Menstrual & Uterine Cycles

The menstrual cycle is entirely hormone driven and controlled by the ovaries and it is superior to the pituitary gland. It is not advisable to attempt any procedure for stabilization of uterine cycle unless the cause of the problem is known. The end result of hormonal imbalance is always anovulatory cycles. The patient however will present with history of menstrual irregularities and inability to conceive. A brief approach to such a case in terms of diagnosis and treatment is presented here. Specific strategy will depend on the nature of the problem.

If the bleeding is chronic, the patient may show evidence of anemia. This must be treated.
A urine based pregnancy test is done to rule out possible pregnancy as a routine precaution. This is to ensure that in the event of a pregrancy already in progress, the patient is not subject to any further investigation.

Tests to check the number and quality of platelet is done to confirm if the patient is suffering from any coagulopathies. If confirmed, this can be confirmed.

A PAP smear is a simple test to rule out cervical cancer.

Liver function tests and tests for thyroid hormone status can help eliminate these problems and if necessary correct them.

Progesterone, esterogen and prolactin levels may need to be checked. Prolactin level may be
high in a pituitary adenoma. Similarly DHEAS may be high in polycystic ovarian disease.
An endometrial biopsy may be necessary through a D & C procedure, direct hysteroscopy enabled biopsy to understand the histo-pathological status of the uterus. A transvaginal ultrasound may be needed to understand the state of the uterus and ovaries.

Generally, most cases of menstrual irregularities will have a high estrogen level in the cycle and a low progesterone level. Besides estrogen, optimal levels of progesterone at the right time is needed for ovulation. Hence using prepared hormones, the patient is placed on a regime that almost mimicks the normal menstrual cycle. If all other factors are normal, this itself will be sufficient to induce ovulation during the fertility window period. This in essence is the method of stabilization of uterine cycle. Oral contraceptive pills are prescribed with caution and only when the female does not want pregnancy. For couples desirous of a child , the female is given a series of progestin therapy. Cycles should stabilize in three months failing which hysteroscopy and if necessary, clomiphine induced release of eggs may be considered.

Non steroidal anti-inflammatory agents (naproxen, mefanemic acid) may be used to reduce bleeds and also pain if any.