Premenstrual Syndrome (Premenstrual Tension):
The premenstrual syndrome is a recurrent, variable cluster of troublesome physical and emotional symptoms that develop during the 7–14 days before the onset of menses and subside when menstruation occurs. The syndrome intermittently affects about 40% of all premenopausal women, primarily those 25–40 years of age. In about 10–15% of affected women, the syndrome may be severe. Although not every woman experiences all the symptoms or signs at one time, many describe bloating, breast pain, ankle swelling, a sense of increased weight, skin disorders, irritability, aggressiveness, depression, inability to concentrate, libido change, lethargy, and food cravings. The cause of premenstrual syndrome is still uncertain but attributed to female hormonal fluctuations. Psychosocial factors also may play a role.
Primary dysmenorrhea is menstrual pain associated with menstrual cycles in the absence of disease findings. The pain usually begins within 1–2 years after the menarche and may become more severe with time. The frequency of cases increases up to age 20 and then decreases with age and markedly with parity. Fifty to 75 percent of women are affected at some time and 5–6% have incapacitating pain.
Secondary dysmenorrhea is menstrual pain for which an organic cause exists. It usually begins well after menarche, sometimes even as late as the third or fourth decade of life.
Inflammation and infection of the vagina are common gynecologic problems, resulting from a variety of pathogens, allergic reactions to vaginal contraceptives or other products, or the friction of coitus. The normal vaginal pH is 4.5 or less, and Lactobacillus is the predominant organism. At the time of the midcycle estrogen surge, clear, elastic, mucoid secretions from the cervical os are often profuse. In the luteal phase and during pregnancy, vaginal secretions are thicker, white, and sometimes adherent to the vaginal walls. These normal secretions can be confused with vaginitis by concerned women.
Endometriosis is an aberrant growth of endometrium outside the uterus, particularly in the dependent parts of the pelvis and in the ovaries and is the most common cause of secondary dysmenorrhea (see illustration). While retrograde menstruation is the most widely accepted cause, its pathogenesis and natural course are not fully understood. The overall prevalence in the United States is 6–10% and is fourfold to fivefold greater among infertile women.
Women with endometriosis will complain of pelvic pain, which may be associated with infertility, dyspareunia, or rectal pain with bleeding. Initially, pain tends to start 2–7 days before the onset of menses and becomes increasingly severe until flow slackens. With increasing duration of disease, pain may become continuous.
Polycystic Ovary Syndrome(PCOS):
Polycystic ovary syndrome is a clinical syndrome characterized by mild obesity, irregular menses or amenorrhea, and signs of androgen excess (eg, hirsutism, acne). In most patients, the ovaries contain multiple cysts. Diagnosis is by pregnancy testing, hormone measurement, and imaging to exclude a virilizing tumor. Treatment is symptomatic.
Polycystic ovary syndrome occurs in 5 to 10% of women and involves anovulation or ovulatory dysfunction and androgen excess of unclear etiology. It is usually defined as a clinical syndrome, not by the presence of ovarian cysts. Ovaries may be enlarged with smooth, thickened capsules or may be normal in size. Typically, ovaries contain many 2- to 6-mm follicular cysts and sometimes larger cysts containing atretic cells. Estrogen levels are elevated, increasing risk of endometrial hyperplasia and, eventually, endometrial cancer. Androgen levels are often elevated, increasing risk of metabolic syndrome and causing hirsutism. Over the long term, androgen excess increases risk of cardiovascular disorders, including hypertension.
Dysfunctional Uterine Bleeding (DUB):
Dysfunctional uterine bleeding is abnormal uterine bleeding that, after examination and ultrasonography, cannot be attributed to the usual causes (structural gynecologic abnormalities, cancer, inflammation, systemic disorders, pregnancy, complications of pregnancy, use of oral contraceptives or certain drugs). Treatment is usually with hormonal therapy, such as oral contraceptives.
Dysfunctional uterine bleeding (DUB), the most common cause of abnormal uterine bleeding, occurs most often in women > 45 (> 50% of cases) and in adolescents (20% of cases).
Amenorrhea (the absence of menstruation):
Amenorrhea (the absence of menstruation) can be primary or secondary.
Primary amenorrhea is failure of menses to occur by any of the following:
- Age 16 or 2 yr after the onset of puberty
- About age 14 in girls who have not gone through puberty (eg, growth spurt, development of secondary sexual characteristics)
Secondary amenorrhea is cessation of menses after they have begun; evaluation for amenorrhea is usually done if menses are absent for > 6 months.
At age 40 to 50 years, the menstrual cycle usually becomes irregular, and ovulation often fails to occur. After a few months to a few years, the cycle ceases altogether
The period during which the cycle ceases and the female sex hormones diminish to almost none is called menopause.
The cause of menopause is “burning out” of the Ovaries.