Menstrual Disorders

August 9, 2020 Rima Medical Science 0

What is menstruation and menstrual disorders?

  • Menstruation is regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina. Menstrual cycle is the monthly series of changes occurring in woman’s body to prepare for the possibility of pregnancy. Each month, one of the ovaries release an egg and hormonal changes prepare the uterus for pregnancy. If the ovulation takes place and egg is not fertilized, the lining of uterus sheds through the vagina. This is called a menstrual period.
  • The first period begins in young girls aged between 12- 13 years. The average menstrual cycle may last for about 28 days, varying between 2-35 days. The menstrual bleeding usually last around 2-7 days.
  • Most of the females suffer from abdominal cramps and pain during menstruation. These symptoms are not severe to categorize them as menstrual disorder.
  • Menstrual disorders can be defined as cluster of physical and emotional symptoms experienced by female during or just before menstruation. These symptoms are severe enough to affect a woman’s daily life and may lead to other complications.

Types of menstrual disorder

Some common menstrual disorders are:

  • Menorrhagia
  • Amenorrhea
  • Dysmenorrhea
  • Hypomenorrhea
  • Polymenorrhea and Oligomenorrhea
  • Pre-menstrual syndrome (PMS)/ Pre-menstrual dysphoric disorder (PMDD)
  • Bleeding between periods or spotting

Menorrhagia (Heavy bleeding)

  • Menorrhagia is heavy menstrual bleeding that lasts more than 7 days or severe bleeding for less than 7 days. The menstrual bleeding and cramping are so severe that they affect female’s daily activities. In normal menstruation phase a female loses about 30 ml of blood. A period in which a female loses about 80 ml of blood can be characterized as menorrhagia.
  • It is the fourth most common condition that require referral to gynecologist. It may lead to anemia and other health problems.
  • The symptoms include bleeding for longer than a week, need to use double sanitary protection, soaking of pad or tampon every 1 or 2 hours and need to wake up at night to change pad. It may be caused due to various reasons like blood diseases, intrauterine device, polyps, hormone imbalance (thyroid disorder, polycystic ovary syndrome (PCOS)), uterine fibroids and cancer and due to some medications.

Amenorrhea (Absence of Menstruation)

  • It is absence of menstruation in a woman or adolescent girl. It is of two types.
  • Primary amenorrhea– when a girl hasn’t started periods by age of 15 or within 5 years of first sign of puberty.
  • Secondary amenorrhea– when a female having regular menstruation doesn’t have period for at least 3 month or 3 menstrual cycle.
  • Amenorrhea can occur due to normal conditions like pregnancy, breastfeeding or menopause. It may be due to other medical problems including thyroid, hypothalamic or pituitary disorder, eating disorder like anorexia and bulimia nervosa, excessive exercise, ovulation abnormality and birth defect.
  • Symptoms may vary. In most female, there are no symptoms other than absence of periods. Some may experience hot flashes, vaginal dryness, headache, vision changes, growth of hair on face and body.

Dysmenorrhea (Painful cramps)

  • It is a type of menstrual disorders characterized by painful period due to cramps. Although all woman experiences painful period at some point, dysmenorrhea can be severe enough to hinder normal activities. It is very common and leading cause of absence of female from school or work.
  • It can be classified into 2 types. Primary dysmenorrhea occurs in absence of underlying pathological condition. The pain occurs due to abnormal uterine contraction due to chemical imbalance in the body. Secondary dysmenorrhea is due to other pathological conditions like fibroids, endometriosis and pelvic inflammatory disease.
  • It may be associated with other symptoms like nausea, diarrhea, vomiting, fatigue and pain conditions like migraine, irritable bowel syndrome and fibromyalgia.
  • Risk factors may include smoking, heavy menstrual flow, nulliparity and depression.

Hypomenorrhea (Light or Short Period)

  • It is also known as scanty menstruation and is characterized by extremely light flow of blood during menstruation or shortened duration of menstruation. It is the opposite of menorrhagia.
  • The causes may be oral contraceptives, Intrauterine devices (IUD), hormonal problem like hypothyroidism, hyperprolactinemia, high androgen and insulin level, polycystic ovarian symptoms (PCOS), premature ovarian failure, nervous and emotional reasons (excessive excitement or stress) or hereditary.

Polymenorrhea or Oligomenorrhea

  • Polymenorrhea is a term used to describe a menstrual cycle that is shorter than 21 days or period that are too close together. A normal menstrual cycle is between 24-38 days long.
  • In some female, it may be normal. However, in some it may indicate underlying cause. It can affect fertility and getting pregnant may become challenging. The potential causes are stress, STDs, endometriosis and menopause.
  • Oligomenorrhea is defined as menstrual cycle length of more than 35 days and is characterized by infrequent periods or periods that are too far apart. The causative factors may be PCOS, stress, unhealthy nutrition, low physical exercise, hyperprolactinemia, eating disorder and intense exercise.

Pre-menstrual syndrome (PMS)/ Pre-menstrual dysphoric disorder (PMDD)

  • PMs isa type of menstrual disorders which refers to wide variety of recurrent, moderate-to severe, physical and behavioral symptoms associated with menstruation. It usually develops during the luteal menstrual cycle (week before menstruation) and disappear within a few days of menstruation.
  • The etiology of PMS is not clear. Several theories suggest, it occurs due to increased sensitivity to normal hormonal changes and neurotransmitter abnormalities.
  • Some of the characteristic symptoms are mood swings, headache, feeling of abdominal bloating, appearance of acne, tenderness of breast, depression.
  • A more severe form of PMS known as PMDD is also known as late luteal phase dysphoric disorder. It occurs in small number of female and lead to significant loss of function due to severity of symptoms. Its symptoms include severe depression, irritation or anger, food cravings or binge eating, tiredness or low energy.
  • PMS can be managed by adopting healthy lifestyle including exercise, smoking cessation, limited alcohol intake, decreased salt and caffeine intake during premenstrual period. Sometimes, medications like diuretics, antidepressants, oral contraceptives and analgesics (e.g. aspirin, paracetamol)are used for PMS and PMDD.

Bleeding between periods or spotting

  • It is also known as breakthrough bleeding and is characterized by vaginal bleeding or spotting that occurs between menstrual periods. The blood is either light red or dark reddish brown.
  • It mostly occurs in women who uses oral contraceptives or IUD. It may also be due to some medical condition.

References

  1. https://www.medicinenet.com/premenstrual_syndrome/article.htm
  2. https://healthtian.com/hypomenorrhea/
  3. https://www.cdc.gov/ncbddd/blooddisorders/women/menorrhagia.html
  4. https://www.healthline.com/health/vaginal-bleeding-between-periods#causes
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