Menstrual Problems

What is the menstrual cycle?

The menstrual cycle is a physiological process that occurs in fertile women. It is under the control of a series of hormones and is necessary for reproduction. It may be divided into three phases: menstruation, follicular phase and luteal phase. Ovulation defines the transition from the follicular phase to the luteal phase. The average menstrual cycle is 28 days but this may vary from woman to woman. Menstruation is the part of a woman’s monthly menstrual cycle in which blood and tissue are discharged from the vagina. It is also commonly called a period or menstrual period.

What are period problems?

Sometimes women have problems in their menstrual cycle, called menstrual irregularities. They may not get periods, get periods too frequently, have unpredictable menstrual bleeding, or they may have painful periods.

Menstrual irregularities may be a sign of a gynaecological condition or problem, usually not serious. It is common for women at the beginning and end of their reproductive lives to miss or have irregular periods. There are many conditions that can cause menstrual irregularities.

Definitions of period problems

Amenorrhoea – occurs when a woman has not started her period by age 16 (known as primary amenorrhoea), or when she misses her period for at least three months in the absence of pregnancy (known as secondary amenorrhoea). Amenorrhoea is not a disease. Instead, it is a symptom of another condition. There is significant overlap between different conditions that manifest with amenorrhoea. Possible causes can include moderate or excessive exercising, eating disorders such as anorexia nervosa or extreme diet, physical or psychological stress, premature ovarian failure, anatomic defects, genetic, tumours and hormonal problems. Treatment of amenorrhoea depends on the underlying cause. Sometimes lifestyle changes can help if weight, stress or extreme physical activity is causing the amenorrhoea. Other times, medical interventions can help the problem.

Oligomenorrhoea – refers to infrequent menstrual periods, occurring at intervals of greater than 35 days. Like amenorrhoea, oligomenorrhoea is not a disease itself, but is a symptom of a larger condition. For example, many women with polycystic ovary syndrome (PCOS) have oligomenorrhoea.

Dysmenorrhoea – refers to painful periods, including severe menstrual cramps. The condition is usually not serious, although it can sometimes be caused by infection, endometriosis, fibroids or ovarian cysts. Painful periods can interfere with daily activities and social/family life. Treatment of dysmenorrhoea has to be tailored to the specific problem; thus a definite diagnosis has to be made.

Menorrhagia – refers to abnormal, heavy menstrual blood loss. In adolescents and women approaching menopause, hormone imbalance problems often cause menorrhagia along with irregular cycles. Treatment for abnormal bleeding depends on the cause.

Premenstrual syndrome (PMS) – is also called premenstrual tension (PMT). This is a collection of physical, psychological and emotional symptoms related to a woman’s menstrual cycle. While most menstrauting women have some symptoms of PMS, the official definition limits the scope to having symptoms of “sufficient severity to interfere with some aspects of daily life”. Such symptoms are usually predictable and occur regularly during the two weeks prior to period. Generally, symptoms may vanish just before or after the start of menstrual flow. Only a small percentage of women (2 to 5%) have significant premenstrual symptoms that are separate from the discomfort associated with menstruation. The exact symptoms and their intensity vary from woman to woman. Most women with PMS experience only a few of the following symptoms: abdominal bloating, abdominal cramps, breast tenderness or swelling, stress or anxiety, trouble falling asleep, joint or muscle pain, headache, fatigue, mood swings, irritability, changes in libido and worsening of existing skin disorders, or eye problems. Many treatments have been suggested for PMS, including diet and lifestyle changes, and other supportive means. Medical interventions are primarily concerned with hormonal intervention and the use of selective serotonin reuptake inhibitors (SSRIs). Read the RCOG information leaflet about PMS…

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