With each menstrual cycle, the endometrium (uterine lining) prepares itself to nourish a fetus. If fertilization doesn’t occur, the body sheds the endometrium during the monthly cycle. In some cases, an irregularity can occur in this cycle, indicating any of the following menstrual disorders:
Types of Menstrual Disorders
Premenstrual Syndrome (PMS)
PMS is any unpleasant or uncomfortable symptom during your cycle that may temporarily disturb normal functioning. These symptoms may last from a few hours to many days, and the types and intensity of symptoms can vary in individuals.
Premenstrual Dysphoric Disorder (PMDD) is a much more severe form of PMS which affects approximately 3%-8% of women of reproductive age. PMDD requires treatment by a physician.
Although each individual may experience symptoms differently, the most common symptoms of PMS may include any of the following:
- Psychological symptoms (depression, anxiety, irritability)
- Gastrointestinal symptoms (bloating)
- Fluid retention (swelling of fingers, ankles and feet)
- Skin problems (acne)
- Muscle spasms
- Heart palpitations
- Vision problems
- Decreased coordination
- Diminished libido (sex drive)
- Changes in appetite
- Hot flashes
Simple modifications in lifestyle can help eliminate or reduce the severity of symptoms, including:
- Exercising 3 to 5 times each week
- Eating a well-balanced diet that includes whole grains, vegetables and fruit, and a decreasing salt, sugar, caffeine and alcohol intake
- Getting adequate sleep and rest
Amenorrhea is characterized by absent menstrual periods. There are two types of amenorrhea:
Types of Amenorrhea
- Primary amenorrhea: Menstruation does not begin at puberty.
- Secondary amenorrhea: Normal and regular menstrual periods which become increasingly abnormal and irregular or absent. This may be due to a physical cause typically of later onset.
Amenorrhea can occur for a number of reasons as part of the normal course of life, such as pregnancy, breast-feeding or menopause. Or, it may occur as a result of medications or a medical problem including:
- Ovulation abnormality
- Birth defect, anatomical abnormality or other medical condition
- Eating disorder
- Excessive or strenuous exercise
- Thyroid disorder
If at least three consecutive menstrual periods are missed in someone who previously had a regular cycle, 6 consecutive cycles in someone who previously had an irregular cycle, or if you’ve never had a menstrual period and are 16 years or older, it is important to see a healthcare professional. As with any condition, early diagnosis and treatment is very important.
Dysmenorrhea is characterized by severe and frequent menstrual cramps and pain associated with menstruation. Cause can be primary or secondary. Secondary dysmenorrhea is caused by other medical conditions, most often endometriosis. Other possible causes may include:
- pelvic inflammatory disease (PID)
- uterine fibroids
- abnormal pregnancy (i.e., miscarriage, ectopic)
- infection, tumors, or polyps in the pelvic cavity
The most common symptoms may include:
- Cramping or pain in the lower abdomen
- Low back pain or pain radiating down the legs
Menorrhagia is the most common type of abnormal uterine bleeding and is characterized by heavy and prolonged menstrual bleeding. In some cases, bleeding may be so severe that daily activities are disrupted.
Other types of this condition, also called dysfunctional uterine bleeding, may include:
- Polymenorrhea: Too frequent menstruation or short cycles less than 21 days.
- Oligomenorrhea: Infrequent menstrual cycles.
- Hypomenorrhea:Light menstrual periods
- Metrorrhagia: Any irregular, non-menstrual bleeding as in bleeding which occurs between menstrual periods
- Postmenopausal bleeding: Any bleeding that occurs more than one year after the last normal menstrual period at menopause
There are several possible causes of abnormal uterine bleeding, including:
- Hormonal imbalance
- Pelvic inflammatory disease (PID)
- Uterine fibroids
- Abnormal pregnancy; i.e., miscarriage, ectopic (tubal pregnancy)
- Infection, tumors or polyps in the pelvic cavity
- Certain birth control devices; i.e., intrauterine devices (IUDs)
- Bleeding or platelet disorders
- High levels of prostaglandins (chemical substances used to control muscle contractions of the uterus)
- High levels of endothelins (chemical substances used to dilate blood vessels)
- Liver, kidney or thyroid disease
Typical symptoms of menorrhagia are when a woman has soaked through enough sanitary napkins or tampons to require changing every hour, and/or a woman’s menstrual period lasts longer than 7 days in duration.
A diagnosis of abnormal uterine bleeding can only be certain when the physician has taken a full history, performed an examination and some testing. It is important to identify and treat underlying medical conditions or check for medications that may be causing or aggravating the condition.
Other diagnostic procedures may include:
- Blood tests
- Pap test
- Ultrasound: An imaging technique which uses high-frequency sound waves to create an image of the pelvic organs.
- Magnetic resonance imaging (MRI): A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of the reproductive organs.
- Laparoscopy: A minor surgical procedure in which a laparoscope, a thin tube with a lens and a light, is inserted into an incision in the abdominal wall. Using the laparoscope to see into the pelvic and abdomen area, the physician can often detect abnormal growths.
- Hysteroscopy: A visual examination of the canal of the cervix and the interior of the uterus using a hysteroscope inserted through the vagina.
- Biopsy (endometrial): Tissue samples are removed from the lining of the uterus with a needle or during surgery to determine if cancer or other abnormal cells are present.
- Dilation and curettage (D&C): A common gynecological surgery which consists of widening the cervical canal with a dilator and scraping the uterine cavity with a curette – a spoon-shaped surgical tool used to remove tissue.
Your doctor may suggest a psychiatric evaluation to rule out other possible conditions, or ask you to track your symptoms in a journal to better assess the timing, severity, onset and duration of symptoms.
A specific treatment plan will be determined by your doctor based on factors such as:
- Your age, overall health and medical history
- Extent of the condition
- Possible cause of the condition
- Current symptoms
- Your tolerance for specific medications, procedures or therapies
Treatments for menstrual disorders
Discussing your menstrual disorder symptoms with your doctor can help determine what type of treatments can best reduce or relieve your symptoms, including:
- Prostaglandin inhibitors
- Hormone supplements
- Oral contraceptives
- Dietary modifications
- Regular exercise