Reproductive ability of women is directly related to menstruation. The girl who is incapable of reproduction in the absence of menstruation before adolescence, becomes fertile with the onset of menstruation through ovulation cycle which works callow in the beginning but later works in an order.
Menstruation is a characteristic that belong to women and primates and guarantees reproduction not every moment but at the time of ovulation. Menstruation is the discharge of intrauterine tissue (endometrium ) by bleeding.
Menstrual period can be divided into three phases.
1st stage is the “follicular phase” when the ovum is selected and become mature till reaching up to 20 mm of size ; 2nd stage is the “Ovulation phase” when the mature ovum is thrown with a small explosion ; and the 3rd stage is “Secretory Phase” when uterus is prepared until the settlement of the embryo in case of pregnancy. If this cycle continues with pregnancy , hormone levels change with the advent of intra-uterine embryo and special mechanism develop inside the uterus; in the absence of pregnancy, prepared tissue starts to be discharged with the main reason of reduce in progesterone hormone level. The cells and bodies making the connection between them are discharged via bleeding and comes out from the vagina. From time to time, the endometrium is thrown suddenly and as a whole, this is called obsolete and it is a very painful process. If intra-cranial hypothalamus, pituitary, thyroid, breasts, adrenal gland, ovaries, uterus, vagina, vulva are healthy and actively operating, menstruation develops. Menstruation cycle deteriorates in case these are not functional or the body gives emergency signal such as disease, stress, hunger, excessive exercise etc.
Absence of menstruation, lack of rapid growth or secondary sex character (breast development, body hair, smell ...) even though the girl is at the age of 14.
Absence of menstruation at the age of 16 despite normal growth and development of secondary sex characters
Absence of menstruation of a menstruating woman at least three times as much as total quantity of time between previous cycles or absence of menstruation for 6 months
These criteria include absence of menstruation but should not wait until criteria are completed in someone who has Turner syndrome, anorexia etc. Diagnosis and treatment should be provided.
In fact, “PREGNANCY” should not be missed in the absence of menstruation. This is required for everyone , no matter the person is a child or an adult.
Then what should be expected from the physician in the absence of menstruation? Firstly, the physician questions a detailed past medical history as well as family history and afterwards, examinations of breast development, body proportion, BMI,ultrasound and genital organ examination are done; if hormonal deficiency is suspected hormone profile (FSH, LH, TSH, estradiol, TSH)and biochemical values are examined.
Examination of the external genitalia is required both for evaluating the development of secondary sex characters and vaginal cavity, and diagnosing congenital malformations of genital organs. Sometimes coverage of the very simple hymen (Hyman imperferatus) can be removed with a simple surgical intervention.
Spontaneously developed amenorrhea in a menstruating woman suggests not only hormonal disorders but also inability to ovulate (anovulation).
'' Menopause'' should be questioned in every women with absence of menstruation no matter what the age is. Menopause may occur before 40s or even 20s. Family history is very important. Some genetic diseases, smoking, chronic diseases, drugs, chemo / radiotherapy ....may cause menopause. Rarely ovulation in young women can come back. But mostly, absence of menstruation is permanent. Especially the women who want to have children should apply to a physician in each menstrual irregularity.
Prolactin is a hormone secreted from the brain without requiring a basal warning and when the level is elevated, it may stop menstruation.
Menstruation deteriorates especially among young people in cases of life threatening situations such as anorexia bulimia; severe depression and sleeping disorders. Diagnosis and treatment should be done with a multidisciplinary approach.
Testicular Feminization leads to the appearance of woman and absence of menstruation due to androgen insensitivity although they are genetically male. Turner syndrome is a genetic disease presenting non-prominent visual symptoms such as flexible arms, lower hairline, short height due to a missing chromosome as well as onset of menstruation at an earlier age followed by menopause.
Birth control pills, 3 months protection needles, use of hormone spiral, Asherman syndrome - nondevelopment of uterus after curettage may lead absence of menstruation, too. These are temporary and gets back to normal with the help of treatment.
As a result, examination by a physician is required in the absence of menstruation.
Oligomenorrhea (Sparse menstruation)
It is the situation when the time between the starting days of menstruation is more than 35 days. Generally causes such as anovulation (especially PCO), insufficient ovarian capacity, Asherman's syndrome are suspected.
Drugs and prevention methods also may be causes.
Treatment is arranged according to diagnosis.
Menorrhagia ( Excessive amount and duration of menstruation)
Menstruation should last in 2 to 8 days as a standard and approximately 3 pads of bleeding should occur. But it may last in 10 days with daily 4 pads of bleeding in women using spiral. If the amount of menstruation much, it is wrong to believe that this is the cause of losing the dirty blood and what is lost is not the dirty blood. What causes the discharge of endometrium is the bleeding that occurs due to opening of vascular mouths between the muscle tissue. In this case, plenty amount of bleeding leads many problems in women - especially anemia.
Women who have much bleeding accept it as normal but this may cause other systemic diseases in the future.
By consulting to a physician, if a woman uses pain-killer during menstruation , that reduces the bleeding amount. But this is same as cutting down an unnecessarily flowing faucet.
Although excessive amount of bleeding sometimes may be a condition without an underlying pathology, in cases when it develops afterwards, it may be the symptom of a pathology such as “fibroid, polyp, hyperplasia, infection, cancer..” and diagnosed with a simple gynecologic examination.
Blood coagulation disorders and blood thinners (aspirin, heparin, etc.) may also increase the amount of bleeding and cause interval bleeding at the same time.
Treatment varies according to the diagnosis.
Metrorrhagia (irregular menstruation; Excessive amount and duration of menstruation)
Anovulation being in the first place, hormone disorders, fibroids, polyps, hyperplasia, cancer, infection, ectopic pregnancy, drug use, thyroid gland disease, adenomyosis should be examined.
If metrorrhagia develops especially after the age of 35, obtaining piece from (endometrial biopsy, pipelle biopsy) uterus or hysterescopy might be required for diagnosis. If diagnostic methods or treatments don’t benefit, hysteroscopy may be required.
Treatment varies according to the diagnosis. If it’s a simple problem, sometimes usage of medication for several months and sometimes surgery may be required.
The time between the onset of cycles are less than 24 days. Organic problems (fibroids, polyps, cancer, ...), perimenopause (menopause) are not present but since ovarian capacity is such reduced, follicular phase becomes shorter and menstruation develops frequently. Diseases of thyroid gland, blood coagulation disorders, drugs may cause frequent menstruation.
Thus, examination by a physician, regulation of medications, reasonable duration between cycles and treatment are required.
Menstruation needs a special order. Therefore, any change in the current cycle requires examination by a physician. Although this is usually caused by a simple reason, negligence leads to loss of life.
Any age group should be examined routinely every year even if there is no complaint.