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What is a normal menstrual cycle?

Bleeding that occurs between 21-28 days, lasts on average for 5 days, with an average quantity of 30-40 ml. We call this state eumenorrhoea.

What is a menstrual disorder?

Any uterine bleeding that deviates from the norm we call abnormal bleeding - naturally in the absence of pregnancy.

The amount of bleeding can change:

• If the amount of timely (regular) bleeding exceeds the average, we call it heavy bleeding (hypermenorrhoea)
• If the amount of regular bleeding is less than average, we call it light bleeding (hypomenorrhoea)

The length of the cycle can change:

• If the cycle length is regularly more than 35 days but less than 90, we call this "infrequent bleeding" (oligomenorrhoea)
• If bleeding occurs regularly more often than every 21 days, we call it frequent bleeding (polymenorrhoea)

If regularity is lost, we call this condition abnormal bleeding (metropathia). In these cases, the cyclical bleeding disappears, and patients notice a frequently varying amount of vaginal bleeding at different times. These bleeds are often persistent, last longer than 7 days, usually recur several times within a month.

This condition can occur at a young (teenage) age when the "learning" regulation of the ovary is not yet perfect. In these cases, we must think of a hormonal (endocrine) cause in a significant proportion of cases.

In adulthood, hormonal and organic (organic) anomalies may underlie menstrual disorders. What could these reasons be? This is included in the FIGO (International Federation of Gynecology and Obstetrics) AUB classification:

Organic reasons:

• Polyp: a mucous membrane fold that the endometrium gives to high estrogen levels (Estrogen is the dominant hormone in the first half of the cycle.)
• Adenomyosis: the glands of the lower layer of the endometrium and the tissue mass between the glands spread among the fibers of the uterine muscle
• Myoma: in the vast majority of cases, a benign smooth muscle tumor whose growth is stimulated by high estrogen levels
• Hyperplasia: excessive growth, proliferation of the endometrium, also due to estrogen
• EIN (endometrial intraepithelial neoplasia): a pre-cancerous condition of uterine cancer, which develops on the ground of endometrium hyperplasia.
• Uterine tumor: in a significant proportion of cases, it is related to excessive estrogen levels.

Non-organic reasons:

• Blood clotting disorder: further investigation is needed
• Ovulation dysfunction: further endocrine examination is needed in this case
• Menstrual disorder due to uterine inflammation: laboratory examination is needed in addition to gynecological; then antibiotic treatment
• Developmental abnormalities: numerous developmental disorders affecting the uterus can cause menstrual disorders
• External reasons: medications, intrauterine device
• Indeterminable reason: it can occur but is rare

From the above listing, it is clear that we are dealing with a very complex set of problems. But why is this a significant question during menopause? And what is the perimenopausal (menopausal) menstrual disorder?

Perimenopause is the period before and after the cessation of regular bleeding. When can this happen? Basically, anytime after the age of 43, but typically around 50-51 in Hungary. How long can this transitional period last? It can vary, but up to 10 years.

Why does menstrual disorder occur more frequently during the perimenopausal period?

The reason for this is that as a result of decreasing and irregular hormone production, cycles in which ovulation does not occur are becoming more frequent. The production of the dominant hormone of the second half of the cycle, progesterone, decreases, resulting in an unbalanced estrogen effect. We must imagine this as if the mucosal build-up, thickening in the first half of the cycle would not be followed by such a (physiological) transformation, as a result of which the endometrium would normally detach; but an irregular, thick vulnerable mucosa develops, causing abnormal bleeding.

What can cause this in menopause?

Essentially, most often the above hormonal changes, which are physiological to some extent. In addition to this, taking hormonal or other medications; or hormone-producing ovarian tumors.

Why can this be a problem anyway? Unfortunately, abnormal bleeding makes everyday life difficult. It impairs quality of life, can cause physical and mental difficulties. In addition, in the case of prolonged or large amounts of bleeding, anemia can develop.

In addition, unfortunately, as can be seen from the previous list, the unbalanced estrogen effect can trigger several non-physiological changes:

• Polyp formation
• Increase in myoma size
• Development or intensification of endometrium overgrowth
• Formation of uterine tumor, or its pre-cancerous condition

Why is it important to see a doctor in case of menstrual disorders developed over the age of 40?

Because the above conditions can be treated with medication in a significant proportion of cases, in other cases surgically. In many cases, bleeding is the first symptom, and the more serious changes only develop over years. So there is time to "intervene"!

We provide comprehensive examination in case of detection of menstrual disorders in our institute. In addition to the gynecological examination, we can provide laboratory, imaging (CT), endocrine examination.

In addition to drug treatment, we are available in the full spectrum of surgical interventions (curettage, hysteroscopy, laparoscopy, laparotomy, and oncological surgeries).