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“Menstrual problems are broad and varied, and can occur in up to 80% of women in Australia
Menstrual Problems Explained
Menstrual problems are broad and varied and are categorised as follows:
- Dysmenorrhoea (painful periods) may be caused by adenomyosis, endometriosis or pelvic infection
- Menorrhagia (heavy periods) may be caused by benign muscle growths called fibroids arising from the uterine muscle wall, or as a result of bleeding disorders, thyroid problems, some forms of contraception and other causes
- Oligomenorrhoea (fewer periods than expected) commonly caused by PCOS (polycystic ovarian syndrome) in which the ovaries will produce more than the usual number of follicles in each cycle. As a result of this the ability to produce a mature follicle from which an egg is released is reduced, and ovulation may be missed, causing absence of periods. Other causes include some hormonal contraceptives and hormonal therapies
- Amenorrhoea (no periods) cessation of periods may occur for a variety of reasons including significant mental and psychological stress, significant weight loss, contraceptive use, and menopause
- Intermenstrual bleeding (bleeding between periods) always needs to be assessed. Commonly it arises in the presence of hormonal contraception or hormonal therapy but may arise without this. Assessment seeks to rule out infection, and other causes of the bleeding for example polyps arising from the skin cells in the uterus (endometrioum)
- Post coital bleeding (bleeding after intercourse) is another condition which always needs to be assessed. It is one of the red flag symptoms for cervical cancer, and as such cervical screening should be performed to ensure there are no pre-cancerous or cancerous changes on the cervix. Other causes include, cervical ectropion, which is a benign skin change on the cervix commonly occurring because of hormonal influence. Additionally, cervical polyps may exist, which are usually benign but should be removed. Many of the GPs at Evoca are able to remove cervical polyps, removing the need to visit a gynaecologist.
- Dysfunctional uterine bleeding (erratic bleeding inconsistent with the menstrual cycle) occurs mostly under the influence of hormonal contraception or therapy. In the absence of this, the whole gynaecological system must be assessed alongside hormones such as thyroid hormones, must be investigated to find the cause of the bleeding
Our Pelvic Pain Services
Pelvic pain affects up to 1 in 5 women in Australia. It may arise from any of the multiple organs in the pelvis, namely, the uterus, ovaries, fallopian tubes, bladder and bowel. It can be caused by a number of conditions.
Doing a thorough assessment of the pelvic pain is key to finding the cause, formulating the diagnosis, and then providing treatment. Your GP at Evoca will take the time to gather a full and extensive history, understanding your symptoms well before arranging any necessary investigations. Once your GP has an
understanding of your history and symptoms, they will provide options for treatment, or a referral if necessary. Managing pelvic pain often requires a multidisciplinary approach given the response of the pelvic muscles to pain arising from the pelvic organs, as well as the brain’s response to this. As such your GP at Evoca may also refer you on to specialist pelvic floor physiotherapists and psychologists to help in the holistic management of the pain. See below for a list of types of pelvic pain:
- Menstrual pain – pain relating to periods is very common and over 90% of women experience menstrual pain at some point in their lives
- Ovulation – many women experience lower pelvic cramping around the time of ovulation, commonly mid cycle
- Endometriosis – this is caused when cells that line the uterus begin to grow in other parts of the body such as on the fallopian tubes, bowels and bladder. These cells undergo the same menstrual changes as those inside the uterus, however, with no means of escape, they build up and cause scarring which results in pain
- Adenomyosis – this is similar to endometriosis, but the abnormal cell growth occurs in the muscular wall of the uterus, and giving rise to similar symptoms, and additionally painful heavy periods with painful intercourse
- Pelvic muscle pain – muscles in and around the pelvis may contract in response to pain arising from any of the organs in the pelvis. This contraction, though initially intermittent can become more constant and give rise to constant pelvic pain
- Pelvic infection/inflammation – this commonly arises from STIs which haven’t been treated in a timely manner, though can occur from other infective sources. The infection is initially low down in the genital tract in the vagina, which then ascends and involves the cervix followed by the uterus and fallopian tubes. The inflammation arising from the infection causes pain
- Vulval pain – the external party of the female genitalia including the clitoris and labia can become painful as a result of irritation, infection, inflammation and trauma. While this is usually a transient symptom and can be resolved when the cause is identified and treated, occasionally vulvodynia (vulva pain) can become chronic in nature and sever, affecting the ability to use tampons or even have intercourse. In this scenario a condition called vaginismus may arise in which the vagina also becomes painful in these scenarios
- Recurrent UTI – repeated urinary tract infections can cause chronic pelvic pain
- Intersitital cystitis – this occurs as a result of chronic inflammation of the bladder lining without urinary tract infection, but usually with symptoms of such, for example urgency and frequency of urination and pain on passing urine, usually in the bladder or pelvic area
- Bowel problems – conditions which cause pain in the bowel such as Irritable Bowel Syndrome (IBS), Inflammatory Bowel Disease (IBD), and chronic constipation, can also cause pain in the pelvis due to the proximity of the bowel to the pelvic organs.
How to prepare for your visit
Keep a diary of your symptoms noting relieving and exacerbating factors or triggers
Keep a diary of your menstrual cycle so that your GP can correlate this with your symptoms. Details such as dates, length, and details of flow are important
Consider and score your pain on a scale of 0-10, with 0 being no pain at all and 10 being the worst you have ever experienced
Come prepared to talk about how these symptoms affect your life day to day, including sexual function, bowel function and bladder function. This will help us tailor a management plan to improve your symptoms.
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Management of pelvic pain comes down to first identifying the cause. In some cases, this may take time to identify. Pelvic pain can be managed by a number of different modalities ranging from TENS, acupuncture and simple pain control, to nerve injections and pelvic floor physiotherapy
Not necessarily. Pelvic pain can arise for a number of reasons and from a number of sources, so it isn’t always caused by endometriosis. All the organs in the pelvic area have the potential to cause pain as well as the ligaments nerves and muscles in the area too.
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