Menstrual Problems

There are several different types of menstrual problems. It often is helpful for women who experience menstrual problems to keep track of their menstrual cycle using a calendar and journal. Knowing when to expect symptoms and what type of symptoms to expect can help women schedule daily activities around their menstrual periods, if necessary.

A woman’s menstrual medical history, including a record of symptoms, can provide important information for developing an effective treatment plan. Important information may include the following:

  • At what age did your periods first begin?
  • When did your periods become painful? On what day(s) of your menstrual cycle do you experience pain? Can you describe the pain (e.g., is it sharp or dull, does it come and go or is it constant)?
  • Are you sexually active? Do you use birth control? If so, what type?
  • What was the date of your last menstrual period? How many days do your menstrual periods usually last?
  • What is the usual flow of your menstrual period? Do you ever notice blood clots in your menstrual flow?
  • How long is your menstrual cycle? Is it consistent?
  • Do you use tampons?
  • What self-care techniques have you tried to relieve your menstrual discomfort?

The absence of menstrual periods (amenorrhea) is a common type of menstrual problem. This condition involves an absence of menstruation for 3 months or longer in a sexually mature woman who is not pregnant or breastfeeding.

Amenorrhea is a symptom of other disorders, which can range from minor to serious. Women who miss 3 or more periods in a row should contact a healthcare provider.

Conditions that can cause amenorrhea include the following:

  • Eating disorders (e.g., anorexia, bulimia)
  • Excessive exercise and a poor diet
  • Extreme physical or emotional stress
  • Hormonal problems that involve the hypothalamus, pituitary, thyroid, ovary, or adrenal glands
  • Medications (e.g., contraceptives)
  • Very low body weight

Heavy or prolonged menstrual periods are called menorrhagia or hypermenorrhea. These conditions are characterized by a menstrual period that lasts longer than 7 days or menstrual flow that soaks through one or more pads or tampons every hour for several hours. Like amenorrhea, menorrhagia and hypermenorrhea are symptoms of another condition, which can vary from minor to serious.

Conditions that can cause menorrhagia or hypermenorrhea include the following:

  • Adenomyosis and endometriosis (disorders of the lining of the uterus)
  • Certain anti-inflammatory or anticoagulant medications
  • Ectopic pregnancy (when a fertilized egg implants in the fallopian tube rather than the uterus)
  • Hormonal imbalance
  • Pelvic inflammatory disease (PID; infection in the reproductive system)
  • Pregnancy complications
  • Use of an IUD (intrauterine device) as a form of contraception
  • Uterine cancer
  • Uterine polyps or uterine fibroids (non-cancerous growths of the uterus)

Other medical conditions, such as liver disease, kidney disease, and thyroid problems also can cause heavy or prolonged menstrual periods. Women who experience menorrhagia or hypermenorrhea should contact a health care provider.

Pain and discomfort just before and/or during menstruation that is severe enough to interfere with normal daily activities is called dysmenorrhea, or premenstrual syndrome (PMS). Symptoms of dysmenorrhea include lower abdominal cramps, intermittent sharp pain in the abdominal region, and lower back pain, as well as abdominal bloating, breast tenderness, headache, sleep problems, and mood swings.

The premenstrual syndrome often occurs in otherwise healthy women and is not related to underlying problems in the uterus or other pelvic organs. However, severe dysmenorrhea may be the result of a medical condition.

Conditions that can cause severe symptoms include the following:

  • Certain sexually transmitted diseases (STDs)
  • Endometriosis (disorder that affects the lining of the uterus)
  • Extreme stress and anxiety
  • Ovarian cysts
  • Pelvic inflammatory disease (PID; infection in the reproductive system)
  • Use of an IUD (intrauterine device) as a form of contraception
  • Uterine fibroids (non-cancerous tumours of the uterus)

If premenstrual pain and discomfort are not severe, self-care techniques (e.g., over-the-counter pain relievers, exercise, heating pads) may provide relief. However, if self-care measures are not effective or the pain is severe, women should contact a health care provider. Depending on the symptoms, physicians may recommend other medications, such as prescription pain relievers, anti-inflammatories, antibiotics, or antidepressants.

Premenstrual dysphoric disorder (PMDD)

Premenstrual dysphoric disorder (PMDD) is a condition characterized by depression and/or severe irritability just before and during a menstrual period. PMDD can cause severe depression, irritability, and tense feelings in conjunction with menstruation. PMDD generally affects less than 10% of sexually mature women.

PMDD is more common in women who have a history of depression, but it can also occur in women with no prior history of the disorder. Women who have the seasonal affective disorder (SAD; depression that is associated with the fall and winter, when sunlight is at its lowest levels) also may be more likely to have PMDD.

PMDD can range in severity from mild anxiety to strong feelings of hopelessness and thoughts of suicide. Some cases of PMDD respond to a healthy diet, regular exercise, and adequate sleep. More serious cases of PMDD may require antidepressant medications. Contact a health care provider if self-care techniques of exercise, diet, and sleep do not improve your symptoms, or depression, anxiety, or mood swings interfere with relationships or daily life.

Bleeding between menstrual periods (e.g., abnormal uterine bleeding, dysfunctional uterine bleeding, spotting) is another common type of menstrual problem. Abnormal uterine bleeding can be a symptom of another medical condition, which can vary from minor to serious. Women who experience abnormal uterine bleeding should contact a healthcare provider.

Conditions that may cause abnormal uterine bleeding include:

  • Blood clotting disorders or use of certain anticoagulant medications
  • Cancer of the cervix, vagina, or uterus
  • Chronic medical conditions, such as thyroid problems or diabetes
  • Complications caused by birth control pills, an IUD (intrauterine device), or pregnancy
  • Pelvic inflammatory disease (PID; infection in the reproductive system)
  • Polycystic ovary syndrome (caused by a hormonal imbalance)
  • Uterine fibroids or uterine polyps (non-cancerous tumours of the uterus)

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