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Menstrual Problems

The following are examples of possible menstrual problems. While most menstrual abnormalities are not cause for concern, they can sometimes signal other medical problems. Therefore, all persistent menstrual abnormalities should be evaluated by a physician. Many problems can be effectively treated with hormonal therapies or other options.

Dysmenorrhea (severe cramps and pain): Uterine contractions are normal during the menstrual period. However, for some women, these contractions cause severe lower abdominal cramps that can begin several hours or days before the onset of menstruation. Dysmenorrhea is divided into two categories: primary and secondary. Primary dysmenorrhea is characterized by intense menstrual cramps that usually begin within the first three years of menstruation. Primary dysmenorrhea is caused by normal uterine contractions. More than 50% of all women suffer from primary dysmenorrhea. Many women find that nonprescription drugs such as aspirin, ibuprofen, and naproxen sodium relieve these cramps. Secondary dysmenorrhea is the onset of severe cramps that occur from other medical conditions, such as non-cancerous uterine tumors (fibroids) or endometriosis (a condition in which the uterine tissue lining grows outside of the uterus).

Menorrhagia (heavy menstrual periods): Most women who need to change tampons or pads frequently or experience long periods (more than six days) do not have dangerously heavy periods (menorrhagia). In many cases, these women may simply have thicker uterine linings that cause them to bleed longer. However, heavy bleeding can be a sign of other conditions, such as non-cancerous uterine tumors (fibroids), pelvic inflammatory disease, abnormal blood clotting, or other problems. Women who experience heavy periods should report the problem to their physicians for further investigation. Heavy bleeding that is independent of other conditions can often be treated with oral contraceptives or other hormonal therapy.

Metrorrhagia (bleeding between periods): Vaginal bleeding that occurs between periods (metorrhagia) may sometimes be called breakthrough bleeding or "spotting." There are several causes of metorrhagia, including oral contraceptives (usually only within the first one to three months of use), a dislodged intrauterine device (IUD), infection, inflammation of the uterus, polyps on the cervix, or an early miscarriage. Bleeding between periods is also common in young women when they just begin menstruating or near the time of ovulation (approximately 14 days before menstruation) in young adult women.

Oligomenorrhea (irregular or abnormally light menstrual periods): Oligomenorrhea is defined as having fewer than eleven menstrual periods a year. This is common in young women who just begin menstruating and women who are approaching menopause. Other causes of oligomenorrhea including pregnancy, thyroid disease, an acute illness, the use of oral contraceptives, stress, emotional problems, etc. Persistent, unexplained irregular periods should be evaluated by a physician.

Primary amenorrhea (failure to begin menstruating): The most common cause of primary amenorrhea is late puberty, which is usually genetically inherited and is not a cause for concern. However, if menstruation has not begun by age 16, clinical investigation is usually warranted. Occasionally, primary amenorrhea may be caused by hormonal problems or abnormalities of the pituitary gland, thyroid or adrenal glands, or the ovaries. Sometimes, hormonal therapy can help treat primary amenorrhea. In rare cases, failure to begin menstruating signals a missing part of the reproductive tract (such as the ovaries, uterus, or chromosomal abnormality).

Secondary amenorrhea (absence of menstruation): The secondary form of amenorrhea occurs after a regular menstrual cycle has already been established. The absence of menstruation for four months or longer is considered to be amenorrhea. Secondary amenorrhea has several causes including pregnancy, breast-feeding, discontinued use of oral contraceptives, too little body fat, drastic dieting or eating disorders (such as anorexia), intense exercise, stress, chronic diseases (such as thyroid disorders), or the use of tranquilizers or antidepressants. In many cases, menstruation returns on its own and there is little cause for concern unless the woman wants to become pregnant. However, women who do not menstruate for four months or longer should be evaluated by a physician to determine whether lifestyle changes or medications (such as oral contraceptives or other hormonal therapy) are necessary.

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Updated: August 17, 2007

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