Menstrual disorders

Specialty of Obstetrics & gynaecology

What are the different types of menstrual disorders?

Disorders of cycle length:

  • Amenorrhea (absence of menstruation)
  • Oligomenorrhea (infrequent menstrual periods that happen more than 35 days apart)

Disorders of flow (abnormal uterine bleeding):

  • Hypomenorrhea (light bleeding during menstruation)
  • Menorrhagia (heavy bleeding or prolonged menstrual periods)
  • Metrorrhagia (bleeding at irregular times outside the menstruation period)

Other menstrual disorders:

  • Dysmenorrhea (painful cramps during menstruation)
  • Premenstrual syndrome (PMS) (a range of physical and emotional symptoms that occur one to two weeks before the menstruation period)
  • Premenstrual dysphonic disorder (PMDD) (a more severe form of PMS that is considered a mental health disorder)

What are the symptoms of menstrual disorders?

Amenorrhea:

  • Absence of period (not including pre-pubescence, post-menopause or pregnancy).
  • Primary amenorrhea is when a girl does not begin to menstruate by the age of 16.
  • Secondary amenorrhea happens when previously regular periods stop for at least 3 months.

Menorrhagia:

  • A type of abnormal uterine bleeding (AUB).
  • When menstrual bleeding is so excessive that women have to put their lives on hold temporarily.
  • Women may need to change their sanitary wear more than once in an hour.
  • Periods can last longer, for more than 10 days.

Dysmenorrhea:

  • Primary dysmenorrhea – pain caused by menstruation.
  • Secondary dysmenorrhea – pain caused by other problems such as fibroids or endometriosis.
  • Extremely painful and persistent menstrual cramps.
  • Pain can be sharp, dull or aching in the lower abdomen or pelvis.

Premenstrual syndrome (PMS):

  • Most women experience PMS before their period.
  • Physical symptoms include bloating, tender breasts, fatigue, clumsiness, headaches and constipation.
  • Emotional symptoms include anger, anxiety, depression, lack of concentration.

What causes menstrual disorders?

Amenorrhea and oligomenorrhea:

  • Weight loss or eating disorders
  • Delayed puberty
  • Polycystic ovary syndrome (PCOS)
  • Endometriosis
  • Stress
  • Extreme athletic training or steroid use

Menorrhagia:

  • Hormonal imbalances
  • Anovulation (when ovulation does not happen, heavy bleeding can occur)
  • Fibroids
  • Uterine polyps
  • Endometriosis
  • Contraceptive medication
  • Cancer
  • Pregnancy or miscarriage
  • Infection of the uterus or cervix

Dysmenorrhea:

  • Primary dysmenorrhea is caused by prostaglandins which are produced in the uterus and contribute to heavy bleeding.
  • Secondary dysmenorrhea is caused by other conditions, such as endometriosis, fibroids, ovarian cysts, ectopic pregnancy, or the intrauterine device (IUD).

What is the treatment for these menstrual disorders?

Abnormal uterine bleeding:

  • Birth control pills can help to regulate menstrual bleeding.
  • Endometrial ablation can be carried out to remove uterine lining to prevent heavy bleeding, however, this procedure can affect fertility.
  • Surgical procedures to address underlying problems, such as a myomectomy to remove fibroids.

Dysmenorrhea:

  • Over-the-counter painkillers can help.
  • Birth control pills can also help sometimes to reduce menstrual cramps.
  • Mild exercise can help too.

PMS and PMDD:

  • PMDD requires specialist treatment, and may involve anti-depressants being prescribed.
  • PMS can benefit from exercise and dietary choices, such as reducing caffeine and alcohol intake.

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