Menstrual disorders: Symptoms, causes and treatments

If you suffer from painful cramps or abnormally heavy bleeding during your menstruation, you may have a menstrual disorder. Find out what you can do to manage this disorder effectively.

What is menstruation?

Menstruation, also known as periods, is the name given to the bleeding phase of the menstrual cycle. This happens every month, as the lining of the uterus (womb) thickens to prepare for potential pregnancy with the implantation of a fertilised ovum (egg cell).

If this doesn’t happen, the womb lining (endometrium) sloughs off and is expelled through the cervix and out through the vagina. The menstrual cycle takes, on average, 28 days. Some people have a slightly longer or shorter cycle than others — anywhere between about 21 to 40 days from the start of one period to the start of the next is within normal range.

The average duration of the period — the bleeding part of the menstrual cycle — is around five days, though anywhere from two to around seven is normal.

What are menstrual disorders?

They could be referred to as problems with your period, period problems, or by more specific names for each type of menstrual problem. A menstrual disorder is anything that is out-of-the-ordinary and problematic to do with the menstrual cycle (periods).

Risk factors for menstrual problems

There are a number of physical and lifestyle factors that can increase the likelihood of menstrual disorders.

Body mass index

The greatest modifiable risk factor for period problems is being either extremely overweight or extremely underweight, both of which can affect the menstrual cycle and also cause problems with fertility. Staying within a healthy weight range can improve some menstrual problems.

Early menarche

Starting your periods aged 11 or younger is associated with having more uncomfortable periods in those earlier years, but doesn’t mean more likelihood of problems later in life.

Smoking

Smokers are more likely to experience problems with their periods.

Extreme exercise regimes

People who follow very strenuous and frequent exercise plans, such as elite athletes, are more like to have less frequent periods, and this can also be associated with reduced fertility.

Stress

Either emotional and psychological stress or stress on the body due to illness or injury can affect periods.

Types and causes of menstrual disorders

The most common menstrual disorders include amenorrhea, dysmenorrhea, and menorrhagia.

Amenorrhoea

This is the absence of menstruation, with missed or stopped periods.

A lack of periods doesn’t necessarily mean a serious problem, but a doctor can give advice about the possible causes and any management needs. Getting medical advice for absent or occasional periods becomes particularly important if you are trying to conceive as it may make it harder to get pregnant.

There are lots of different conditions or treatments which can cause amenorrhea, including polycystic ovarian syndrome and cancer treatments, amongst others.

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Periods also stop during pregnancy, and frequently remain absent while breastfeeding. Having no periods while breastfeeding makes getting pregnant in that time less likely, but it is still possible so it’s important to use appropriate contraception if trying to avoid conception while breastfeeding.

Primary amenorrhea

Not starting periods by the age of 16, where there is no other cause for delayed puberty, is known as primary amenorrhea. Causes can include very low weight, eating disorders, intense long-term athletic activity, and some chronic or genetic conditions.

Dysmenorrhoea (period pain)

Having period pain or cramps is very common, and may fluctuate throughout life. Mild to moderate pain accompanying a period does not usually have any significant underlying cause, but if it is a problem that affects everyday life and is not manageable with simple home remedies, it’s okay to seek medical advice.

Problematic dysmenorrhea can have a number of underlying causes which may need further investigation and treatment, and can include:

• Endometriosis: A condition where the type of cells that normally line the womb also grow in other places outside of the womb and around the nearby organs.
• Fibroids: Benign (not cancerous) growths within the uterus can cause problems with periods.
• Polycystic ovarian syndrome: A condition where the ovaries begin the process of releasing too many eggs at once or release them too frequently, causing the ovaries to have a lumpy appearance under ultrasound and causing pain and irregular periods, as well as some other symptoms.

Menorrhagia (heavy bleeding)

The amount of bleeding during a period is different from one person to the next. Knowing what’s normal for you means that you can spot problems and know when to ask for help.

If bleeding is so heavy that you’re having to change pads or other sanitary products more than around every two hours, or if you’re frequently bleeding through clothes or bedding, there will be some support available from your GP to help manage this problematic bleeding.

Irregular periods

Irregular periods are fairly common, particularly during puberty or towards the time of the menopause. If periods are significantly irregular to the point where they’re causing stress or other problems, or if periods were previously stable and have suddenly become very erratic, a GP should be able to advise on whether any investigations or specific management plans are needed.

Premenstrual syndrome (PMS)

PMS (pre-menstrual syndrome) or PMT (pre-menstrual tension) is a term used to describe some physical and emotional changes associated with fluctuating hormonal levels at different points throughout the menstrual cycle. Most commonly, PMS symptoms begin a few days before the period and include low mood or irritability, anxiety, fatigue, and tearfulness.

Physical effects include bloating, changes in appetite, greasy or spotty skin, and breast tenderness. Trying to maintain a healthy sleep pattern and diet, as well as getting exercise and prioritising self-care can help improve some symptoms.

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Diagnosis

Most common menstrual disorders can be diagnosed based on a description of symptoms alone, but if there is any question over a diagnosis or whether there is an underlying cause that might need different treatment, a doctor can request further investigations.

Some of the investigations into menstrual problems can include:

Urine tests

This can help identify other possible causes for lower abdominal pain, such as urine infections or kidney problems.

Blood tests

These can help give a clue into other conditions and also identify other problems resulting from menstrual disorders, such as anaemia linked to heavy periods.

Ultrasound scans

These are the same kinds of ‘jelly’ scans used to monitor pregnancy, but and can be used either externally on the outside of the tummy or internally using a special wand in the vagina to get a good view of the female reproductive system.

Hysteroscopy

A procedure where a very fine fibre-optic tube is passed into the womb through the vagina and cervix and used to visualise the inside of the uterus and check for any abnormalities. Small tissue samples can be taken from any areas that look problematic.

Laparoscopy

This is a type of surgical procedure done under general anaesthetic where very small incisions are made in the abdomen to allow a tube to be passed in to visualise the organs and take small tissue samples if necessary.

Treating menstrual disorders

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Medical treatment for menstrual disorders depends on the type of problem, the underlying cause, and any other co-existing conditions. Treatment can include:

Hormonal contraceptives

Hormonal contraceptives can help to regulate the cycle and can make periods significantly lighter. Some hormonal contraceptives can stop periods altogether for the duration of treatment. Hormonal contraceptives can include one of the various forms of contraceptive pill, injections or hormone-releasing implants usually inserted under the skin in the upper arm.

An intra-uterine system or ‘coil’ is a small device inserted through the cervix into the womb that releases hormones into the womb which prevent pregnancy and can improve symptoms of PMS, dysmennorhea, and menorrhagea.

Medications to help control bleeding

Medications particularly a tablet called tranexamic acid can help control bleeding.

Medications to help manage pain

Medications that help manage pain, usually simple painkillers like ibuprofen.

Surgery

Some underlying causes of menstrual problems may require surgical treatment. Surgery for menstrual problems can include endometrial ablation — a procedure where the lining of the womb is removed, or a hysterectomy — total removal of the womb, with or without the ovaries.

Traditional Chinese Medicine (TCM)

It’s important to use an accredited TCM practitioner who will recommend treatment based on a holistic assessment. Some of the treatments offered by TCM practitioners can include acupuncture and acupressure, herbal remedies, moxibustion and more.

There are a range of other alternative or complementary therapies including massage, yoga, forms of herbalism and homeopathy. The evidence base for these therapies varies so it’s important to use an accredited practitioner, and to get advice from your GP if you have any concerns.

Preventing menstrual problems

It isn’t always possible to prevent menstrual problems, but with support from a GP or specialist gynaecology team, there are lots of ways of managing problems. Staying generally healthy is the best thing a person can do individually to reduce their risk of all kinds of health problems, including problems with menstruation. Maintaining a healthy weight, eating a healthy balanced diet, and following a healthy lifestyle are all good ways to stay well.

Managing menstrual problems at home

Minor menstrual problems like period pain and some heavier bleeding are very common and can often be managed at home using simple techniques and treatments. As always, it’s still important to see a doctor if things aren’t manageable or if you have specific concerns.

Pain

Exercise

For simple period pains, gentle exercise can have a really good effect. If there is a more complicated underlying cause, it is best to ask a doctor about vigorous exercise.

Heat

Using heat packs or hot water bottles on the painful areas, particularly the lower tummy or the lower back can really improve the pain of period cramps and discomfort.

Simple painkillers

Paracetamol, ibuprofen or aspirin are common painkillers which can have a good effect on pain. It’s important to stay within the limits of the dosage amounts and timings stated on the packaging.

Distraction

If you’re having period cramps, it can be hard to feel up to doing anything at all, but for mild pain and some of the low mood that can accompany that time of the month, getting up and about, taking a little exercise and just staying busy, can make a big difference.

Heavy flow

There are more options for managing periods than ever before — with period pants and washable pads, menstrual cups, disposable or biodegradable pads and tampons, there are lots of products to try. Choosing products designed for heavy flow can help ease the practical side of managing a problem period.

Staying well

Menstrual problems can affect anyone with a womb and aren’t always possible to anticipate or prevent. That said, having a good base level of health can help your body cope with problems and fight infections. In particular, maintaining a healthy weight — neither too high nor too low — is known to help regulate periods and prevent problems.

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When to seek help for a menstrual problem

It is always alright to ask for professional help if you have any concerns, but there are a few times when you should seek emergency assessment. These include:

Symptoms of a pelvic infection

Usually flu-like symptoms, fever and shivering with heavy bleeding and severe abdominal pain.

Symptoms of toxic shock syndrome

This is particularly associated with leaving a tampon in place for too long, but has become less common with modern tampon manufacturing methods and more awareness of the need for good tampon hygiene.

Extreme pain with heavy bleeding

There are a number of reasons for sudden extreme pain, and these can include infection and ectopic pregnancy. Different underlying causes can need different types of investigation and treatment so it’s important to get properly assessed.

Heavy bleeding can also cause problems like anaemia and fatigue, so even if you’re managing the flow and any discomfort, it’s always okay to ask your doctor for support if you feel unwell.

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This article was first published in Homage.