Common Menstrual Problems: Menstrual Disorders, Dysmenorrhea and Abnormal Non-Menstrual Bleeding

Menstruation, commonly known as a period, is a natural process that occurs in girls and women. During puberty, hormonal changes in the body stimulate the ovaries to release mature eggs in a cyclic manner. Typically, only one ovary releases an egg during each menstrual cycle, while the other remains inactive. Simultaneously, the lining of the uterus thickens to prepare for the potential implantation of a fertilized egg. If pregnancy does not occur, the uterine lining and the unfertilized egg are shed approximately two weeks after ovulation. This shedding of the uterine lining is what we refer to as menstruation. The length of the menstrual cycle varies from person to person, usually ranging from 21 to 35 days, with the actual menstrual bleeding lasting around 2 to 7 days. Most girls experience their first menstruation, called menarche, between the ages of 10 and 15, while women typically reach menopause, the permanent cessation of menstruation between the ages of 45 and 55.

Menstrual Disorders

Menstrual Disorders are characterized by irregular or abnormal changes in the menstrual cycle or blood flow in women. They are prevalent among many women, particularly during puberty or menopause. Several factors can contribute to menstrual disorders. The following are some primary factors that can affect hormone secretion and result in menstrual disorders:

1. Uterine conditions such as uterine fibroids, adenomyosis/endometriosis, Endometrial Polyps, or cervical polyps.
2. Ovarian conditions such as polycystic ovary syndrome (PCOS)
3. Endocrine disorders such as thyroid disorders
4. Changes in body weight and eating disorders
5. Intense physical activities and stress
6. Medications such as antibiotics, antidepressants and others

Symptoms of Menstrual Disorders

Menstrual Disorder

The menstrual cycle is counted from the first day of menstrual bleeding to the day before the next menstrual bleeding starts. Each person’s menstrual cycle is different, and a cycle ranging from 21 to 35 days is considered normal. However, significant variations in cycle length or consistently having too short or too long cycles may indicate an underlying issue.

Prolonged Menstrual Period

A normal menstrual period typically lasts around 2 to 7 days. If the period extends beyond 7 days, it is considered a prolonged menstrual period.

Heavy Menstrual Bleeding

Women lose about 60-80cc of menstrual blood during each menstrual period on average. It is difficult to measure the exact amount of menstrual blood. To determine if your menstrual bleeding is excessive, you can pay attention to the type of sanitary pads you use and how often you need to change them. If you require extra-long and highly absorbent pads, need to change them every 1-2 hours, and saturate each pad with blood, or if you need to use maternity pads or diapers, then your menstrual blood flow is considered heavier than average. If you notice large blood clots in your menstrual blood or experience heavy bleeding that soaks through clothing, or if you have symptoms of anaemia such as dizziness, rapid heartbeat, shortness of breath and fatigue, it is essential to seek medical attention promptly.

Dysmenorrhea (Painful Cramps)

Dysmenorrhea is a condition that affects many women. It is characterized by varying degrees of pain, bloating, and a sense of heaviness in the lower abdomen and lower back before or during menstrual periods. Dysmenorrhea can be broadly categorized into primary dysmenorrhea and secondary dysmenorrhea:

Primary Dysmenorrhea

Primary dysmenorrhea primarily affects younger women. Symptoms typically occur during the first one or two days of the menstrual period, including cramping, throbbing, or spasmodic pain. These symptoms result from the excessive production of prostaglandins by the uterine endometrium, which leads to uterine contractions. The pain may radiate to the thighs and can be accompanied by lower backache, breast tenderness, nausea, and diarrhoea, among other symptoms. As the menstrual period progresses, the pain usually subsides. In most cases,

Secondary Dysmenorrhea

Secondary dysmenorrhea is more commonly observed in women after adolescence. It is associated with abnormalities in the reproductive system, such as endometriosis, uterine fibroids, adenomyosis, endometrial polyps, or pelvic inflammatory disease. Depending on the specific underlying condition, secondary dysmenorrhea can cause pain in a broader range of areas, including the lower back, tailbone, buttocks, and thighs. Unlike primary dysmenorrhea, pain caused by underlying conditions tends to worsen with age.

Abnormal Non-Menstrual Bleeding

Non-menstrual bleeding refers to vaginal bleeding that occurs outside of the regular menstrual cycle. If the bleeding consistently happens in the middle of the time between the last and next menstrual periods, it is likely to be ovulation bleeding. Ovulation bleeding is characterized by a small amount of blood, usually just a few drops, and is considered normal. However, if non-menstrual bleeding occurs irregularly, it is essential to consider other conditions or diseases as potential causes. The first step is to rule out pregnancy-related issues such as ectopic pregnancy, miscarriage, or abortion. If pregnancy is excluded as a possibility, non-menstrual bleeding may be attributed to hormonal imbalances, pelvic inflammatory disease, cervical polyps, or cervical ectropion (often mistakenly referred to as cervical erosion). The presence of polyps or fibroids inside the uterine cavity can also lead to non-menstrual bleeding, and the concern of a potential association with endometrial cancer arises. Different symptoms may accompany other causes. If there is persistent bleeding and the amount of bleeding increases, it is crucial to seek medical attention promptly.

• Absence of the first menstrual period by the age of 16.
• Cessation of menstrual periods before the age of 45.
• Experiencing vaginal bleeding one year or more after menopause.
• Sudden irregularity in the menstrual cycle.
• Menstrual cycles that are excessively long or short.
• Non-menstrual bleeding.
• Bleeding after sexual intercourse.
• Excessive menstrual flow.
• Severe menstrual pain.

Women should understand their menstrual patterns well and can keep track of each menstrual cycle and bleeding using pen and paper or mobile apps. It is important to promptly seek medical attention to determine the underlying cause if any abnormalities are detected. Diagnostic methods include:

• Cervical cytology (Pap smear) test
• Transvaginal or abdominal ultrasound examination
• Hysteroscopy (examination of the uterine cavity using a hysteroscope)

Menstrual issues can have various causes. If the disorders are due to stress or an irregular lifestyle, it may be possible to restore normal menstrual patterns by making lifestyle adjustments, practicing relaxation techniques, and managing stress. However, if the menstrual problems are caused by other underlying conditions, targeted treatment is necessary, which may involve medication or even surgical interventions.

Medication Treatment

Doctors will prescribe different medications based on the specific symptoms and underlying causes. For example, if the issue is dysmenorrhea, analgesics may be prescribed. If there is excessive menstrual bleeding, medications to control bleeding or anti-inflammatory drugs may be recommended. Hormonal medications, such as birth control pills, can be used to address menstrual disorders. It is important to consult a doctor for personalized advice based on individual circumstances.

Read more:Which pain reliever is recommended for menstrual cramps?

Surgical Treatment

Surgical intervention may be necessary if the menstrual issues are caused by abnormalities or conditions affecting the cervix, uterine cavity, or ovaries, such as polyps, fibroids, or even malignant tumours. In addition to traditional open surgery, some procedures can be performed using minimally invasive techniques such as laparoscopy or hysteroscopy (examination of the uterine cavity using a hysteroscope). The specific approach will depend on the individual situation and should be discussed with a doctor for proper evaluation and treatment planning.

Virtus Obstetrics and Gynaecology specialists