Menstruation

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Serious Conditions Related to Menstruation

There are several serious health conditions that can have an effect on menstruation. Toxic shock syndrome (TSS) is a potentially life-threatening bacterial infection that often is associated with the use of super-absorbent tampons. Less often, this infection may be associated with the use of the contraceptive sponge.

Symptoms of toxic shock syndrome include the following:

• Confusion
• Headaches
• Low blood pressure (hypotension)
• Muscle aches
• Rash on the palms of the hands and soles of the feet
• Redness of the eyes, mouth, and throat
• Seizures
• Sudden high fever
• Vomiting or diarrhea

Women who experience any of these symptoms after using tampons should seek immediate medical attention. If you use tampons, it is important to change them every 4–8 hours and use the least absorbent tampon for your menstrual flow.

Pelvic inflammatory disease (PID) is an infection that occurs in women when bacteria enter the reproductive organs. Sexually transmitted bacteria (e.g., gonorrhea, chlamydia) are two common types of bacteria that can cause PID. In some cases, bacteria can be introduced into the uterus through insertion of an intrauterine device (IUD) or by other medical procedures. PID can result in infertility due to scarring of the tissue of the reproductive organs.

PID may not cause noticeable symptoms. When symptoms do occur, they may include the following:

• Fatigue
• Fever
• Heavy vaginal discharge
• Irregular menstrual bleeding
• Low back pain
• Painful intercourse or urination
• Pelvic pain
• Vomiting or diarrhea

The following symptoms may indicate severe PID infection or complications and require immediate medical attention:

• Fainting (loss of consciousness)
• Fever higher than 101 degrees F
• Severe pain in the lower abdomen
• Severe vomiting

Endometriosis is abnormal growth of the lining of the uterus (endometrium). This condition occurs when endometrial tissue forms in places other than the inside lining of the uterus, such as on the fallopian tubes, ovaries, or other areas within the pelvis.

Symptoms of endometriosis include the following:

• Blood in the urine (hematuria)
• Bowel problems
• Heavy menstrual bleeding
• Infertility
• Painful intercourse and menstruation
• Pelvic pain

Adenomyosis occurs when endometrial tissue forms within the muscle tissue of the uterus. Symptoms of adenomyosis, which can sometimes go unnoticed, may include the following:

• Heavy, prolonged menstrual bleeding that may include blood clots
• Irregular menstrual bleeding (bleeding between periods)
• Painful menstruation or intercourse

Polycystic ovary syndrome (PCOS) is a condition that is caused by a hormonal imbalance. PCOS is a disorder characterized by numerous cysts on the ovaries. Complications of PCOS include diabetes and infertility. PCOS symptoms include the following:

• Acne
• Darkening skin patches
• Excessive growth of body hair
• Hair loss
• High blood pressure (hypertension)
• High cholesterol (hypercholesterolemia)
• Infertility
• Irregular menstrual periods

Other medical conditions that can cause menstrual problems include non-cancerous growths or tumors of the pelvic organs such as uterine fibroids, uterine polyps, and ovarian cysts. Cancer of the pelvic organs (e.g., ovarian cancer, endometrial (uterine) cancer, cervical cancer) can also cause menstrual problems.

When to Seek Medical Care

The following menstrual symptoms may indicate a serious medical condition. Women who experience these symptoms should contact a health care provider immediately:

• Menstruation stops for 3 months or longer
• Menstrual periods are less than 21 days apart or more than 45 days apart
• Severe abdominal or pelvic pain occurs during menstruation or sexual intercourse
• Menstruation has not started by the age of 16
• Menstrual bleeding is excessive (more than one pad or tampon per hour for several hours)
• Menstrual period lasts longer than 7 days
• You experience bleeding or spotting between periods
• Fever, vomiting, or weakness occurs after using tampons

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