Is your period normal? A brief overview of menstrual problems | The Family Planning Association of Sri Lanka

Is your period normal? A brief overview of menstrual problems

Some women get their period like clockwork, with no pain and at the same time each month, causing little inconvenience. However, some women experience many physical and/or emotional symptoms before and during menstruation, such as heavy bleeding, painful periods and unmanageable mood swings, which may disrupt a woman's life and affect her ability to conceive.

Menstrual disorders can be caused by delayed puberty, uterine fibroids, hormonal imbalances, clotting disorders, cancer, sexually transmitted diseases (STDs), polycystic ovarian syndrome (PCOS), endometriosis, pelvic disease, medications, contraceptives, infections, miscarriages and genetics.

Symptoms of menstrual disorders may be physical such as, abnormal menstrual bleeding, pain or cramping, bloating, swollen and painful breasts, fatigue, headaches; or mental symptoms such as, emotional distress/depression, anger, anxiety, confusion, mood swings and inability to concentrate.

There are many types of menstrual disorders, including:

  • Amenorrhea - The absence of menstrual bleeding. This could be primary, when a girl does not begin to menstruate by age 16 or secondary, when periods that were previously regular stop for at least 3 months.
  • Dysmenorrhea - Painful menstrual periods. Severe, frequent cramping during menstruation, where pain occurs in the lower abdomen and spreads to the lower back and thighs.
  • Fibroids - Noncancerous growths that develop in or around the womb ( Uterus ) 
  • Hypomenorrhea - Light Menstruation
  • Menorrhagia - Abnormal uterine bleeding/ heavy menstrual bleeding which lasts for over 7 days and where women have to change sanitary napkins more than five times a day and even during the night. Other types of abnormal uterine bleeding include bleeding after sex and bleeding after menopause. 
  • Metrorrhagia - Breakthrough bleeding, refers to bleeding that occurs at irregular intervals and with variable amounts.
  • Oligomenorrhea - Light or infrequent menstruation occurring more than 35 days apart.
  • Premenstrual syndrome (PMS) - Physical and emotional discomfort prior to menstruation usually in the late 20s or early 40s, caused by rising and falling levels of the hormones oestrogen and progesterone, which may influence brain chemicals, and hence the mood. 
  • Premenstrual Dysphoric Disorder (PMDD) - is a much more severe form of PMS that is associated with severe physical and emotional discomfort prior to menstruation.

Fortunately, treatment options exist. Diagnosis starts with a detailed medical history and physical exam, including pelvic exam and Pap smear testing (if eligible). Blood tests, hormonal tests, ultrasounds and MRIs too can be conducted. You may be asked to keep a record of the frequency and duration of your periods, amount of flow, pain and any other symptoms, so that you can discuss these with your doctor. You must also tell your doctor about medications, surgeries, sexual activity and history of STDs, contraceptive use, breast discharges and blood clots. The more information you can give your health care professional, the better. 

Treatment for menstrual disorders will depend on age, the underlying cause, its severity, the woman's desire to have children, preferred treatment options, health history and the doctor’s recommendation. Treatment options range from lifestyle changes such as dietary changes and exercise, to medical options such as pain relievers and contraceptives to surgery.

Menstrual disorders are one of the most occurring gynecologic issues that affect women of child bearing age and a frequent reason women consult doctors. Thus, if your periods feel overwhelming, come too frequently (fewer than 21 days apart), do not come often enough (more than three months apart), or last longer than 10 days, discuss your symptoms with your health care professional and seek the best treatment to make your menstrual cycle tolerable.

References

Healthcare: Obstetrics and Gynecology, Baylor Medicine 
https://www.bcm.edu/healthcare/specialties/obstetrics-and-gynecology/ob-gyn-conditions/menstrual-disorders

Menstrual Disorders, Mount Sinai 
https://www.mountsinai.org/health-library/report/menstrual-disorders#:~:text=Menstrual%20disorders%20include%3A,during%20a%20normal%2Dlength%20period.

Menstrual Disorders, Healthy Women 
https://www.healthywomen.org/condition/menstrual-disorders

Author

The Family Planning Association of Sri Lanka

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