Etiology and diagnosis of menstrual disorders

Irregular menstruation refers to abnormal changes of the cycle and quantity of menstruation. The changes of cycle manifest early menstruation, delayed menstruation,irregular menstruation and menostaxis, etc. ; the changes of quantity manifest profuse menstruation and scanty menstruation. Irregular menstruation is usually due to emotional factors, or attack by exogenous cold, heat and dampness that impair the thoroughfare and conception vessels and affect the functions of the viscera and the balance between qi and blood as well as that between yin and yang. Clinically changes of cycle and quantity usually appear simultaneous in irregular menstruation, though there is difference between the change of cycle and the change of quantity. For example, early menstruation is usually profuse and delayed menstruation is often scanty. Scanty early menstruation and profuse delayed menstruation are either of asthenia or of sthenia, and due to either cold or heat.Syndrome differentiation of irregular menstruation for deciding treatment should be done according to the period,quantity, color and nature of menses as well as the conditions of the tongue and pulse. The therapeutic methods for the treatment of irregular menstruation are regulating qi and blood, nourishing the kidney, strengthening the spleen and dispersing stagnation of liver qi. For the regulating qi and blood, the key point is to differentiate whether the disorder involves qi or blood. Menstruation comes from the kidney, so nourishing the kidney qi can stabilize the uterus and supplementing the kidney is essential to the regulation of menstruation. Nourishing the spleen and stomach can promote the production of blood and dispersing stagnant liver qi can promote the flow of qi, which may ensure timely sufficiency of blood in the thoroughfare and conception vessels as well as the uterus. Besides, treatment should concentrate on either the root aspect or branch aspect in clinical treatment according to the occurrence of disorder before menstruation, or during menstruation or after menstruation. Usually routine treatment focuses on the root aspect, treatment during menstruation concentrates on the branch aspect and treatment after menstruation emphasizes on the regulation of the spleen and stomach as well as that of qi and blood.Cares should be taken in using drugs of warm and dry nature to disturb blood before and during menstruation and drugs of cold and cool nature during menstruation. Regulation of menstruation should be done according to whether irregular menstruation occurs before or after disease.If disease occurs after irregular menstruation, the treatment should focus on the regulation of menstruation; if disease occurs before irregular menstruation, the treatment should concentrate on dealing with the disease. Moreover the treatment is carried out according to the age of the patient.

Early menstruation

Menstruation occurring 7 - 10 days earlier than usual is called early menstruation. If it occurs 3 - 5 days earlier than usual or just occasionally occurs earlier, it is not morbid. Continuous occurrence of early menstruation for hree cycles is regarded as morbid.

Early menstruation is usually due to blood heat and qi asthenia. Blood heat is due to frequent predomination of yang, or five emotions transforming into fire due to extreme emotional changes, or excessive intake of acrid and hot foods, or attack by exogenous heat which lead to accumulation of heat in blood and the thoroughfare and conception vessels, driving blood to flow abnormally; it may be caused by frequent deficiency of yin or intemperance in sexual life or serious and prolonged disease which consumes body fluid and disturbs the uterus; it may result from weakness of the thoroughfare and conception vessels.

Key points for diagnosis

(1) Menstruation occurs over 7 days earlier than usual.

2) Early menstruation accompanied by profuse discharge of menses may lead to metrorrhagia and metrostaxis.

(3) Menstruation more than 10 days earlier than usual with vaginal bleeding should be differentiated from intermenstrual bleeding.

(4) No organic changes in the pelvis are found in gynecologic examination.


Delayed menstruation

Delayed menstruation means that menstruation occurs over seven clays later than usual or occurs once 40 -50 days. However, occasional delayed menstruation is re-
garded as normal. Only delayed menstruation occurring for consecutive three times is considered morbid.

Delayed menstruation is either asthenia or sthenia. The former is due to consumption of blood after prolonged disease or delivery or frequent asthenia of yang and endogenous asthenia-cold; the latter is due to exogenous cold attack and endogenous cold generated by interior injury leading to stagnation of cold in the meridians and vessels,or due to mentat depression or qi stagnationand blood stasis.

Key points for diagnosis

(1) Menstruation occurs seven days later than usual continuously for three cycles.

(2) Excluding pregnancy in diagnosing woman of childbearing age.

(3) Excluding hemorrhagic disease if menstruation with mild vaginal bleeding occurs half a month later than usual accompanied by abdominal pain.


Irregularity of menstrua cycle

Menstruation occurs over seven days earlier or later than usual is called irregularity of menstrual cycle which is often caused by mental depression, stagnation of liver qi; or by frequent asthenia of the kidney, lack of proper care fter prolonged illness, multiparity and excessive sexual life which consume kidney qi. Prolonged duration of the illness may lead to metrorrhagia and metrostaxis.

Key points for diagnosis

(1) Menstruaton occurs seven days earlier or later than usual for three continuous cycles.

(2) Menstruation is not prolonged and menses is not profuse. Cares should be taken to differentiate it from metrorrhagia and metrostaxis.

Profuse menorrhea

Profuse menorrhea means that the quantity of menses obviously increases or menstruation lasts for over seven days.

Profuse menorrhea is usually caused by failure of qi to control blood due to asthenia, or by heat driving blood to flow abnormally, or by weakness of the thoroughfare and conception vessels.

Key points for diagnosis

(1) Menorrhea increases noticeably but stops after a certain period of time.

(2) Profuse menorrhea usually appears together with early menstruation or delayed menstruation.

(3) Fulminant profuse menorrhea or incessant menorrhea or irregular menstrual cycle indicates metrorrhagia and metrostaxis.

Scanty menstruation

Scanty menstruation means that menorrhea is obviously reduced and the menstrual cycle is less than two days.

The cause of scanty menstruation is similar to that of delayed menstruation and is either asthenia or sthenia. Asthenia syndrome is due to constitutional blood asthenia or kidney asthenia which leads to deficiency of essence and blood, asthenia of nutrient blood and insufficiency of blood in the uterus. Sthenia syndrome is due to stagnation of exogenous cold in the meridians and vessels; or due to qi stagnation and unsmooth circulation of blood that blocks the thoroughfare and conception vessels and the uterus,preventing the occurrence of menorrhea; or due to internal retention of phlegm and dampness that hinders the uterine collaterals and leads to scanty menorrhea.

Key points for diagnosis

(1) Menstrual cycle is basically normal, but menses is scanty or even just a little.
 
(2) Cares should be taken to exclude scanty menses due to contraceptives in women of childbearing age.

(3) Menstruation in early pregnancy is different from the problem mentioned above.