Applications of genome editing technology in the targeted therapy of human diseases: mechanisms, advances and prospects
When Your Girl Has Unusual Menstrual Bleeding
Menstrual irregularities are a common experience for adolescent girls, especially in the first few years after their first period.
While some variability in menstrual cycles is normal, unusually heavy or persistently irregular bleeds can sometimes be a sign of underlying health issues.
Abnormal menstrual bleeding refers to any irregularity in the menstrual cycle.
This can include periods that are unusually heavy or light, last longer than usual, or occur between regular periods.
While some degree of irregularity can be normal and common in adolescent girls as the body adapts to new hormone changes, persistent or severe cases might indicate a health problem.
Heavy menses and blood loss can also lead to anaemia, where the body lacks enough red blood cells, causing tiredness and fatigue.
Causes
Here are some causes of menstrual irregularities:
> Hormonal changes
During adolescence, the menstrual cycle often starts off irregularly because the hypothalamic-pituitary-ovarian (HPO) hormonal axis, which controls menstruation, is still maturing.
This can lead to variations in the cycle length and flow.
Anovulation occurs when the ovaries don't release an egg, leading to irregular or heavy bleeding.
This is particularly common during the first year after menstruation begins, as the body adjusts to its new hormonal rhythm.
> Polycystic ovary syndrome (PCOS)
PCOS is a common condition that affects the ovaries and can cause irregular periods, excessive hair growth and acne.
The exact cause of PCOS is unknown, but it is believed to be caused by a combination of genetic, environmental factors and imbalances in hormone levels.
Most, but not all, people with PCOS have excess weight and there is also a risk of developing metabolic complications such as insulin resistance and diabetes.
> Thyroid disorders
Thyroid problems can cause irregular periods.
Hypothyroidism (an underactive thyroid producing too little thyroid hormones) can result in infrequent menses, whereas hyperthyroidism (an overactive thyroid with too much thyroid hormones) can cause frequent and heavy menses.
> Elevated prolactin levels
Prolactin is a hormone that helps with milk production and is high during pregnancy and after childbirth.
High levels of prolactin, though less common, can cause menstrual irregularities.
This condition, called hyperprolactinaemia, can lead to missed periods or irregular bleeding.
Hyperprolactinaemia outside of natural lactation can be caused by pituitary tumours in the brain (prolactinomas), certain medications, hypothyroidism, trauma, chest wall irritation, or conditions affecting the hypothalamus or pituitary gland.
> Lifestyle factors
Intense physical activity, underweight, high levels of stress and eating disorders such as anorexia nervosa and bulimia, can disrupt menses flow.
> Bleeding disorders
Bleeding disorders such as von Willebrand disease and platelet function disorders impair the blood's ability to clot properly, leading to prolonged or heavy menstrual bleeding.
> Pregnancy
Pregnancy must be excluded in sexually-active teenagers with secondary amenorrhoea (no period) early in the evaluation.
Important signs
While some degree of irregularity is typical during adolescence, certain patterns should prompt a visit to the doctor.
These include:
> Delayed menstruation
If a girl hasn't started menstruating by age 15 or within three years of developing breasts (i.E. Primary amenorrhoea).
> Absence of periods
Missing periods for three consecutive months (i.E. Secondary amenorrhoea).
> Irregular cycles
Menstrual cycles that are consistently shorter than 21 days or longer than 45 days, or cycles that vary widely in length, may indicate hormonal imbalances.
> Heavy bleeding (menorrhagia)
Periods that are excessively heavy – i.E. Requiring frequent changes of sanitary products every one or two hours, contains blood clots or lasting more than seven days – could suggest menorrhagia.
> Bleeding between periods
Bleeding or spotting between periods might signal hormonal issues or other underlying conditions.
> Severe pain
Painful periods that interfere with daily activities (i.E. Dysmenorrhoea) should be evaluated by a healthcare provider.
Diagnosis and treatment
When adolescents experience abnormal menstrual bleeding, doctors will typically perform a thorough evaluation.
This usually includes taking a medical history, which would cover detailed history of menstrual cycles, weight changes and any related symptoms; conducting a physical examination; and doing tests like blood tests to check for anaemia or hormonal imbalances, and imaging tests like ultrasounds, to assess the ovaries and uterus.
In cases of secondary amenorrhoea, pregnancy must be excluded if there are no other apparent causes.
The treatment options depend on the underlying cause, for example:
> Heavy bleeding
If the menstrual bleeding is severe, treatment might include iron supplements to address anaemia, or other medications to control bleeding, such as tranexamic acid or non-steroidal anti-inflammatory drug (NSAIDS).
A blood transfusion will likely be needed in extreme cases where the blood loss is severe enough to cause symptomatic anaemia with significant symptoms such as dizziness or shortness of breath, or haemodynamic instability with low blood pressure or rapid heart rate.
> Irregular bleeding
Hormonal pills can help regulate menstrual cycles by balancing hormone levels.
> Thyroid issues
If hypothyroidism is present, thyroid hormone replacement with L-thyroxine is necessary.
If hyperthyroidism is present, first-line therapy is anti-thyroid medications such as carbimazole or methimazole, to lower the thyroid hormones.
> High prolactin levels
Depending on the underlying cause, medications to lower prolactin levels might be prescribed if elevated prolactin is identified.
> Lifestyle and eating disorders
Treatment for adolescents with eating disorders such as anorexia nervosa focuses on restoring healthy body weight through nutritional rehabilitation, psychology and family support.
Restoration of normal body weight normalises hormone levels and menstrual cycles without the need of medications.
While menstrual irregularities during adolescence are common as the body adjusts to new hormonal levels, it is essential for parents to bring their daughters to seek medical advice if symptoms are severe or persistent to enable early identification and treatment of any underlying health issues.
Dr Jeanne Wong Sze Lyn is a consultant paediatrician and paediatric endocrinologist. For more information, email starhealth@thestar.Com.My. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
Why Blood In Your Bowels Should Be Considered A Serious Health Issue
By paying attention to your body's signals, you can prevent more serious health complications
Your body often sends signals when something isn't quite right. One of the most alarming signs that should never be ignored is the presence of blood in your bowels. Whether you notice bright red streaks or darker, tarry stool, the sight of blood during a bowel movement can be unsettling. And it should be. This isn't something to shrug off or delay addressing. Blood in your bowels could be a sign of several potentially serious health conditions, and understanding the cause is crucial for early intervention and treatment.
Let's explore why this symptom demands immediate attention, what might be causing it, and how you should respond when faced with this serious health issue.
Understanding the causes of blood in the bowelsThe presence of blood in your stool can be the result of numerous health issues, ranging from mild to life-threatening. While some causes may be relatively harmless, others require prompt medical intervention. Here are some of the most common reasons for blood in the bowels:
Seeing blood in your bowels isn't just physically concerning; it can take a major emotional toll. The anxiety of not knowing what's causing the bleeding — coupled with fears about potential serious diagnoses — can be overwhelming. Many people hesitate to seek medical help, worrying about the worst-case scenario. But delaying action can worsen the situation. It's important to address not only the physical aspect of this symptom but also the emotional strain it can cause.
Talking to a trusted health care provider, getting informed and taking control of your health can help alleviate some of that emotional weight. You don't have to live in fear when solutions and treatments are available.
When to act fastIf you notice blood in your stool, it's natural to feel alarmed. The key is knowing when to seek medical help. In some cases — such as with minor hemorrhoids or anal fissures — over-the-counter treatments and dietary changes can provide relief. However, there are specific situations where immediate medical attention is necessary:
Ignoring these symptoms can lead to worsening conditions and missed opportunities for early intervention. Consulting with a health care provider can provide peace of mind and — if necessary — begin a treatment plan to address the underlying issue.
Finding the cause of the bleedingTo determine the exact cause of blood in your bowels, your healthcare provider may recommend several diagnostic tests. These tests can range from simple to more invasive, depending on the suspected cause:
Early detection is key, especially in cases where more serious conditions like colorectal cancer or inflammatory bowel disease are present. Once the cause of the bleeding is identified, appropriate treatment can begin.
From lifestyle changes to medical interventionTreatment for blood in the bowels varies depending on the cause. For less serious conditions — such as hemorrhoids or minor anal fissures — lifestyle changes may be enough to manage symptoms:
In more serious cases — such as with diverticular disease, colorectal cancer or severe gastrointestinal infections — medical interventions might be necessary. These could range from antibiotics for infections to surgery for more advanced cases of cancer or complications from diverticulosis.
Don't ignore the signs your body is sendingBlood in your bowels should never be considered a minor issue. While some causes may be benign, others can be life-threatening. The most important takeaway is that early detection and treatment are critical. By paying attention to your body's signals, seeking medical advice promptly and addressing the underlying cause of bleeding, you can prevent more serious health complications.
Your health matters. Don't let fear or hesitation stop you from taking the necessary steps toward understanding and managing the cause of blood in your bowels. Whether it's a minor issue or something more serious, timely intervention can make all the difference.
This story was created using AI technology.
Blood Specialists Shortage Leaves Patients In Danger
Bridget Ayitasi from Madi-Okollo District suffers from a neurological disorder and has been receiving medical care.
In February, the six-month-old was scheduled to undergo surgery at Cure Children's Hospital of Uganda in Mbale District, where she has been receiving medical care.
However, the surgery was cancelled after the doctors discovered that Ayitasi's platelet count was too low, which could lead to severe complications during surgery.
Platelets play a critical role in blood clotting, and when their levels are insufficient, the body's ability to form clots and control bleeding is compromised.
The doctors explained to Ayitasi's mother, Beatrice, that without a haematologist to manage her daughter's condition, they couldn't proceed with the surgery.
"We needed to refer her to Mulago National Referral Hospital in Kampala. They have specialists who can assess her condition and stabilise her platelets. But here, we cannot," a doctor, who only identified himself as Okello, said.
Beatrice's heart sank. The journey to Mulago Hospital was long, and she didn't have money for transport, let alone enough for upkeep in Kampala while her daughter underwent treatment.
"How am I supposed to get there?" Beatrice asked, her voice trembling. "We don't even have enough money for our upkeep."
Ms Sarah Namakoye, a mother awaiting surgery for her child at Mbale Regional Referral Hospital, said as ordinary people, they are struggling to access medical care.
"We are told the doctors are at Mulago. We have no money to travel there and also to meet costs. We have run out of options," she said.
The shortage of haematologists in Mbale is a silent crisis affecting countless families like that of Bridget, health experts in the region say.
Haematologists are critical for diagnosing and treating blood disorders, yet the country has only a handful of these specialists, most of whom are concentrated in major cities such as Kampala.
In the absence of haematologists, surgeons are forced to make difficult decisions to either refer the patients to larger hospitals in Kampala or attempt to manage complex conditions on their own.
Dr Denis Mayambala, a retired doctor who worked at Mbale Regional Referral Hospital for more than a decade, said: "We often encountered children with conditions that require the expertise of a haematologist, but we did not have any in the region."
Dr Mayambala said doctors do their best but there are limits on what they can do without specialists.
"We try to stabilise the patient as much as possible before referral," he said, adding, "but it is not always enough. And for many families, the cost of travelling to Kampala is prohibitive."
Dr Moses Mugonya, the Mbale City health officer, said the lack of haematologists in referral hospitals is a glaring gap in our healthcare system.
"This is a total frustration to the patients and their families," Dr Mugonya, said.
Mr Steven Masika, the spokesperson of the Inzu Ya Masaba, the Bugisu cultural institution, said measures should be taken to ensure that the referral hospitals are equipped with experts in every field to improve healthcare.
"The facilities are not well staffed with haematologists, which is a big disservice to many but at times you find the government allocating resources to areas of no importance," he said.
Ms Hajira Namagogwe, the Busia Resident District Commissioner, said they have been advocating for increased funding for healthcare services in the region.
"This is not just about one or two patients; this is a systemic issue that affects all communities," Ms Wabwire said.
Dr Aggrey Dhabangi, a transfusion physician who works at Uganda Blood Transfusion Service, said ensuring that platelet levels are adequately restored before surgery is crucial.
"Surgeons often decide against performing surgery on patients with low platelet counts due to the heightened risk of excessive bleeding," he said.
"Low platelet counts in children can result from various causes, which are broadly categorised as acquired or inborn," he added.
Low platelet levels are caused by infections like malaria, autoimmune disorders like Immune Thrombocytopenic Purpura (ITP), certain medications, nutritional deficiencies, and genetic disorders such as congenital bone marrow failure syndromes.
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