Menstrual problems

Written by: 
Dr Roger Henderson

Women may experience a variety of common problems with their menstrual cycleThe monthly sequence by which a woman’s body prepares for potential fertilisation of an egg released from the ovaries, involving thickening of the uterus lining and then shedding of the lining when pregnancy does not occur. (periods) at any age during their fertile years. Many such problems are harmless but they can cause significant distress to the woman experiencing them.

The most common problems are:

Amenorrhoea

Amenorrhoea is the term used to describe the complete absence of periods for a reason other than pregnancy or breastfeeding. Up to 30 per cent of women experience some form of amenorrhoea at one time or another during their reproductive years.

Amenorrhoea is classified as either primary or secondary. Primary amenorrhoea occurs if a girl has not had any periods by the time she is 16. Secondary amenorrhoea is defined as occurring when the periods stop for at least 6 consecutive months in a woman who has previously had a regular menstrual cycleThe monthly sequence by which a woman’s body prepares for potential fertilisation of an egg released from the ovaries, involving thickening of the uterus lining and then shedding of the lining when pregnancy does not occur..

Most cases are due to hormonal irregularities, and stopping hormonal contraceptionA means of preventing pregnancy. after long-term usage is a common cause. However, stressRelating to injury or concern. and being severely underweight may also trigger the condition, as can excessive exercising.

The treatment for amenorrhoea depends on the underlying cause and may not be needed at all, especially if fertility is not an issue.

Oligomenorrhoea

Infrequent or irregular periods, a problem known as oligomenorrhoea, is diagnosed when a woman has a period only once every 6 weeks to 6 months. The causes can be similar to those for absent periods (amenorrhoea), or the problem may occur with a condition called polycystic ovary syndrome (PCOS). This is an inherited disorder affecting the ovaries that causes irregular periods, weight gain and excessive body hair.

Dysmenorrhoea

Pain that occurs immediately before or during menstruation is known as dysmenorrhoea. Painful periods are severe enough in 10 per cent of women to interfere with their normal daily activities. The pain may last from a few hours up to 72 hours, and the woman may experience nausea, headaches and diarrhoeaWhen bowel evacuation happens more often than usual, or where the faeces are abnormally liquid. in addition. There is often no apparent cause for dysmenorrhoea, but in some cases the problem may be due to either endometriosisA condition in which tissue that normally lines the uterus (womb) of a woman is found outside the uterus or in other parts of the body. or fibroids.

Endometriosis occurs when cells that normally line the uterus The womb, where embryo implantation occurs and the growing foetus is nourished.(womb) are found in places other than the uterus. These respond to the normal hormonal changes in each menstrual cycleThe monthly sequence by which a woman’s body prepares for potential fertilisation of an egg released from the ovaries, involving thickening of the uterus lining and then shedding of the lining when pregnancy does not occur. by building up, breaking down and bleeding, just as the uterine lining does normally.

Fibroids are harmless growths in the muscular wall of the uterus that affect around 1 in 5 women in their lifetime. These can be small or large and they may cause no symptoms at all, or may cause significant pain along with heavy periods.

Even if painful periods are found to be due to endometriosisA condition in which tissue that normally lines the uterus (womb) of a woman is found outside the uterus or in other parts of the body. or fibroids, treatment may not be necessary; if it is needed, hormonal treatments and surgery are options.

Menorrhagia

Excessively heavy menstrual bleeding that occurs repeatedly is known as menorrhagia. It typically causes bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. loss of more than 80ml (2.7fl oz), double the expected bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. loss during an average period.

Although conditions such as fibroids or endometriosisA condition in which tissue that normally lines the uterus (womb) of a woman is found outside the uterus or in other parts of the body. often cause menorrhagia, there may be no obvious cause found.

Treatment options vary from person to person and include the contraceptiveA term used to describe something that prevents pregnancy. pill, non-hormonal treatments such as tranexamic acid - tablets taken at the time of menstruation that help to lessen bleeding - and fitting an intrauterine contraceptive deviceA small device placed into the uterus to prevent conception, possibly by preventing the implantation of the embryo. (IUCDAn abbreviation for intrauterine contraceptive device, a small device placed into the uterus to prevent conception, possibly by preventing the implantation of the embryo.), often called the 'coil', into the uterus. Severe cases may require surgery, either to remove the uterine lining or in the form of a hysterectomy.

Pre-menstrual syndrome (PMS)

For most women, the normal hormonal fluctuations that occur during each menstrual cycleThe monthly sequence by which a woman’s body prepares for potential fertilisation of an egg released from the ovaries, involving thickening of the uterus lining and then shedding of the lining when pregnancy does not occur. cause few problems, but for others they can be a source of distress.

Symptoms that may be experienced in the time leading up to a period, known as the premenstrual phase, include breast tenderness, bloating and fatigue as well as low mood and irritability. Such symptoms are most often experienced in women aged 30-46. They typically occur in the week before the period starts and stop quickly once bleeding begins.

Treatments for PMS include natural therapies such as evening primrose oil, vitamin B6 and St John's Wort, and conventional treatments such as the contraceptiveA term used to describe something that prevents pregnancy. pill, hormonal treatment and a group of antidepressants called SSRIs (selective serotonin reuptake inhibitors).