Challenges with Menstruation:Fibroids,Endometriosis, and More

Experiencing menstruation is a natural part of life for most women, but the way it manifests varies from person to person. How can you determine if your menstrual cycle is causing unexpected problems?

Many girls and women encounter typical discomfort during their periods, such as cramps, lower back pain, fatigue, or general unease. However, for some, the pain is so severe that it leads to missed days at work or school. Others face exceptionally heavy bleeding that leaves them feeling drained.

These signs could potentially point to underlying issues, yet discussing menstrual problems can often be considered awkward or embarrassing.

Dr. Lisa Halvorson, a women's health expert at the NIH, notes, "Women tend to shy away from conversations about pelvic pain or abnormal bleeding, but it's important to recognize that the menstrual cycle is a vital aspect of your overall health."

Engaging in a dialogue with your healthcare provider is essential to explore your potential treatment options.

Common Menstrual Challenges

For most women, menstrual cycles typically span between 21 to 35 days, and for teenagers, it can extend up to 45 days. The duration of bleeding usually falls within the range of three to seven days. It's essential for women to become familiar with their own menstrual patterns since what's considered normal for one woman may not be the same for another.

The most prevalent menstrual irregularities encompass the absence of a period, irregular menstruation, excessive or insufficient bleeding, and the presence of excruciatingly painful cramps.

A multitude of factors can contribute to these issues, including scarring, hormonal imbalances, specific diseases or conditions, and even certain medications.

Among the most prevalent disorders leading to menstrual problems are uterine fibroids and endometriosis.

Uterine fibroids are benign growths or tumors composed of muscle cells and various other cell types that develop within or outside the uterine wall.

Studies estimate that over 70% of women in the United States will have at least one fibroid during their lifetime, though most do not experience symptoms.

Endometriosis results from tissue that typically lines the uterus growing outside of it on other organs. While many women with endometriosis remain asymptomatic, others endure life-altering symptoms.

Dr. Lisa Halvorson points out, "Endometriosis likely accounts for at least one-third of infertility in women."

Both fibroids and endometriosis can have a familial predisposition, leading women to believe that severe pain or heavy bleeding is a normal part of being a woman.

Dr. Ayman Al-Hendy, an NIH-funded gynecologist at the University of Illinois, emphasizes that families might perpetuate a culture of enduring these symptoms. However, it's crucial to recognize that treatments are available that can enhance both your health and your quality of life.

Identifying the Underlying Causes

Distinguishing between various menstrual issues can pose a challenge for healthcare professionals. Hormonal changes can be detected through blood tests, and when it comes to fibroids, ultrasound imaging proves highly effective.

However, diagnosing endometriosis presents a significant challenge, as explained by Dr. Stacey Missmer, an NIH-supported researcher at Michigan State University. Endometriosis is not easily discernible through imaging tests, and there are currently no available blood tests for its detection. The definitive way to confirm the presence of endometriosis in a woman is through surgery, during which a doctor examines the abdominal cavity through a small incision.

This diagnostic process can result in delays, primarily because surgery is not a decision to be made hastily, as noted by Missmer. In some cases, when endometriosis is suspected, doctors may initially prescribe medications to assess whether they offer relief.

Contemporary Treatment Approaches

Various medications employed to address issues like fibroids, endometriosis, and menstrual disorders function by modifying specific hormones. Birth control pills and other pharmaceuticals can inhibit these hormones.

These treatments can be effective for many women, as Dr. Lisa Halvorson notes. However, she also points out, "They can hinder a woman's ability to conceive," which may limit the duration of use for some.

Researchers have devised alternative methods to manage fibroids that don't necessitate extensive surgical procedures, and these approaches often yield positive results. Nonetheless, there is the possibility of fibroid recurrence.

For individuals with endometriosis, surgical interventions aimed at removing adherent tissue can provide relief from pain for some. Nevertheless, not all women experience relief from this type of surgery.

In cases where medications or less invasive treatments fail to provide relief, a hysterectomy may be considered as an option. This surgical procedure involves the removal of the uterus and sometimes the ovaries, rendering the individual incapable of conceiving.

Dr. Ayman Al-Hendy emphasizes that hysterectomies were once more prevalent but have become less common due to the availability of alternative treatments. He explains, "We now tend to resort to it only when other options have proven ineffective." However, it's important to note that hysterectomy does not guarantee a complete resolution of chronic pelvic pain for everyone.

Exploring Enhanced Solutions

NIH-funded researchers are actively engaged in the pursuit of innovative methods to detect, manage, and prevent menstrual issues.

Dr. Lisa Halvorson underscores the necessity for improved, noninvasive means of diagnosing endometriosis. She points out, "We require more effective methods that don't involve surgery."

Dr. Stacey Missmer is spearheading efforts to develop a test for endometriosis. She elaborates, "Many scientists are currently investigating the potential of utilizing blood, urine, and saliva. We aim to identify a distinctive signal that can ascertain whether a woman has endometriosis, eliminating the need for surgical intervention."

Regarding both fibroids and endometriosis, Dr. Halvorson emphasizes the urgency for nonhormonal treatments. She notes that such treatments are essential because "some women cannot tolerate the side effects of hormonal therapies," which are also unsuitable for women desiring pregnancy.

Dr. Ayman Al-Hendy's research delves into potential novel approaches for managing fibroids. His laboratory has uncovered evidence suggesting that vitamin D deficiency may contribute to fibroid growth. His team is presently working on developing new medications based on vitamin D and intends to assess their effectiveness in reducing fibroid size.

Researchers also hold hope that a deeper understanding of the underlying biological mechanisms responsible for menstrual problems can pave the way for early intervention and prevention, as explained by Al-Hendy.

For the time being, Al-Hendy highlights the significant benefits of women being aware of the prevalence of these disorders and the treatment options already available.

Missmer emphasizes the importance of open communication. She asserts, "If you experienced pain every time you moved your elbow, you wouldn't hesitate to consult a doctor and discuss it. Similarly, if you're experiencing pain during your period, there's no reason why it shouldn't be addressed."