Menstrual Problems

Menstrual Problems: Symptoms, Causes, Diagnosis, Treatment, and Prevention

What is Menstrual Problems?

Irregularities in menstrual cycle are sign of pathological condition unless there is no pregnancy involved. There can be many types of irregularities in menses and they vary from individual to individual.

What is a Normal Menstrual Cycle?

Before understanding the menstrual problems it is very important to know the normal menses. Average menstrual cycle of a woman is considered of 28 days and average period lasts for 3-5 days but there can be huge variations from woman to woman. A cycle of 3 days can be normal for a woman while a 7 days cycle can be normal for other. Length and frequency of cycle does not matter and can vary, it’s the changes in cycle and menstrual flow which matter most. Women must keep records of their menstrual cycle dates as it can be helpful to understand the changes.

What are the Types of Menstrual Irregularities?

Pre Menstrual Syndrome

This is one of the most common problems experienced by teenagers. Pre menstrual syndrome begins around 7 days before start of menstrual period and ends after the period starts. Hormonal changes in body are supposed to cause this syndrome as levels of estrogen and progesterone drops around 7 days prior to period. Some of the common symptoms experienced are:

  • Fatigue
  • Headache
  • Constipation/diarrhea/bloating
  • Acne
  • Sore breasts
  • Back ache
  • Stress

You must consult a Gynecologist if these Symptoms are severe and interferes with your daily activities.

Irregualr Periods

It takes around 2-3 years for a female body to adjust with hormonal changes after onset of puberty. An average cycle is considered to be of 28 days; however periods can vary from 21 days to 45 days and is considered to be normal. It is a matter of concern if the period is less than 21 days or more than 45 days and also if you miss periods for more than 3 months. You must consult your doctor in such case. Women who are sexually active must consult a doctor if they skip period for a month to rule out pregnancy. Some of the common causes of irregular periods are hormonal imbalance, stress, anxiety, intake of certain medicines, pituitary gland disorder, thyroid hormones disorders, and poly cystic ovarian syndrome.

Amennorhea

Absence of periods is known as amenorrhea. There are basically two types of Amenorrhea:


i) Primary amenorrhea: 

If a girl does not gets her menstrual periods by the age of 16 or 3 years after first signs of her puberty is considered to have primary amenorrhea. Some of the common causes of it can be genetic abnormalities, hormonal imbalance or structural anomalies. 

ii) Secondary amenorrhea: 

If a woman having normal menstruation suddenly stops menstruating for more than 6 months or 3 of her usual cycles is supposed to have secondary amenorrhea. Pregnancy is most important cause of secondary amenorrhea and hence must be ruled out. Some of the common causes of secondary amenorrhea are hormonal imbalance, stress, ovarian cysts, anorexia, thyroid disorders, excessive exercises with poor diet etc.

A healthy diet with proper vitamins, nutrients and minerals will avoid secondary amenorrhea. Alcohol, smoking, coffee etc must be avoided.

Menorrhagia

Prolonged or extremely heavy period is known as Menorrhagia. Periods with heavy bleeding are usually normal but a period with excessive continues bleeding for more than 7 days is considered as menorrhagia. The most common cause of menorrhagia is hormonal imbalance between estrogen and progesterone hormones. Other causes can be fibroids, thyroid disorders, clotting disorders, infection or inflammation of vagina or cervix etc. 

“YOU MUST CONSULT A GYNECOLOGIST IF YOU HAVE HEAVY PERIODS THAT LAST LONGER THAN 7 DAYS.”


Dysmenorrhea

Painful menstruation is known as dysmenorrhea. There are basically two types of dysmenorrhea:

  1. Primary Dysmenorrhea:
    It is not caused by infection or diseases; prostaglandin is cause of Primary dysmenorrhea. Increased amount of prostaglandins causes cramps, nausea, vomiting, back ache, diarrhea etc. These symptoms last for one or two days. 
  2. Secondary Dysmenorrhea:
    It is usually caused by conditions like fibroids, endometriosis, pelvic inflammatory diseases, adenomyosis etc. 


LIGHT CRAMPS AND PAIN DURING PERIODS ARE NOT UNCOMMON BUT SEVERE PAIN IS A MATTER OF CONCERN AND REQUIRES MEDICAL ATTENTION TO DIAGNOSE THE UNDERLYING DISEASE.


Endometriosis

Growth of tissue of uterus outside the uterine cavity (in fallopian tube, ovaries, etc) is known as endometriosis. It causes abnormal bleeding, painful menses, pelvic pain, painful urination (dysuria), fatigue, constipation, back ache, depressions, fever, spotting, pain during intercourse, etc. It can cause infertility in females and is one of the common causes of infertility. Some of the common causes of endometriosis are hormonal imbalance, retrograde menses, birth defects like imperforated hymen etc. 

How to Diagnose Menstrual Problems?

  1. Pelvic examination: Physical examination.
  2. Pap smear: Screening test to diagnose pre malignant or malignant tumors.
  3. Blood tests: To check hormonal levels.
  4. Urine analysis: To diagnose infection.
  5. Ultrasound and CAT scans.

What are the Treatments for Menstrual Problems?

Menstrual problems caused by hormonal imbalance like irregular bleeding etc can be treated by contraceptive pills or hormonal replacement therapy. Fibroids, polyps, endometriosis can be treated surgically. Other underlying diseases like thyroid disorders, clotting disorders, infection, inflammation etc must be treated if any.

When to Consult your Doctor?

  • If you are more than 15 years and yet have not started your menses.
  • If period suddenly stops or is delayed after it has been regular.
  • Frequent heavy and prolonged periods as it can lead to anemia.
  • Suffering from very painful periods.

How to Prevent Menstrual Problems?

  • Maintain a healthy and proper diet with lots of green vegetables and fruits.
  • Avoid alcohol, smoking, coffee and salt intake.
  • Include more amount of calcium in your diet.
  • Pain killers can be helpful in case of mild pain.
  • Regular mild exercises will keep you active and fit.

References

  • Menstruation and Menstrual Problems (https://www.nichd.nih.gov/health/topics/menstruation)
  • Menstrual Disorders (https://www.bcm.edu/healthcare/specialties/womens-health-maternity/obgyn-conditions/menstrual-disorders)