Menstrual Problems
It is very common to
experience problems with menstruation from time to time. These
problems can be related to the length or frequency of your
periods, the amount of flow, or to symptoms related to menstrual
cyclicity. Some of these problems are of a serious nature and
some are not. In this section, we will discuss the most common
problems associated with menstruation. For a firm diagnosis and
treatment, consult your physician.
Premenstrual
Syndrome
Painful Periods
Abnormal Bleeding
Premenstrual
Syndrome
Although definitions of premenstrual syndrome (PMS) vary, it is
generally described as a cyclic problem, followed by a period of
time with no symptoms. Symptoms are generally seen 7 to 10 days
before the menstrual period begins and can vary in severity from
cycle to cycle. These symptoms usually go away soon after the
onset of the period. PMS symptoms include headaches, mood
disturbances, constipation, food cravings, weight gain, and
breast tenderness. Charting the menstrual cycle along with any
PMS symptoms for 3 to 6 months will allow a woman to see if her
problems are cyclical in nature. For more information on PMS, see
the PMS section of this site.
Painful
periods
The medical name for painful periods is dysmenorrhea. Menstrual
pain can vary from a dull pain in the back or abdomen to severe
cramping and lower abdominal pain. The pain is usually greater at
the beginning of the period, and in rare cases can be accompanied
by nausea and diarrhea.
If a girl experiences menstrual pain from her first period, it is
referred to as primary dysmenorrhea. Primary dysmenorrhea is
thought to be a result of uterine cramping and is not associated
with a gynecological disease. Prostaglandin production causes
uterine muscles to contract, which can be perceived as menstrual
cramping. Primary dysmenorrhea can last throughout the
childbearing years. If menstrual pain begins after a woman has
been menstruating for a number of years, it is considered
secondary dysmenorrhea. Secondary dysmenorrhea is far more likely
to be caused by some other underlying disorder such as
endometriosis.
Endometriosis, which is often characterized by
painful periods, occurs when fragments of the endometrium (the
tissue that lines the uterus) grows outside the uterus in places
such as the lining of the pelvic cavity, the fallopian tubes, the
ovaries, the intestinal tract, or, less commonly, in the vagina.
Each month, these fragments of endometriosis grow like the lining
of the uterus. However, because they are enclosed in the pelvic
and abdominal cavities, the tissue cannot escape. This causes an
irritation of the lining of the cavity, which can be painful.
Another result of endometriosis is the formation of scar tissue,
which can distort the normal pelvic anatomy. Endometriosis of the
ovary can lead to the development of endometriotic or
"chocolate" cysts. The curious thing about
endometriosis is that the amount of disease does not always
correlate with the degree of symptoms. For example, a woman that
has a very small amount of the disease can experience a great
deal of pain. The opposite is also true.
Endometriosis is a chronic condition that can
persist throughout the reproductive life and typically regresses
at menopause when hormonal stimulation stops. This causes the
endometriotic implants to shrink and symptoms to subside.
Treatment of endometriosis includes painkillers, hormonal
medications and/or surgery. If there is a possibility that you
are suffering from endometriosis, please see your doctor.
Most cases of dysmenorrhea can be treated with over-the-counter
pain relievers such as ibuprofen, which block the formation of
prostaglandins, thereby reducing contractions that can cause
pain. Some women find that exercise also helps. If the pain is
severe or very bothersome, your doctor can prescribe a different
medication. If you think that you have dysmenorrhea, see your
doctor.
Abnormal
Bleeding
Infrequent
Periods
The medical name for infrequent periods is oligomenorrhea. This
term is used when a woman has normal periods (in regards to the
amount and length of menstrual flow), but the interval between
periods is greater than 35 days. Infrequent periods are common in
women who just started menstruating, and during the few years
preceding menopause. During the first two years of menstruating,
it is normal to have infrequent periods. Thereafter, if your
periods are still infrequent, a gynecologist should be consulted.
Symptoms that can help your physician determine the cause of
oligomenorrhea are marked weight changes, milky white discharge
from your breasts, acne, hair on your face or chest, or hot
flashes.
Too-Frequent
Periods
Polymenorrhea is the medical term for normal periods that occur
too frequently, meaning periods that occur in intervals that are
closer than 25 days. Polymenorrhea is annoying, inconvenient and
a sign that ovulation may not be occurring. If ovulation is found
to be normal, polymenorrhea can be an indication of a uterine
problem such as fibroids. Furthermore, excessive bleeding can
lead to anemia. For all these reasons, consult your gynecologist
for evaluation and treatment if you think that you may be
suffering from polymenorrhea.
Mid-cycle
Bleeding
Some women experience light bleeding or "spotting" for
one or two days in the middle of their menstrual cycle. This
bleeding is thought to be caused by a temporary drop in estrogen
that occurs at ovulation. This is a normal process. To determine
the existence of mid-cycle bleeding, a woman should chart her
cycle over several months to confirm that the bleeding occurs at
ovulation. However, if bleeding is occurring at any time in your
cycle, consult your doctor.
Absence of
Periods
Absence of periods, whether it is temporary or permanent, is also
known as amenorrhea. If a girl has not had her period by age 14
but is undergoing pubertal changes such as breast development,
underarm and pubic hair growth, and a growth spurt, the lack of
menstruation is not yet a cause for alarm. However, a 14-year-old
who hasn't shown any signs of pubertal development should be seen
by a doctor. Furthermore, if by age 16, a girl has still not had
her first period, even if she is undergoing the other normal
pubertal changes, it is time to consult a gynecologist. This is
known as primary amenorrhea. Women and girls who are very thin,
obese, have eating disorders or who are involved in intensive
athletic programs often have a delayed menarche.
If a woman has had periods in the past but is now without them,
this is known as secondary amenorrhea. The most common cause of
amenorrhea is pregnancy. If a woman is not pregnant, a cause must
be identified. There are a number of hormonal conditions that
must be eliminated such as thyroid disease, elevated prolactin,
and premature menopause. Amenorrhea is also commonly found in
women who are very thin, have an eating disorder, and in athletes
who perform regular, strenuous activity. The uterus must also be
considered as a possible source of the problem. Certain surgical
procedures of the uterus and cervix may lead to scarring which
can obstruct the menstrual outflow. If you know that you're not
pregnant but you have not menstruated for three months, a
consultation with your gynecologist should be arranged. If the
amenorrhea is a result of low estrogen levels, it may put you at
increased risk of accelerated bone loss and cardiovascular
disease as is the case in a menopausal woman. Your physician will
ask many questions and conduct the appropriate tests to determine
the cause of the amenorrhea.
Heavy
Periods
Periods that are unusually heavy or prolonged are medically known
as menorrhagia. Medical textbooks define menorrhagia as a
menstrual flow that exceeds 80 ccs of fluid. However, it is
nearly impossible for a woman to quantify the amount of her blood
loss. Therefore, if you have noted a marked increase in bleeding
from previous cycles, if you are soaking through 1-2 pads in 1-2
hours, if you're passing large clots, or if you have been
bleeding for longer than seven days, see your doctor. There are
many possible causes of menorrhagia. Regular but heavy periods
can be caused by structural abnormalities in the uterus such as
endometrial polyps or fibroids, or clotting problems. If the
bleeding pattern is irregular, it may be caused by the absence of
ovulation which can cause dysfunctional uterine bleeding.
Menorrhagia is a common problem, especially in the first few
years of menstruating and the last few years before menopause. It
is generally not a serious problem, but it can be inconvenient.
Also, if longstanding, it can lead to iron-deficiency anemia.
Therefore, you should see your doctor if you are concerned that
your periods are heavy.
Short or
Scanty Periods
Short or
scanty periods that last less than two days, are referred to as
hypomenorrhea, and may be a woman's normal pattern. It may also
be seen at puberty or when a woman is approaching menopause.
Since estrogen is crucial to the growth of the endometrium, any
condition that causes decreased estrogen production will result
in hypomenorrhea. These conditions have been outlined above in
the section dealing with amenorrhea. Rarely, surgical procedures
that involve the uterus (such as a D&C can result in scarring
of the endometrium. The scar tissue replaces the normal
endometrium, and results in less menstrual shedding. You should
see your doctor if the problem persists so that he or she can
rule out the possibility that hypomenorrhea is the symptom of an
underlying condition.
Dysfunctional Uterine Bleeding
Dysfunctional uterine bleeding is the name given to abnormal
bleeding patterns that occur as a result of irregular or absent
ovulation. This condition occurs when the ovaries continue to
make estrogen without the cyclic production of progesterone.
Therefore, the normal sequence of growth and sloughing of the
uterine lining is disrupted and results in erratic vaginal
bleeding that is unpredictable and alternates between heavy and
light. This condition can lead to anemia. If you have any
abnormal bleeding patterns, consult a physician for diagnosis and
treatment.
Diagnosis
and Treatment of Abnormal Bleeding
To diagnose the cause of abnormal bleeding, a doctor will
evaluate the symptoms and medical history of the patient. A
complete physical, including a pelvic examination, will be
performed and laboratory tests, such as blood tests, biopsies,
pap smears, and pelvic sonograms will help determine the cause.
The treatment will depend upon the cause of the dysfunction as
well as the patient's reproductive desires at that time. If she
wishes to be pregnant, the focus of the treatment will be on
promoting regular ovulation. If pregnancy is not an issue, the
goal is to promote the return to a normal bleeding pattern. It is
important to see a doctor if abnormal bleeding occurs so that
serious problems can be ruled out or treated if necessary.
[Homepage] [External Anatomy] [Internal Anatomy] [Introduction] [[Breast Self-Exam]
The contents of this Web site are for informational purposes only and are not intended to be used for medical advice. You should consult your physician or health care provider on a regular basis. You should consult your physician immediately with any problem about which you are concerned.