Menstrual disorders

Most women experience a form of menstrual dis- order at some time. A regular menstrual cycle begins between the ages of 12 and 13 years. Most cy- cles occur between 21 and 35 days, with 3 to 10 days of bleeding and 1 to 11⁄2 fluid ounces (30 to 40 ml) of blood loss. A typical menstrual cycle occurs about every 28 days, unless a woman is pregnant or moving into menopause. When the menstrual cycle is abnormally disrupted, a menstrual disorder may be occurring.

Menstrual disorders include amenorrhea (the cessa- tion of menstruation), oligomenorrhea (infrequent menstruation), menorrhagia (heavy bleeding), meno- metrorrhagia (irregular heavy bleeding), dysmenorrhea (severe menstrual cramps), and premenstrual syndrome (PMS); emotional symptoms a week preceding menses. The physical and emotional symptoms accom- panying these irregularities in the menstrual cycle may cause serious anxiety and distress for patients and their families and diminish the quality of life.

Symptoms and signs

Symptoms of menstrual disorders vary depending on the cause. Most menstrual disorders are caused by a hormonal imbalance or a dysfunction that is related di- rectly to the female reproductive organs. A common cause of menstrual irregularity is polycystic ovary syn- drome (POS), in which there is anovulation (lack of ovulation), which can result in oligomenorrhea or menometrorrhagia. The lack of progesterone associated with anovulation in POS can predispose a woman to endometrial cancer. In primary amenorrhea, the only symptom is delayed menstruation; in secondary amen- orrhea, menstruation stops for at least three months.




Heavy bleeding and fatigue due to the loss of iron- rich blood are the symptoms of menorrhagia. In this type of menstrual disorder, blood flow soaks through a tampon or pad every hour for several hours, or a peri- od lasts more than seven days. Symptoms of primary dysmenorrhea include severe cramping, pelvic pain, nausea, and vomiting and diarrhea. The symptoms may be stronger on one side of the body than the other. In secondary dysmenorrhea, the pain might feel like regular menstrual cramps but lasts longer than normal and occurs throughout the month. Another menstrual disorder is PMS, which is used to describe emotional symptoms like mood swings in the week preceding menses. If PMS is severe and debilitating, it is also known as premenstrual dysphoric disorder (PMDD).

Causes and risks

Since menstrual disorders is a general term to describe pathological variations in the menstrual cycle, the causes of each component are different. Lifestyle choices such as excessive exercise or low body weight can lead to primary amenorrhea. Medical conditions causing amenorrhea include Turner’s syndrome, a birth defect related to the reproductive system, or ovarian problems. Secondary amenorrhea can be caused by pregnancy, breast-feeding, sudden weight loss or gain, intense exercise, stress, endocrine disorders affecting the thyroid, pituitary, or adrenal glands, and surgical procedures affecting the ovaries, including removal of the ovaries, cysts, or ovarian tumors. Amenorrhea is common in athletes or dancers and is frequently asso- ciated with two other disorders—reduced bone mass and eating disorders. This combination is sometimes called the female athlete triad.

Heavy or irregular bleeding during menstruation is a symptom of an underlying condition rather than a dis- ease itself. It is usually related to a hormonal imbalance but can be caused by fibroids, cervical or endometrial polyps, the autoimmune disease lupus, pelvic inflamma- tory disease (PID), blood platelet disorder, a hereditary blood factor deficiency, or possibly, some reproductive cancers. Having these other conditions may increase the risk of menstrual disorders in a particular individual.

Dysmenorrhea is usually related to the production of prostaglandins, naturally occurring chemicals that cause an inflammatory reaction. Women with severe men- strual pain have higher levels of prostaglandin in their menstrual blood than women without such pain. In some women, prostaglandins can cause some of the smooth muscles in the gastrointestinal tract to contract, resulting in the nausea, vomiting, and diarrhea that some women experience. Other causes of dysmenor- rhea include fibroids, PID, an intrauterine device, uter- ine, ovarian, bowel, or bladder tumor, uterine polyps, inflammatory bowel disease, scarring or adhesions from surgery, and endometriosis or adenomyosis, conditions in which the endometrial lining grows in other areas of the pelvic cavity. As in menorrhagia, having any of these conditions increases the risk for menstrual disorders. The likely causes of PMS or PMDD are hormonal imbalances.

Diagnosis and treatments

Menstrual disorders are diagnosed by considering family and medical history, eating and exercise habits, lifestyle, stress levels, changes in body weight, and a pelvic exam. Routine blood tests are done to measure hormone levels and to check for pregnancy. A diagnosis may include an endometrial biopsy in which a small amount of tissue is scraped from the lin- ing of the uterus for examination. An ultrasound of the pelvic area typically allows visualization of any in- ternal structural anomalies. Similarly, surgical proce- dures may include laparoscopy, in which a thin tube with a camera attached is inserted through a small incision below or through the navel, or a hysteroscopy, in which a thin tube with a camera attached is inserted into the vagina and up through the cervix; these allow internal views of the abdominal cavity and uterus, respectively.

Treatments for menstrual disorders depend on which type of disorder is diagnosed. In the case of amenorrhea, simple changes in lifestyle such as reduc- ing the intensity of exercise, maintaining an appropri- ate weight, and reducing stress levels may solve the problem. Surgery is recommended only in rare cases in which amenorrhea is linked to ovarian cysts, vaginal blockage, or uterine anatomical abnormalities. It is es- sential to determine the cause before treating menor- rhagia. Medical therapies may help, but occasionally surgery is indicated. In most cases, surgery involves re- moving the lining of the uterus temporarily or perma- nently. There are a number of procedures that can achieve this goal, such as a dilation and curettage, en- dometrial biopsy, endometrial resection, and endome- trial ablation. Primary dysmenorrhea is handled with drugs and nonmedical treatments. Drugs include ei- ther over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDS) or prescription medications such as oral contraceptives that provide cycle control and re- duce menstrual blood flow.

Nonmedical treatments include using a heating pad on the abdomen or taking warm baths to reduce dis- comfort. Taking B vitamins, magnesium, and omega- 3 fatty acid supplements may also help. Menstrual disorders are diverse and complicated and require medical consultation.