What are the most common menstrual disorders in women?

In this article below, Dr Sharmistha Guha, a revered consultant obstetrician and gynaecologist, outlines some of the most common menstrual disorders, and details what typically causes these disorders in women.

What are the most common menstrual disorders? What can cause these menstrual disorders?

There are many different types of menstrual disorders. The most common gynaecological problem in women is menstrual disorders. The most commonly reported problem is irregular periods. This can be due to many reasons and varies according to age.

When a young girl has menarche, she may have irregular periods in the first few years, and this is usually due to anovulatory cycles. This means that although she is having periods, she is not ovulating every month as the ovaries are still immature.

This gives rise to irregularity of periods. Irregular periods could also be due to a condition called polycystic ovarian syndrome (PCOS). This needs to be investigated by doing blood tests as well as a pelvic ultrasound scan.

The second most common problem is heavy periods. Again, there are many causes, with the causes varying according to age and presentation. Young girls could have heavy periods due to anovulatory cycles as mentioned above or due to PCOS. The periods come after long gaps, and when they come, they are very heavy due to the fact that there is a lot of endometrium (lining of the womb) to shed.

Periods can be heavy in women between 30 and 40 years of age due to conditions such as fibroids, adenomyosis, or endometriosis. Women over the age of 40 tend to have heavy periods due to hormonal age-related changes and no particular cause is found.

This is referred to as dysfunctional uterine bleeding. The women in this age group may also suffer from heavy periods mainly due to the above or other conditions such as adenomyosis, fibroids, endometriosis, or, very rarely, malignancies such as endometrial cancer. Therefore, it is important to investigate if women’s periods change from normal to heavy.

Women could also suffer from scanty or no periods (oligomenorrhoea or amenorrhoea). This could be due to PCOS or premature ovarian failure, although some women may get oligomenorrhoea as a natural change without any hormonal problems. Amenorrhoea, on the other hand, is typically due to pregnancy or premature ovarian failure.

In addition to these common menstrual disorders, other examples of menstrual disorders include period pain, intermenstrual bleeding (bleeding in between periods), post-coital bleeding (bleeding after sex), premenstrual syndrome etc. All of these need to be investigated in order to find the cause and treat accordingly.

What causes premenstrual syndrome? What are the symptoms?

PMS or premenstrual syndrome is present in about 40 per cent of women with about five to eight per cent of women suffering from severe PMS. It consists of a vast array of psychological symptoms such as depression, anxiety, irritability, loss of confidence and mood swings.

There could also be physical symptoms such as feeling bloated. Diagnosis of PMS is not made according to the type of symptoms but rather on the timing of the symptoms and the degree of impact that it has on the woman’s daily activities. In order to differentiate physiological menstrual symptoms from PMS, it must be demonstrated that symptoms cause significant impairment to the individual during the second half of the menstrual cycle.

What is the difference between PMS and PMDD?

The term PMDD (premenstrual dysphoric disorder) was coined by the American Psychiatric Associated in 1994 and is diagnosed only after the fulfilment of strict criterias. The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) demands five out of 11 stipulated symptoms, one of which must include mood. The symptoms must strictly occur in the second half of the menstrual cycle, and must be severe enough to disrupt daily functioning. However, these restrictive criteria may exclude women with a narrow range of severe symptoms who should receive treatment.

How is PMDD treated?

PMDD is treated with various lifestyle changes such as dietary changes (an increase in protein and carbohydrates and a decrease in sugar, caffeine, alcohol etc.), regular exercise, good stress management, and taking vitamin supplements. Drug treatment usually comes in the form of SSRIs (Selective Serotonin Reuptake Inhibitors) which, simply put, are nerve hormone modifying drugs.

It can also be treated with contraceptive pills. In the worst-case scenario, surgical measures such as hysterectomy and bilateral oophorectomy (removal of womb and both ovaries) may have to be undertaken. After the surgery, women may opt for hormone replacement therapy, and in the absence of the womb, oestrogen only replacement could be given.

If you wish to schedule in an appointment with Dr Sharmistha Guha, you can visit her Top Doctors profile today to do just that.