MENSTRUAL PROBLEMS
WHAT PROBLEMS ARE THERE? : The main problems associated with menstrual cycle that may require treatment are:

• Amenorrhoea ( absence of menses)
• Dysmenorrhoea (pains during menses)
• Menorrhagia (excessive blood loss) and
• Premenstrual syndrome (distressing symptoms prior to menses)

AMENORRHOEA (absence of menses)
Symptoms: Absence of menses. Episodes of amenorrhoea occur, with the odd menses now and then
Causes: Amenorrhoea is normal before puberty, after menopause or during pregnancy and lactation. Others include: Anorexia nervosa, severe stress, regular strenuous exercise, the contraceptive pill-if this is stopped after prolonged use, menses may be irregular for a while.
Possible complications: None
Treatment in the home: None
When to consult a doctor: If menses stop without apparent reason. If pregnancy is likely, If anorexia is suspected, If a girl over the age of 16 has never had menses.
What the doctor may do: If you are over 16 and have never had menses, examine you to make sure that no underlying disorder is causing the amenorrhoea. In most cases the examination will reveal that there is nothing and no treatment will be necessary. Menses will start normally due to course.

• If menses are delayed by more than two weeks, examine you, and if there is a possibility of pregnancy, carry out a pregnancy test.
• If you are not pregnant and otherwise well, no treatment will be necessary. Menses may again start naturally in the next few months.
• If the menses have not restarted within a few months, he may arrange for diagnostic test to establish whether there is any underlying problem. If no problem is found, no treatment will be given.
• Should you wish to conceive, he may prescribe a fertility drug to restart ovulation.

NB. Amenorrhoea is no safeguard against pregnancy. Use contraception if you do not wish to fall pregnant.

DYSMENORRHOEA (pains during menses)
Symptoms: Severe cramping abdominal pain. Pain may spread to the back, sometimes nausea and vomiting, pain usually starts at the onset of menses.
Causes: Normal hormonal changes during menses, endometriosis, pelvic inflammatory disease, passage of blood clots during abnormally heavy menses.
Possible complications: None
Treatment in the home: Take aspirin or paracetamol in recommended doses to relieve pain. A hot bath or hot water bottle placed over the lower abdomen may also help.
When to consult a doctor: If the pain is intolerable, If menses have started to be painful after several trouble-free years.
What the doctor may do: Take a clinical history and do a physical examination. Prescribe analgesics or other suitable painkillers. Suggest using the oral contraceptive pill or some other hormonal treatment to control menstrual pain. By imposing an artificial hormonal cycle menstrual pain can be greatly reduced. If pain during menses is a new symptom, arrange for diagnostic test to establish the underlying cause. Refer you to a gynaecologist.

MENORRHAGIA (excessive blood loss)
Symptoms: Excessively heavy bleeding or flooding. Prolonged bleeding or flooding, Prolonged bleeding. Lasts more than nine days, or the time of heavy bleeding is more than four days. Frequent bleeding, i.e. menses occur more than once every 21 days. The heavy bleeding may occur regularly or irregularly.
Causes: Hormonal imbalance, fibroids, endometriosis, pelvic infection, intra-uterine contraceptive device, miscarriage.
Possible complications: Anaemia
Treatment in the home: None
When to consult a doctor: If heavier loss occurs after delayed menses, if menses have become heavier than normal, and the changes persists, if there are signs of anaemia (pallor, fatigue breathlessness on exertion, palpitations).
What the doctor may do: Take a clinical history and do a physical examination. Arrange for a full blood count; suggest an alternate method of contraception if you are using an intra-uterine contraceptive device, prescribe drug treatment to reduce excessive bleeding. Refer you to a gynaecologist is surgery is to be considered.

PREMENSTRUAL SYNDROME (distressing symptoms prior to menses)
Symptoms: Starts two to four days before menstruation and ceases immediately menses begin. Crying spells, irritability, depression, mood swings, painful breasts, abdominal bloating, swelling, and weight gain.
Causes: Normal hormonal changes that occur during the menstrual cycle, more common in women who suffer from depression.
Possible complications: None
Treatment in the home: Regular exercise or relaxation techniques may help to relieve anxiety and tension.
When to consult a doctor: If the symptoms are pronounced, If the condition is adversely affecting personal relationships or performance at work.
What the doctor may do: Take clinical history and do physical examination. Give advice on exercise and diet. He may suggest that you increase your intake on leafy green vegetables and that you reduce your intake on sugar, salt, caffeine, chocolate, alcohol, protein and fats. Recommend that you stop smoking, arrange for counseling and psychotherapy, for moderate to mild symptoms prescribe a vitamin B complex/mineral preparation or evening primrose oil. Prescribe hormonal treatment.