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<p>Because menstruation is related to the uterus, which is an important reproductive organ for women, when abnormalities occur, warning signs are often found from “abnormal menstruation,” whether it is heavy and prolonged bleeding, blood clots, increased menstrual pain, or in some cases, pain similar to menstrual cramps even when not menstruating. What diseases can these abnormal symptoms indicate? How serious are they? Let’s understand and be aware of these diseases&#8230;</p>
<h2 style="color: #008080;"><span style="color: #00826a;">What kind of heavy menstruation is considered “abnormal”?</span></h2>
<p>Of course, every woman has heard the term “heavy menstruation,” and each person defines heavy differently. But medically&#8230; the term heavy menstruation indicating abnormal signs is:</p>
<ul>
<li>Menstruation lasting more than 7 days</li>
<li>During the day, bleeding is so heavy that sanitary pads need to be changed every hour, including changing pads during sleep at night</li>
<li>Entering the 50s or approaching menopause, but menstruation becomes heavier instead of lighter</li>
</ul>
<p>Therefore, if you have abnormal heavy menstruation symptoms as described, including menstrual pain, irregular cycles, or heavy vaginal discharge, you should see a doctor for a thorough diagnosis.</p>
<h2 style="color: #008080;"><span style="color: #00826a;">Detecting lesions from “heavy menstruation” with these examinations</span></h2>
<ol>
<li>Internal examination</li>
<li>Examine the vagina and cervix for lumps, wounds, or polyps, along with collecting cervical cells to check for infections or inflammation, as well as palpating the uterus and ovaries to see if they are normal in size, tender on pressure, or if any abnormal lumps are found</li>
<li>Ultrasound: If the initial diagnosis finds abnormalities in the uterus or ovaries, ultrasound helps improve diagnostic accuracy. Ultrasound can be done both abdominally and vaginally.</li>
</ol>
<h2 style="color: #008080;"><span style="color: #00826a;">What gynecological diseases can menstrual abdominal pain signal?</span></h2>
<ul>
<li>Endometriosis on the ovary or chocolate cyst: Severe menstrual pain that worsens every month may be a warning sign of endometriosis on the ovary or chocolate cyst. Many women overlook this because they think it is a normal monthly symptom.</li>
<li>Uterine fibroids: Whether it is heavy and prolonged menstruation with blood clots, increased menstrual pain, or in some cases, pain similar to menstrual cramps even when not menstruating. These fibroids can grow and press on nearby organs, causing other complications.</li>
</ul>
<h2 style="color: #008080;"><span style="color: #00826a;">Understanding “chocolate cyst” – what is it?</span></h2>
<p>‘Chocolate cyst disease,’ also known as ‘ovarian endometriosis,’ normally the uterine lining is inside the uterine cavity, but endometriosis is an abnormal growth of uterine lining tissue in other locations in the pelvic area or other organs. This causes abnormal symptoms during the menstrual cycle. For example, if it grows on the ovary, it can form a cyst called a chocolate cyst. If the uterine lining cells implant in the uterine muscle, it can cause fibroids from endometriosis. Generally, this disease can have various lesions such as brown spots, red spots, clear cysts in pelvic organs, or cysts on the ovary containing thick dark brown fluid resembling chocolate in color and texture&#8230; hence the name ‘chocolate cyst.’</p>
<h2 style="color: #008080;"><span style="color: #00826a;">Warning symptoms caused by chocolate cyst disease</span></h2>
<ul>
<li><span style="color: #00826a;"><strong>Menstrual abdominal pain</strong></span> with characteristics different from normal menstrual pain: the pain severity increases every month, for example, pain that used to go away on its own requiring medication, then needing stronger pain injections, pain so severe it causes fainting, or pain outside the menstrual period.</li>
<li><span style="color: #00826a;"><strong>Deep pain or discomfort</strong></span><span style="background-color: rgb(255 255 255 / var(--tw-bg-opacity)); color: var(--tw-prose-body); font-family: ui-sans-serif, system-ui, -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, 'Noto Sans', sans-serif, 'Apple Color Emoji', 'Segoe UI Emoji', 'Segoe UI Symbol', 'Noto Color Emoji'; font-size: 1rem;"> in the vagina or lower abdomen during intercourse due to adhesions from the disease to the uterus or lesions in the pelvic area, restricting uterine movement, especially adhesions around the uterine ligaments causing pain during intercourse.</span></li>
<li><span style="color: #00826a;"><strong>Infertility</strong></span><span style="background-color: rgb(255 255 255 / var(--tw-bg-opacity)); color: var(--tw-prose-body); font-family: ui-sans-serif, system-ui, -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, 'Noto Sans', sans-serif, 'Apple Color Emoji', 'Segoe UI Emoji', 'Segoe UI Symbol', 'Noto Color Emoji'; font-size: 1rem;"> because this disease often involves cysts on the ovaries, reducing ovulation efficiency, or adhesions in both fallopian tubes preventing fertilization or implantation in the uterus.</span></li>
<li><span style="color: #00826a;"><strong>Detection of ovarian cysts</strong></span><span style="background-color: rgb(255 255 255 / var(--tw-bg-opacity)); color: var(--tw-prose-body); font-family: ui-sans-serif, system-ui, -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, 'Noto Sans', sans-serif, 'Apple Color Emoji', 'Segoe UI Emoji', 'Segoe UI Symbol', 'Noto Color Emoji'; font-size: 1rem;"> without abnormal symptoms.</span></li>
</ul>
<h2 style="color: #008080;"><span style="color: #00826a;">Triggers that cause chocolate cyst disease</span></h2>
<p>Studies have found that factors causing chocolate cyst disease include a family history of the disease, women who have not had children, early menstruation (before age 11), short menstrual cycles (less than 27 days), or prolonged or heavy menstruation.</p>
<h2 style="color: #008080;"><span style="color: #00826a;">There are two main treatment approaches:</span></h2>
<ul>
<li><span style="color: #00826a;"><strong>Medication</strong></span> Generally, medications used inhibit ovarian function, which may stop menstruation and reduce menstrual pain. The effect on endometriosis varies depending on individual response. Medication use requires regular monitoring and evaluation by a doctor to assess lesion response. If medication is ineffective, surgery will be recommended.</li>
<li><span style="color: #00826a;"><strong>Surgery</strong></span><span style="background-color: rgb(255 255 255 / var(--tw-bg-opacity)); color: var(--tw-prose-body); font-family: ui-sans-serif, system-ui, -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, 'Noto Sans', sans-serif, 'Apple Color Emoji', 'Segoe UI Emoji', 'Segoe UI Symbol', 'Noto Color Emoji'; font-size: 1rem;"> involves removing lesions or chocolate cysts, which also provides tissue for diagnosis. Surgery is indicated based on treatment needs. Current surgical methods include open abdominal surgery and laparoscopic surgery. There are two surgical options: removing only lesions for treatment and diagnosis in patients who want children or are under 45 years old, and hysterectomy with ovary removal in those who do not want children and are near menopause. Laparoscopic surgery has advantages such as reducing adhesions, faster recovery, and less pain compared to open surgery.</span></li>
</ul>
<h2 style="color: #008080;"><span style="color: #00826a;">Did you know? Proper treatment reduces the chance of repeated chocolate cyst surgery</span></h2>
<p>We must understand the nature of this disease: it is not cancer but a hormone-related condition with symptoms following the menstrual cycle. Therefore, women who have had this disease may continue to have it until the ovaries atrophy and stop producing hormones or reach menopause. If the ovaries still function, the disease persists and worsens. Patients should receive accurate diagnosis early to get appropriate medication and surgery when indicated, and be monitored until menopause to reduce risks of repeated surgery, infertility, or even cancer transformation.</p>
<h2 style="color: #008080;"><span style="color: #00826a;">Uterine fibroids: a dangerous threat to watch out for</span></h2>
<p>Small uterine fibroids often show no symptoms, but over 50% of patients with fibroids experience abnormal symptoms! This means most people with fibroids are unaware until abnormalities are found during annual health checks, such as internal exams or ultrasounds. Common abnormal symptoms include:</p>
<ul>
<li>Abnormal vaginal bleeding, gradually increasing menstrual bleeding causing unnoticed anemia, fatigue, easy tiredness, and frequent fainting</li>
<li>Severe menstrual pain</li>
<li>Pain during intercourse</li>
<li>Bloating, feeling of abdominal enlargement, constipation, or palpable abdominal lumps</li>
<li>Frequent urination or incomplete urination in some cases</li>
</ul>
<h2 style="color: #008080;"><span style="color: #00826a;">How many ways are there to treat uterine fibroids?</span></h2>
<ol>
<li>Injection to block blood vessels feeding the fibroid (non-surgical): This radiological technique involves inserting a catheter through the groin artery to the fibroid and injecting substances to block blood flow, causing the fibroid to shrink. This method is limited to fibroids that are not too large.</li>
<li>Fibroid removal surgery: Some patients who want to have children undergo this surgery, but it may not always be successful. Methods include laparoscopic surgery via the vagina, small incision open surgery, etc.</li>
<li>Hysterectomy: The choice depends on symptoms and whether the patient has completed childbearing. Surgical methods include vaginal hysterectomy, laparoscopic hysterectomy, small incision open hysterectomy, and traditional open abdominal hysterectomy.</li>
</ol>
<h2 style="color: #008080;"><span style="color: #00826a;">Don’t want uterine fibroids? You can prevent them!!</span></h2>
<p>Since the exact cause of uterine fibroids is unknown, it is only known that the disease is related to genetics and female hormones. It is also known that being overweight, underweight, or overly stressed affects the pituitary gland’s hormone secretion, disrupting ovarian function. Therefore, maintaining physical and mental health to keep hormone function normal will help the uterus and ovaries function well.</p>
<p>Whether it is chocolate cysts, uterine fibroids, or other gynecological diseases, early treatment is essential. So if you notice abnormal symptoms, do not ignore them; see a doctor for a thorough diagnosis.</p>
<p>&nbsp;</p>
<p style="text-align: right;"><span style="color: #00826a;"><strong>Dr. Aranya Yantapan</strong></span><br />
Specialist in Gynecologic Laparoscopic Surgery<br />
Women’s Health Center, Phyathai 2 Hospital</p>


Heavy menstrual bleeding with blood clots or severe menstrual cramps should not be ignored because these are warning signs of gynecological diseases such as chocolate cysts or uterine fibroids.

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Severe menstrual pain, heavy periods... warning signs of diseases that should not be overlooked!

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