Menstrual Disorders

Menstrual disorders are common during adolescence and perimenopause, causing anxiety for patients and their families. The cause could be variable-harmonal, genetic, clotting disorder or pelvic diseases. Physical and psychological factors also contribute to the problem.

Median age of menarche (beginning of menstrual period is) 12 years however, this age is declining over the past few years to 10yrs preceded by thelarche (breast development) by2 years

Normal menstrual cycle length can vary from 21 to 35 days  with 3to 7 days of bleeding with 20 to 80 ml bleed considered normal. Deviation from this would be labelled a disorder

  • Amenorrhea:
    • Primary amenorrhea is absence of menstruation by age 16 years and 14 years if there is lack of pubertal development (Secondary sexual characters like breast development & axillary and public hair.) also
    • Secondary amenorrhea is absence of periods for 3 consecutive months
  • Dysmenorrhea is painful period, when patient complains of crampy lower abdominal and pelvic pain that radiates to thighs and back.  
    • It is Primary when pain is not associated with any pelvic pathology, only due to excessive prostaglandins.
    • Secondary  when pelvic pathology like endometriosis  pelvic inflammatory disease or fibroids are causing pain, it is rare , and  occurs several years later than menarche and need evaluation.
    • Mittelschmerz pain occurs mid-cycle because of rupture of follicle in some women
  • Menorrhagia Bleeding lasts more than 8days and with blood loss over 80 ml
  • Oligomenorrhea or scanty periods.Period prolonged beyond 35 days and bleeding very scanty just spotting, needs evaluation.
  • Metorrhagia or break through bleeding. Intermenstrual bleeding has no relation with period and is of variable amounts. This needs evaluation.
  • Dysfunctional uterine bleeding is a general term for abnormal uterine bleedingwhich is usually excessive, anovulatory and caused by harmonal problems. Occurs during few years after menarche and before menopause.Other type of abnormal bleeding include postcoitalbleed and postmenopausal bleeding which need urgent evaluation.
  • Pre menstrual syndrome (PMS) This is a set of physical, emotional and behavioural symptoms that occur in the last week (luteal phase) before menstruation, in most cycles, usually when women are in their late 20s to early 40s.

Treatment options available for these menstrual disorders are:

  • Non steroidal anti inflammatory drugs like aspirin acetaminophen ibuprofen naproxen and mefenamic  acid.
  • Oral contraceptives (Combined estrogen & progesterone pills)
  • Progestins oral or injectable progesterone (Provera) or LNG-IUD (Mirena)
  • Danazol
  • Gnrh agonists
  • Tranexamic acid for heavy bleeding.
  • Endometrial ablation -Radiofrequency ablation, hydrothermal ablation, cryogenic and microwave endometrial ablation for metorrhagia.
  • Hysterectomy when medicines and other procedures fail.
  • Nerve destruction techniques like LUNA and LPSN for treating severe dysmenorrhea.

(Dr. Lily Khosa)
Head Hospital Services
IIT Hospital