Menstrual Problems

Menstrual problems have become very common, due to faulty living style, unhealthy eating habits and stressful work schedules. There can be distinctive kinds of problems related to menstruation like irregular periods, late periods, pre-menstrual tension and excessive pain during menstruation, stoppage of menstruation and excessive discharge of blood during menstruation. Read on to explore more menstrual problems information, its causes and symptoms…

Period or menstrual problems are one of the four most common reasons why women of a reproductive age see their GP.

Many menstrual problems are innocent, even though they may cause significant distress and discomfort.

This is the complete absence of periods. If an otherwise normal girl of 16 has never menstruated, this is called primary amenorrhoea.

The same diagnosis is given to a girl of 14 who has never had a period if she also fails to show any signs of sexual development, such as breast or pubic hair growth.

Secondary amenorrhoea is when menstruation has stopped for six consecutive months in a woman who has previously had regular periods.

Excluding pregnancy as a cause, about 20%-30% of women experience amenorrhoea at some time during their reproductive life.

The underlying cause is usually hormonal. Secondary amenorrhoea can occur for a time after a woman stops using hormonal contraceptives, for example.

Other causes of amenorrhoea include stress, excessive exercise or being very underweight or malnourished, as found in anorexia.

Very rarely, there may be some inherited problem to blame.

The treatment depends on the underlying cause and what the woman wants. Some women may not view their condition as a problem unless they want to start a family, for example.

Conversely, a woman with amenorrhoea may still be fertile and should be advised to use a contraceptive if she does not want to become pregnant.

This is irregular or infrequent periods. Menstruation can occur anywhere between every six weeks and six months.

Many of the causes are the same as those for amenorrhoea. A common cause is a condition called polycystic ovary syndrome (PCOS).

This is an inherited hormonal disorder that affects the ovaries. The ovaries have an abnormally large number of follicles - little swellings that develop each month to release an egg.

In PCOS, the follicles remain immature meaning that eggs are often not released and the woman rarely ovulates and so is less fertile.

In addition to irregular periods, women with PCOS may also have excess body hair and be overweight.

As with amenorrhoea, treatment of oligomenorrhoea depends on the underlying cause and what the woman wants.

Again, a woman with infrequent periods may still be fertile and should be advised of this.

Period pains, or dysmenorrhoea, affect 40-70% of women of reproductive age.

For about one in 10 women the discomfort and pain is bad enough to interfere with their daily lives.

A certain amount of discomfort around the time of ovulation and menstruation is normal and it has been proposed that it is related to the movements of the womb and the hormones and chemicals that circulate around the body at that time of the month.

However, sometimes dysmenorrhoea is a sign of an underlying disease.

The pain typically occurs in the lower abdomen and/or pelvis and can radiate to the back and along the thighs, lasting somewhere between eight and 72 hours.

It can occur before or during menstruation or both. Headaches, diarrhoea, nausea and vomiting may accompany it.

When there is no underlying cause, simple analgesia with a non-steroidal anti-inflammatory drug such as ibuprofen might be all that is needed.

Some women find that going on the combined oral contraceptive pill lessens the discomfort.

Others have reported being helped by acupuncture, TENS therapy (a painless way of stimulating the nerves using pulsed energy) or a hot water bottle applied locally to the area of discomfort.

If there is an underlying disease causing the dysmenorrhoea then this should be treated.

Often there will be other symptoms too, such as heavy bleeding or pain or bleeding after intercourse.

The most common diseases associated with dysmenorrhoea are endometriosis and fibroids.

Endometriosis is a condition where the cells that make up the lining of the womb are also found in places other than the womb.

With each menstruation, this tissue outside of the womb responds to the same hormones that control periods and therefore builds up and breaks down and bleeds in the same way as the womb lining.

This can lead to inflammation and pain. Endometriosis can be treated with hormones or surgery to shrink or remove the problematic tissue.

Fibroids are non-cancerous or benign growths in the uterus.

A fifth of women develop them in their lifetime. They can be very small or as big as a melon.

Some cause no problems while others cause significant pain and heavy periods.

Treatment options include hormonal therapy and surgery.

Other less common causes of dysmenorrhoea are previous pelvic surgery and a pelvic infection.

Many women experience physical and mood changes around the time of their period, but for some it can be a particularly difficult time.

There are more than 150 symptoms associated with premenstrual syndrome (PMS), but the common ones include low mood and irritability, breast tenderness and bloating.

Typically PMS symptoms appear before in the days before period and cease once menstruation begins.

It is not known what causes PMS but hormonal changes are thought to be involved. PMS severity often increases around hormonal surges, such as puberty and pregnancy.

Women aged 30-45 often experience the most severe PMS.

Treatments are available to ease the symptoms. These include hormonal contraceptives and more potent hormonal drugs.

Some may prefer to try non-hormonal alternatives such as vitamin B6 and evening primrose oil.

Menorrhagia is recurrently heavy bleeding during menstruation.

About a third of women describe their periods as heavy. The average blood loss during menstruation is typically about 40ml. With menorrhagia the loss is 80ml or more.

Women with menorrhagia may have to use double sanitary protection - towels and tampons - and the heavy bleeding may stop them from doing normal activities because of flooding through clothes, for example.

In most cases no cause can be found. However, there may be an underlying cause such as endometriosis or fibroids.

It is important to investigate the bleeding and check that it is not due to something more sinister like cancer of the uterus or cervix.

The treatment depends on the cause. If there is no underlying problem that needs treating, the bleeding can often be reduced with non-hormonal tablets (tranexamic acid), oral contraceptives or by fitting a contraceptive coil into the womb.

If these do not work, a woman might want to consider surgery to remove the uterus completely or have the womb lining stripped.

She may also need to take iron or folic acid supplements if the blood loss has made her anaemic.