Dysmenorrhea and Menorrhagia and Hygiene Among Young Adults
Chapter One
Aim of the study
The main aim of the study is to carry out an investigation into dysmenorrhea and menorrhagia and hygiene among young adults. The study will seek to establish the causes and effects of these menstrual disorders. Additionally, this study introduces the treatment and management of dysmenorrhea and menorrhagia.
CHAPTER TWO
LITERATURE REVIEW
The normal menstrual cycle
Menstruation is the monthly physiologic shedding of the endometrium (Munro, 2011). The menstrual cycle is regulated by a combination of the hypothalamus, hypophysis, ovaries, and uterus. The hypothalamus and the pituitary gland regulate the reproductive hormones. The pituitary gland is often referred to as the master gland because of its important role in many vital functions, many of which require hormones. The hypothalamus first releases gonadotropin-releasing hormone (GnRH). GnRH, in turn, stimulates the pituitary gland to produce follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The ovaries at the command of FSH and LH secrete estrogen and progesterone (Ryan, 2017).
Normal menstruation results from progesterone withdrawal from estrogen-primed endometrium (Ryan, 2017). Menstrual cycle is the result of a complex interaction between the various organs as shown in Fig.1. Dysfunction at any level can interfere with ovulation and the menstruation.
Concept of menstrual disorder
A menstrual disorder is characterized as any abnormal condition with regards to a person’s menstrual cycle (Iacovides et al., 2016). There are many different types of menstrual disorders that vary with signs and symptoms, including pain during menstruation, heavy bleeding, or absence of menstruation. Normal variations can occur in menstrual patterns but generally menstrual disorders can also include periods that come sooner than 21 days apart, more than 3 months apart, or last more than 10 days in duration. Variations of the menstrual cycle are mainly caused by the immaturity of the hypothalamic-pituitary-ovarian (HPO) axis, and early detection and management is required in order to minimize the possibility of complications regarding future reproductive ability (Blessing, 2019).
Though menstrual disorders were once considered more of a nuisance problem, they are now widely recognized as having a serious impact on society in the form of days lost from work brought about by the pain and suffering experienced by women. These disorders can arise from physiologic sources (pregnancy etc.), pathologic sources (stress, excessive exercise, weight loss, endocrine or structural abnormalities etc.), or iatrogenic sources (secondary to contraceptive use etc).
There are a number of different menstrual disorders. Problems can range from heavy, painful periods to no periods at all. There are many variations in menstrual patterns, but in general women should be concerned when periods come fewer than 21 days or more than 3 months apart, or if they last more than 10 days. Such events may indicate ovulation problems or other medical conditions (Pinzauti et al., 2015).
Concept of Dysmenorrhea
Dysmenorrhea is defined as the presence of painful cramps of uterine origin that occur during menstruation and represents one of the most common causes of pelvic pain and menstrual disorder (Ryan, 2017). The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (Iacovides et al., 2016: pp. 73). In particular, chronic pelvic pain is located in the pelvic area and lasts for 6 months or longer (Iacovides et al., 2016).
The burden of dysmenorrhea is greater than any other gynecological complaint: dysmenorrhea is the leading cause of gynecological morbidity in women of reproductive age regardless of age, nationality, and economic status 4– 7 (Harada and Momoeda, 2016). The effects extend beyond individual women to society, resulting annually in an important loss of productivity. Thus, the World Health Organization estimated that dysmenorrhea is the most important cause of chronic pelvic pain (Ryan, 2017).
The estimated prevalence of dysmenorrhea is high, although it varies widely, ranging from 45 to 93% of women of reproductive age and the highest rates are reported in adolescents (Janssen et al., 2013). Because it is accepted as a normal aspect of the menstrual cycle and therefore is tolerated, women do not report it and do not seek medical care. Some women (3 to 33%) have very severe pain, severe enough to render them incapacitated for 1 to 3 days each menstrual cycle, requiring absence from school or work. Indeed, dysmenorrhea has a high impact on women’s lives, resulting in a restriction of daily activities, a lower academic performance in adolescents, and poor quality of sleep, and has negative effects on mood, causing anxiety and depression (Iacovides et al., 2016).
Dysmenorrhea can occur without an underlying problem. Underlying issues that can cause dysmenorrhea include uterine fibroids, adenomyosis, and most commonly, endometriosis (Van den Bosch et al., 2015). It is more common among those with heavy periods, irregular periods, those whose periods started before twelve years of age and those who have a low body weight. A pelvic exam and ultrasound in individuals who are sexually active may be useful for diagnosis. Conditions that should be ruled out include ectopic pregnancy, pelvic inflammatory disease, interstitial cystitis and chronic pelvic pain (Kumar and Elavarasi, 2016).
CHAPTER THREE
CONCLUSION AND RECOMMENDATIONS
Conclusion
Menstrual disorders like dysmenorrhea and menorrhagia are very common during the early post-menarchal years among young adults. Proper understanding of the normal menstrual cycle is necessary to pinpoint the causes of these disorders and aids in the judicial management of them. An accurate diagnosis obtained by thorough history, complete physical examination and focused investigations in these young adults is mandatory to direct appropriate management.
The study discussed the management and treatment dysmenorrhea and menorrhagia menstrual disorder. Menstrual problem is a chronic disease which leads to various complications on long standing. This research have proven that personal hygiene during menstruation is a good way of managing menstrual disorder.
Recommendations
- The physician must always consider the adolescent’s sensitivity and vulnerability in evaluating and treating various disorders of menstruation.
- Workshops, seminars and lecturers should be held to raise women’s general information about the physiology of menstruation and its relationship with hormonal changes are highly recommended.
- There should be a need to strongly educate women on menstrual disorder and the need to seek expert managements in severe cases.
- Self-management and self-medication should be strongly discouraged as some students tend to get involved in drug abuse and misuse.
REFERENCES
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- Harada, T., & Momoeda, M. (2016). Evaluation of an ultra-low-dose oral contraceptive for dysmenorrhea: a placebo-controlled, double-blind, randomized trial. Fertility and sterility, 106(7), 1807-1814.
- Iacovides, S., Avidon, I., & Baker, F. C. (2015). What we know about primary dysmenorrhea today: a critical review. Human reproduction update, 21(6), 762-778.
- Janssen, E. B., Rijkers, A. C. M., Hoppenbrouwers, K., Meuleman, C., & d’Hooghe, T. M. (2013). Prevalence of endometriosis diagnosed by laparoscopy in adolescents with dysmenorrhea or chronic pelvic pain: a systematic review. Human reproduction update, 19(5), 570-582.
- Kumar, K. H., & Elavarasi, P. (2016). Definition of pain and classification of pain disorders. Journal of Advanced Clinical and Research Insights, 3(3), 87-90.