Menstrual Disorder Treatment in Dubai | Heavy & Irregular Periods

Expert treatment for menstrual disorders in Dubai. Comprehensive care for heavy periods, irregular cycles, painful menstruation, and missing periods by experienced gynecologists.

Comprehensive Menstrual Disorder Diagnosis & Treatment

Menstrual disorders affect 14-25% of women of reproductive age, significantly impacting quality of life, work productivity, and emotional wellbeing. At our Dubai clinic, DHA-licensed gynecologists provide expert evaluation and treatment for all menstrual irregularities following American College of Obstetricians and Gynecologists (ACOG) and International Federation of Gynecology and Obstetrics (FIGO) guidelines. Our comprehensive approach addresses heavy menstrual bleeding (menorrhagia), irregular or absent periods (oligomenorrhea/amenorrhea), painful periods (dysmenorrhea), premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD), breakthrough bleeding, and post-menopausal bleeding through thorough diagnostic workup, medical management, minimally invasive procedures, and surgical interventions when necessary.

What Does Menstrual Disorder Evaluation Involve?

Comprehensive menstrual disorder evaluation involves detailed menstrual history (cycle length, duration, flow volume, pain severity using validated scales), bleeding diary review tracking patterns over 2-3 months, physical examination including pelvic exam and speculum examination, laboratory testing (complete blood count for anemia, hormonal panel including FSH, LH, prolactin, thyroid, testosterone, progesterone, coagulation studies if excessive bleeding), transvaginal ultrasound assessing uterine size, endometrial thickness, fibroids, ovarian cysts, adenomyosis, endometrial biopsy if abnormal bleeding and age >45 or risk factors for endometrial cancer, treatment options including hormonal therapy (birth control pills, IUD, progestins), tranexamic acid or NSAIDs for heavy bleeding, endometrial ablation for refractory cases, and hysterectomy reserved for severe cases unresponsive to conservative management.

Who Needs Menstrual Disorder Treatment?

Women with heavy menstrual bleeding: soaking through pad/tampon every 1-2 hours, passing large clots, bleeding >7 days
Those experiencing anemia symptoms from blood loss: fatigue, weakness, shortness of breath, pale skin, dizziness
Anyone with irregular cycles: periods occurring <21 days or >35 days apart, unpredictable timing
Women with absent periods (amenorrhea): missing 3+ consecutive periods without pregnancy, never had period by age 16
Those with severe menstrual pain (dysmenorrhea) interfering with daily activities, school, or work
Women experiencing premenstrual symptoms significantly affecting mood, relationships, or functioning (PMS/PMDD)
Anyone with breakthrough bleeding on hormonal contraception or unusual bleeding between periods
Post-menopausal women experiencing any vaginal bleeding (always requires evaluation to rule out cancer)

Benefits of Expert Menstrual Disorder Care

Accurate diagnosis identifying underlying cause: fibroids, adenomyosis, polyps, hormonal imbalances, blood disorders
Anemia treatment and prevention through bleeding reduction improving energy, concentration, and overall health
Restored quality of life: ability to work, exercise, travel without fear of heavy bleeding or severe pain
Menstrual cycle regulation enabling family planning, fertility optimization, and predictable periods
Pain relief through targeted treatments reducing dysmenorrhea from debilitating to manageable
Preservation of fertility with uterus-sparing treatments (hormonal therapy, ablation) avoiding hysterectomy when possible
Cancer detection and prevention: identifying and treating endometrial hyperplasia before it progresses to cancer
Improved mental health addressing PMS/PMDD symptoms that cause depression, anxiety, and relationship difficulties
Personalized treatment plans balancing symptom relief with your fertility goals, lifestyle, and preferences
Long-term management strategies preventing recurrence and optimizing reproductive health

Preparing for Your Menstrual Health Consultation

Important Preparation Guidelines:

Track your menstrual cycles for 2-3 months before consultation: start date, duration, flow heaviness, pain severity
Use bleeding diary or period tracking app documenting number of pads/tampons used daily, clot size
Note associated symptoms: cramping severity (0-10 scale), nausea, diarrhea, headaches, mood changes
List all medications and supplements including hormonal contraceptives, NSAIDs, herbal remedies
Document impact on daily life: days missed from work/school, activities avoided, quality of life impairment
Bring previous ultrasound reports, blood test results, or operative notes if any prior gynecologic procedures
Prepare questions about treatment options, fertility preservation, expected outcomes, and timeline for improvement

What to Expect During Your Visit

1Before the Exam

•Detailed menstrual history review: age at first period, cycle regularity, changes over time, previous treatments
•Bleeding pattern assessment: frequency, duration, volume (pictorial blood loss assessment chart may be used)
•Pain evaluation: location, severity, timing (during period vs ovulation vs continuous), pain medication effectiveness
•Reproductive history: pregnancies, deliveries, miscarriages, contraception use, fertility desires
•Medical history: bleeding disorders, thyroid disease, PCOS, medications affecting menstruation

2During the Exam

•Physical examination: abdominal palpation checking for masses, enlarged uterus, tenderness
•Speculum examination: visualizing cervix, checking for polyps, lesions, source of bleeding
•Bimanual pelvic exam: assessing uterine size, mobility, tenderness, adnexal masses
•Blood tests: Complete blood count (hemoglobin, iron levels), hormonal panel (FSH, LH, prolactin, TSH, testosterone), progesterone (confirms ovulation), coagulation studies if heavy bleeding or bruising history
•Transvaginal ultrasound: evaluating endometrial thickness, uterine fibroids, adenomyosis, ovarian cysts, structural abnormalities
•Endometrial biopsy if indicated: in-office procedure sampling uterine lining (age >45, irregular bleeding, obesity, PCOS)

3After the Exam

•Diagnosis discussion: specific menstrual disorder identified (menorrhagia, anovulation, fibroids, adenomyosis, etc.)
•Treatment options explained: hormonal (pills, IUD, progestins), non-hormonal (tranexamic acid, NSAIDs), procedural (ablation, myomectomy)
•First-line treatment prescribed: often hormonal IUD (Mirena) for heavy bleeding, combined pills for irregular cycles
•Anemia management: iron supplementation if low hemoglobin, dietary counseling, follow-up CBC in 3 months
•Pain management plan: NSAIDs scheduled dosing (not as-needed), heat therapy, pelvic floor physical therapy referral
•Follow-up bleeding diary: track response to treatment over next 2-3 cycles
•Reassessment in 3-6 months: if treatment effective, continue; if not, escalate to second-line options
•Surgical referral if conservative management fails: endometrial ablation, fibroid removal, or hysterectomy discussion

Why Choose Our Menstrual Disorder Specialists in Dubai?

Comprehensive Diagnostic Approach

Thorough evaluation identifying root cause rather than just treating symptoms. We investigate hormonal imbalances (PCOS, thyroid, prolactin), structural abnormalities (fibroids, polyps, adenomyosis), blood disorders, medications, and systemic conditions. Transvaginal ultrasound, laboratory testing, and endometrial sampling when indicated ensure accurate diagnosis guiding effective treatment.

Medical Management Expertise

First-line hormonal and non-hormonal treatments achieving excellent results without surgery in 80% of cases. Mirena IUD reduces bleeding 90% within 6 months. Tranexamic acid decreases flow 40-60% without hormones. Combined oral contraceptives regulate cycles and reduce dysmenorrhea. GnRH agonists shrink fibroids pre-operatively. Individualized protocols based on age, fertility desires, contraindications.

Minimally Invasive Procedures

Office-based endometrial ablation permanently reducing or eliminating periods in women who completed childbearing. Outpatient hysteroscopic polypectomy removing endometrial polyps. Laparoscopic myomectomy preserving fertility while removing fibroids. Uterine artery embolization coordination for fibroid treatment. Less invasive alternatives to hysterectomy whenever possible.

Fertility Preservation Focus

For women desiring future pregnancy, uterus-sparing treatments prioritized. Ovulation induction for anovulatory irregular cycles. Myomectomy rather than hysterectomy for fibroids. Medical management avoiding endometrial ablation. Addressing PCOS, thyroid disorders, hyperprolactinemia restoring ovulation. Coordination with fertility specialists when indicated. Protecting reproductive potential while managing symptoms.

Anemia and Quality of Life Restoration

Aggressive anemia treatment improving energy, cognition, and wellbeing. Intravenous iron infusions for severe anemia or oral intolerance achieving rapid hemoglobin recovery. Bleeding reduction preventing recurrent anemia. Quality of life assessment using validated questionnaires demonstrating treatment efficacy. Patients report dramatic improvements in daily functioning, productivity, and mental health.

PMS/PMDD Specialized Care

Evidence-based treatment for premenstrual disorders affecting mood, anxiety, and functioning. SSRIs (fluoxetine, sertraline) reducing PMDD symptoms 60-75%. Continuous or extended-cycle contraceptives eliminating hormone fluctuation triggers. Lifestyle modifications (exercise, stress reduction, diet). Calcium, magnesium, vitamin B6 supplementation. Cognitive behavioral therapy referrals. Comprehensive approach addressing biological and psychological factors.

Frequently Asked Questions

Q1.What is considered heavy menstrual bleeding and when should I see a doctor?

Heavy menstrual bleeding (menorrhagia) is defined as blood loss >80ml per cycle, but measuring is impractical. PRACTICAL CRITERIA: Soaking through pad or tampon every 1-2 hours for several consecutive hours, Passing blood clots larger than quarter (>2.5cm), Bleeding lasting >7 days, Needing to change protection during night, Bleeding affecting daily activities (missing work/school, avoiding exercise/social events), Symptoms of anemia (fatigue, weakness, shortness of breath, dizziness, pale skin). CAUSES: Fibroids (benign uterine tumors—most common cause), Adenomyosis (uterine lining grows into muscle wall), Endometrial polyps, Hormonal imbalances (anovulation, PCOS, thyroid disorders), Blood clotting disorders (von Willebrand disease—affects 1% of women, often undiagnosed), Medications (anticoagulants, aspirin), IUD, Endometrial hyperplasia or cancer (especially >45 years). WHEN TO SEEK CARE URGENTLY: Bleeding so heavy you feel dizzy or lightheaded (possible severe anemia or hemorrhage), Bleeding after menopause (always abnormal, requires cancer screening), Bleeding during pregnancy (miscarriage or complication). ROUTINE CONSULTATION: If bleeding meets criteria above for 2+ consecutive cycles, if anemia symptoms present, or if bleeding impairs quality of life. DON'T WAIT: Many women delay years before seeking help, suffering unnecessarily and developing severe anemia. Treatment is highly effective—80-90% improve with medical management alone.

Q2.What causes irregular or missing periods?

Irregular periods (cycles <21 days or >35 days) or absent periods (amenorrhea—missing 3+ cycles) have numerous causes. MOST COMMON CAUSES: PCOS (Polycystic Ovary Syndrome): 70% of anovulatory irregular periods. Hormonal imbalance, ovarian cysts, hirsutism often present. STRESS: Physical (extreme exercise, rapid weight loss) or psychological stress disrupts hypothalamus-pituitary-ovarian axis. THYROID DISORDERS: Both hypothyroidism and hyperthyroidism cause irregular cycles. Check TSH. WEIGHT CHANGES: Being significantly underweight (BMI <18.5) or obese (BMI >30) disrupts ovulation. BREASTFEEDING: Lactational amenorrhea—normal while exclusively nursing. PERIMENOPAUSE: Irregular cycles in 40s leading to menopause (average age 51). MEDICATIONS: Hormonal contraceptives (especially progestin-only, Depo-Provera), antipsychotics, chemotherapy. HYPERPROLACTINEMIA: Elevated prolactin (pituitary tumor, medications) causes amenorrhea and galactorrhea. PREMATURE OVARIAN INSUFFICIENCY: Menopause before age 40 (1% of women). FSH elevated. LESS COMMON: Asherman syndrome (uterine scarring from D&C), chromosomal abnormalities (Turner syndrome), congenital absence of uterus. EVALUATION: Pregnancy test (always first—unexpected pregnancy common cause!), Hormonal panel (FSH, LH, prolactin, TSH, testosterone, progesterone challenge test), Pelvic ultrasound, Endometrial biopsy if >45 or risk factors. TREATMENT: Depends on cause. PCOS—Metformin, ovulation induction if pregnancy desired, hormonal contraceptives for cycle regulation. Thyroid—thyroid hormone replacement. Hyperprolactinemia—dopamine agonists (cabergoline). Stress/weight—lifestyle modification. Perimenopausal—hormonal management or observation if near menopause. IMPORTANCE OF REGULAR CYCLES: Anovulatory irregular cycles increase endometrial cancer risk (unopposed estrogen). Progestin therapy (pill, IUD) protects endometrium even if don't want period regulation.

Q3.What are the treatment options for heavy menstrual bleeding?

Treatment depends on severity, underlying cause, age, and fertility desires. FIRST-LINE MEDICAL MANAGEMENT: HORMONAL IUD (Mirena, Kyleena): Most effective medical treatment. Reduces bleeding 90% by 6 months, 20% become amenorrheic (no periods—safe and reversible). Lasts 5 years. First choice for women who don't want pregnancy. TRANEXAMIC ACID: Non-hormonal medication reducing bleeding 40-60% by preventing clot breakdown. Take during period only (not continuously). No contraceptive effect. Good option if hormones contraindicated. COMBINED ORAL CONTRACEPTIVES: Reduce bleeding 40-50%, regulate cycles. Extended or continuous regimens (skip placebo weeks) reduce annual bleeding episodes. NSAIDs (Ibuprofen, Naproxen): Reduce bleeding 20-30% and relieve pain. Take scheduled during period, not as-needed. Prostaglandin inhibitors reduce uterine contractions and bleeding. ORAL PROGESTINS: Cyclical (days 14-25 of cycle) or continuous. Protect endometrium from hyperplasia, reduce bleeding. SECOND-LINE MEDICAL: GnRH AGONISTS (Leuprolide): Induce temporary menopause, shrink fibroids. Pre-operative for 3-6 months before surgery. Side effects (hot flashes, bone loss) limit long-term use. PROCEDURAL TREATMENTS (when medical fails): ENDOMETRIAL ABLATION: Destroys uterine lining permanently. Outpatient procedure (thermal balloon, radiofrequency, microwave). 90% reduction in bleeding, 40% amenorrhea. ONLY for women who completed childbearing (pregnancy dangerous after ablation). UTERINE ARTERY EMBOLIZATION: For fibroids. Blocks blood supply shrinking fibroids 40-60%. Preserves uterus but may affect fertility. SURGICAL: MYOMECTOMY: Removes fibroids, preserves uterus and fertility. Laparoscopic or open depending on size/number. HYSTERECTOMY: Definitive cure. Reserved for failed medical/procedural treatments or patient preference. Laparoscopic, vaginal, or robotic approaches. TREATMENT SELECTION: Age <35 wanting fertility—medical management preserving ovulation, myomectomy if fibroids. Age >35 not desiring fertility—Mirena IUD first-line, ablation if fails. Severe anemia requiring rapid improvement—GnRH agonist plus iron, then definitive treatment.

Q4.How can I treat painful periods (dysmenorrhea)?

Dysmenorrhea (painful periods) affects 50-90% of women, severe in 10-20% significantly impairing function. TWO TYPES: PRIMARY DYSMENORRHEA: No underlying pelvic pathology. Caused by excess prostaglandins causing intense uterine contractions. Starts 1-2 years after first period. Pain begins with bleeding, lasts 1-3 days. Cramping lower abdomen, back, thighs. Associated nausea, diarrhea, headache. SECONDARY DYSMENORRHEA: Due to pelvic pathology (endometriosis, adenomyosis, fibroids, PID, IUD). Starts later in reproductive years. Pain may begin before bleeding, last longer, worsen over time. TREATMENT FOR PRIMARY: NSAIDs (FIRST-LINE): Ibuprofen 400-600mg or naproxen 500mg every 6-8 hours STARTING 1-2 DAYS BEFORE PERIOD (prophylactic, not reactive). Inhibits prostaglandin synthesis reducing cramping 70-80%. Take with food. HORMONAL CONTRACEPTIVES: Combined pills, patch, ring reduce dysmenorrhea 60-70% by thinning endometrium (less prostaglandin production) and suppressing ovulation. Continuous/extended regimens skip periods entirely. Mirena IUD effective—lighter periods or amenorrhea. HEAT THERAPY: Heating pad, hot water bottle, warm bath. As effective as ibuprofen in some studies. Relaxes uterine muscle, increases blood flow. EXERCISE: Regular aerobic exercise reduces cramp severity. Endorphins provide natural pain relief. TENS (Transcutaneous Electrical Nerve Stimulation): Blocks pain signals. Some evidence of benefit. DIETARY: Omega-3 fatty acids (fish oil), magnesium, vitamin E, vitamin B1 may help in some studies. Avoid caffeine, salt before period. TREATMENT FOR SECONDARY: Treat underlying condition. Endometriosis—hormonal suppression (continuous contraceptives, progestins, GnRH agonists), laparoscopic excision. Adenomyosis—Mirena IUD, GnRH agonists, hysterectomy if severe. Fibroids—see above treatments. WHEN MEDICAL FAILS: Presacral neurectomy (surgical nerve cutting—rarely done). Laparoscopic uterine nerve ablation (LUNA—limited evidence). Hysterectomy (last resort for severe refractory dysmenorrhea). RED FLAGS REQUIRING EVALUATION: Pain worsening over time (endometriosis), Pain not relieved by NSAIDs/hormones, Pain between periods or with sex (pelvic pathology), New onset after age 25 (secondary cause), Associated heavy bleeding, fever, abnormal discharge (infection). Don't suffer—effective treatments exist!

Q5.What is PMS vs PMDD and how are they treated?

PMS (Premenstrual Syndrome) and PMDD (Premenstrual Dysphoric Disorder) are cyclical mood and physical symptoms occurring in luteal phase (1-2 weeks before period), relieved with menstruation. PMS: Mild-moderate symptoms not significantly impairing function. Affects 20-50% of women. Symptoms: Bloating, breast tenderness, fatigue, irritability, mild mood changes, food cravings, headache. PMDD: Severe symptoms significantly impairing work, relationships, or daily functioning. Affects 3-8% of women. Diagnostic criteria (DSM-5): ≥5 symptoms including ≥1 of: Depressed mood, hopelessness; Marked anxiety, tension; Mood swings; Persistent anger, irritability. Plus physical symptoms (bloating, breast pain, fatigue). Symptoms must occur most cycles, confirmed by 2+ months prospective daily tracking. CAUSES: Exact mechanism unclear. Abnormal brain response to normal hormone fluctuations. Serotonin dysregulation. Sensitivity to progesterone metabolites. Genetic component. TREATMENT: LIFESTYLE (first-line for PMS, adjunct for PMDD): Regular exercise (aerobic 30min most days) reduces symptoms 30-50%. Stress reduction (yoga, meditation, cognitive behavioral therapy). Sleep hygiene (7-9 hours). Avoid caffeine, alcohol, salt, sugar in luteal phase. Complex carbohydrates, frequent small meals stabilize blood sugar and mood. SUPPLEMENTS: Calcium 1200mg daily reduces PMS 50% (best evidence). Magnesium 200-400mg daily. Vitamin B6 50-100mg. Vitamin E 400IU. Chasteberry (Vitex agnus-castus)—modest benefit, some evidence. MEDICATIONS: SSRIs (FIRST-LINE FOR PMDD): Fluoxetine, sertraline, escitalopram reduce symptoms 60-75%. Can be taken continuously or luteal phase only (days 14-28). Effective within 1-2 cycles. Hormonal contraceptives: Continuous or extended-cycle pills eliminate hormone fluctuation. Yasmin (drospirenone/ethinyl estradiol) specifically FDA-approved for PMDD. Some women worsen on hormonal contraception—trial needed. GnRH agonists (severe PMDD): Induce medical menopause eliminating cycle. Add-back estrogen-progestin to prevent bone loss, hot flashes. Reserved for refractory cases. Spironolactone: Diuretic reducing bloating, breast tenderness. WHEN TO SUSPECT PMDD: Symptoms interfere with work, school, relationships. Previous antidepressant trials for "depression" were ineffective (because underlying PMDD, not depression). Suicidal ideation or severe hopelessness premenstrually. DIAGNOSIS REQUIRES SYMPTOM TRACKING: Daily mood diary for 2-3 cycles documenting symptom severity and timing. Confirms cyclical pattern distinguishing PMDD from chronic depression/anxiety. BOTTOM LINE: PMS—lifestyle + supplements often sufficient. PMDD—SSRIs highly effective, continuous hormonal contraceptives, CBT. Don't dismiss as "just PMS"—PMDD is serious psychiatric condition requiring treatment.

Q6.Could my heavy periods be caused by a blood clotting disorder?

YES—13-20% of women with heavy menstrual bleeding have underlying bleeding disorders, most commonly von Willebrand Disease (VWD). Often undiagnosed for years. SUSPECT BLEEDING DISORDER IF: Heavy periods since menarche (first period)—lifelong pattern suggests inherited disorder. Bleeding after delivery, miscarriage, or surgery (requiring transfusion, readmission, prolonged bleeding). Easy bruising (large bruises from minor trauma or spontaneous bruising). Frequent nosebleeds (>10 minutes or requiring medical attention). Bleeding gums (during brushing, dental work). Family history of bleeding disorder or heavy periods (mother, sisters). MOST COMMON: VON WILLEBRAND DISEASE: Affects 1% of population, most common inherited bleeding disorder. Deficiency or dysfunction of von Willebrand factor (helps platelets stick together and clot). Type 1 (75%): Partial deficiency, mild-moderate bleeding. Type 2: Qualitative defect, variable severity. Type 3: Complete deficiency, severe bleeding (rare). DIAGNOSIS: Bleeding assessment tools (questionnaires scoring bleeding history), Coagulation tests: von Willebrand factor antigen, VWF activity (ristocetin cofactor), Factor VIII level, Platelet function testing. Note: VWF levels fluctuate—may need repeat testing, affected by stress, estrogen. TREATMENT FOR VWD: Tranexamic acid (Lysteda): Antifibrinolytic preventing clot breakdown. First-line, reduces bleeding 40-50%. Hormonal contraceptives: Combined pills, Mirena IUD. Estrogen increases VWF levels (temporary effect while on hormones). Desmopressin (DDAVP): Nasal spray or injection releasing stored VWF from blood vessel walls. Used peri-operatively or for acute bleeding. NOT for Type 2B or 3. VWF concentrate infusions: For severe deficiency or major surgery/delivery. Hematology referral. OTHER BLEEDING DISORDERS: Platelet function disorders (rare): Abnormal platelets despite normal count. Factor deficiencies (rare): Factor VII, XI. Acquired: Chronic liver disease, kidney disease, anticoagulant medications. MANAGEMENT APPROACH: Screen with history—high-risk features warrant coagulation testing. Coordinate care between gynecology and hematology. Adjust treatment based on bleeding disorder type (some hormones contraindicated in certain conditions). Prophylactic treatment before surgery/delivery preventing excessive bleeding. Family screening if diagnosis confirmed. IMPORTANCE: Identifying bleeding disorder changes management. Some treatments (NSAIDs, IUD) may be contraindicated or less effective. Specialized perioperative management prevents complications. Family members can be tested and treated.

Q7.When is endometrial biopsy necessary and what does it involve?

Endometrial biopsy samples uterine lining to detect cancer, precancer (hyperplasia), or other abnormalities. INDICATIONS: Age >45 with abnormal uterine bleeding (any irregular, heavy, or intermenstrual bleeding). Younger women (<45) with abnormal bleeding PLUS risk factors: obesity (BMI >30), PCOS, diabetes, chronic anovulation, family history of colon/endometrial cancer (Lynch syndrome), tamoxifen use. Post-menopausal bleeding (ANY vaginal bleeding after 12 months amenorrhea)—ALWAYS investigate, 10% have cancer. Endometrial thickness >4-5mm on ultrasound in post-menopausal woman. Failed medical management for heavy bleeding (before ablation or hysterectomy—exclude cancer). PROCEDURE: Office-based, 5-10 minutes, no anesthesia usually (some offer paracervical block or oral pain medication pre-procedure). Speculum inserted, cervix visualized and cleaned. Thin flexible catheter (Pipelle) inserted through cervix into uterus. Suction applied while moving catheter side-to-side sampling endometrial tissue. Brief cramping during sampling (similar to strong menstrual cramp lasting 30-60 seconds). Remove catheter and speculum. Mild cramping and spotting for 1-2 days after (take ibuprofen). SEND SAMPLE to pathology—results in 5-7 days. PAIN MANAGEMENT: Take ibuprofen 600mg 1 hour before procedure. Paracervical block (local anesthetic injection) reduces pain if offered. Deep breathing during procedure. Most women tolerate well—discomfort brief. RESULTS: NORMAL: Proliferative (first half cycle) or secretory (second half) endometrium. No treatment needed. HYPERPLASIA: Endometrial thickening/overgrowth due to unopposed estrogen. Simple vs complex (architecture), without vs with atypia (cell changes). WITHOUT ATYPIA: Progestin therapy (oral or Mirena IUD) reverses hyperplasia. Repeat biopsy 3-6 months confirming resolution. WITH ATYPIA: 25-30% have concurrent cancer. Hysterectomy recommended (or high-dose progestin if fertility desired with close surveillance). CANCER: Endometrial adenocarcinoma. Staging and treatment planning with gynecologic oncologist. Hysterectomy ± chemotherapy/radiation. POLYP: If biopsy suggests polyp, hysteroscopic polypectomy (direct visualization and removal) recommended. INSUFFICIENT SAMPLE: Cervical stenosis preventing catheter passage (especially post-menopausal). Hysteroscopy with D&C under anesthesia alternative. COMPLICATIONS: Rare—infection (<1%), uterine perforation (very rare), vasovagal reaction (fainting). WHEN BIOPSY NOT NEEDED: Ovulatory regular cycles in young healthy women (bleeding due to ovulation dysfunction, not structural pathology). Obvious cause on ultrasound (fibroid, polyp) in low-risk patient—proceed directly to treatment. BOTTOM LINE: Quick office procedure providing critical information. Detects endometrial cancer early when curable (95% 5-year survival if localized). Identifies precancer enabling prevention. Don't avoid due to fear—discomfort temporary, information life-saving.

Q8.What is adenomyosis and how is it treated?

Adenomyosis is a condition where endometrial tissue (uterine lining) grows into the myometrium (muscular uterine wall), causing enlarged, tender uterus, heavy bleeding, and severe cramping. Often called "endometriosis of the uterus" but distinct entity. PREVALENCE: 20-35% of women, peak age 40s, often multiparous (had pregnancies). Difficult to diagnose—requires imaging or pathology. SYMPTOMS: Heavy menstrual bleeding (50-70% of women with adenomyosis)—diffuse process affecting entire uterus. Severe dysmenorrhea (painful periods) worsening over time—deep aching, cramping throughout cycle, not just during period. Enlarged, tender uterus (2-3 times normal size, "boggy" on exam). Chronic pelvic pain, pain with intercourse (dyspareunia). Symptoms often worsen with each pregnancy. DIAGNOSIS: Clinical suspicion: Heavy bleeding + severe pain + enlarged tender uterus in 40s. Transvaginal ultrasound: Globular uterus, heterogeneous myometrium, thickened anterior/posterior wall asymmetry, myometrial cysts. Sensitivity 70-80%. MRI: Gold standard imaging. Thickened junctional zone (>12mm diagnostic), high T2 signal foci in myometrium. Sensitivity 90%. Expensive, reserved for unclear cases or pre-surgical planning. Definitive diagnosis: Only by pathology after hysterectomy. Pre-operative diagnosis always presumptive. MEDICAL TREATMENT (first-line): MIRENA IUD: Most effective medical treatment. Reduces bleeding 90%, pain 60-70%. Progestogenic effect on adenomyotic tissue. First choice if uterus not too large (<12cm). NSAIDs: Ibuprofen, naproxen scheduled during period reducing pain and bleeding 20-30%. Prostaglandin inhibitors. COMBINED ORAL CONTRACEPTIVES: Continuous or extended-cycle (skipping periods) reduces symptoms. Thin endometrium, suppress ovulation, decrease prostaglandins. GnRH AGONISTS: Leuprolide induces temporary menopause, shrinks adenomyotic tissue. Dramatic symptom relief but recurrence when stopped. Used short-term (3-6 months) pre-surgery or perimenopausally to bridge to natural menopause. Side effects limit long-term use. TRANEXAMIC ACID: Reduces bleeding 40-50% without hormones. No effect on pain. DANAZOL, Gestrinone: Older medications, significant androgenic side effects. Rarely used. PROCEDURAL/SURGICAL: UTERINE ARTERY EMBOLIZATION: Blocks blood supply to uterus shrinking adenomyotic tissue. 70-80% symptom improvement. Preserves uterus but may affect fertility. Less effective than for fibroids. ENDOMETRIAL ABLATION: Destroys lining reducing bleeding. 50-60% success (lower than for other causes of heavy bleeding because adenomyosis is within muscle, not just lining). Only if childbearing complete. ADENOMYOMECTOMY: Surgical excision of adenomyotic tissue preserving uterus. Technically difficult, high recurrence. Reserved for focal adenomyosis in women desiring fertility. Limited availability—specialized centers only. HYSTERECTOMY: Definitive cure. Only option guaranteeing symptom resolution. Recommended for severe symptoms unresponsive to medical management in women who completed childbearing. 95% satisfaction rate. FERTILITY IMPACT: Adenomyosis may impair implantation reducing IVF success (though data conflicting). GnRH agonist treatment for 3-6 months before IVF may improve outcomes. Surgical management controversial. PROGNOSIS: Chronic progressive condition often worsening until menopause. Symptoms resolve after menopause (no more estrogen stimulation). Medical management controls symptoms but doesn't cure disease. BOTTOM LINE: Adenomyosis is common cause of heavy painful periods in 40s. Mirena IUD first-line treatment. Hysterectomy definitive if medical fails and childbearing complete.

Q9.Can menstrual disorders affect fertility?

YES—many menstrual disorders indicate ovulation problems, hormonal imbalances, or structural abnormalities affecting fertility. IRREGULAR OR ABSENT PERIODS: Anovulation (not ovulating) is most common. Can't conceive without ovulation. PCOS: 70% of anovulatory infertility. Irregular periods, high androgens, ovarian cysts. Treatment: Metformin, letrozole/clomiphene ovulation induction achieves 70-80% ovulation rate. Hypothalamic amenorrhea: Stress, low weight, excessive exercise suppressing GnRH. Treatment: Lifestyle modification (weight gain, reduce exercise), stress management. If not responsive, letrozole or gonadotropins. Hyperprolactinemia: Elevated prolactin suppressing ovulation. Treatment: Dopamine agonists (cabergoline, bromocriptine) restore ovulation 80-90%. Thyroid disorders: Both hypo- and hyperthyroidism impair ovulation. Treatment: Thyroid hormone normalization restores fertility. Premature ovarian insufficiency: Ovarian failure before age 40. Rare spontaneous pregnancy possible but usually requires egg donation. HEAVY BLEEDING: Fibroids: Submucosal fibroids (bulge into uterine cavity) reduce implantation, increase miscarriage risk. Treatment: Hysteroscopic myomectomy removes cavity-distorting fibroids improving pregnancy rates. Polyps: Endometrial polyps impair implantation. Treatment: Hysteroscopic polypectomy. Quick outpatient procedure increasing conception rates. Adenomyosis: May reduce implantation. GnRH agonist treatment before IVF may help. Endometrial hyperplasia: Anovulation causing thickened lining. Must treat (progestin therapy) before attempting conception to reset endometrium. PAINFUL PERIODS: Endometriosis: 30-50% of women with endometriosis have infertility. Distorts pelvic anatomy, inflammatory factors impair egg/sperm/embryo function. Treatment: Laparoscopic excision improves natural conception rates 50% if mild-moderate disease. IVF if severe or surgery ineffective. LONG CYCLES (>35 days): Infrequent ovulation = fewer chances to conceive. Annual ovulation attempts (12-14) vs normal (12-14). Treatment: Ovulation induction increasing ovulation frequency. EVALUATION: Infertility workup recommended if: Trying 12+ months without pregnancy (age <35), or 6+ months (age ≥35). Known menstrual disorder indicating anovulation or structural abnormality. Includes: Partner semen analysis, Hormonal testing (day 3 FSH/estradiol, AMH, progesterone day 21), Ultrasound (antral follicle count, assess for fibroids/polyps), HSG (fallopian tube patency test), Ovulation tracking (ultrasound, LH testing). TREATMENT APPROACH: Correct underlying menstrual disorder (treat PCOS, remove polyps/fibroids, etc.). Ovulation induction if anovulatory (letrozole, clomiphene, gonadotropins). IUI (intrauterine insemination) if ovulating but not conceiving. IVF if tubal factor, male factor, advanced age, or failed treatments. GOOD NEWS: Most menstrual disorder-related infertility is treatable. PCOS women achieve 70-80% pregnancy rates with ovulation induction. Fibroids/polyps removed, fertility often restored. Thyroid/prolactin normalized, ovulation resumes. BOTTOM LINE: Irregular periods = fertility red flag. Early evaluation and treatment improve outcomes. Don't wait—egg quality declines with age, especially after 35.

Q10.How much does menstrual disorder treatment cost in Dubai and is it covered by insurance?

Menstrual disorder treatment costs vary by approach (approximate Dubai costs): CONSULTATION & DIAGNOSTICS: Initial comprehensive gynecology consultation: AED 500-800. Follow-up visits: AED 300-500. Complete blood count (CBC): AED 80-150. Hormonal panel (FSH, LH, prolactin, TSH, testosterone, progesterone): AED 500-1,000. Coagulation studies (PT, PTT, VWF panel): AED 400-800. Transvaginal ultrasound: AED 400-700. Endometrial biopsy (office): AED 800-1,500. Pelvic MRI: AED 1,500-2,500. MEDICAL MANAGEMENT: Mirena IUD: AED 800-1,200 one-time (lasts 5 years = AED 160-240/year). Combined oral contraceptives: AED 30-80 per month (AED 360-960/year). Tranexamic acid: AED 100-200 per cycle. NSAIDs (generic ibuprofen): AED 20-50 per month. GnRH agonist injections: AED 500-1,000 per month (short-term use). Iron supplementation: AED 50-150 per month. PROCEDURAL TREATMENTS: Hysteroscopic polypectomy (office or OR): AED 3,000-7,000. Endometrial ablation: AED 8,000-15,000. D&C under anesthesia: AED 3,000-6,000. Uterine artery embolization: AED 15,000-25,000. Myomectomy (laparoscopic): AED 15,000-30,000. Hysterectomy (laparoscopic): AED 20,000-35,000. Hysterectomy (vaginal): AED 15,000-25,000. INSURANCE COVERAGE: Most UAE health insurance plans cover: Consultation and diagnostic testing (ultrasound, labs, biopsy). Medical management (hormonal treatments, Mirena IUD, tranexamic acid). Procedures if medically necessary (polyp removal, ablation, myomectomy, hysterectomy). Pre-authorization often required for procedures. Coverage varies: Some plans cover 80-100% after deductible. Others have co-pays (AED 100-300 per visit). Medication coverage depends on formulary—generics usually covered, some require co-pay. GOVERNMENT INSURANCE (Thiqa, Saada, Daman): Typically covers consultations, diagnostics, medically necessary procedures at government facilities or network providers. May have lower out-of-pocket costs. UNINSURED/SELF-PAY: Government hospitals (Rashid, Latifa) offer subsidized gynecology care: Consultation AED 100-200. Many private clinics offer payment plans for surgical procedures. Generic medications significantly cheaper than brand-name. COST-EFFECTIVENESS: Medical management (Mirena, tranexamic acid, pills) is very cost-effective—controls symptoms for years at low annual cost. Hysterectomy is one-time expense providing definitive cure—cost-effective for severe refractory cases compared to ongoing medical costs. RECOMMENDATION: Verify insurance benefits before procedure (pre-authorization prevents surprise bills). Request itemized cost estimates from clinic/hospital. Compare in-network vs out-of-network costs if applicable. Our clinic: Insurance verification assistance, transparent pricing, works with all major insurers, affordable self-pay options.