The menstrual cycle takes, on average, 28 days, although some women have a slightly longer or shorter cycle. Normal ranges from about 21 to 40 days from the start of one period to the start of the next. The average duration of the period — the bleeding part of the menstrual cycle — lasts around five days. Anywhere from two to around seven days is normal. However, if you experience excruciating cramps or abnormally heavy bleeding during your menstruation, menstrual disorders may be at play.
Types and Causes of Menstrual Disorders
Menstrual disorders are anything out of the ordinary and problematic with the menstrual cycle. They could be referred to as period problems or by specific names for various menstrual disorders. The most common menstrual disorders include dysmenorrhea, amenorrhea, and menorrhagia.
Dysmenorrhoea (Period Pain)
Having period pain or cramps is very common, and may fluctuate throughout life. Mild to moderate pain accompanying a period does not usually have any significant underlying cause. But if it affects everyday life and is not manageable with simple home remedies, consider seeking medical advice.
Problematic dysmenorrhea can have a number of underlying causes which may need further investigation and treatment. These may include:
- Endometriosis: Where cells that normally line the womb also grow in places outside of the womb and surrounding organs.
- Fibroids: Benign (non-cancerous) growths within the uterus that can cause problems with periods.
- Polycystic Ovarian Syndrome (PCOS): When ovaries begin the process of releasing too many eggs at once or too frequently. Aside from causing pain and irregular periods, it also results in the ovaries appearing lumpy under ultrasound.
(See also: Take Charge of Your Body: PCOS & Fertility)
This is the absence of menstruation, with missed or stopped periods.
A lack of periods doesn’t necessarily mean a serious problem, but seeing a doctor can be helpful. Getting medical advice for absent or occasional periods becomes particularly important if you are trying to conceive. Amenorrhea may make it harder to get pregnant. There are lots of different conditions or treatments which can cause it. These include PCOS and cancer treatments, among others.
Periods also stop during pregnancy, and frequently remain absent while breastfeeding. Having no periods while breastfeeding makes getting pregnant in that time less likely. It is still possible though, so use appropriate contraception if you are trying to avoid conception.
Not starting periods by the age of 16, where there is no other cause for delayed puberty. Causes for primary amenorrhea can include very low weight, eating disorders, intense long-term athletic activity, and some chronic or genetic conditions.
Menorrhagia (Heavy Bleeding)
The amount of bleeding during a period differs from one person to the next. Knowing what’s normal for you means that you can spot problems and know when to ask for help. If bleeding is so heavy that you’re having to change pads or other sanitary products more often than every two hours, or if you frequently bleed through clothes or bedding, consult your GP. They will be able to provide help in managing your menorrhagia.
Irregular periods are fairly common, particularly during puberty or towards the time of the menopause. If periods are significantly irregular to the point where they’re causing stress or other problems, or if periods were previously stable and have suddenly become very erratic, consult your GP. They should be able to advise on whether your condition warrants further investigations or suggest management plans.
Pre-menstrual Syndrome (PMS)
PMS refers to physical and emotional changes due to fluctuating hormonal levels at different points throughout the menstrual cycle. Another name for it is pre-menstrual tension (PMT). Most commonly, PMS symptoms begin a few days before the period. They include low mood or irritability, anxiety, fatigue, and tearfulness. Physical effects include bloating, changes in appetite, greasy or spotty skin, and breast tenderness. Maintaining healthy sleep patterns and diets, as well as getting exercise and prioritising self-care can help improve some symptoms.
Risk Factors for Menstrual Disorders
There are a number of physical and lifestyle factors that can increase the likelihood of menstrual disorders.
Body mass index: The greatest modifiable risk factor for period problems is being either extremely overweight or extremely underweight. Both can affect the menstrual cycle and also cause problems with fertility. Staying within a healthy weight range can improve some menstrual disorders.
Early menarche: Starting your periods at 11 or younger is associated with having more uncomfortable periods in those initial years. However, it does not indicate a higher likelihood of menstrual disorders later in life.
Smoking: Smokers are more likely to experience problems with their periods.
Extreme exercise regimens: People following very strenuous and frequent exercise plans, such as elite athletes, often have less frequent periods. This can also be associated with reduced fertility.
Stress: Emotional and psychological stress or stress on the body due to illness or injury can affect periods.
Diagnosing Menstrual Disorders
Most common menstrual disorders can be diagnosed based on a description of symptoms alone. However, if a diagnosis is questionable or a doctor suspects underlying causes, they may request further investigations. Some of the investigations into menstrual disorders can include:
- Urine tests: This can help identify other possible causes for lower abdominal pain, such as urine infections or kidney problems.
- Blood tests: These can help give a clue into other conditions and identify other problems resulting from menstrual disorders. For example, anaemia due to heavy periods.
- Ultrasound scans: These are the same kinds of ‘jelly’ scans for monitoring pregnancy. While they are usually performed externally on the surface of the belly, it can also be done by inserting a special wand via the vagina to get a good view of the reproductive system.
- Hysteroscopy: A procedure where a very fine fibre-optic tube is passed into the womb through the vagina and cervix. It enables a visual examination of the inside of the uterus for any abnormalities. Small tissue samples can be taken from any areas that look problematic.
- Laparoscopy: This is a surgical procedure where the doctor makes pinhole incisions in the abdomen to insert a tube. It allows them to visualise the organs and take small tissue samples if necessary. Laparoscopy requires general anaesthesia.
Treating Menstrual Disorders
Medical treatment for menstrual disorders depends on the type of problem, underlying causes, and any other co-existing conditions. Treatments can include:
- Hormonal contraceptives: They can help to regulate the cycle and can make periods significantly lighter. Some hormonal contraceptives can stop periods altogether for the duration of treatment. Hormonal contraceptives can include various forms of contraceptive pill, injections, or hormone-releasing implants. An intra-uterine system (IUS) or ‘coil’ is a small device inserted through the cervix into the womb that releases hormones to prevent pregnancy. This can improve symptoms of PMS, dysmenorrhoea, and menorrhagia.
- Medication: Medications, usually a tablet of tranexamic acid, can help control bleeding. Simple painkillers like ibuprofen can help in pain management.
- Surgery: Some underlying causes of menstrual disorders may require surgical treatment. These include endometrial ablation, a procedure where the lining of the womb is removed. In some cases, a hysterectomy or total removal of the womb, with or without the ovaries.
- Traditional Chinese Medicine (TCM): It’s important to use an accredited TCM practitioner who recommends treatments based on a holistic assessment. Some of the treatments can include acupuncture and acupressure, herbal remedies, and moxibustion.
There are a range of other alternative or complementary therapies including massage, yoga, forms of herbalism, and homeopathy. The evidence base for these therapies varies so it’s important to consult accredited practitioners. Get advice from your GP if you have any concerns.
Managing Menstrual Disorders at Home
Minor menstrual disorders like period pain and some heavier bleeding are very common. These can often be managed at home using simple techniques and treatments. As always, it’s still important to see a doctor if things aren’t manageable or if you have specific concerns.
These can be useful for pain management:
- Exercise: For simple period pains, gentle exercise can have a really good effect. If there is a more complicated underlying cause, it is best to ask a doctor about vigorous exercise.
- Heat: Use heat packs or hot water bottles on painful areas, particularly the lower tummy or lower back. These can provide relief for period cramps and discomfort.
- Simple painkillers: Paracetamol, ibuprofen, or aspirin are common painkillers which can have a helpful effect on pain. It’s important to stay within the limits of the dosage amounts and timings according to the packaging.
- Distraction: If you’re having period cramps, it can be hard to feel up to doing anything at all. But getting up and about and just staying busy can make a difference for mild cramps and period blues.
There are more options for managing periods than ever before. Think period pants and washable pads, menstrual cups, and disposable or biodegradable pads and tampons. Choosing products designed for heavy flow can help ease the practical side of managing a problem period.
When to Seek Help for Menstrual Disorders
It is always all right to ask for professional help if you have any concerns. However, there are a few times when you should seek emergency assessment immediately. These include:
- Symptoms of a pelvic infection: Usually flu-like symptoms, fever and shivering, with heavy bleeding and severe abdominal pain.
- Symptoms of toxic shock syndrome: This is particularly associated with leaving a tampon in place for too long. This has become less common with modern tampon manufacturing methods and more awareness of the need for good tampon hygiene.
- Extreme pain with heavy bleeding: There are a number of reasons for sudden extreme pain. These can include infection and ectopic pregnancy. Different underlying causes require different types of investigation and treatment so it’s important to get a proper assessment.
Heavy bleeding can also cause problems like anaemia and fatigue. So even if you’re managing the flow and discomfort, it’s always okay to ask your doctor for support.
Manage Menstrual Disorders Holistically
Menstrual disorders can affect anyone with a womb and aren’t always possible to anticipate or prevent. That said, having a good base level of health can help your body cope with problems and fight infections. In particular, maintaining a healthy weight — neither too high nor too low — can help regulate periods and prevent problems. With support from a GP or specialist gynaecology team, menstrual disorders don’t have to rule your life.
This article first appeared on Homage, an award-winning personal care solution that provides on-demand holistic home and community-based caregiving and medical services to seniors and adults, allowing them to age and recover with grace, control, and dignity.
Featured image: Nataliya Vaitkevich