with products of conception but rarely is this the case. Blood clotting is always possible but is designed not to occur in women because plasmin, an enzyme in the endometrial tissue, keeps the menstrual blood from clotting. While some iron is lost through menstrual bleeding, it is rare to have iron deficiency anemia just because of menstruation.
Menstrual Disorders There are several menstrual disorders that can affect a woman. Each disorder represents a problem with some aspect of the menstrual cycle. For example, oligomenorrhea is a menstrual disorder that means a woman is having infrequent periods. The menstrual condition known as hypomenorrhea means the woman has extremely light periods or episodes of menstrual bleeding that are short in duration. Women with polymenorrhea have periods that are more often than every twenty-one days apart. The menstrual disorder known as hypermenorrhea involves having period bleeding that is extremely heavy or periods that last a long time. Dysmenorrhea is a condition of very painful bleeding, while metrorrhagia involves having spotting between periods that don’t rise to the level of an actual period. Absent periods altogether mean that the woman has no periods at all. Dysfunctional uterine bleeding is a hormonal menstrual problem in which the woman bleeds abnormally in any one of several ways. Women with dysfunctional uterine bleeding do not ovulate normally or don’t ovulate at all. Often the problem in this type of bleeding abnormality is a hormonal condition, but it can indicate the presence of uterine fibroids or other gynecological problems. As there can be bleeding at any point in pregnancy, all women with abnormal vaginal bleeding who are of childbearing years should have a pregnancy test as part of the workup. Many women want to control the frequency of menstruation or the amount of bleeding per menstrual cycle. The best way to do this is to take some form of hormonal birth control pills. Most hormonal birth control pills contain estrogen that is taken for twenty-one days of the cycle along with a small amount of progesterone. There is a seven-day break in which no pills are taken or the woman takes a placebo pill containing no hormones whatsoever. It is during this time that the woman has her menstrual period. Besides controlling the frequency of the periods, birth control pills prevent pregnancy with less than a ten percent failure rate with ordinary use. In the last fifteen years, there has been the development of extended cycle combined birth control pills that prevent periods from happening at all. Progesterone implants can also be used that decrease the frequency of periods to only about three to four periods per year. The mini-pill contains progestin only and is taken continuously so that no periods occur. In this way, the woman has control over when she would like to have her period. This practice is referred to as menstrual suppression.
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