Menstrual Disorders

Types of Menstrual Disorders

A menstrual disorder is defined as a physical or emotional problem which interferes with the normal menstrual cycle. It typically causes severe pain, unusually heavy or light bleeding, delayed menarche (first period), or missed periods. Normally, a woman of childbearing age menstruates approximately every 28 days, except when she is pregnant or pre-menopausal. Menstrual irregularities include amenorrhea (absence of menstruation), dysmenorrhea (menstrual pain), menorrhagia (abnormally heavy or prolonged menstrual bleeding), metrorrhagia (bleeding between periods), premenstrual syndrome (symptoms starting one to two weeks before a period), and premenstrual dysphoric disorder (severe depressive symptoms, irritability, and tension prior to menstruation). Almost every woman will experience one or more of the above at some point in her lifetime. A lot of these menstrual disorders share the same type of causes, symptoms, and effective treatments. Since there is much overlap, it is important to seek the advice of a doctor.

Amenorrhea

Menarche, the average age of menstruation, is around 12 years. Amenorrhea is defined as the absence of menstruation (period flow). Primary amenorrhea is when a girl has not started menstruating but she is more than 15 years old and has already experienced other puberty changes, such as breasts developing and pubic hair formation.

Often the cause of amenorrhea is not known but it can be caused by:

  • Abnormally formed genitalia and/or pelvic organs. These include blockage/narrowing of the cervix, hymen completely enclosing vaginal opening, missing uterus/vagina, or vaginal septum.
  • Hormonal conditions or ovarian dysfunction resulting from anorexia, inadequate nutrition, chronic illnesses (i.e., cystic fibrosis, heart disease), genetic defects/disorders, prenatal/postnatal infections, other birth defects, or tumors.

Dysmenorrhea

Dysmenorrhea is the medical term for menstrual pain. Primary dysmenorrhea is menstrual cramping, normally associated with a period, while secondary dysmenorrhea is pain resulting from a reproductive disorder, such as endometriosis or uterine fibroids.

Causes of secondary dysmenorrhea include:

  • Endometriosis: Endometrial tissue occurring outside the uterus.
  • Adenomyosis: Uterine lining grows into other uterine muscles.
  • Pelvic Inflammatory Disease: Bacterial infection starting in the uterus which spreads to other reproductive organs.
  • Cervical stenosis: Narrowing of the cervix.
  • Fibroids: Benign uterine tumors.

The pain of secondary dysmenorrhea usually begins earlier in the menstrual cycle and lasts longer than typical menstrual cramps. Other symptoms include:

  • Severe pain or a feeling of pressure in the abdominal region.
  • Pain in the hips, lower back, or inner thighs.

Treatments for mild menstrual cramps:

  • Take a pain reliever as soon as cramps begin.
  • Use a heating pad or hot water bottle, on the lower back/abdomen.
  • Massage lower back/abdomen.
  • Rest.
  • Avoid caffeine, smoking, and/or alcohol.
  • Get regular exercise.
  • Medicines. In the case of severe dysmenorrhea, a doctor may prescribe anti-inflammatory medications and/or oral contraceptives.

Menorrhagia

Menorrhagia is abnormally heavy or prolonged menstrual bleeding where every period causes enough blood loss and cramping that a sufferer cannot maintain their normal everyday activities. Appropriate treatment depends on the cause.

Sometimes, the cause of this disorder is unknown, but common causes include:

  • Hormonal imbalance. Excessive endometrium develops which is shed by heavy bleeding.
  • Ovarian dysfunction. When ovulation does not occur, progesterone is not produced. Anovulation causes hormonal imbalance and sometimes menorrhagia.
  • Uterine fibroids. Benign uterine tumors can cause heavier or prolonged menstrual flow.
  • Polyps. Smaller, benign growths on the lining of the uterus commonly occur because of high hormonal levels.
  • Adenomyosis. Endometrial glands become embedded in the uterine muscle causing heavy bleeding/painful periods.
  • IUDs. Menorrhagia is common in users of copper intrauterine devices.
  • Pregnancy complications. Heavy bleeding may be due to miscarriage or ectopic pregnancy.
  • Cancer. Rarely, uterine, ovarian, or cervical cancers cause excessive bleeding.
  • Medications. Anti-inflammatory drugs, anticoagulants, and improper use of hormonal medications may cause menorrhagia.
  • Other medical conditions. These include pelvic inflammatory disease, thyroid disease, endometriosis, liver disease, and kidney disease can be associated with this disorder.

Signs and symptoms of menorrhagia often include:

  • Soaking one or more sanitary pads/tampons hourly, for several hours.
  • Needing double sanitary protection for menstrual flow.
  • Changing sanitary protection at night.
  • Bleeding for longer than seven days.
  • Passing large blood clots.
  • Needing to restrict daily activities.
  • Anemia symptoms (tiredness, fatigue, shortness of breath).

Metrorrhagia

Metrorrhagia, bleeding between menstrual periods, is very common in teenagers and pre-menopausal women. Once again, treatment is cause-dependent, including prescription hormones, discontinuing problematic birth control methods, surgical procedures (D&C, hysterectomy), radiation, and chemotherapy.

Common causes of metrorrhagia are:

  • Hormonal imbalances.
  • Cervical/uterine polyps.
  • Uterine fibroids.
  • Infection and/or inflammation of the uterus, cervix, and/or vagina.
  • Cervical erosion.
  • Using an IUD or oral contraceptives.
  • Endometriosis.
  • Uterine adhesions (scar tissue).
  • Dry vagina (decreased estrogen).
  • Chronic conditions (i.e., thyroid problems, diabetes, and/or blood-clotting problems).
  • Medications (i.e., anticoagulants).
  • Stress.
  • Reproductive cancers.

Premenstrual Syndrome

Premenstrual syndrome (PMS), a group of symptoms starting one to two weeks prior to a period, affects the majority of childbearing age women. It is not known what causes PMS. However, hormonal changes trigger symptoms which go away once a period begins. Treatment with over-the-counter pain relievers (ibuprofen, aspirin, and naproxen) can ease cramp pain, headaches, backaches, and breast tenderness. Proper sleep, regular exercise, and avoidance of sodium, caffeine, and alcohol also help.

Premenstrual syndrome symptoms often include:

  • Breast swelling and/or tenderness.
  • Acne breakouts.
  • Bloating/weight gain.
  • Headaches and/or joint pain.
  • Food cravings.
  • Mood swings/irritability.

Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder is a condition where a woman has severe depressive symptoms, irritability, and tension prior to menstruation. This condition is much more severe than premenstrual syndrome.

An exact cause is not known. However, hormonal changes are thought to play a role. Affecting three to eight percent of childbearing age women, there may be other factors involved like:

  • Anxiety/depression.
  • Seasonal affective disorder.
  • Abuse of alcohol.
  • Being overweight.
  • Excess caffeine intake.
  • Mother has/had premenstrual dysphoric disorder.
  • Inadequate exercise.

Symptoms are typically more debilitating than those of PMS, including at least one mood-related symptom. At least five of the following must be present for a premenstrual dysphoric disorder diagnosis:

  • Lack of interest in relationships and/or participating in activities.
  • Fatigue.
  • Feelings of hopelessness, sadness, and/or thoughts of suicide.
  • Feelings of tenseness and/or anxiousness.
  • Food cravings and/or binging.
  • Mood swings with crying.
  • Panic attacks.
  • Irritability/anger.
  • Physical symptoms (bloating, tender breasts, headaches, joint/muscle pain).
  • Insomnia and/or problems concentrating.

Symptoms of this disorder can be eased by:

  • Eating a healthy diet.
  • Avoiding salt, sugar, alcohol, and/or caffeine.
  • Exercising regularly.
  • Treating insomnia symptoms naturally.

Resources

  • Cleveland Clinic (2013). Dysmenorrhea. Retrieved from: http://my.clevelandclinic.org/disorders/dysmenorrhea/hic_dysmenorrhea.aspx
  • Mayo Clinic (2013). Menorrhagia. Retrieved from: http://www.mayoclinic.com/print/menorrhagia/DS00394/DSECTION=all&METHOD=print
  • Medline Plus (2013). Menstruation. Retrieved form: http://www.nlm.nih.gov/medlineplus/menstruation.html
  • Medline Plus (2013). Premenstrual Syndrome. Retrieved from: http://www.nlm.nih.gov/medlineplus/premenstrualsyndrome.html

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