Menstrual Disorders:
Understanding causes, symptoms, and treatment

Common Menstrual Disorders

Heavy menstrual bleeding, or menorrhagia, can significantly impact a woman’s quality of life. You may be having abnormally heavy menstrual bleeding if you have blood clots, overflow, low blood count and have the need to change soaked pads frequently.

Causes

  1. Hormonal Imbalances: Inconsistencies in oestrogen and progesterone levels can disrupt the regular menstrual cycle, leading to heavy bleeding.
  2. Fibroids: These are usually non-cancerous growths in the womb muscle that may result in very heavy and/or painful periods if the fibroid is large or growing in the womb, impacting the womb lining.
  3. Abnormal Womb Lining: Abnormal womb lining thickening due to polyps or pre-cancerous thickening (hyperplasia).
  4. Endometriosis: Heavy menstrual bleeding is one of the signs of endometriosis.
  5. Medical Conditions: Diagnoses like polycystic ovary syndrome (PCOS) and thyroid disorders can contribute to menorrhagia.

Treatment

Treatment for heavy menstrual bleeding is dependent on its underlying cause. A womb lining biopsy and ultrasound may be required to establish the cause. Hormonal or non-hormonal medications may be prescribed to regulate the menstrual cycle. For heavy bleeding due to conditions like ovarian cysts, polyps or fibroids, surgery may be necessary to remove them.

A regular menstrual cycle lasts 21 to 35 days for most women. However, some women have irregular menstrual cycles, which means their periods are shorter or longer than usual. Irregular periods may also indicate an underlying health issue. Women with irregular periods may experience unpredictable cycles, frequent changes in flow, or missed periods altogether.

Causes

  1. Polycystic Ovary Syndrome (PCOS): A common hormonal disorder affecting the ovaries, PCOS can lead to irregular periods, among other symptoms.
  2. Ovarian Cysts: may affect hormonal balance
  3. Thyroid Disorders: Overactive or underactive thyroid function
  4. Stress and Lifestyle Factors: Excessive exercise, drastic weight loss, high stress levels

Investigations

Ultrasound Pelvis

To rule out conditions like ovarian cysts, polycystic ovary syndrome (PCOS), or any structural abnormalities in the reproductive organs.

Hormonal Blood Test

To assess hormone levels, including estrogen, progesterone, testosterone, and thyroid hormones.

Treatment

Hormone Regulation

Birth control or non-birth control hormone pills can regulate hormone levels which in turn regulates the menstrual cycle.

Weight Management and Lifestyle Changes

Weight reduction, stress management may improve hormonal imbalance

Correction of Underlying Thyroid Disorder
Removal of Ovarian Cyst

If an ovarian cyst is identified and deemed problematic, surgical removal may be considered

Painful periods, known as dysmenorrhea, can be a monthly ordeal for many women. Cramping and pelvic pain are common symptoms, often accompanied by headaches and nausea.

Causes

  1. Primary Dysmenorrhoea: Caused by chemicals called prostaglandins produced during the period
  2. Secondary Dysmenorrhoea: This may be due to:
  • Endometriosis 
  • Fibroids
  • Ovarian Cysts – benign or malignant tumours

Treatment of Painful Periods

  1. Pain relief Medications: Medications such as Panadol (acetaminophen) and NSAIDs (nonsteroidal anti-inflammatory drugs) provide relief from menstrual pain
  2. Hormonal Pills: Hormonal medication such as birth control pills can regulate menstrual cycles and reduce pain.
  3. Hormone treatment for Endometriosis: Hormonal pills specifically designed to treat endometriosis-related pain, such as Visanne.
  4. Surgery: Removal of root causes such as fibroids, cysts, or endometriosis

PMS is seen in physical and emotional manifestations that happen in the days leading up to menstruation. Common symptoms include mood swings, bloating, and breast tenderness.

Causes

  1. Hormonal Changes: Irregularities in oestrogen and progesterone levels contribute to PMS.
  2. Serotonin Levels: Changes in serotonin, a neurotransmitter, can affect mood and lead to PMS symptoms.

Treatment

Changes in lifestyle habits like regular exercise and a balanced diet can help manage PMS. For severe cases, your doctor may prescribe medications like antidepressants or recommend hormonal therapies.

Heavy menstrual bleeding, or menorrhagia, can significantly impact a woman’s quality of life. You may be having abnormally heavy menstrual bleeding if you have blood clots, overflow, low blood count and have the need to change soaked pads frequently.

Causes

  1. Hormonal Imbalances: Inconsistencies in oestrogen and progesterone levels can disrupt the regular menstrual cycle, leading to heavy bleeding.
  2. Fibroids: These are usually non-cancerous growths in the womb muscle that may result in very heavy and/or painful periods if the fibroid is large or growing in the womb, impacting the womb lining.
  3. Abnormal Womb Lining: Abnormal womb lining thickening due to polyps or pre-cancerous thickening (hyperplasia).
  4. Endometriosis: Heavy menstrual bleeding is one of the signs of endometriosis.
  5. Medical Conditions: Diagnoses like polycystic ovary syndrome (PCOS) and thyroid disorders can contribute to menorrhagia.

Treatment

Treatment for heavy menstrual bleeding is dependent on its underlying cause. A womb lining biopsy and ultrasound may be required to establish the cause. Hormonal or non-hormonal medications may be prescribed to regulate the menstrual cycle. For heavy bleeding due to conditions like ovarian cysts, polyps or fibroids, surgery may be necessary to remove them.

A regular menstrual cycle lasts 21 to 35 days for most women. However, some women have irregular menstrual cycles, which means their periods are shorter or longer than usual. Irregular periods may also indicate an underlying health issue. Women with irregular periods may experience unpredictable cycles, frequent changes in flow, or missed periods altogether.

Causes

  1. Polycystic Ovary Syndrome (PCOS): A common hormonal disorder affecting the ovaries, PCOS can lead to irregular periods, among other symptoms.
  2. Ovarian Cysts: may affect hormonal balance
  3. Thyroid Disorders: Overactive or underactive thyroid function
  4. Stress and Lifestyle Factors: Excessive exercise, drastic weight loss, high stress levels

Investigations

Ultrasound Pelvis

To rule out conditions like ovarian cysts, polycystic ovary syndrome (PCOS), or any structural abnormalities in the reproductive organs.

Hormonal Blood Test

To assess hormone levels, including estrogen, progesterone, testosterone, and thyroid hormones.

Treatment

Hormone Regulation

Birth control or non-birth control hormone pills can regulate hormone levels which in turn regulates the menstrual cycle.

Weight Management and Lifestyle Changes

Weight reduction, stress management may improve hormonal imbalance

Correction of Underlying Thyroid Disorder
Removal of Ovarian Cyst

If an ovarian cyst is identified and deemed problematic, surgical removal may be considered

Painful periods, known as dysmenorrhea, can be a monthly ordeal for many women. Cramping and pelvic pain are common symptoms, often accompanied by headaches and nausea.

Causes

  1. Primary Dysmenorrhoea: Caused by chemicals called prostaglandins produced during the period
  2. Secondary Dysmenorrhoea: This may be due to:
  • Endometriosis 
  • Fibroids
  • Ovarian Cysts – benign or malignant tumours

Treatment of Painful Periods

  1. Pain relief Medications: Medications such as Panadol (acetaminophen) and NSAIDs (nonsteroidal anti-inflammatory drugs) provide relief from menstrual pain
  2. Hormonal Pills: Hormonal medication such as birth control pills can regulate menstrual cycles and reduce pain.
  3. Hormone treatment for Endometriosis: Hormonal pills specifically designed to treat endometriosis-related pain, such as Visanne.
  4. Surgery: Removal of root causes such as fibroids, cysts, or endometriosis

PMS is seen in physical and emotional manifestations that happen in the days leading up to menstruation. Common symptoms include mood swings, bloating, and breast tenderness.

Causes

  1. Hormonal Changes: Irregularities in oestrogen and progesterone levels contribute to PMS.
  2. Serotonin Levels: Changes in serotonin, a neurotransmitter, can affect mood and lead to PMS symptoms.

Treatment

Changes in lifestyle habits like regular exercise and a balanced diet can help manage PMS. For severe cases, your doctor may prescribe medications like antidepressants or recommend hormonal therapies.

Diagnosis and Evaluation

Importance of Seeking Medical Care

While some period irregularity is common, persistent or severe symptoms warrant medical evaluation. Early discovery of the underlying condition can prompt early treatment and prevent worsening.

Delayed treatment may result in issues such as low blood count, poor quality of life, reduced fertility and even delayed diagnosis of serious underlying pathology such as cancer.

Furthermore, certain menstrual disorders, if left untreated, can lead to complications. For example, heavy menstrual bleeding could result in anaemia due to significant blood loss. Early intervention and management can help prevent or address such complications.

How do I find out the reasons for my abnormal period?

A systematic approach involving various diagnostic methods is typically employed to find out the reasons for abnormal periods.
Gynaecological Examination and Ultrasound Pelvis

To assess for abnormalities of the womb/ovaries.

Blood Test

Assessing hormonal levels and identifying potential causes of abnormal periods.

Surgical Procedures

This may include:

  • Hysteroscopy to examine inside of the womb to examine for abnormalities.
  • Dilation and Curettage (D&C) for evaluation and treatment of abnormal uterine bleeding, especially in older women aged >40 yrs

Surgical Procedures
This may include:
  • Hysteroscopy to examine inside of the womb to examine for abnormalities.
  • Dilation and Curettage (D&C) for evaluation and treatment of abnormal uterine bleeding, especially in older women aged >40 yrs

Diagnosis and Evaluation

Importance of Seeking
Medical Care

While some period irregularity is common, persistent or severe symptoms warrant medical evaluation. Early discovery of the underlying condition can prompt early treatment and prevent worsening.

Delayed treatment may result in issues such as low blood count, poor quality of life, reduced fertility and even delayed diagnosis of serious underlying pathology such as cancer.

Furthermore, certain menstrual disorders, if left untreated, can lead to complications. For example, heavy menstrual bleeding could result in anaemia due to significant blood loss. Early intervention and management can help prevent or address such complications.

How do I find out the reasons for my abnormal period?

A systematic approach involving various diagnostic methods is typically employed to find out the reasons for abnormal periods.
Gynaecological Examination and Ultrasound Pelvis

To assess for abnormalities of the womb/ovaries.

Blood Test

Assessing hormonal levels and identifying potential causes of abnormal periods.

Surgical Procedures

This may include:

  • Hysteroscopy to examine inside of the womb to examine for abnormalities.
  • Dilation and Curettage (D&C) for evaluation and treatment of abnormal uterine bleeding, especially in older women aged >40 yrs

When to see your gynaecologist?

If you are experiencing the following symptoms:

  • Irregular, infrequent or frequent menstrual cycles
  • Heavy menstrual bleeding with clots, flooding or anaemia
  • Severe period cramps or pain, with or without heavy flow
  • Painful intercourse, which may be due to endometriosis or pelvic inflammatory disease
  • Abdominal pain not related to period cycle

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Frequently Asked Questions

If you’re experiencing irregular, painful, or heavy periods, do consult your gynaecologist. A scan and further tests may be recommended to exclude more serious underlying conditions.

Depending on the underlying cause, abnormal periods can impact fertility. Conditions such as fibroids, ovarian cysts, endometriosis, and PCOS can affect pregnancy outcomes. 

Fibroids and cysts may interfere with ovulation, while endometriosis can lead to blocked tubes. Irregular or infrequent periods resulting from PCOS may prevent you from conceiving.

Yes, menstrual disorders are very common. Studies show that as many as 97% of women experience at least one form of menstrual disorder.