Menstrual Disorder

Some women get through their monthly periods easily with few or no concerns. Their periods come like clockwork, starting and stopping at nearly the same time every month, causing little more than a minor inconvenience.

How the Menstrual Cycle Works

Your menstrual period is part of your menstrual cycle—a series of changes that occur to parts of your body (your ovaries, uterus, vagina and breasts) every 28 days, on average. Some normal menstrual cycles are a bit longer; some are shorter. The first day of your menstrual period is day one of your menstrual cycle. The average menstrual period lasts about five to seven days. A "normal" menstrual period for you may be different from what's "normal" for someone else.

Types of Menstrual Disorders

If one or more of the symptoms you experience before or during your period causes a problem, you may have a menstrual cycle "disorder." These include:

• Abnormal Uterine Bleeding (AUB) Which may include heavy menstrual bleeding, no menstrual bleeding (amenorrhea) or bleeding between periods (irregular menstrual bleeding)
• dysmenorrhea (painful menstrual periods)
• premenstrual syndrome (PMS)
• premenstrual dysphonic disorder (PMDD)

A brief discussion of menstrual disorders follows below.

Heavy menstrual bleeding

One in five women bleed so heavily during their periods that they have to put their normal lives on hold just to deal with the heavy blood flow.

Heavy menstrual bleeding can be caused by:

• hormonal imbalances
• structural abnormalities in the uterus, such as polyps or fibroids
• medical conditions

Many women with heavy menstrual bleeding can blame their condition on hormones. Your body may produce too much or not enough estrogen or progesterone—known as reproductive hormones—necessary to keep your menstrual cycle regular.

Certain medical conditions can cause heavy menstrual bleeding. These include:

• thyroid problems
• blood clotting disorders such as Von Willebrand's disease, a mild-to-moderate bleeding disorder
• idiopathic thrombocytopenic purpura (ITP), a bleeding disorder characterized by too few platelets in the blood
• liver or kidney disease
• leukemia
• medications, such as anticoagulant drugs such as Plavix (clopidogrel) or heparin and some synthetic hormones.

Other gynecologic conditions that may be responsible for heavy bleeding include:

• complications from an IUD
• fibroids
• miscarriage
• ectopic pregnancy, which occurs when a fertilized egg begins to grow outside your uterus, typically in your fallopian tubes

Other causes of excessive bleeding include:

• infections
• precancerous conditions of the uterine lining cells

Amenorrhea

You may also have experienced the opposite problem of heavy menstrual bleeding—no menstrual periods at all. This condition, called amenorrhea, or the absence of menstruation, is normal before puberty, after menopause and during pregnancy. If you don't have a monthly period and don't fit into one of these categories, then you need to discuss your condition with your health care professional.

There are two kinds of amenorrhea: primary and secondary.

• Primary amenorrhea is diagnosed if you turn 16 and haven't menstruated. It's usually caused by some problem in your endocrine system, which regulates your hormones. Sometimes this results from low body weight associated with eating disorders, excessive exercise or medications. This medical condition can be caused by a number of other things, such as a problem with your ovaries or an area of your brain called the hypothalamus or genetic abnormalities. Delayed maturing of your pituitary gland is the most common reason, but you should be checked for any other possible reasons.
• Secondary amenorrheais diagnosed if you had regular periods, but they suddenly stop for three months or longer. It can be caused by problems that affect estrogen levels, including stress, weight loss, exercise or illness.

Additionally, problems affecting the pituitary gland (such as elevated levels of the hormone prolactin) or thyroid (including hyperthyroidism or hypothyroidism) may cause secondary amenorrhea. This condition can also occur if you've had an ovarian cyst or had your ovaries surgically removed.

Severe menstrual cramps (dysmenorrhea)

Most women have experienced menstrual cramps before or during their period at some point in their lives. For some, it's part of the regular monthly routine. But if your cramps are especially painful and persistent, this is called dysmenorrhea, and you should consult your health care professional.

Premenstrual syndrome (PMS)

PMS is a term commonly used to describe a wide variety of physical and psychological symptoms associated with the menstrual cycle. About 30 to 40 percent of women experience symptoms severe enough to disrupt their lifestyles. PMS symptoms are more severe and disruptive than the typical mild premenstrual symptoms that as many as 75 percent of all women experience.

Physical symptoms associated with PMS include:

• bloating
• swollen, painful breasts
• fatigue
• constipation
• headaches
• clumsiness

Emotional symptoms associated with PMS include:

• anger
• anxiety or confusion
• mood swings and tension
• crying and depression
• inability to concentrate

PMS appears to be caused by rising and falling levels of the hormones estrogen and progesterone, which may influence brain chemicals, including serotonin, a substance that has a strong affect on mood. It's not clear why some women develop PMS or PMDD and others do not, but researchers suspect that some women are more sensitive than others to changes in hormone levels.

PMS differs from other menstrual cycle symptoms because symptoms:

• tend to increase in severity as the cycle progresses
• are relieved when menstrual flow begins or shortly after
• are present for at least three consecutive menstrual cycles

Symptoms of PMS may increase in severity following each pregnancy and may worsen with age until they stop at menopause. If you experience PMS, you may have an increased sensitivity to alcohol at specific times during your cycle. Women with this condition often have a sister or mother who also suffers from PMS, suggesting a genetic component exists for the disorder.

Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder is far more severe than the typical PMS. Women who experience PMDD (about 3 to 8 percent of all women) say it significantly interferes with their lives. Experts equate the difference between PMS and PMDD to the difference between a mild tension headache and a migraine.

The most common symptoms of PMDD are heightened irritability, anxiety and mood swings. Women who have a history of major depression, postpartum depression or mood disorders are at higher risk for PMDD than other women. Although some symptoms of PMDD and major depression overlap, they are different:
• PMDD-related symptoms (both emotional and physical) are cyclical. When a woman starts her period, the symptoms subside within a few days.
• Depression-related symptoms, however, are not associated with the menstrual cycle. Without treatment, depressive mood disorders can persist for weeks, months or years. If depression persists, you should consider seeking help from a trained therapist.