Menstrual disorders are problems that affect a women’s normal menstruation cycle. There are several types of menstrual disorders, and problems can range from heavy, painful periods to no periods at all. There are many variations in menstrual patterns, but in general, women should be concerned when periods come fewer than 21 days or more than three months apart, or if they last more than 10 days. Such events may indicate ovulation problems or other medical conditions. These are some of the most common menstrual disorders.
Dysmenorrhea literally means painful menstruation. Pain occurs in the lower abdomen, but can spread to the lower back and thighs. Dysmenorrhea is usually referred to as primary or secondary:
- Primary dysmenorrhea (spasmodic): Cramping pain caused by menstruation. The cramps occur from contractions in the uterus and are usually more severe during heavy bleeding.
- Secondary dysmenorrhea: Menstrual-related pain that accompanies another medical or physical condition, such as endometriosis or uterine fibroids.
Menorrhagia is the medical term for menstrual periods with abnormally heavy or prolonged bleeding. If you have one or two periods with heavy or prolonged bleeding, there’s probably no reason to worry. Although heavy menstrual bleeding is a common concern, most women don’t experience blood loss severe enough to be defined as menorrhagia.
With menorrhagia, you can’t maintain your usual activities when you have your period because you have so much blood loss and cramping. If you dread your period because you have such heavy menstrual bleeding, talk with your doctor. There are many effective treatments for menorrhagia. Signs and symptoms may include:
- Soaking through one or more sanitary pads or tampons every hour for several consecutive hours
- Needing to use double sanitary protection to control your menstrual flow
- Needing to wake up to change sanitary protection during the night
- Bleeding for longer than a week
- Passing blood clots larger than a quarter
- Restricting daily activities due to heavy menstrual flow
- Symptoms of anaemia such as tiredness, fatigue, or shortness of breath
Do call your healthcare professional if the heavy bleeding is accompanied by pain that is not relieved by ibuprofen or acetaminophen. Avoid taking aspirin because it could worsen the bleeding problem. If you have bleeding after menopause, or the abnormal bleeding is accompanied by fever or other symptoms, again, consult your healthcare professional.
Amenorrhea is when you don’t get your monthly period. It can be temporary or permanent. Amenorrhea can result from a change in function or a problem with some part of the female reproductive system. There are times when you’re not supposed to get your period, such as before puberty, during pregnancy, and after menopause. If amenorrhea lasts for more than three months, it should be investigated. There are two classifications of amenorrhea:
- Primary amenorrhea: This is when you haven’t gotten a first period by age 15 or within five years of the first signs of puberty. It can happen due to changes in organs, glands, and hormones related to menstruation.
- Secondary amenorrhea: This is when you’ve been getting regular periods, but you stop getting your period for at least three months or you stop your menses for six months when they were previously irregular. Causes can include pregnancy, stress, and illness.
Having regular periods is an important sign of overall health. Missing a period – when not caused by pregnancy, breastfeeding, or menopause – is generally a sign of another health problem. Some examples include anorexia nervosa, hyperthyroidism, and excessive exercise, which affects the menstrual cycle. If you miss your period, talk to your healthcare provider about possible causes, including pregnancy. A complete medical history and blood tests will be the first steps your healthcare professional takes to identify the cause of your amenorrhea and develop a treatment plan.
Hypomenorrhea, also known as short and scanty periods, is extremely light menstrual blood flow. In some women, it may be normal to have less bleeding during menstrual periods. Less blood flow may be genetic and, if enquiries are made, it may be found that woman’s mother and/or sister also have decreased blood flow during their periods. Pregnancy can normally occur with this type of decreased flow during the period. The incidence of infertility is the same as in women with normal blood flow.
Hypomenorrhea can occur normally at the extremes of the reproductive life – just after puberty and just before menopause. This is because ovulation is irregular at this time, and the endometrial lining fails to develop normally. But normal problems at other times can also cause scanty blood flow. Ovulation due to a low thyroid hormone level, high prolactin level, high insulin level, high androgen level, and problems with other hormones can also cause scanty periods.
Premenstrual Syndrome (PMS)
Premenstrual syndrome, or PMS, refers to the physical and emotional symptoms that many women experience in the lead-up to menstruation. Although the cause of PMS isn’t clear, you can manage it with medication and other strategies. Additionally, symptoms ease during the woman’s period and there is usually at least one symptom-free week before the symptoms return. PMS is a complex condition that includes physical and emotional symptoms. Research shows that:
- women with PMS are hypersensitive to their own normal cyclic hormones (progesterone and oestrogen) during their menstrual cycle
- brain chemicals (specifically the neurotransmitters serotonin and gamma butyric acid) play a role
- symptoms do not occur during pregnancy or after menopause
PMS differs from one woman to the next, spanning physical and mood symptoms. They can include:
- abdominal bloating
- digestive upsets, including constipation and diarrhoea
- fluid retention
- weight gain
- breast tenderness or swelling
- joint or muscle pain
- poor sleep or sleepiness
- food cravings
- headache and migraine
- hot flushes or sweats
- increased appetite
- increased sensitivity to sounds, light, and touch
Premenstrual Dysphoric Disorder (PDD)
Premenstrual dysphoric disorder (PMDD) is a severe, sometimes disabling extension of premenstrual syndrome (PMS). Although PMS and PMDD both have physical and emotional symptoms, PMDD causes extreme mood shifts that can disrupt daily life and damage relationships.
In both PMDD and PMS, symptoms usually begin seven to 10 days before your period starts and continue for the first few days of your period. Both PMDD and PMS may cause bloating, breast tenderness, fatigue, and changes in sleep and eating habits. In PMDD, however, at least one of these emotional and behavioural symptoms stands out:
- Sadness or hopelessness
- Anxiety or tension
- Extreme moodiness
- Marked irritability or anger
The cause of PMDD isn’t clear. Underlying depression and anxiety are common in both PMS and PMDD, so it’s possible that the hormonal changes that trigger a menstrual period can worsen the symptoms of mood disorders.
Uterine fibroids are benign (not cancerous) growths that develop from the muscle tissue of the uterus. They are also called leiomyomas or myomas. The size, shape, and location of fibroids can vary greatly. They may be inside the uterus, on its outer surface or within its wall, or attached to it by a stem-like structure. A woman may have only one fibroid or many of varying sizes. A fibroid may remain very small for a long time and suddenly grow rapidly, or grow slowly over a number of years. Fibroids may have the following symptoms:
- Changes in menstruation
- Longer, more frequent, or heavy menstrual periods
- Menstrual pain (cramps)
- Vaginal bleeding at times other than menstruation
- Anemia (from blood loss)
- Pain during sex
- Difficulty urinating or frequent urination
- Constipation, rectal pain, or difficult bowel movements
- Abdominal cramps
- Enlarged uterus and abdomen
Fibroids also may cause no symptoms at all, and may be found during a routine pelvic exam or tests for other problems.
Polycystic Ovarian Syndrome (PCOS)
Polycystic ovary syndrome (or polycystic ovarian syndrome – PCOS) is a complex hormonal condition. ‘Polycystic’ literally translates as many cysts. This refers to the many partially formed follicles on the ovaries, which each contain an egg. These rarely grow to maturity or produce eggs that can be fertilised. Women with PCOS commonly have high levels of insulin that don’t work effectively or male hormones known as ‘androgens’, or both. The cause is not fully understood. However, family history and genetics, hormones, and lifestyle play a role.
Insulin-resistance is present in up to four out of five women with PCOS. Women who have a mother, aunt, or sister with PCOS are 50% more likely to develop PCOS. The condition is also more common in women of Asian, Aboriginal and Torres Strait Islander, and African backgrounds. PCOS is relatively common, especially in infertile women. To be diagnosed with PCOS, women need to have two out of three of the following:
- irregular or absent periods
- acne, excess facial or body hair growth, scalp hair loss, or high levels of androgens (testosterone and similar hormones) in the blood
- polycystic ovaries (many small cysts on the ovaries) visible on an ultrasound
Women who have PCOS may experience the following symptoms, but you don’t have to have all of these to have PCOS:
- irregular menstrual cycles – periods may be less or more frequent due to less frequent ovulation (release of an egg)
- amenorrhoea (no periods) – some women with PCOS do not menstruate, in some cases for many years
- excessive facial or body hair growth (or both)
- scalp hair loss
- reduced fertility (difficulty in becoming pregnant) – related to less frequent or absent ovulation
- mood changes, including anxiety and depression
- sleep apnoea
Treating Menstrual Disorders
Treatments for menstrual disorders range from over-the-counter medications to surgery, with a variety of options in between. Your treatment options will depend on your diagnosis, its severity, which treatment you prefer, your health history, and your healthcare professional’s recommendation.
3 Lifestyle Tips to Manage Period Pain
1. Don’t put up with painful periods. If your menstrual periods cause mild to moderate discomfort, relief may be as close as your medicine cabinet. Acetaminophen (Tylenol) often relieves mild menstrual pain. Ibuprofen, naproxen, and mefenamic acid (brands such as Motrin IB, Advil, Bayer Select Pain Relief Formula, and Midol IB) can relieve moderate to more severe pain. These medications work best when symptoms first begin. If menstrual pain lasts several days, your doctor may prescribe another type of pain reliever. Discuss your symptoms and treatment options with your healthcare professional.
2. Relax yourself to ease painful menstruation. Next time you get painful menstrual cramps, lie down with a heating pad on your abdomen. Then, use your fingertips to lightly massage your belly in a circular motion. Drinking warm beverages that aren’t caffeinated, taking a warm shower, performing waist-bending exercises, and walking can help.
3. Oral contraceptives or contraceptive patches often alleviate menstrual pain. If you have menstrual pain, your doctor may offer to put you on an oral contraceptive as a means of treating your discomfort. Unless you wish to stay on the pill for contraception, you can discontinue taking it after six to 12 months. Many women report continued relief from menstrual pain even after they stop taking oral contraceptives.
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