Menstrual Disorders

Non-menstrual vaginal bleeding

Vaginal bleeding is a fairly common symptom in women. It can range from small episodes of bleeding, perhaps following sexual intercourse, or mid-cycle, to severe haemorrhage requiring emergency assessment and treatment. In all cases, it's important to arrange a consultation.
The initial assessment of abnormal bleeding is to confirm that the bleeding is from the uterus. Yinka will take a careful history; he begins by making a distinction between a physical cause for the bleeding and a dysfunction in the relationship between the hormones originating in the brain and ovaries.

During a normal menstrual cycle, two hormones called oestrogen and progesterone are made by the ovaries; the production of these hormones is controlled by the pituitary gland in the brain. The hormones have an influence on the endometrium (the lining of the uterus), preparing it during each menstrual cycle for a possible pregnancy. Any disturbance to the function of hormones and the complex relationship between the ovaries and the pituitary gland can lead to non-menstrual vaginal bleeding.

Non-ovulating cycles are a common cause of abnormal bleeding. Certain lifestyle factors, such as alcohol consumption and smoking, or excessive weight loss, may have an effect. Gynaecological problems such as polycystic ovarian disease, endometriosis and pelvic inflammatory disease can also produce abnormal bleeding.

Investigating Abnormal Bleeding

Investigation of the causes of abnormal bleeding includes blood tests to assess hormones and ultrasound scans to check for structural causes. A review of cervical smear results is also useful. In some age groups and where the cause is not immediately found, a diagnostic laparoscopy and possibly hysteroscopy would be the investigation of choice. The treatment may involve medication or surgery, depending on the definitive diagnosis.

Dysmenorrhoea: Painful Menstruation

Painful periods are the most common of all gynaecological disorders: more than half of all women are affected by this at some point in their life.

When dysmenorrhoea occurs within a few years of the onset of menstrual periods, it is known as 'primary dysmenorrhoea'; when it occurs later in life, it is known as 'secondary dysmenorrhoea' and is generally related to gynaecological disease such as endometriosis, pelvic inflammatory disease or uterine fibroids.

If you are having painful periods, once the cause is found treatment is usually successful.
Investigation of painful menstruation.

A thorough investigation of painful menstruation entails careful checks including blood tests to assess hormone function and ultrasound scans to check for structural causes within the uterus.  

For more detailed investigation, for instance where a cause is not immediately found or your personal situation and history suggests the need, a diagnostic laparoscopy and possibly hysteroscopy would be the investigation of choice.

Premenstrual symptoms

Premenstrual symptoms are a common part of the menstrual cycle. They affect approximately 85% of women, with most women experiencing at least one premenstrual symptom. Typically there is a pattern of symptoms month after month, and when these are repeated or severe, they interfere with daily life.

The symptoms can be emotional as well as physical.
Emotional symptoms include:
  • depression
  • mood swings
  • irritability
  • difficulty concentrating
  • crying spells

Physical symptoms include:
  • breast tenderness
  • bloating
  • aches and pains
  • fatigue
  • gastrointestinal upset

To diagnose the underlying causes of premenstrual symptoms, Yinka will take a full medical history and will review your personal record of symptoms relating to your menstrual cycle.
Some premenstrual symptoms overlap with conditions like depression, anxiety, irritable bowel syndrome (IBS) and chronic fatigue syndrome or thyroid disease.

Diagnosis may involve hormone analysis, blood tests and ultrasound scans to observe the structure and condition of the uterus in close detail. Yinka's experience in gynaecological diagnosis and women's health will help him to suggest a plan of treatment or management that addresses the underlying causes that are unique to you.

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