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The menstrual cycle is a natural occurrence in biological females. It is a monthly cycle of changes that the body goes through in order to prepare for pregnancy. The whole process of menstruation is different for individual female bodies. And due to the widespread lack of knowledge about this fundamental biological process, many women still need clarification about what is expected and what is abnormal about their menstrual cycle. So let’s dive into menstruation and related disorders to get a better understanding of what constitutes an abnormal cycle and to learn when you should seek help from a professional. While suffering, many women do not realise when to see a doctor because their condition has been left undiagnosed.
What are Menstrual Disorders?
Menstrual disorders are characterised by disruptive physical and emotional symptoms that occur right before and during menstruation, such as severe bleeding, missed periods, and uncontrollable mood swings.
How does the menstrual cycle work?
Your monthly period is part of your menstrual cycle, a sequence of changes in your body (ovaries, uterus, vagina, and breasts) that occur every 28 days on average. Some menstrual periods are slightly longer than others. The first day of your menstrual cycle is the first day of your menstrual period. The usual menstrual cycle lasts between five and seven days.
But not all biological females have a normal menstrual cycle, some might be undergoing irregular periods or irregular menstruation which might be a result of changes in hormone levels, stress, medication or some underlying health conditions and more.
Here are some of the common Menstrual Disorders that every woman should know about –
Amenorrhea:
This disorder is the absence of menstruation during a woman's reproductive years. The reasons for this illness are numerous, and it can be divided into primary and secondary amenorrhea. This is not a life-threatening condition.
Primary amenorrhea is the lack of menstruation in a person who has not had a period by age 16. It is mainly caused by a disorder in your endocrine system regulating your hormones. This can occur due to low body weight caused by eating disorders, extreme activity, or drugs.
Causes of Primary Amenorrhea
- Pregnancy
- Tumours
- Congenital abnormalities (Müllerian aplasia, cervical and vaginal anomalies)
- Endocrine lesions
Secondary amenorrhea refers to the absence of periods (3 or more in a row) in a female who has had periods in the past. It can be caused by problems that affect estrogen levels, including stress, weight loss, exercise, or illness.
Causes of Secondary Amenorrhea
- Weight loss
- Chronic ovulation
- Pituitary Tumours
- Ovarian Tumours (1)
Premenstrual Syndrome (PMS):
This collection of physical, emotional, and behavioural symptoms occurs in most cycles during the last week of the luteal phase (a week before menstruation). The symptoms usually do not appear until at least day 13 of the period cycle and disappear within 4 days of the onset of bleeding. (2)
Some women get their periods with no or just minor symptoms of PMS. Others may experience PMS symptoms that are so severe that going to work or school becomes difficult. Severe PMS symptoms may indicate premenstrual dysphoria (PMDD). When you no longer have a period, such as after menopause, PMS fades away. PMS may return after pregnancy, although you may experience distinct PMS symptoms.
Symptoms of PMS
- Constipation or diarrhoea
- Bloating or a gassy feeling
- Cramping
- Headache or backache
- Irritability or hostile behaviour
- Feeling tired
- Sleep problems
- Appetite changes or food cravings
- Trouble with concentration or memory
- Tension or anxiety
- Depression, feelings of sadness, or crying spells
- Mood swings
Premenstrual Dysphoric Disorder (PMDD):
Premenstrual dysphoric disorder is far more severe than the typical PMS (Premenstrual symptoms). PMDD patients experience PMS symptoms (bloating, headaches, and breast soreness) in the weeks prior to their period. Symptoms can be alleviated with hormonal birth control and medications. Experts believe that decreasing levels of estrogen and progesterone hormone after ovulation and before menstruation may trigger the symptoms.
Signs of the conditions include:
- Anger or irritability.
- Feeling overwhelmed or tense
- Anxiety and panic attacks
- Depression
- Less focus
- Fatigue and low energy
- Headaches(3)
Dysmenorrhea:
Dysmenorrhea is characterised by intense cramping during menstruation. The pain starts in the lower abdomen and spreads to the lower back and thighs. It can be classified into Primary and Secondary dysmenorrhea.
Primary dysmenorrhea begins with your first period and continues throughout your life. It is typically permanent. It might result in severe and frequent menstrual cramping due to irregular uterine contractions.
Secondary dysmenorrhea is the pain caused by menstruation due to another medical or physical condition, like endometriosis or uterine fibroids. Other causes include uterine fibroids, pelvic inflammatory disease (PID), infection, tumours, or polyps in the pelvic cavity.
Some common symptoms of dysmenorrhea include
- Cramping in the lower abdomen
- Low back pain
- Nausea
- Vomiting
- Diarrhoea
- Fainting
- Headaches (4)
Menorrhagia:
This disorder is characterised by heavy menstrual bleeding which lasts more than 7 days. Several factors can cause this condition. The average woman who is not undergoing menorrhagia sheds roughly 1 ounce (30 mL) of blood and changes her sanitary products 3 to 5 times daily during a regular menstrual cycle. Clot formation is also widespread and often menorrhagia is accompanied by dysmenorrhea as passing the large clots can be painful.
Causes of menorrhagia:
- Uterus or cervix cancer
- Intrauterine device (IUD)
- Tumours in the uterus (fibroid or polyps)
- Hormone-related problems
- Bleeding disorders or platelet function disorder
- Certain drugs (anticoagulants, antidepressants, hormonal contraceptives) (5,6)
Seek the help of a healthcare professional if you think you experience the conditions mentioned above. A professional can examine your medical history to establish whether another medical condition causes a menstruation problem. For example, Appendicitis, Urinary Tract Infections, Ectopic Pregnancy, and Irritable Bowel Syndrome are examples of non-menstrual illnesses that can cause abdominal pain. Heavy bleeding and severe pain can be caused by Endometriosis and Uterine Fibroids.
This was all about some common menstrual disorders. In part 2 of this series, let's look at the diagnosis and treatment given for each of the aforementioned conditions.
REFERENCES:
- https://www.ncbi.nlm.nih.gov/books/NBK482168/#:~:text=Amenorrhea%20is%20defined%20as%20the,as%20primary%20and%20secondary%20amenorrhea.
- https://www.mountsinai.org/health-library/report/menstrual-disorders#:~:text=Menstrual%20disorders%20are%20problems%20that,years%20between%20puberty%20and%20menopause.
- https://my.clevelandclinic.org/health/articles/9132-premenstrual-dysphoric-disorder-pmdd
- https://www.mountsinai.org/health-library/report/menstrual-disorders#:~:text=Menstrual%20disorders%20are%20problems%20that,years%20between%20puberty%20and%20menopause.
- https://www.hopkinsmedicine.org/health/conditions-and-diseases/dysmenorrhea
- https://www.cdc.gov/ncbddd/blooddisorders/women/menorrhagia.html#:~:text=Menorrhagia%20is%20menstrual%20bleeding%20that,larger%2C%20that%20is%20heavy%20bleeding.
- https://www.healthywomen.org/condition/menstrual-disorders
