Tuesday, March 29, 2011

Menstrual Conditions/Irregularities - Menorrhagia

Menorrhagia is defined as a condition of excessive bleeding in the menstruation phase of the menstrual cycle in the reproductive age of a woman leading to heavy blood loss that can interfere with the woman normal activities, as a result of disruption of normal hormonal regulation of periods or disorders of certain reproductive organs.

Types of menorrhagia
1. Primary menorrhagia
Girls are especially prone to anovulatory cycles in the 2 years after the first menstrual as a result of the immature reproductive organs, which can lead to disturbance of protaglandins production, causing pains and heavy period.
2. Secondary menorrhagia
Secondary menorrhagia is a result of as a result of disruption of normal hormonal regulation of periods or disorders of certain reproductive organs, that lead menstrual cramps and pain and excessive bleeding.

Symptoms
1. Spotting or bleeding between menstrual periods
2. Excessive menstrual bleeding
3. Heavy period
4. Symptoms of anemia (caused by loss of iron in the blood)
5. Constant pain in the lower abdomen during menstrual period
6. Irregular menstrual periods
7. Period with heavy period occurs almost in every period.
8. Blood loss from 30 to 44 milliliters
9. Etc.

Diagnosis
A. Primary menorrhagia
Girl with menorrhagia in the first 2 years of the menstruation may be tested
1. Red blood cell and fatty acid analysis
It is a blood test for cholesterol, triglyceride, HDL, and LDL. Occasionally, a lipoprotein electrophoresis or lipoprotein-a (Lp-a). The high levels of the test result may increase the risk of arachidonic acid cause of menorrhagia.
2. Red blood cells count
The aim of the blood test is to rule the case of amenia.
3. Hormone levels testing (FSH)
the aim of the test to check for hormone follicle stimulating hormone that may lead inovulation cause of heavy menstruation.
4. Serum vitamin levels
The test for certain vitamin levels is to rule out the heavy period is caused by vitamin deficiency.
5. Etc.

B. Secondary menorrhagia
1. Blood count
Test for blood count to rule out the amenia cause of menorrhagia.
2. Basal body temperature
In women, the record of basal body temperature is to rule out the anovulation cause of menorrhagia. Ovulation causes an increase of one-quarter to one-half degree Celsius in basal body temperature (BBT). It is one of self exam method commonly used by women to time of most fertility.
3. Thyroid function
In a study of Menorrhagia and hypothyroidism - Evidence supports association between hypothyroidism and menorrhagia by Andrew D Weeks, specialist registrar in obstetrics and gynaecology, researchers found that All the available evidence supports a causative association between hypothyroidism and excessive menstrual loss. Some of the study methods are weak by modern standards, but in the absence of evidence to the contrary the conclusion must be that hypothyroidism is a correctable cause of menorrhagia.
4. Ultrasound
Ultra sound to examine the pelvic region is to rule out certain types of abnormality cause of menorrhagia such as uterine fibrosis, polyps, ovarian tumors, endometriosis, etc..
5. Blood coagulation test
Abnormal process by which blood forms clots (coagulation) to prevent blood loss during menstruation can lead menorrhagia.
6. Etc.

Causes and Risk factors
A. Primary menorrhagia
1. Age
Girl in their first 2 years of menstruation may be experience the adnominal cramps and pain and heavt period as a result of the immature of the reproductive organs.
2. Increase arachidonic acid in endometrium
High amount of polyunsaturated omega-6 fatty acid may results in overproduction of the family2 series of eicosanoid, elading to thickening of endometrium, dilation of blood vessels.
3. Hormone imbalance that prevent ovulation
Stress, infection, imbalance of neurotransmitter, under weight and accumulated toxic chemical may interfere with production of certain hormone which can disrupt ovulation and case menorrhagia.
3. Vitamin A deficiency
Vitamin A, an antioxidant enhances the body immune system fighting the against the forming of free radicals to protect the normal cell reproduction and against damage. Deficiency of vitamin A is one of the factor for women who were experience heavy menstrual bleeding.
4. Bleeding or platelet disorders
Abnormal process by which blood forms clots (coagulation) to prevent blood loss during menstruation can lead menorrhagia.
5. Excess toxicity
Excessive toxibody may be resulted in heavy period as a result of the body of trying to remove toxins through the blood.
6. Vitamin K deficiency
Vitamin K is blood coagulation. Normally produced by bacteria in the intestine, women with intestine diseases may not produce enough vitamin K to stop the heavy flowing of blood during menstruation.
7. Anemia
Women with the type of anemia having red blood cells breaking down faster than normal people, may also have heavy flowing of blood during menstruation caused by regular blood flow and breaking off of red blood cells thereby, reducing the coagulation function.
8. Stress
Women who cannot adjust to events in life that are stressful, or seem to be stressful in their mind causes hormone imbalance resulting in overproduction of either estrogen or progesterone.
9. Etc.

B. Secondary menorrhagia
1. Age
Women who are at the age of 40 - 50 may be experience abnormal menstrual cramps and pain and heavy than normal period as a result of approaching to the menopause stage.
2. Medical conditions
Women with certain medical conditions, including pelvic inflammatory disease (PID), thyroid problems, endometriosis are at higher risk of menorrhagia.
3. Intrauterine device (IUD)
Uncorrected use of Intrauterine device (IUD) can lead to menorrhagia.
4. Reproductive diseases
Certain reproductive diseases, including Adenomyosis, Dysfunction of the ovaries, Uterine fibroids, etc., may cause hormonal imbalance and result in menorrhagia.
5. Misscariage and etopical pregnancy
Misscariage and etopical pregnancy can lead to heavy bleeding.
6. Vitamin K deficiency
Vitamin K is blood coagulation. Normally produced by bacteria in the intestine, women with intestine diseases may not produce enough vitamin K to stop the heavy flowing of blood during menstruation.
7. Anemia
Women with the type of anemia having red blood cells breaking down faster than normal people, may also have heavy flowing of blood during menstruation caused by regular blood flow and breaking off of red blood cells thereby, reducing the coagulation function.
8. Stress
Women who cannot adjust to events in life that are stressful, or seem to be stressful in their mind causes hormone imbalance resulting in overproduction of either estrogen or progesterone.
9. Etc.

Prevention
For both primary and secondary menorrhagia
A. Diet
1. Lettuce
Flavonoids are plant pigments responsible for the color of flowers, fruits, and sometimes leaves. Study shows that flavonoids supply us with natural, anti-inflammatory, and antioxidants having great effect on menorrhagia excess pain and on the heaviness of the period.

2. Flax seed oil
Flax contains high amounts of omega 3 fatty acid and lignans. It also is a powerful antioxidant. Besides working together with vitamin K in helping the circulation of blood and providing blood clotted vessels, it also helps to reducing pain caused by menorrhagia.

3. Broccoli
Broccoli contains high amounts of iron, and vitamin C and K that not only helps to relief the pain caused by menorrhagia, but also provides iron, the mineral that is needed to prevent heavy blood loss special for women with anemia. Vitamin K also increases blood clotting the damage blood vessels.

4. Kelps
Kelps are large seaweeds. It grows in underwater forests in clear, shallow oceans. It is rich in iodine and alkali that helps to balance hormones caused by thyroid glands resulting in heavy flow of blood during menstruation as well as containing incredibly high trace minerals and vitamins to feed and nourish the endocrine glands.

5. Carrot
Carrots contain high amounts of vitamin A as well as antioxidants, alpha carotene, and beta carotene. Vitamin A is required for normal reproductive function, and development of ovaries and placenta that is vital for women's menstrual cycle. It's antioxidants also help to reduce menstrual pain caused by menorrhagia.

6. Fermented soybeans
Fermented soybeans are made from soybean. It contains large amounts of vitamin K which is involved in the formation of calcium-binding groups in proteins as well as helping blood clots caused by heavy blood flow during menstruation.

7. Etc.

B. Nutritional Supplements
For both primary and secondary menorrhagia
1. Iron
Iron is essential for women suffering from menorrhagia. Since excessive bleeding causes the loss of iron causing iron deficiency, without enough iron our body cannot reproduce red blood cells to replace those lost in bleeding resulting in symptoms of paller, weakness, fatigue as well as increasing the risk of inflammation.

2. Vitamin B complex
Vitamin B complex is a liver tonic vitamin. It helps the liver to convert the bad estrogen, xanooestrogen into weaker and less dangerous forms and converts omega 6 oils into a form that can be used by the body to produce the good type prostaglandins instead of dinoprostone resulting in reduced bleeding during menstruation.

3. Cod liver oil
Cod liver oil contains high amounts of omega 3 fatty acids that control heavy bleeding during periods. Since red meat and dairy products contain arachidonic acid without balancing intake of omega 3 fatty acid, this causes the over production of dinoprostone leading to increased blood flow, and reducing blood-clotting ability.

4. Zinc
Besides having an important role in treating enlarged prostate in men's health, this mineral is vital for the healthy functioning of the reproductive system in women as well as maintaining hormone balancing.

5. Flavonoid
Flavonoid is a powerful antioxidant activity. It helps to protect small blood vessels from damage resulting in protecting against the blood loss of menorrhagia during menstruation.

6.Vitamin A
Vitamin A is an antioxidant. It works together with iron and copper to help enhance the production of red blood cells. Vitamin A deficiency has been found in women with menorrhagia.

7. Vitamin C
Besides being an antioxidant that helps our body to fight against free radicals from building up and help the digestive system's metabolism to reduce menstrual pain, it also helps excessive blood flow during menstruation as a resulting of strengthening small blood vessels known as capillaries.

8. Etc.

Treatments
I. Conventional medicine
A. Primary menorrhagia
A.1.Ethamsylate
In a study of A double-blind trial of ethamsylate in the treatment of primary and intrauterine-device menorrhagia by R F Harrison, S Cambell, researchers found that During ethamsylate treatment the mean menstrual blood-loss was reduced by 50% in patients with primary menorrhagia and by 19% in patients with an I.U.C.D. This difference between the two groups is probably accounted for by the differing values of initial blood-loss which was significantly higher in the group with primary menorrhagia.

A.2. Include those in the secondary menorrhagia with the recommendation of your doctor.

B. Secondary menorrhagia
B.1. Hormone treatments
1. Contraceptive pill
a. Low-dose combination birth control pills which contains low-dose synthetic forms of the hormones estrogen and progesterone may be use to treat amenorrhea by controlling the menstrual cycle or bring the period back.
b. Risks and side effects
b.1. Growth of fibroids
Growth of fibroid is caused high level of estrogen and progesterone. The intake of the pill increase the level of both hormones resulting in increase the risk of growth of fibroid.
b.2. Recurrent of menstrual symptoms
Some women stop taking the pill may see all the menstrual symptoms coming back.
b3. Blood clots
Estrogen in the pill may cause blood clots in the small vessels in the leg and the lung.
b.4. Stroke and heart diseases
Study shows that women who have higher natural estrogen levels may have a higher risk of stroke and heart diseases.
b.5. Depression and mood swing
At the beginning, it may cause abnormal fluctuations in estrogen and progesterone elevate both physical and psychological stress, eventually resulting in both depression and mood swing
b.6. Bleeding and spotting
Bleeding and spotting is normal for the first six months for women who begin with any oral contraceptive combination pill treatment.
b.7. Lost interest in sex
Some women may experience lower sexual desire
b.8. Nutritional deficiency
Oral contraceptive pill causes vitamin and mineral imbalances or deficiencies.
b.9. Etc.

2. Norethisterone (Progesterone only pill)
Norethisterone a progestogen and has been used used treat premenstrual syndrome, painful periods, abnormal heavy bleeding, irregular periods. In a study of A comparative study of danazol and norethisterone in dysfunctional uterine bleeding presenting as menorrhagia M. Bonduelle, J.J. Walker and A.A. Caldert, researcher found that Since this study was undertaken, a report of
objective measurement of blood loss in small groups of patients9 casts further doubt on the
efficacy ofnorethisterone, although it confirms that of danazol. Since norethisterone is very widely used, a detailed assessment of its efficacy and safety in comparison to danazol is overdue. Should such a study confirm the findings discussed here then danazol could usefully be employed as first line therapy in the management of dysfunctional uterine bleeding presenting as menorrhagia.

3. Danazol
Danazol is synthetic steroid ethisterone, a modified testosterone that is used to inhibit ovarian steroidogenesis resulting in decreased secretion of estradiol and may increase androgens. although it is a standard medicine in treating menorrhagia
According the study of Efficacy of vaginal danazol treatment in women with menorrhagia during fertile age by Luisi S, Razzi S, Lazzeri L, Bocchi C, Severi FM, Petraglia F., researchers concluded that vaginal danazol resulted in effective medical treatment in young women with menorrhagia, and, because of a lack of significant adverse effects, it may be proposed as an alternative treatment.

4. Contraceptive coil (Mirena)
a. It is a soft, flexible T-shaped (birth control) device placed inside the uterus by your doctor within 7 days after the start of your period with medication Mirena continuous release over a period of 5 years to prevent pregnancy and reduce symptoms of menorrhagia. According to the study of SAFETY AND EFFICACY OF MIRENA IN MENORRHAGIA : 10 YEARS RESULTS OF VUOKKO-STUDY by R. Hurskainen, researcher suggested The preliminary 10-year results of Vuokko study show that LNG-IUS is a good alternative option to hysterectomy in the treatment of menorrhagia. Although half of the women assigned to the LNG-IUS group eventually underwent hysterectomy, the costs remain significantly lower than in hysterectomy group. The transition from menorrhagia to menopause seems to be well tolerated and associated with a favourable bleeding pattern.
b. Risks and side effects
b.1.Spotting between periods
b.2. Complete absence of menstrual flow
b.3. Decreased bleeding during periods
b.4. Prolonged bleeding during periods
b.5. Breast pain and tenderness
b.6. Etc.

B.2. Non-hormonal treatments
1. Cyklokapron (tranexamic acid )
The medication has been used widely to reduce short-term in people up to 50% with a certain type of bleeding disorder, including menorrhagia.
2. According to the article of Cyklokapron posted in Drug.com
Risks and Side effects of Cyklokapron Injection include
a. In patients with acquired defective color vision, since this prohibits measuring one endpoint that should be followed as a measure of toxicity
b. In patients with subarachnoid hemorrhage. Anecdotal experience indicates that cerebral edema and cerebral infarction may be caused by Cyklokapron in such patients.
c. In patients with active intravascular clotting.
d. In patients with hypersensitivity to tranexamic acid or any of the ingredients.

B.3. Non-steroidal anti-inflammatory drugs (NSAIDs)
1. Non-steroidal anti-inflammatory drugs (NSAIDs) are drugs with analgesic and antipyretic, anti-inflammatory effects, including over counter medicine aspirin, ibuprofen, and naproxen. The medicine has been use to reduce blood loss (it has been shown to be effective in randomized controlled trials, reducing menstrual blood loss (MBL) by 29.0% (95% CI 27.9 to 30.2%). and menstrual cramps and pain for women with menorrhagia)
2. Risks and side effects
a. Stomach bleeding
b. Heart failure
c. Toxicity to the kidneys, ears, and stomach
d. Heart diseases
e. Some researchers advised that Taking more than one NSAID is risky.
f. Etc.

II. Herbs
For both primary and secondary menorrhagia
1. Ashoka (Saraca indica)
Ashoka is a sacred plant and has a religious importance. It is reported to have a stimulating effect on the endometrium and ovarian tissue. It's use in treatment of excessive uterine bleeding, dysmenorrhoea, depression, bleeding hemorrhoid, and uterine fibroid. It is considered a uterine sedative and tonic for women in India.

2. Amalaki
Amalaki has been used over 5000 years in India medication. Amlaki contains high amounts of Vitamin C, bioflavonoids, flavonoids, polyphenols, and Alpha and beta carotene that not only helps to strengthen our immune system's fighting against the forming of free radicals, it also helps to inhibit cyclo-oxygenase and lipoxygenase enzymes that cause menstrual cramps and heavy blood flow.

3. Manjishta
Manjishta is a climbing plant found in the Himalayas and hill stations in India. It has been used to treat hepatic obstructions. Root paste removes freckles, and discoloration of the skin, blood circulation and purification, cancer and diarrhea. Manjishta has the same properties like ginger, it helps to reduce menstrual cramps as well as regulating blood flow during menstruation.

4. Shatavari
Shatavari is a climbing plant which grows in low jungle areas throughout India and is an ayurvedic medicine for women. It has been used in India to treat infertility, decreased libido, threatened miscarriage, menopause and nourishing the female reproductive system.

5. Gokshura
Gokshura is a perennial herb with many spreading slender branches. It contains high amounts of calcium. Traditionally, gokshura has been used in Chinese medicine to treat headaches, vertigo, dizziness and heavy blood flow in menstruation due to ascendant liver yang and wind heat.

6. Fo-ti root
Fo-Ti Root is native to China. It has been used in Chinese medicine to treat premature aging, weakness, regulating vaginal discharge, angina pectoris and promoting hair grow and increasing men's libido.

7. Cayenne
Cayenne is a dark-green annual or short-lived perennial plant. Cayenne contains capsaicin that has been shown to promote the release of substance P from sensory neurons, a neuropeptide involved in the sensation of pain, stops blood flow, and is popularly used by Chinese practitioners in treating heavy blood flow during menstruation.

8. Etc.

III. Chinese herbs
For both primary and secondary menorrhagia
1. Cayenne pepper
Cayenne pepper helps to improve the circulatory system that feeds the necessary nutrition to the cell structure of the arteries, veins and capillaries that helps to make small blood vessels in the uterine elastic, thereby reducing the excessive blood flow during menstruation. It also has a property that enhances digestive system metabolism as well as relaxing muscles resulting in reduced menstrual cramps.

2. Raspberry tea
Raspberry tea contains astringent, a substance that tends to shrink or constrict body tissues. It also has properties that help to stop excessive bleeding and calm cramps during heavy menstrual period.

3. Angelica root
Chinese Angelica is a sturdy perennial plant that is native to China and Japan. It has been used for over 5000 years in traditional Chinese medicine in treating an overall tonic for the reproductive system as well as balancing hormones and it is also used to relieve the discomforts of premenstrual syndrome, dysmenorrhea and amenorrhagia. It is well known as female ginseng.

4. Radix Notoginseng
Also known as tian san qi or tien chi ginseng. It has been used in China for centuries in treating excessive bleeding. It is widely used in Asia for angina to help lower cholesterol and triglycerides, and to expand coronary arteries in order to promote blood circulation and prevent blood clots thereby helping to control excessive menstrual bleeding or menorrhagia. It also is a powerful antioxidant that helps to reduce inflammation thus reducing pain caused by menstruation disorders.

5. Ajuga forrestii diels
It is used for traumatic swelling, bruising or for blood disorders. It is also used to inhibit internal bleeding due to trauma, surgery, or cerebral hemorrhage as well as helping traumatic bleeding during menstrual bleeding and relieving pains.

6. Rhizoma dioscoreae nipponicae
Rhizoma dioscoreae nipponicae is among the most famous Chinese traditional medicines specially used to improve blood circulation, stop internal bleeding, painful obstruction and gynaecological blood diseases.7. Rhizome DioscoreaeRhizome is a wheat plant. It contains thiamine, riboflavin, niacin, and small amounts of vitamin A that helps to reduce inflammation resulting in a reduced menstrual cramps. Taken Internally, it can stop internal bleeding such as bleeding ulcers, blood in urine or stool, and menorrhagia.

7. Etc.

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