Don’t just go with the flow: the types of menstrual disorders

A menstrual disorder refers to irregular symptoms or occurrences during the menstrual cycle, which lasts between 22-45 days. Though often poetically referred to as the “moon cycle”, the menstrual cycle is not tied to the phases of the moon -- but it does have a dark side. Around a quarter of menstruating women experience irregularities or disorders during their cycle, but menstrual health literacy is still not accessible to everyone. Some women may feel shame due to their menstrual disorders and some might even realise that anything is wrong. Ms Sameena Muzaffar, a respected consultant obstetrician and gynaecologist, breaks down the kinds of menstrual disorders and what they mean.

On any given day of the month, around 800 million people are menstruating. The menstrual tends to start during adolescence, from the ages of 10 to 16, and should continue monthly (or to be precise, every 22-45 days) until about 50 years of age, excluding the pregnancy and lactation period. On average, a woman will go through the menstrual cycle 450 times! That’s why it is so important to understand what is happening during the cycle, and what should not be happening.

There are several types of menstrual disorders, with symptoms that range from hormonal to physical.

One that you’ve probably heard of already is premenstrual syndrome (PMS). This is a routine disorder, one that many women can attest to and is thought to be caused by the uptick in hormones going through the body a week or so before the period starts, causing feelings such as anxiety, irritability, fatigue, negative emotions, food cravings and hunger. Physical symptoms like bloating, tenderness of the breast, sensitivity to temperature, and perhaps even facial blemishes. Though experienced by many women with minor effects, a little more than five per cent of women have severe symptoms of PMS.

For those who have more of a difficult time in the weeks leading up to their period, they may have premenstrual dysphoric disorder, which is characterised by extreme feelings of dysphoria, mania, or depression, for example. The criteria for this condition are strictly outlined in the DSM-V, such as PMDD can only occur in the second half of the cycle, the person must have at least five of 11 symptoms (one of which must be a mood disorder) and actually inhibit their daily function.

Types of menstrual disorders

There are disorders of cycle length, referring to the time in between bleeding periods. A cycle which is longer than 45 days or shorter than 22 days is irregular, such as:

• Amenorrhea is the absence of menstruation in a woman within the “reproductive age range” for three cycles or more. If a period hasn’t happened by the age of 15, then it is called primary amenorrhea.
• Oligomenorrhea is infrequent periods with more than 35 days in between blood flows.
• Polymenorrhea are frequent periods with 21 days or less in between blood flows.

The period portion of the menstrual cycle should look bright red with a watery consistency to brown with a thicker, jelly-like consistency depending on where in the cycle you are. It should smell like blood or slightly like metal, and the total amount of blood shed throughout the whole period should be around 60ml. Of course, every body is different and there are variations to this that don’t immediately mean that something is wrong with your cycle.

The following list of disorders describes when irregularities of flow might be a medical issue:

• Abnormal uterine bleeding (AUB) is the disruption to regular blood flow, such as after sexual intercourse, or during menopause. When bleeding occurs between periods it is also called metrorrhagia, which is specific to problems of the endometrial lining. This irregular bleeding can be painful.
• Hypomenorrhea is when the blood flow is light and only lasts two days.
• Menorrhagia is when the blood flow is heavy and lasts longer than seven days.
• Dysmenorrhea is when cramps or actual menstruation itself is notably painful to the point of disruption of regular activities.

A period that is too smelly or an unusual colour such as orange is not also normal and should be discussed with your doctor or gynaecologist.

Causes and consequences of menstrual disorders

Some things that may be linked to or causing menstrual disorders are:

• uterine fibroids
• hormonal imbalances
• sexually transmitted infections (STIs)
• issues with the body’s ability to make blood clots
• medications
• prolonged stress
• being under- or overweight
• thyroid diseases

A common cause of menstrual disorders is polycystic ovary syndrome (PCOS), which affects 10 per cent of menstruating women and is caused by high amounts of androgens; or conversely, endometriosis, which is characterised by high amounts of oestrogen and uterine tissue that grows in other places in the body.

Another possibility is birth control medicines and devices like the uterine coil may suppress the bleeding entirely or partially and there could be irregular flow or spotting – whilst normal, any concerns should be expressed.

If medical attention or treatment is not sought for menstrual disorders, they can devolve into worse conditions such as anaemia and iron deficiencies (especially for those experiencing heavy bleeding), infertility, higher risk of endometrial and cervical cancers, as well as a decline of mental health due to the disruption and discomfort.

If you are having difficulties with your period and would like to discuss with a professional, Ms Sameena Muzaffar is available to consultation via her Top Doctors profile.