Menstrual Disorders

For every day of every month, there seems to be a different word to describe the way a woman's body changes during "that time of the month." Whether there's too much or too little bleeding, pain and bloating, or mood swings, menstrual disorders can mess with a woman's mind as well as her physical well-being. Luckily, according to the American College of Obstetricians and Gynecologists (ACOG), many symptoms of menstruation can be managed, and many disorders can be treated.

The cycle

The monthly menstrual cycle, according to the National Women's Health Information Center (NWHIC), is how a woman's body prepares for the possibility of pregnancy. (Read about "Healthy Pregnancy") A girl, according to NWHIC, usually starts menstruating when she is about 12 years old. NWHIC says a cycle can range from 23 to 35 days, but on average is usually 28 days. During this cycle, an egg, released from an ovary, travels down the fallopian tubes towards the uterus. The uterus has been preparing for this by building up a lining of extra blood and tissue. If the egg is fertilized by a sperm cell, the fertilized egg will attach itself to the uterine wall marking the beginning of pregnancy. If the egg is not fertilized, the thick uterine lining and extra blood will be shed through the vaginal canal. That expulsion of blood and tissue is what is commonly called a period. A period, according to ACOG, usually lasts between three and seven days. After the period ends, the cycle begins all over again.

Some common menstrual disorders include:

• amenorrhea (lack of periods)
• dysmenorrhea (painful periods)
• menorrhagia (heavy or lengthy periods)
• metrorrhagia (spotting)
• premenstrual syndrome (mood changes just prior to menses)

Below you'll find information on all these issues.

Amenorrhea

If a woman's regular periods stop at any age, or a teenager fails to develop a menstrual cycle, she may have amenorrhea. ACOG says the most common reason for a missed period is pregnancy, and suggests taking a pregnancy test. ACOG says several other reasons for missed periods include:

• illness
• sudden change in weight
• eating disorders (Read about "Eating Disorders")
• extreme exercise
• hormone irregularities as a result of conditions such as polycystic ovary syndrome or thyroid disease (Read about "Polycystic Ovary Syndrome" "Thyroid")
• certain conditions such as Turner syndrome (Read about "Turner Syndrome")
• certain medications
• stress, such as going away to college, or emotional trauma, such as the death of a spouse or close family member (Read about "Stress")
• structural abnormalities of the reproductive organs

ACOG advises that you see your healthcare provider if you haven't had a period by age 16, or if you miss periods frequently.

While exercise is important for our health and well-being, it can also pose some medical problems for teenage girls and women. According to the American Academy of Pediatrics (AAP), female athletes can be at risk for menstrual disorders such as amenorrhea. AAP says if this is the case, menses may be delayed until age 16, there may be fewer menstrual cycles or periods may occur after the 35th day of a cycle, rather than the 28th day, which is considered average. Part of the problem, according to AAP, may stem from the athlete burning too many calories, and not eating enough. AAP stresses that menstrual dysfunction is not a normal result of exercise and can cause a decrease in bone mineral density or a loss of calcium from the bones. (Read about "Osteoporosis")

Dysmenorrhea

Painful periods can be put in two different groups, according to FDA:

• primary dysmenorrhea
• secondary dysmenorrhea

Primary dysmenorrhea will usually start within three years of a girl's first period. FDA says it will last one or two days a month, and can continue through menopause. (Read about "Menopause") Primary dysmenorrhea is believed to be caused by the normal production of chemical substances called prostaglandins. These prostaglandins make the uterus contract, sometimes so much that the blood supply is cut off for a short time, depriving the uterine muscle of oxygen. That process can cause painful cramping.

Newer pain relievers are helping dull the ache many women feel as their periods begin. Nonsteroidal anti-inflammatory drugs (NSAIDS) have provided much needed relief for many women according to FDA, because they reduce the production of prostaglandin. These medications can be found in prescription form, or over-the-counter. (Read about "Medication and Digestion") Hormonal medications are sometimes prescribed to help relieve cramping, and FDA says exercise is thought to be of some benefit as it raises levels of the brain's pain relieving chemicals. (Read about "The Brain")

Secondary dysmenorrhea, according to FDA, is pain caused by disease. Uterine fibroids, pelvic inflammatory disease and endometriosis all fall into this category. FDA says one indication that disease is causing the menstrual pain is if pain also occurs at other times during the month or during intercourse. You should seek your healthcare provider's advice should you have concerns about any abnormal pain. (Read about "Uterine Fibroids" "Endometriosis")

Menorrhagia and Metrorrhagia

A heavy flow during periods and/or lengthy menstrual periods could be diagnosed as menorrhagia. Bleeding or spotting between periods is known as metrorrhagia. The two, alone or together, can be called dysfunctional uterine bleeding. This abnormal uterine bleeding may, according to the U.S. Food and Drug Administration (FDA), be caused by a number of different problems:

• hormonal imbalance (Read about "Polycystic Ovary Syndrome")
• fibroids (Read about "Uterine Fibroids")
• overgrowth of endometrial tissue (Read about "Endometriosis")
• a bleeding disorder called von Willebrand Disease (Read about "Bleeding Disorders")
• cancer (Read about "Cervical Cancer" and "Uterine Cancer")
• thyroid abnormalities (Read about "Thyroid")
• other conditions such as adenomyosis, which is a thickening of the walls of the uterus

Sometimes, according to FDA, there is no identifiable cause for the bleeding.

Once your physician or healthcare provider is able to diagnose the cause of the abnormal bleeding, a treatment program can begin. There are options to discuss with your doctor.

• Medication - FDA says doctors usually start with medications. Some FDA approved estrogens and progestins are used to treat abnormal uterine bleeding. A non-hormonal treatment to help blood to clot may also be an option.
• D and C - D and C is also known as dilatation and curettage. It is a procedure in which the physician first dilates or opens the woman's cervix and then inserts a thin, spoon-shaped instrument and uses it to scrape (curettage) the lining of the uterus. The American College of Surgeons says D and C can be used to diagnose, or to treat heavy menstrual bleeding. D and C is often combined with a procedure called hysteroscopy, a procedure to look into the uterus through the cervix with a small telescope-like instrument. If fibroids or other abnormal structures are found, they can often be removed with the hysteroscope.
• Endometrial ablation - FDA calls endometrial ablation, a viable alternative to a hysterectomy. Endometrial ablation, according to FDA, is a minimally invasive surgery using electrical energy, heat or cold to destroy the endometrium (uterine lining). This may minimize the bleeding, but FDA warns the results may last just a decade and the procedure may not be for everyone. FDA does not advise endometrial ablation for women who want to have children. However, it is still possible to get pregnant after endometrial ablation but it would be considered a high risk pregnancy. While complications are rare, FDA says blood loss, accidental damage to internal organs and perforation of the uterus are possible.
• Endometrial resection - In this procedure, a surgical wire loop is used to remove the lining of the uterus.
• Hysterectomy - A hysterectomy can, according to FDA, help improve the life of some women who suffer from abnormal uterine bleeding who cannot be helped by other treatments. The surgery, which involves the removal of the uterus, is somewhat common in this country. (Read about "Hysterectomy") The Centers for Disease Control and Prevention (CDC) say five out of every 1,000 women have the operation every year. Not all of those procedures are to treat abnormal bleeding however; some are to treat cancers. (Read about "Uterine Cancer") Experts warn that it should be the last step in finding a way to resolve abnormal bleeding. Removal of the uterus will leave a woman sterile. The surgery may be done conventionally or robotically. (Read about "Robotic Surgery")
• Fibroid treatment - If fibroids are found to be the cause of the heavy bleeding, FDA says there are medications, called gonadotropin-releasing hormone agonists (GnRHa), your physician may prescribe that will temporarily shrink the fibroids. It involves an injection that temporarily stops estrogen production. These medicines can be used for three months, six months or even longer if indicated and with proper monitoring. FDA warns that side effects can include loss of bone density and hot flashes. Once the GnRHa injections are stopped, fibroids can return to their original size in three months.

  If the fibroids are causing pain and anemia (Read about "Anemia") because of heavy bleeding, FDA says there are several surgical options for removing fibroids:

  • Myomectomy - surgically removing only the fibroids.
  • Myolysis - shrinking the fibroids using electric current or a laser.
  • Uterine Fibroid Embolization (UFE) or Uterine Artery Embolization (UAE) - cutting off the blood supply to the fibroids.
  • Hysterectomy - surgical removal of the uterus.

FDA says no treatment, other than a hysterectomy, can guarantee an end to abnormal uterine bleeding and fibroids. (Read about "Uterine Fibroids")

Premenstrual Syndrome (PMS)

Premenstrual syndrome is not only real, but it's downright bothersome. (Read about "Premenstrual Syndrome") According to ACOG, 20 to 40 percent of all women suffer symptoms of PMS, which occurs in the last 7 to 10 days of the menstrual cycle. FDA puts these symptoms into four groups:

While FDA says diet and exercise can help relieve some symptoms, prescription medications may be prescribed in moderate to severe cases. This can include the use of natural or synthetic progesterones or short-term use of low-dose antidepressants. Your healthcare provider may ask you to keep a daily diary of your symptoms for one or two menstrual cycles. This is important so the healthcare provider can prescribe the best treatment for your symptoms.

Related Information:

    Genital Health - Female

    Endocrine System