Menstrual disorders

Overview

While some women experience no abnormalities during their monthly cycle, there are several menstrual disorders that can cause both physical and emotional pain. Some of these abnormalities include premenstrual dysphoric disorder and premenstrual syndrome.  

Causes and risk factors

While the causes of menstrual disorders can vary, some common reasons include:

  • Hormonal causes
  • Uterine fibroids –  benign tumors that derive from the uterine muscle
  • Polyps
  • Endometrial cancer
  • Pregnancy
  • Adenomyosis – a condition in which endometrial tissue is present and grows into the uterine wall
  • Stress
  • Family history
  • Tobacco use

Types of menstrual disorders

There are several types of menstrual disorders that result in various symptoms. Some common disorders include:

  • Premenstrual syndrome (PMS) – This refers to uncomfortable symptoms during a women’s menstrual cycle that can affect daily function.
  • Premenstrual dysphoric disorder (PMDD) – This has similar, yet amplified symptoms to PMS; however, these symptoms are often debilitating and interfere with work, relationships and activities. This condition requires medical attention and treatment. Approximately 3-8 percent of women of reproductive age are affected by PMDD. While the exact cause is unknown, abnormal reactions to normal hormone changes that happen during a women’s menstrual cycle are thought to play a role.
  • Amenorrhea –This is the absence of a women’s menstruation. Women who have missed at least three periods in a row, or haven’t gotten their period by the age of 15, have this condition. Common causes include pregnancy, reproductive organ irregularities and issues with hormone regulation.
  • Dysmenorrhea – This refers to painful cramps that a woman may experience before or during her menstrual period. There are two types: primary and secondary. Primary is simply another name for common menstrual cramps. These are typically present in the lower abdomen or back. Secondary dysmenorrhea is pain caused by a dysfunction in a woman’s reproductive organ. They tend to last longer than common menstrual cramps.

Menorrhagia – The most common type of abnormal menstrual bleeding, menorrhagia refers to abnormal periods characterized by heavy and prolonged bleeding. The bleeding can be so severe it may disrupt daily activities.

Symptoms

Common symptoms of menstrual disorders include:

Premenstrual syndrome (PMS):

  • Tension or anxiety
  • Depressed mood
  • Mood swings, irritability
  • Insomnia
  • Joint or muscle pain
  • Fatigue
  • Weight gain attributed to fluid retention
  • Acne
  • Breast tenderness
  • Constipation
  • Headache

Premenstrual dysphoric disorder (PMDD):

  • Irritability
  • Nervousness
  • Altered appetite
  • Bloating
  • Breast tenderness
  • Swelling
  • Muscle and joint pain

Amenorrhea:

  • Nipple discharge
  • Extra facial hair
  • Pelvic discomfort
  • Headache
  • Hair loss

Dysmenorrhea:

  • Pain in lower back/abdomen
  • Nausea
  • Vomiting
  • Diarrhea
  • Overall achiness

Menorrhagia:

  • Heavy bleeding
  • Fatigue 

Diagnosis and testing

When it comes to diagnosing a menstrual disorder, your doctor will get a comprehensive view of your medical history, in addition to hormonal studies. Diagnosis practices for irregularities like PMS, PMDD, abnormal bleeding and dysmenorrhea include:

  • Ultrasound – Your doctor may use an ultrasound to provide a better image of your pelvic structures, in addition to ruling out pregnancy.
  • Endometrial biopsy – During an endometrial biopsy, your doctor removes a sample of tissue from the lining of your uterus, which will be analyzed to identify possible issues.

Treatment options

Treatment for menstrual disorders can vary based on your exact diagnosis. Some common treatments include:

  • Medical treatments – birth control pills, either combined or progesterone only
  • Surgical treatment – surgical treatment of menstrual disorders can mean traditional or minimally invasive surgery to treat conditions such as polyps and fibroids. Your doctor may even recommend a hysterectomy, which is the removal of your uterus, or a partial hysterectomy.