Menstrual Conditions

What is menorrhagia?

Menorrhagia refers to excessive menstrual bleeding. This can mean that your bleeding lasts for more than seven days, that the bleeding is very heavy, or a combination of both.

What are the symptoms of menorrhagia?

• Bleeding through one or more sanitary pads or tampons every hour for several consecutive hours
• Needing to use double sanitary protection to control your menstrual flow
• Waking up to change sanitary protection during the night
• Bleeding that lasts longer than a week
• Passing blood clots larger than a quarter
• Interference with daily activities
• Symptoms of anemia, including fatigue or shortness of breath

What are the possible causes of menorrhagia?

• Hormone imbalance
• Uterine fibroids
• Polyps
• Adenomyosis
• Intrauterine device (IUD)
• Pregnancy complications
• Cancer
• Inherited bleeding disorders
• Medications
• Liver or kidney disease

What should I do if I experience menorrhagia?

See your Hoag gynecologist or OB/GYN if you experience menorrhagia. Excessive or prolonged menstrual bleeding can lead to severe pain and/or anemia.

What are the treatment options for menorrhagia?

Hoag’s multidisciplinary team of board-certified gynecologic and OB/GYN health experts and other subspecialists work together to provide a coordinated approach to treatment options, which may include:

• Hormonal therapy
• Hysteroscopy – your doctor will atypical structures in your uterus, like fibroids and polyps.
• Uterine artery embolization – this procedure stops blood flow to fibroids, causing them to shrink.
• Myomectomy – your doctor will remove fibroids, while keeping your uterus intact.
• Endometrial ablation – this procedure uses laser, heat, electricity, energy or freezing to destroy the uterus lining.
• Hysterectomy – this is the surgical removal of part or all of the uterus. It may include the removal of the fallopian tubes and ovaries.
  • Laparoscopic hysterectomy is a hysterectomy performed with the aid of a laparoscope, a thin, flexible tube containing a video camera that guides the surgeons as they remove the uterus through the laparoscope tube or through the vagina.
  • Robotic-assisted hysterectomy is a minimally invasive procedure where a surgeon controls the arms of a robot to perform a surgery. The movement is more precise and there is better visibility than conventional laparoscopy. Hoag is a national leader in robotic-assisted gynecologic surgeries.
  • Vaginal hysterectomy is the removal of the uterus through the vagina. It is considered one of the most minimally invasive types of hysterectomies.

What is amenorrhea?

Amenorrhea is the medical term for the absence of menstruation. There are two types of amenorrhea:

• Primary amenorrhea refers to the absence of menstruation in someone who has not had a period by age 15.
• Secondary amenorrhea refers to the absence of three or more periods in a row by someone who has had periods in the past.

What are the possible causes of amenorrhea?

For primary amenorrhea, a girl might not get her period due to irregular hormone levels, anatomical problems or other factors.

Secondary amenorrhea can be caused by pregnancy, menopause, breastfeeding or other issues including:

• Contraception
• Medication
• Being under or overweight
• Stress
• Excessive Exercise
• Hormonal imbalance due to thyroid issues, polycystic ovarian syndrome, pituitary tumor or premature menopause
• Structural issues with your reproductive organs

Should I be concerned if I am experiencing amenorrhea?

Talk to your doctor if you have concerns about:

• Infertility or concerns about future pregnancy
• Stress
• Osteoporosis
• Cardiovascular disease
• Pelvic pain

See your Hoag gynecologist or OB/GYN if you’re experiencing amenorrhea.

What causes oligomenorrhea?

Oligomenorrhea can be caused by:

• Hormone imbalance
• Infection
• Structural abnormalities
• Medications
• Diabetes
• Scarring from surgery
• Eating disorders
• Extreme exercise

Hormonal conditions that can lead to oligomenorrhea include:

• Polycystic ovarian syndrome (PCOS)
• Androgen-secreting tumors
• Cushing’s syndrome
• Prolactinoma
• Primary ovarian syndrome
• Hyperthyroidism
• Congenital adrenal hyperplasia

Medications that can lead to infrequent periods include:

• Hormonal contraceptives
• Antipsychotics
• Antiepileptics

How is oligomenorrhea diagnosed?

To diagnose oligomenorrhea, your doctor will conduct a physical exam, which may include an abdominal, pelvic and rectovaginal exam to look for signs of inflammation, scar tissue or masses. Your Hoag gynecologist or OB/GYN may also order blood tests to check your hormone levels and blood sugar.

Hoag’s advanced imaging capabilities can also be put to use to diagnose the cause of your condition. These procedures include:

• CT scans
• Pelvic and abdominal ultrasounds
• Magnetic resonance imaging (MRI)

What are the treatments for oligomenorrhea?

Treatments vary depending on the cause for your condition. They can include:

• Hormone therapy – your doctor may prescribe birth control pills or other hormone treatments if your oligomenorrhea is caused by a hormone imbalance.
• Surgery – if you have an androgen-secreting tumor, your doctor may recommend surgery to remove it.
• Lifestyle changes – if diet and exercise are thought to be behind your oligomenorrhea, your doctor may work with you to make lifestyle and nutritional adjustments.
• Mental health care – women who develop oligomenorrhea due to an eating disorder may require care from a nutritionist and therapist.

See your Hoag gynecologist or OB/GYN if you’re experiencing oligomenorrhea.

What is hypomenorrhea?

The heaviness of menstruation is usually determined by how much endometrial lining has built up over the course of the month. For some women, light menstruation is normal. But for others, bleeding lightly or for only two days or less may be cause for concern.

What causes hypomenorrhea?

Hypomenorrhea can be caused by:

• Pregnancy
• Sudden changes in weight
• Stress
• Hypothyroidism
• Hormonal contraception
• Polycystic Ovarian Syndrome (PCOS)
• Perimenopause

How is hypomenorrhea treated?

Your treatment plan will vary depending on the underlying cause of your condition. Call your primary care physician, gynecologist or OB/GYN if you are concerned about light periods.

What is endometriosis and what are the symptoms?

Endometriosis is a common health problem in women in which the endometrium, or lining of the uterus, starts to grow outside the uterus. It can grow on other structures in the body, including the ovaries, fallopian tubes and pelvic cavity.

Symptoms of endometriosis may include:

• Pain in the lower abdomen or pelvis, or the lower back, mainly during menstrual periods
• Very painful menstrual cramps; pain may get worse over time
• Chronic pain in the lower back and pelvis
• Pain during or after sex
• Intestinal pain
• Painful bowel movements or painful urination during menstrual periods
• Spotting or bleeding between menstrual periods
• Infertility or not being able to get pregnant
• Fatigue
• Diarrhea, constipation, bloating, or nausea, especially during menstrual periods

Who is at risk of developing endometriosis?

More than five million women in the United States have endometriosis. It is one of the most common health problems for women. It can occur in any teen or woman who has a menstrual period, but it is most common in women in their 30s and 40s.

The symptoms of endometriosis stop for a time during pregnancy. Symptoms also tend to decrease with menopause, when menstrual periods end for good. In some cases, women who take menopausal hormone therapy may still have symptoms of endometriosis.

Recent research shows a link between endometriosis and a family history of:

• Allergies, asthma, and chemical sensitivities
• Autoimmune diseases, in which the body’s system that fights illness attacks itself instead. These can include hypothyroidism, multiple sclerosis, and lupus
• Chronic fatigue syndrome (CFS) and fibromyalgia
• Being more likely to get infections and mononucleosis
• Mitral valve prolapse, a condition in which one of the heart’s valves does not close as tightly as normal
• Frequent yeast infections
• Certain cancers, such as ovarian, breast, endocrine, kidney, thyroid, brain, and colon cancers, and melanoma and non-Hodgkin’s lymphoma

What causes endometriosis?

It has not been determined exactly what causes endometriosis, however doctors have identified some risk factors:

• Never having had children
• Menstrual periods that last more than seven days
• Short menstrual cycles (27 days or less)
• A family member (mother, aunt, sister) with endometriosis
• A health problem that prevents the normal passage of menstrual blood flow
• Damage to cells in the pelvis from an infection

Because certain GYN cancers may occur at a higher rate among women with endometriosis, talk to your gynecologist or OB/GYN if you are experiencing any symptoms or risk factors related to endometriosis.

How is endometriosis diagnosed?

Diagnostic tests your gynecologist or OB/GYN may perform include:

• Pelvic Exam
• Ultrasound
• Laparoscopy – likely only to be used if medication is not effective

How is endometriosis treated?

Treatment for endometriosis depends on the extent of the condition, symptoms experienced, and whether you want to have children.

In some cases of endometriosis, medications or NSAIDs (nonsteroidal anti-inflammatory drugs) may be used to relieve pelvic pain. In some women, birth control pills and other hormonal therapies have slowed the growth of the endometriosis.

For more serious cases, when medical and hormonal therapies fail, endometriosis resection surgery may be required to remove the endometriosis implants and the scar tissue caused by the condition. At Hoag, we offer the most advanced surgical options available for treating endometriosis, including minimally invasive options such as laparoscopic and GYN robotic surgery.

Hoag’s GYN robotic team is recognized as a Center of Excellence in Robotic Surgery (COERS) by the Surgical Review Corporation for demonstrating unparalleled commitment and ability to consistently deliver safe, effective, evidenced-based care. Hoag is committed to providing the highest-quality care to its patients through expert use of the da Vinci® Surgical System.

The combination of technological advancements provided by robotic-assisted surgery ensures the surgery is much easier to perform.

Additional benefits to GYN robotic-assisted surgery include:

• Less post-operative pain and scarring
• Decreased blood loss and lower risk of blood transfusion
• Lower risk of infection
• Shorter hospital stay
• Faster return to normal activities

Can I get pregnant if I have endometriosis?

Yes. While endometriosis can affect fertility, most patients with endometriosis can get pregnant spontaneously. Symptoms of endometriosis may subside or go away entirely for a while during pregnancy. Talk to your OB/GYN about your plans to start a family if you have endometriosis.

What is a painful period?

Severe and frequent cramping that disrupts your daily activities are signs of painful periods and should be discussed with your doctor. Whether you’ve had painful periods since you first began menstruating or if the pain develops over time, your Hoag doctor can help you with these symptoms.

What causes painful periods?

Causes of dysmenorrhea include:

• Endometriosis
• Ovarian Cysts or PCOS
• Infection
• Fibroids

How is dysmenorrhea treated?

Treatment for dysmenorrhea depends on the underlying cause. For mild cases not related to an underlying health issue, treatment may include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Oral contraceptives
• IUD can also help to reduce painful periods

In the case of pain resulting from an underlying condition such as fibroids or endometriosis, there are several treatment options available, including:

• Myomectomy (surgical removal of a fibroid)
• Minimally-invasive surgery

Your gynecologist or OB/GYN may also prescribe medications or procedures to address the other symptoms of dysmenorrhea, including:

• Diarrhea
• Nausea
• Vomiting
• Headache
• Discomfort in the lower back

What is Polycystic ovary syndrome (PCOS) and what are the symptoms?

Polycystic ovary syndrome (PCOS) is the name given to a number of symptoms related to hormonal imbalance that interferes with ovulation. The ovaries of women with PCOS may appear enlarged or surrounded by cysts, small fluid-filled sacs containing a follicle in which a single egg is readying for ovulation.

In PCOS, follicle development ends too soon, and ovulation does not occur.

Symptoms include:

• Irregular periods
• Facial or excessive body hair
• Severe acne
• Male-pattern baldness
• Difficulty getting pregnant
• Small pieces of excess skin on the neck or armpits (skin tags)
• Dark or thick skin patches on the back of the neck, in the armpits, and under the breasts
• Weight gain, especially around the belly

How is PCOS diagnosed?

Your gynecologist or OB/GYN may order:

• An Ultrasound test to look at your ovaries. Polycystic ovaries may look larger, and many follicles containing immature eggs may develop around the edge of the ovary.
• Blood test to check your hormone levels.

How is PCOS treated?

If you do plan to become pregnant, your treatment may include:

• Lifestyle changes – a healthy diet and more physical activity can help you lose weight and help your body use insulin more efficiently, which could lower blood glucose levels, and may help you ovulate.
• Medications – your doctor may prescribe medications to cause ovulation. Learn more about fertility treatment options here.

If you do not plan to become pregnant, your treatment may include:

• Birth control pills
• Diabetes medication

See your Hoag gynecologist or OB/GYN if you’re experiencing PCOS.

What are the health risks of PCOS?

Women with PCOS are likely to have problems getting pregnant. They may also be at increased risk of developing:

• Type 2 diabetes
• High blood pressure
• Heart and vascular problems

If you are experiencing fertility problems, learn more about fertility options here.

What are premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD), and how are they different?

Both premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are collections of physical and behavioral symptoms some women experience before their menstrual period. Fluctuations in hormones during your menstrual cycle can cause a cascade of symptoms. However, PMDD is a more severe, and sometimes disabling, form of premenstrual syndrome PMS. It is a medical condition that requires attention and treatment.

What are the symptoms of PMS and PMDD?

Symptoms of both PMDD and PMS include:

• Bloating
• Breast tenderness
• Fatigue
• Changes in sleep and eating habits
• Nausea
• Constipation
• Backaches
• Headaches
• Pelvic heaviness or pressure
• Abdominal cramping

In PMDD, symptoms may also include:

• Severe psychological symptoms (irritability, fatigue, forgetfulness) that disrupt daily life
• Respiratory issues, such as allergies and infections
• Vision changes or eye complaints
• Aggravated skin disorders
• Heart palpitation
• Muscle spasms

Who is at risk for developing PMS?

According to the National Institutes of Health, nearly 90% of women in the United States experience uncomfortable symptoms before their periods. If these symptoms disrupt your daily life, reach out to your primary care physician, gynecologist or OB/GYN to find out if your PMS is actually PMDD.

How is PMS treated?

If PMS symptoms become severe enough to disrupt your life on a monthly basis, your doctor may recommend treatment options including:

• Hormonal birth control
• Supplements, including calcium, magnesium, or vitamin B6
• Pain medication

Talk with your primary care physician, gynecologist or OB/GYN to discuss possible treatment options.

Who is at risk of developing PMDD?

While any woman can develop PMDD, women with the following may be at increased risk:

• A family history of PMS or PMDD
• A personal or family history of depression, postpartum depression, or other mood disorders
• A history of smoking

How is PMDD treated?

Your primary care physician, gynecologist or OB/GYN may recommend:

• Antidepressants
• Birth control pills
• Nutritional supplements
• Diet and lifestyle changes