Menstrual Disorders in Jaipur

What menstrual disorders are and how they happen

Menstrual disorders cover irregular, heavy or painful periods that affect daily life. Heavy menstrual bleeding means blood loss that interferes with your physical, social, emotional or material quality of life. It is not normal and can be a sign of an underlying health problem that needs treatment.

A normal cycle comes every 21 to 35 days and lasts up to 7 days. When cycles fall outside 38 days or vary by more than 21 days, it suggests an ovulatory disorder.

The FIGO PALM-COEIN system groups causes into structural problems — polyp, adenomyosis, leiomyoma (fibroids), malignancy — and non-structural problems — coagulopathy, ovulatory disorders, endometrial causes, iatrogenic (treatment-related) and not otherwise classified.

The lining of the womb (endometrium) thickens each month under the influence of oestrogen. If ovulation does not occur, progesterone is not produced to stabilise the lining. Unopposed oestrogen leads to marked proliferation and thickening, resulting in heavy bleeding with altered frequency.

Hypoxia, inflammation, haemostasis and angiogenesis all play crucial roles in the normal shedding and scarless repair of the endometrium; perturbation of these processes can cause abnormal bleeding.

Many women with fibroids or polyps have no symptoms at all. When symptoms appear, they reflect the size, number and location of these growths. Fibroids are hormone-responsive tumours; by age 50, almost 70% of white women and over 80% of black women will have developed at least one fibroid. Adenomyosis is associated with increasing age and may co-exist with fibroids. The incidence of polyps and fibroids both increase with age and they frequently co-exist.

Symptoms of menstrual disorders and warning signs that need urgent care the same day

You may have heavy menstrual bleeding if you need to change your pad or tampon every 1 to 2 hours, or use two types of period product together such as a pad and a tampon.

Other signs include:

• Periods lasting more than 7 days
• Passing blood clots larger than about 2.5 cm (the size of a 10p coin)
• Bleeding through to clothes or bedding
• Needing to change pads or tampons during the night

You may also avoid daily activities like exercise or take time off work because of your periods, or feel tired or short of breath a lot.

Bleeding that soaks through one or more tampons or pads every hour for several hours in a row, or needing to wear more than one pad at a time, are also signs of heavy menstrual bleeding. Menstrual flow with blood clots as big as a quarter or larger is another sign.

Irregular cycles — periods that come too often, too rarely, or unpredictably — suggest an ovulatory disorder. Painful periods that affect your life also need evaluation.

Warning signs that need urgent care the same day include bleeding between periods or after sex, severe pain during periods that is not relieved by usual painkillers, heavy bleeding with dizziness, fainting or shortness of breath (which may indicate severe anaemia), and heavy periods with other symptoms such as pain when passing urine, passing stool or during sex. Persistent intermenstrual bleeding should be evaluated promptly as it can be an early sign of endometrial cancer.

Causes of menstrual disorders and who is at higher risk

Structural causes include fibroids, polyps, adenomyosis and malignancy. Fibroids and polyps can cause heavy menstrual bleeding. Adenomyosis can also cause heavy bleeding. Endometrial cancer is the most common gynaecological malignancy in the western world and heavy menstrual bleeding can be an early sign. Uterine sarcoma is rare but may cause abnormal bleeding.

Non-structural causes include coagulopathies (bleeding disorders), ovulatory disorders, endometrial causes and iatrogenic causes. Coagulopathies affect about 13% of women presenting with heavy menstrual bleeding; the majority have Von Willebrand disease. Irregular ovulation can cause heavy bleeding. Polycystic ovary syndrome (PCOS) and hypothyroidism are medical conditions that can cause heavy menstrual bleeding.

Obesity, anorexia, weight loss, mental stress and extreme exercise can also affect ovulation:

• Obesity
• Anorexia
• Weight loss
• Mental stress
• Extreme exercise

Endometrial causes occur in a structurally normal uterus with regular cycles and no coagulopathy; they likely reflect local problems with clotting, inflammation or blood vessel formation. The copper intrauterine device (IUD) can cause heavier menstrual bleeding, especially during the first year of use. Some medicines, including anticoagulants and chemotherapy, can cause heavy periods. Blood thinners and aspirin can also cause heavy bleeding.

Pregnancy-related causes include ectopic pregnancy and miscarriage. Pelvic inflammatory disease can cause heavy bleeding. Endometriosis can also cause heavy menstrual bleeding.

Higher risk factors include age — fibroids and polyps increase with age; obesity — a high BMI increases the risk of ovulatory dysfunction and heavy or irregular menstrual loss; Black women have an approximately twofold increased risk of fibroids; long-term use of tamoxifen, previous pelvic radiation therapy and rare inherited disorders increase the risk of uterine sarcoma; and a structured history can identify 90% of women with systemic bleeding disorders.

How menstrual disorders are diagnosed: examination and tests

When you see your gynaecologist about menstrual disorders, you will be asked about your menstrual cycle — the dates your period started, how long bleeding lasted, and the amount of flow. You will also be asked about past and present illnesses, surgical procedures, and your birth control method. A structured screen for coagulopathies identifies 90% of women with disorders of systemic haemostasis.

A physical examination is done. Transvaginal ultrasound (TV-USS) remains the most acceptable and validated first-line investigation. It helps identify fibroids, polyps and adenomyosis, though fibroids may be confused for focal adenomyosis and vice versa using conventional imaging. Saline infusion sonohysterography (SIS) and selected hysteroscopy improve sensitivity and specificity for diagnosis of polyps and submucosal fibroids.

An ultrasound exam uses sound waves to make a picture of the pelvic organs. A hysteroscopy uses a thin, lighted scope inserted into the uterus through the cervix to see the inside of the uterus. Sonohysterography places fluid in the uterus through a thin tube while ultrasound images are made.

MRI plays a role in selected patients with fibroids and in assessment for uterine artery embolisation, though it is relatively poor at ruling out sarcomatous change.

Blood tests may be ordered to check for iron deficiency anaemia and other underlying conditions. An endometrial biopsy removes a sample of the lining and looks at it under a microscope to rule out malignancy or premalignant changes.

Endometrial sampling is recommended in women with persistent intermenstrual bleeding or aged 45 years or older with treatment failure; some guidelines lower this age to 40. Clinical judgement is used for women under 40 with risk factors such as obesity and PCOS. The endometrium should be properly sampled and evaluated before any surgery to rule out malignancy.

Treatment options without surgery for menstrual disorders and when surgery is advised

Medical therapy is tailored to the individual. Non-hormonal options include tranexamic acid and NSAIDs (such as mefenamic acid), which are the only fully non-contraceptive medical options. Tranexamic acid is an antifibrinolytic that prevents the breakdown of clots; it is taken during heavy bleeding days, typically 1 g three to four times daily for about 4 days per month.

It reduces bleeding by 30–55% in chronic abnormal uterine bleeding. NSAIDs reduce prostaglandin levels and achieve a 25–50% reduction in blood loss. They can be used together but should be stopped after 3 months if there is no improvement; if beneficial, they may be continued indefinitely.

Hormonal options include combined oral contraceptive pills (COCP), which suppress ovulation and reduce blood loss by about 50% while regulating bleeding. The vaginal ring and transdermal patch work similarly but require less frequent administration. Progestin therapy (such as norethisterone 5 mg three times daily from day 5 to 26 of the cycle) reduces blood loss by over 80%.

The levonorgestrel-releasing intrauterine system (LNG-IUS) decreases menstrual loss by up to 96% after one year. Depot medroxyprogesterone acetate (DMPA) is an injection given every 12–14 weeks and can induce amenorrhoea in up to 50% of users.

GnRH agonists induce a temporary medical menopause and are effective but limited to short-term use due to side effects on bone density; add-back hormone therapy is used after 6 months.

Surgical management is considered when medical therapy fails to alleviate symptoms, or for structural causes such as fibroids or polyps. Hysteroscopy can be diagnostic or operative to remove polyps or fibroids. Endometrial ablation destroys the lining of the uterus to stop or reduce menstrual bleeding. It is typically considered after medication or other therapies have not worked.

It should not be used if you desire future fertility, have known or suspected premalignant or endometrial carcinoma, or for the sole treatment of fibroids or polyps. Contraception is recommended after ablation in premenopausal women.

Other surgical options include myomectomy (removing fibroids without removing the uterus), uterine artery embolisation (blocking blood flow to fibroids), and hysterectomy (removal of the uterus) when other treatments have failed or are not an option. Your surgeon will advise which option suits you based on your fertility wishes, the underlying cause, and your overall health.

Your first visit and tests for menstrual disorders

Your first visit usually takes 20 to 30 minutes. Your doctor will ask about your menstrual cycle, including the dates your period started, how long bleeding lasted, and the amount of flow. You will be asked about past and present illnesses, surgical procedures, and your birth control method.

The doctor will also ask whether heavy periods are affecting your daily life, if you have severe pain, bleeding between periods or after sex, or other symptoms such as pain when passing urine or during sex.

A physical examination is done. Blood tests are often ordered to check for iron deficiency anaemia and other underlying conditions. An ultrasound exam uses sound waves to make a picture of the pelvic organs and is the first-line imaging test.

If needed, your doctor may suggest a hysteroscopy, where a thin, lighted scope is inserted through the cervix to see inside the uterus.

An endometrial biopsy may be taken to look at the lining under a microscope, especially if you are aged 40 or above with risk factors such as obesity or polycystic ovary syndrome, or if you have persistent intermenstrual bleeding. Other tests such as sonohysterography or MRI may be used in selected cases. Please bring any previous medical records, imaging reports, and a list of medicines you are taking.

How menstrual disorder treatment works

Treatment is tailored to the cause of your bleeding, your age, other medical conditions, and whether you wish to have children in the future. Your doctor will discuss the options with you.

Medical options are often tried first. Non-hormonal tablets such as tranexamic acid reduce heavy bleeding by helping blood clot; it is taken only on heavy bleeding days, typically 1 g three to four times a day for up to five days. NSAIDs such as mefenamic acid are also used during the first days of the period.

Combined oral contraceptive pills regulate cycles and reduce blood loss by about 50 percent in studies. Progestogen tablets such as norethisterone 5 mg three times daily from day 5 to 26 of the cycle can reduce blood loss by more than 80 percent. The levonorgestrel-releasing intrauterine system reduces menstrual loss by up to 96 percent after one year.

Other hormonal options include:

• The vaginal ring
• Transdermal patch
• Depot medroxyprogesterone acetate injection every 12 to 14 weeks
• The etonogestrel implant

GnRH agonists or antagonists may be used for short periods before surgery to shrink fibroids.

If medical treatment does not help, or if there are structural causes such as polyps or fibroids, your doctor may refer you for a hysteroscopy. This can be diagnostic or operative to remove polyps or fibroids. Endometrial ablation is a day-care procedure that destroys the lining of the uterus to stop or reduce menstrual bleeding.

It is considered only after medication or other therapies have not worked and is not suitable if you want future pregnancy. Contraception is recommended after ablation until menopause. Other surgical options such as myomectomy, uterine artery embolisation, or hysterectomy may be discussed depending on your situation. Your surgeon will advise which technique suits you.

Risks and possible complications of menstrual disorder treatments

All treatments carry some risks.

With combined oral contraceptive pills, common side effects include:

• Breast tenderness
• Breakthrough bleeding
• Nausea
• Weight gain

Serious but rare risks include blood clots, stroke, and cardiovascular disease, particularly in women over 35 who smoke, have hypertension, migraine with aura, or a personal or family history of venous thromboembolism. Progestogen-only pills can cause irregular and unpredictable bleeding.

Depot medroxyprogesterone acetate may cause:

• Weight gain
• Headaches
• Oedema
• Depression
• A temporary reduction in bone mineral density with long-term use

The etonogestrel implant often causes breakthrough bleeding. GnRH agonists and antagonists create a low-oestrogen state that can lead to hot flushes, vaginal dryness, bone loss, and reduced HDL cholesterol; add-back hormone therapy is used after six months to protect bone. Danazol can cause male characteristics such as acne and voice changes.

Tranexamic acid is generally well tolerated; gastrointestinal symptoms are the most common side effect. NSAIDs should be avoided if you have a peptic ulcer, kidney disease, or allergy.

Hysteroscopy carries risks of uterine perforation, infection, and Asherman syndrome (scar tissue inside the uterus). Endometrial ablation risks include uterine perforation, infection, vaginal or skin burns, and incomplete ablation of the cavity. Pregnancy after ablation is rare but carries a greatly increased risk of serious complications.

If fibroids are large or the cavity is distorted, some ablation devices cannot be used. Your doctor will explain the risks that apply to your chosen treatment.

Recovery and aftercare for menstrual disorder treatment

Most medical treatments start working within one or two cycles. Tranexamic acid and NSAIDs are taken only during heavy bleeding days, usually about four days a month. Hormonal tablets are taken daily or cyclically as prescribed. The intrauterine system is fitted in the clinic; you may have cramps and spotting for a few weeks.

If cramps are not eased with routine painkillers, contact the hospital. If the threads are not visible, an ultrasound is done to check the position.

After hysteroscopy or endometrial ablation, you usually go home the same day. You may have watery vaginal discharge for about a week. Use sanitary pads, not tampons, for two weeks. Avoid heavy lifting and strenuous exercise for a few days. Your doctor will advise when you can return to work and normal activities. Contraception must be continued after ablation until menopause.

Call the hospital if you develop:

• Heavy bleeding that soaks a pad in an hour
• Fever
• Severe abdominal pain
• Foul-smelling discharge
• Feel faint

Regular follow-up is important to check haemoglobin levels and treatment response. If medical treatment shows no improvement after three months, your doctor will review the plan. Maintaining a healthy weight and regular exercise can help reduce ovulatory dysfunction.

Results of menstrual disorder treatments

In studies, tranexamic acid reduces menstrual blood loss by 30 to 55 percent and improves quality of life. NSAIDs such as mefenamic acid reduce blood loss by 25 to 50 percent. Combined oral contraceptive pills give an estimated 50 percent reduction and regularise cycles.

High-dose progestogen (norethisterone 5 mg three times daily from day 5 to 26) reduces blood loss by more than 80 percent. The levonorgestrel intrauterine system decreases menstrual loss by up to 96 percent after one year, with amenorrhoea in up to 90 percent of users at one year in some trials.

GnRH agonists achieve amenorrhoea in up to 90 percent of women but are limited to short-term use due to side effects.

Endometrial ablation results in amenorrhoea in about 25 percent of women and a 90 percent patient satisfaction rate in studies. Microwave endometrial ablation has shown higher satisfaction rates in some studies. Hysteroscopic removal of polyps or fibroids improves bleeding in most women.

Outcomes vary depending on the underlying cause, age, and whether other conditions such as adenomyosis or coagulopathy are present. About one in five women may have persistent bleeding despite treatment. Your doctor will discuss what results you can expect based on your diagnosis.

Cost and insurance for menstrual disorder treatment in Jaipur

The typical price range for evaluation and treatment of menstrual disorders in India is ₹800 to ₹2,500. The final cost depends on the reason for the problem. If it is due to hormonal issues, the cost covers certain tests and medication.

If it is due to fibroids or ovarian cysts, the cost depends on the line of treatment chosen, such as hysteroscopy or endometrial ablation.

Jaipur Hospital is a NABH-accredited multispeciality hospital established in February 1991. It accepts RGHS, MAA Yojana, CGHS, and a panel of private insurers and TPAs. If you have an individual health insurance policy, inpatient treatment is usually covered after a waiting period of two years from the policy start date.

If you are covered under a company-provided policy, surgery may be covered from day one. Please check the terms of your policy for room rent capping and co-payment details to avoid financial surprises. The hospital has an in-house pharmacy, diagnostic laboratory, and imaging facilities. For an estimate, please contact the hospital on 0141-2551500, 0141-2554139, or +91-7414-001-001.