Regular menstrual periods are a healthy and normal part of a woman’s life between puberty and menopause. Menstrual disorders can present in a variety of ways and be due to a range of causes, with the potential to cause severe disruption to your comfort, fertility, and overall quality of life.
Your menstrual period signifies the shedding of the lining of your uterus. This lining, known as the endometrium, thickens in preparation for a potential pregnancy at regular intervals as part of your menstrual cycle. If no pregnancy is established during that cycle, the endometrium breaks down and is discarded from your body through menstrual bleeding.
All women experience periods differently. Even what may be considered a “normal” menstrual period can still be inconvenient or accompanied by discomfort such as cramping, bloating, and mood changes.
Menstrual disorders involve cycles that deviate significantly from average, though it can be difficult to identify whether your experience is normal or pathological.
Your periods may be considered abnormal if:
Occasionally, events or illness can cause a temporary disruption to your normal period, such as intense stress, rapid weight loss, or pregnancy and breastfeeding.
If you are concerned about your period symptoms and their impact on your life, including your fertility, a comprehensive assessment with an experienced gynaecologist can help to identify what is normal from what requires treatment.
Irregular menstrual periods and menstrual disorders can include an absence of periods (amenorrhoea), very frequent periods (polymenorrhoea), or unusually light menstrual bleeding (hypomenorrhoea). The most common menstrual disorders involve abnormally painful, heavy, or infrequent periods.
It is not unusual to experience a mild degree of cramping, bloating, and discomfort in the few days leading up to your period and during menstruation. Dysmenorrhoea is characterised by severe, throbbing pain and cramping in your lower abdomen, which can radiate to your lower back, hips, or thighs. This pain can often be intense enough to prevent you from taking part in your usual activities, and may be accompanied by nausea, vomiting, fatigue, and changes to bowel movements.
Dysmenorrhoea is most common in teenage girls and younger women, often due to high levels of prostaglandin, a hormone-like compound. However, around 10% of very painful periods are caused by conditions such as:
Abnormally heavy or prolonged periods can cause significant disruption to your daily life. You may need to change your pad or tampon hourly, including overnight, and on the heaviest days of your period, be unable to leave the house. Women with menorrhagia also often pass large blood clots with their period, and can feel tired or short of breath from blood loss and low iron. A menstrual period is considered to be longer than normal if it lasts beyond seven days.
Around half of all cases of menorrhagia will not have an identifiable underlying cause. In the other half, assessment may uncover menorrhagia causes such as:
While it can be normal to experience minor variation of a few days in the timing of your monthly period, women with oligomenorrhoea typically go for longer than 35 days between menstruation. Having infrequent menstrual periods can lead to difficulties falling pregnant, as it means you are not ovulating regularly or at a predictable time.
The most common cause of infrequent menstrual periods is polyendocrine metabolic ovarian syndrome (PMOS, formerly known as polycystic ovary syndrome) a common gynaecological disorder characterised by elevated levels of male hormones (androgens). In addition to irregular periods, PMOS also presents with symptoms such as weight gain, excessive body and facial hair growth, and acne.
Infrequent periods may also be due to:
In the perimenopause stage, as older women approach menopause and the conclusion of their reproductive years, it is normal for menstrual periods to become irregular and less frequent.
Treatment for menstrual disorders is targeted at restoring your quality of life by addressing pain and discomfort, or treating infertility if you are currently trying to conceive or planning to in the near future.
The most appropriate treatment will depend on the underlying cause of your abnormal periods. Dr Mayooran’s investigations are guided by your symptoms and medical history, and may include blood tests, imaging with ultrasound, or more specialised procedures such as a diagnostic laparoscopy or hysteroscopy.
Non-steroidal anti-inflammatory medications such as ibuprofen or naproxen have a dual effect as a pain reliever and to reduce blood loss. Tranexamic acid can also be a useful medication for treatment of heavy periods by supporting your body’s natural blood clotting process.
Hormone-based medications such as the oral contraceptive pill, progestogens, or oestrogen may be prescribed in some cases of absent, irregular, or heavy periods. Depending on the underlying cause, these medications can help regulate menstrual bleeding, reduce blood loss in the case of heavy periods, or provide more predictable cycles. Hormonal medications are not suitable for all women.
Through their action in modifying reproductive hormone levels, long-term contraception options often play a first-line role in managing period disorders. Heavy menstrual bleeding and severely painful periods can be treated with these implants, which include hormonal intrauterine devices (IUD) or progesterone implants (surgically inserted under the skin of your arm). These implants can remain in place for years before needing replacement.
Appropriate long-acting reversible contraception can result in less pain and much lighter bleeding, or in some cases, no menstrual bleeding at all.
Abnormal menstrual bleeding caused by an underlying gynaecological condition may require surgery. If the condition can be managed with a non-surgical approach, this is usually attempted first before escalating to surgery.
Surgical treatment for endometriosis is typically performed via laparoscopy or robot-assisted surgery. The aim is to remove the abnormal growths of endometrium-like tissue from your pelvis, and fix any areas of scarring or adhesion. Heavy menstrual periods may also be treated with endometrial ablation, which involves intentional, controlled destruction of the lining of your uterus.
Treating uterine fibroids and polyps, ovarian cysts, and adenomyosis can often be achieved through laparoscopic or hysteroscopic surgery. In addition to helping to normalise menstrual bleeding and addressing period pain, treating these conditions have the potential to improve your fertility and overall wellbeing.
If the periods are heavy and not amenable to non surgical management and if you have completed family, Dr Mayooran can offer you either endometrial ablatio or Laparoscopic or Robotic Hysterectomy. If bleeding is heavy and fertility is desirable and the bleeding is due to fibroids, Dr Mayooran can offer you Robotic/Laparoscopic Myomectomy or Hysteroscopic Myomectomy.
