Menstrual disorders

What are menstrual disorders?

One of the most common reasons for gynaecologists visit is menstrual disorders or period problems. Menstrual disorders are problems related to a woman’s normal menstrual cycle also knows as periods. Menstrual problems and their symptoms could also affect a woman’s normal life and may also affect her ability to become pregnant.

The Indian scenario of menstrual disorders

Often times, menstrual disorders affect the daily lives of women including their social lives. It limits their daily activities and may also be a cause of college/school absenteeism among adolescents girls and in India, it is often unreported due to cultural reasons.

A study on menstrual disorders in India said that 79% of women had a menstrual complaint in their previous cycle however, only one third of them seek doctor’s help. A high 43% of women do not take any measure for their period problems!

Following are the most common problems associated with menstrual cycle:

Painful Period (Dysmenorrhea) – Common pain in more than half of women who menstruate for 1 to 2 days each month. Most of it is mild but some undergo severe pain every month. It’s usually caused by the womb contracting to push out the blood.

Abnormal bleeding during menstruation (Menorrhagia) – Heavy bleeding is considered when it interferes with normal activities and women are unable to complete it owing to heavy flow. Talking to the doctor about your bleeding, in terms of how often you have to change your sanitary pads or other methods you use (towels, tampons, period underwear or menstrual cup).

The absence of menstrual bleeding (Amenorrhea) – When a female does not start menstruating even after turned 16, the condition is amenorrhea.

Light or infrequent menstruation (Oligomenorrhea) – Normal period cycle usually lasts 2 to 7 days, with the average period lasting 5 days. The average period cycle is to have period every 28 days and this length of the menstrual cycle varies from woman to woman. Even cycles that are somewhat longer or shorter than this, from 23 to 35 days, are normal. Periods are irregular when they usually occur more than 35 days apart.

Premenstrual syndrome (PMS) – Most women experience this in some point of their lives. It is physical and emotional discomfort that has multiple symptoms prior to menstruation. Pre-menstrual syndrome is linked to the changing levels of hormones throughout the menstrual cycle.

Premenstrual Dysphoric Disorder (PMDD) – Premenstrual Dysphoric Disorder (PMDD) is a severe form of PMS that significantly affects a woman’s life. The most common symptoms of PMDD include heightened irritability, anxiety and mood swings and often medical intervention is necessary.

Endometriosis – A condition where tissue like the lining of the womb (endometrium) grows in other places outside the womb. Endometriosis can cause pain and multiple symptoms.

What causes menstrual disorders?

Menstrual disorders can be caused by a variety of factors, including:

  • Hormonal imbalances
  • Uterine fibroids (non-cancerous growths in the uterus)
  • Cancer
  • Sexually transmitted infections (STIs)
  • Polycystic ovary syndrome (PCOS) – cysts on the ovaries
  • Genetics – if the mother had PMS problem, chances are that the daughter would have similar symptoms

What are the symptoms of menstrual disorders?

Symptoms may vary depending on the type of disorder:

  • Pain
  • Cramping – sudden pain in lower stomach due to muscles that do not relax after contraction
  • Depression
  • Headaches
  • Emotional distress
  • Bloating or fullness in the abdomen

How are menstrual disorders diagnosed?

The first step is to report symptoms to the doctor to get a proper diagnosis. It is important to not consider these symptoms as a way of life and to report and treat it. Diagnosis starts with a detailed medical history and physical exam and may also include pelvic exam and pap smear in some cases. If the doctor suggests to keep a diary of menstrual cycles, including dates, amount of flow, pain and any other symptoms, it is advisable to comply with it. There are also many apps available for the same thing.

Additional testing:

  • Blood tests
  • Hormonal tests
  • Ultrasound – To detect conditions that may be causing menstrual disorders
  • Magnetic resonance imaging (MRI) – For detailed pictures of the uterus and surrounding organs.
  • Hysteroscopy – To detect the uterus for fibroids, polyps, or other areas of concerns, a small, lighted telescope is inserted through the vagina and cervix
  • Laparoscopy – Using a tiny lighted instrument with a camera on the end (laparoscope), abnormalities of the reproductive organs are studied. A small incision in the abdomen.

How are menstrual disorders treated?

Treatment for these disorders depends on the related causes, the woman’s desire to have children, her age, etc. Treatment options range from medical to non-medical such as: Dietary changes – Reduce salt, caffeine, sugar, and alcohol intake before the period to reduce cramping and other symptoms. Medical treatment – In some conditions such as heavy bleeding, painful periods, pain relievers may be used. Hormonal contraceptives help to reduce heavy bleeding and regulate or reduce, menstrual periods. Surgical treatment – If required, surgery is performed in some cases, either to diagnose the disorder or to treat.
  • Hysteroscopy – a minimally invasive approach to examine and treat areas of concern inside the uterus.
  • Laparoscopy – using a camera inserted in small incisions in the abdomen.
  • Through traditional abdominal techniques, procedures include –
    • Endometrial ablation – destroys the lining of the uterus to stop periods (in case of heavy bleeding)
    • Hysterectomy – the surgical removal of the uterus.

Menstrual disorders in India is a matter of concern because often time it goes under-reported and seeking help is impaired by a culture of silence, embarrassment, and hesitation. Women generally perceive these problems as universal and as a part of daily life. This needs to change and if some women are suffering from any period problems, please seek consultation from a doctor.

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  1. Period Problems. Accessed on Nov 10, 2023
  2. Menstruation and Menstrual Problems Accessed on Nov 10, 2023.
  3. Laksham KB, Selvaraj R, Kar SS. Menstrual disorders and quality of life of women in an urban area of Puducherry: A community-based cross-sectional study. J Family Med Prim Care. 2019 Jan;8(1):137-140. Accessed on Nov 10, 2023
  4. Top 5 Common Menstrual Disorders You Need to Know About. Accessed on Nov 10, 2023

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