Doctor’s Corner
IN the last two articles we discussed metrorrhagia, which is the medical term used to define bleeding between periods for women in the reproductive age group.
But as explained in those articles, the subject of metrorrhagia is so broad that we needed to cover it in more than just one instalment.
This article serves as the final discussion on this important topic.
As we mentioned earlier, bleeding between periods is an extremely common problem affecting 20 percent of healthy women.
Women in Lesotho are affected socially, psychologically and financially by this “problem”.
Loss of self-esteem or confidence is among the commonest social problems that women who experience metrorrhagia endure.
Psychologically, the fear that one may bleed uncontrollably in public areas is devastating and traumatising.
The expense of having to change sanitation material such as cotton wool, tampons and pads usually more than twice a day is unbearable for most women in general.
We have discussed in detail the causes of bleeding between periods such as fibroids and endometrial carcinoma (cancer of the womb).
There are causes of bleeding between periods such as endometrial hyperplasia, which is the thickening of the lining of the womb; endometrial polyps, the outgrowths of the lining of the womb; and dysfunctional uterine bleeding (DUB), bleeding without a known cause.
Dysfunctional uterine bleeding is the most common cause of bleeding in adolescence.
It may be defined medically as a change between the length of your menstrual periods and the duration of menstrual flow during each period.
It is a condition that is said to be present in a woman after the doctor has searched for all other “causes of bleeding from the womb” (a diagnosis of exclusion) such as fibroids, cancer of the womb, infections of the womb, foreign objects such as the intrauterine contraceptive devices, bleeding disorders and thyroid diseases.
Only when a thorough screening for these other causes of bleeding is negative can a doctor say that a woman has DUB.
The exact cause of DUB is not well understood in the medical circles. However, some studies done in the United States said that psychological stress has been shown to trigger DUB.
Women who have DUB usually complain of either or all of the following symptoms: bleeding between periods, menses that last for more than seven days, frequent periods that occur usually less than 24 days apart or more than 35 days apart.
The management for DUB is hormonal therapy which in our setting consists of an injection of medroxyprogesterone acetate, commonly known as DEPOT, once every three months or combined oral contraceptive pills taken daily for a specified period.
Endometrial hyperplasia (thickening of the womb’s internal lining) is a rarer cause of bleeding between periods and classically it is diagnosed by taking samples from the womb.
These samples are then viewed under the microscope and the lining of the womb is seen to be thickened.
Treatment dwells mostly in hormonal therapy.
Endometrial polyps are outgrowths from the womb’s muscle lining. They often cause patients to complain of bleeding between periods and bleeding particularly after sex.
Treatment is called polypectomy, which basically involves the removal of polyps surgically.
This marks the end of this series of articles covering bleeding between periods (metrorrhagia).
Points to note are that bleeding between periods is a common problem among women of the reproductive age group.
Metrorrhagia affects women socially, psychologically and financially.
Men need to understand these important issues that affect women in order to be able to support them emotionally and even financially.
