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MESSAGES TO
Menstrual Problems

Menstrual Problems

A DxD Session with Dr Fong Yoke Fai


Ended on Wed Jul 24 2019
Ended

Top Answers


Bloating and cramping are what doctors term as "vague" symptoms as they do not specifically point to any particular organ or structure in the body, yet sometimes these can be the first signs of something more serious happening within the body. 

For a younger person, female, like yourself, it very often could be due to hormonal changes or fluctuations during the menstrual cycle. Some are associated with "premenstrual symptoms" such as headaches, mood change, feeling of water retention, or even acne outbreaks. 

However, as mentioned earlier, sometimes these symptoms could be due to other medical conditions, such as endometriosis, or growths within the pelvis such as ovarian cysts.

If the symptoms are persistent or worsening, it may be a good idea to get an ultrasound scan of the pelvis (which is easy to perform).

Best regards

Dr YF Fong

4 Apr 2018

Mid cycle spotting is not uncommon, and it occurs around the time of the ovulation, due to a temporary drop in the levels of hormones (which helps to build up the inner lining of the womb). 

If you have taken the birth control pill and it stops the mid cycle spotting, it indicates ovulation as the likely reason for the mid cycle bleeding. This is because the birth control pill works by inhibiting ovulation (hence preventing pregnancy).

Usually mid cycle spotting due to ovulation lasts 1-2 days and clears quickly. However, there could be other reasons for longer bleeding, such as endometrial polyps or a very thickened womb lining. If you are worried, then I would suggest getting an ultrasound of the pelvis to check the uterus/ lining of the womb.   

Regards

Dr YF Fong

4 Apr 2018

Thanks for your question. 

It may be helpful if we explore some of the causes for this intermittent bleeding - sometimes termed as "breakthrough bleeding". 

If the pill is not taken on a daily / regular basis, the temporary drop in the level of hormones can lead to intermittent bleeding. If you are on any long term medication (eg some antibiotics or anti-epilepsy medication) that increases hormonal metabolism/ breakdown, this can lead to a lowered level of the contraceptive hormone and this can also lead to bleeding. 

Sometimes, if the pill is of a ultralow dose of hormone, or the progestogen component (birth control pills consist of both estrogen and progestogen components) is "mild", some women do have breakthrough bleeding even when they are taking the pill regularly. In this instance, a switch of contraceptive pills may help. 

However, do remember to go for your regular Pap smear screening. If the bleeding is persistent even after a switch of pills or even when you stop the pill, then it is probably advisable to see a doctor to check for other abnormalities such as endometrial polyps or cervical problems.

Regards,

Dr Fong Yoke Fai                                                                                                         

18 Apr 2018

You should be able to delay the onset of your menses till after the trip. Usually we will recommend starting to take some hormone pills at least 3-4 days prior to your menses, and to continue throughout the trip, till you are back.

Once home, you can stop the hormone pills and then your menses should come within the next 1-2 days.

You may get some minor side effects like water retention, feeling of bloatedness, occasionally headaches or slight mood change etc. Usually the chance is low given that we are giving a low dose hormone pill and the side effects will resolve once you stop it. 

You may see either a GP or Gynaecologist to get the hormone pill. Please note that the hormone pill is not meant to be contraceptive in nature in this instance and it does not stop ovulation or prevent pregnancy. 

Have a good trip!

Best regards

Dr YF Fong

4 May 2018

If you are only having menses once a year, this is highly unusual and I would highly suggest that you see a gynaecologist for evaluation. 

Normal cycle length usually ranges between 24 to 38 days - that is, most women would have a menstrual bleed a month.

While some women do have a longer cycle length of say 45 to even 60 days, a history of having menses only 2-3 times a year would immediately alert the gynaecologist to look for the possibility of polycystic ovarian syndrome.

This is a condition whereby the eggs of the ovary do not develop to maturity enough to ovulate, hence there are many eggs that are "arrested" in mid phase.

These eggs continue to produce the female hormone estrogen, which stimulate and thicken the womb lining, but yet there is no ovulation to trigger the second half of the menstrual cycle to result in menses (shedding of the womb lining). 

This is a cause for concern because the continued stimulation of the womb lining (due to unopposed estrogen) can cause womb lining thickening that can increase the risk for cancer of the womb lining in the future.

Polycystic ovarian syndrome is also associated with other risks such as obesity, hypertension, and diabetes mellitus. 

Of course if ovulation only occurs sporadically, this can affect the chances of getting pregnant. 

I would advise you NOT to delay in seeking a gynaecological evaluation. 

Best regards

Dr Fong Yoke Fai

6 May 2018

Menstruation can be assessed according to frequency (24 -38 days), regularity (+/- 7days), duration (<8 days) and volume (whether heavy, normal or light).

If you have been bleeding for about 4 weeks, it is considered as a form of abnormal uterine bleeding (AUB) and you should probably seek a medical consult. 

AUB can be both pregnancy or non-pregnancy related causes. Examples of pregnancy related causes can be threatened miscarriage, ectopic pregnancy or early miscarriage.

Non-pregnancy related causes can be due to endometrial polyps, inflammation or infection of the genital tract, hormonal imbalance (e.g. thyroid disorders), non ovulation or fibroids. 

A clinical assessment with a pelvic ultrasound scan should be able to evaluate for most of these causes.

Hope this helps.

Regards,

Dr Fong Yoke Fai

15 May 2018

 

The best advice I can give is actually to go for a check. There are reliable tests to check for infections such as chlamydia, gonorrhea, and other possible STIs. While a white discharge is often associated with a fungal/ yeast infection, which sometimes flare up with the menses, there can be a concurrent bacterial infection which may or may not be sexually transmitted. 

Some of these STIs in women can be silent, yet can have important sequelae. For example, STIs like chlamydia and gonorrhea are associated with pelvic infections that can lead to subsequent damage to the fallopian tubes (which bring the egg from ovary to the uterus), and this can result in infertility or an increased risk for future ectopic pregnancies.

Anyone can be at risk for STIs as long as there is unprotected intercourse, that is, sex without the use of condoms. Of course, we would like to emphasise that prevention is better than cure, so insisting on use of condoms from beginning to the end of sex would be a good way to protect yourself.

Hope this helps.

Dr Fong Yoke Fai

21 May 2018

Treatment is dependent on whether the fibroids are affecting the woman's quality of life e.g. heavy menstrual bleeding, severe pain, anemia etc.

If removal is required, surgical options include hysteroscopic surgery, laparoscopic surgery, and for some cases, open surgery. The type of surgery performed will be dependent on the assessment done by the gynaecologist to determine the nature and location of the fibroids.

Hysteroscopic surgery is a minimally invasive procedure that is done trans-vaginally to remove the fibroids. It can be done as a day surgery. As there are no incisions made, the recovery rate is usually very high as there are no scars in the abdomen.

Laparoscopic surgery is another minimally invasive surgical option where a few small incisions are made on the abdomen. Thin surgical instruments are inserted through the incisions to remove the fibroids and the incisions are stitched up after.

The recovery rate of this procedure is also very fast since only small incisions of 5-10 mm are made on the abdomen. In some instances, it is even possible to perform single incision myomectomy that will minimize scarring and post operative pain.

Alternatively, there is an advanced non-invasive, non-surgical therapy called High-Intensity Focused Ultrasound (HIFU). This is a day surgery procedure that uses Real time ultrasound and high-intensity ultrasound waves to target individual fibroids to destroy the cells and shrink them.

Hope this helps.

Dr Fong Yoke Fai

22 Jun 2018

Usually some variation in the volume of flow and presence of clots do occur from cycle to cycle. However, if you do notice there has been a consistent increase over a number of cycles, then one should consider the possibility of fibroids and endometrial polyps.

Menstrual bleeding comes from shedding of the inner lining (endometrium) of the womb at the end of every menstrual cycle. If there are any factors that may increase the surface area for bleeding, or interfere with the mechanism of clotting (the usual way a person stops bleeding), then a woman may experience heavy menstrual flow. 

Fibroids (muscular growths of the uterus) may occur within or near the inner lining of the womb, thereby distorting the normal mechanism of clotting and allowing more surface area for small blood vessels to bleed. Similarly, polyps which are excess outgrowths from the womb lining can also have a similar presentation. 

Of course there could be other unusual causes but these are generally quite rare e.g. blood clotting disorders. 

Fibroids and polyps can interfere with future pregnancy, since they occupy space within the cavity of the womb and can prevent implantation of the pregnancy. If they are present and significant enough to cause heavy menstrual bleeding, then they should be dealt with, usually with a fairly simple procedure to remove/ cut it out. 

An assessment with a pelvic ultrasound scan will help and should be able to detect any significant fibroids or polyps. Hope this helps.

Dr Fong Yoke Fai 

16 Jul 2018

Some women experience mid cycle spotting for a couple of days and this might actually be a sign of ovulation. This is because just before ovulation occurs, there is a little dip in the level of hormones produced by the ovary. This results in slight spotting before the levels build up quickly again.

Some gynaecologists will prescribe the birth control pill for a few cycles to see if the mid cycle bleeding stops. The rationale is that if ovulation is the cause, then the birth control pill works by stopping ovulation and so there is no bleeding.

It is unusual to bleed continuously for 3 weeks though. Even for normal menstruation, it usually does not last beyond 1 week. In a young woman, this is quite likely due to hormonal changes related to delayed or missed ovulation. However, there can be other possibilities such as polyps, fibroids, inflammation or sometimes infection of the genital tract. If the prolonged bleeding is persistent, do see a doctor for an evaluation.

Best rgds

Dr YF Fong

29 Aug 2018

Top Questions


I’m a 23 year old female, sexually active but I’ve been practicing safe sex. I get spotting instead of a regular period, and previously took hormone pills to stop my spotting when I’m on holiday. After taking those pills my period was rather regular, but recently I’ve been spotting again.

I noticed that my menstrual blood is very dark (almost black) on the first day of my period. The blood becomes lighter and redder on subsequent days. This has been happening for the past 3 cycles. When is dark menstrual blood a cause for concern? 

I’m 44 this year, my menstrual cycle is usually prompt. However I missed my cycle this month. I also find myself perspiring easily, even in an air-conditioned room. How will I know if my menopause has started?