for irregular menses. They do not correct the underlying problem that
causes the irregularity but they will regulate the pattern very precisely
to the same day of the week each cycle. In general, oral contraceptives
are very safe and will not cause an alteration in the body even after
taking for a very long time. Some women cannot take birth control
pills, however, so other treatments are also used.
Women
with irregular menses due to hypothalamic factors can take a sequential
hormone regimen. In this regimen, estrogen is given each day and then
progesterone is given for 10-14 days each month in order to induce
a withdrawal bleed. This regimen will not protect against pregnancy
should ovulation occur so if a pregnancy is desired, this may be the
best regimen.
For polycystic
ovarian syndrome most physicians will prescribe oral progestins or
progesterone to take for 10 days every two months if there has not
been a spontaneous menses. This is thought to protect against the
development of endometrial cancer or hyperplasia from the long term
elevation of estrogens.
Carbohydrate metabolism abnormalities are often successfully treated
with a combination of diet and medications, and the menstrual irregularities
may disappear. Metformin, a drug which reduces high insulin levels
has been shown to make women with PCOS resume normal menses in almost
90% of cases. This is a dramatic breakthrough in treatment and one
worth seeing your physician about if you have PCOS.
