Women can have a host of problems with their menstrual cycle or menstrual period, which are collectively called as menstrual disorders. The disorders are abnormal duration of menstrual cycle (polymenorrhea and oligomenorrhea), stoppage of periods (amenorrhea), excessive or irregular menstrual bleeding (menorrhagia and metrorrhagia), painful periods (dysmenorrhea) and non-release of egg by ovary (anovulation). A related entity is the premenstrual syndrome.
When the menstrual cycle interval is less than 21 days, it is called polymenorrhea. If this occurs over a long period of time it can lead to complications with pregnancy or also infertility.
Causes and Treatment
Some of the causes are stress, perimenopause, endometriosis, sexually transmitted diseases, malnutrition and hormonal problems. Treatment depends on the cause. Hence, you should get a medical checkup done to find out the cause.
When the periods occur at intervals over 35 days, it is called oligomenorrhea. It can be caused by hormonal disorders (overactivity of thyroid or pituitary glands), excessive exercise, breastfeeding, stress, eating disorders and polycystic ovary syndrome.
Again, the underlying cause should be treated to regularize the menstrual cycle.
Lack of menstrual periods before menopausal age is called amenorrhea.It is physiological during pregnancy and breastfeeding. It is called primary when menstruation has not occurred even once by the usual age of around 16 years. Primary amenorrhea is generally due to developmental abnormalities of any of the female reproductive organs (uterus, ovary and vagina). Amenorrhea is termed secondary when menses cease in a previously menstruating woman. Secondary amenorrhea is due to intrauterine adhesions, polycystic ovary syndrome, certain drugs (oral contraceptives), exercise, stress, eating disorders and hormonal imbalance. Treatment can be medical or surgical depending on the cause.
Menorrhagia and Metrorrhagia
Menorrhagia is excessive menstrual bloodflow at regular intervals. When the bleeding is irregular or between periods, it is called metrorrhagia. A combination of the two is called menometrorrhagia. These can occur due to a variety of causes like infections, trauma, hormonal imbalance, blood disorders, pregnancy complications, foreign bodies like intrauterine device, and diseases like fibroids and endometrial cancer.
Diagnosis and Treatment
A variety of treatment options are available depending on the cause, including medical and surgical. So, you need to get a medical checkup and undergo some investigations like Pap smear, endometrial biopsy, ultrasound of pelvis and endoscopy of uterus (hysteroscopy), to find the cause.
Dysmenorrhea (menstrual cramps)
Dysmenorrhea is pain occurring during menstruation, so it is also called as menstrual cramps or menstrual pain. The pain can be varied – sharp, dull, throbbing, burning or nauseating. The pain can radiate to thighs or lower back. When the pain is not due to any gynecological problem, it is termed as primary dysmenorrhea.
It is due to release of chemicals called leukotrienes and prostaglandins during the menstrual cycle. Secondary dysmenorrhea is due to some pathology like fibroids, endometriosis, pelvic inflammatory disease and bicornuate uterus.
For primary amenorrhea, nonsteroidal anti-inflammatory drugs (NSAIDs – analgesics), drotaverine (muscle relaxant) and hormonal contraception are helpful. A variety of alternative therapies are also useful, like acupressure, topical heat, and vitamin B1 and E. Secondary amenorrhea can be addressed by treating the cause.
Anovulation is the absence of ovulation (that is, release of egg by ovary). It causes female infertility and accounts for 40% of all such cases. Hormonal imbalance due to hypothalamic-pituitary or thyroid endocrine gland dysfunction is the main cause of anovulation. Anovulation can also be due to polycystic ovary syndrome, obesity, weight loss and emotional stress. Anovulation may be associated with irregular periods.
Diagnosis and Treatment
Confirmatory test for ovulation is change in body temperature (tracked for some months), which usually happens after ovulation. Ovulation predictor kits are also available. Treatment depends on the cause. Some cases respond to simple lifestyle changes or diet. Fertility drugs like clomiphene, gonadotropins and bromocriptine, are also available for this condition.
Premenstrual syndrome (PMS)is a constellation of emotional as well as physical symptoms associated with the menstrual cycle, which tend to affect some or the other aspect of life.
The specific symptoms vary, but they tend to be characteristic for each affected woman. The symptoms usually start 10 days before menses, and disappear around the time of menstrual blood flow.
Symptoms that are common are tension, irritability and unhappiness (dysphoria).Other symptoms are stress, anxiety, sleeplessness, fatigue, headache, mood swings and changes in sexual drive. Physical symptoms occurring with menstrual cycle are abdominal cramps, tenderness or swelling of breasts, acne, constipation, and muscle or joint pains. Intensity of symptoms can vary between cycles.
Causes and Risk Factors
Some of the risk factors are high intake of caffeine, stress, family history of PMS, history of depressive episodes, and deficient levels of some vitamins and minerals like vitamins D and E, magnesium and manganese. Exact cause is not known, but genetic predisposition to PMS is postulated because of its high concordance in twins.
Diagnosis and Treatment
The diagnosis rests on typical history and complaints. There are no confirmatory tests or investigations for premenstrual syndrome. Antidepressants, decreased intake of caffeine, vitamin and mineral supplements, analgesics and oral contraceptive pills have a role in the treatment of PMS. Other agents that have some benefit are clonidine, chasteberry and St. John’s wort.