Menstrual disorders
Description
An in-depth report on the causes, treatment, and prevention of menstrual cramps.
Alternative Names
Dysmenorrhea; Menorrhagia; Amenorrhea; Cramps; Heavy menstrual bleeding
Menstrual Disorders
There are a number of different menstrual disorders. Problems can range from heavy, painful periods to no period at all.
Dysmenorrhea (Painful Cramps)
Dysmenorrhea is severe, frequent cramping during menstruation. Pain occurs in the lower abdomen but can spread to the lower back and thighs. Dysmenorrhea is usually referred to as primary or secondary.
Primary dysmenorrhea.
Cramps occur from contractions in the uterus. These contractions are a normal part of the menstrual process. With primary dysmenorrhea, cramping pain is directly related to and caused by menstruation. About half of menstruating women experience primary dysmenorrhea. It usually begins 2 to 3 years after a women begins to menstruate. The pain typically develops when the bleeding starts and continues for 32 to 48 hours. Cramps are generally most severe during heavy bleeding.
Secondary dysmenorrhea
. Secondary dysmenorrhea is menstrually related pain that accompanies another medical or physical condition, such as endometriosis or uterine fibroids.
Menorrhagia (Heavy Bleeding)
During normal menstruation the average woman loses about 2 ounces (60 ml) or less of blood. Menorrhagia is the medical term for significantly heavier bleeding. Menorrhagia occurs in 9 - 14% of all women and can be caused by a number of factors. Women often overestimate the amount of blood lost during their periods. Clot formation is fairly common during heavy bleeding and is
not
a cause for concern. However, women should consult their doctor if any of the following occurs:
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Soaking through at least one pad or tampon every hour for several hours
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Heavy periods that regularly last 10 or more days
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Bleeding between periods or during pregnancy. Spotting or light bleeding between periods is common in girls just starting menstruation and sometimes during ovulation in young adult women, but it is still a good idea to speak with a doctor.
Amenorrhea (Absence of Menstruation)
Amenorrhea is the absence of menstruation. There are two categories:
primary
amenorrhea and
secondary
amenorrhea. These terms refer to the time when menstruation stops:
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Primary amenorrhea occurs when a girl does not begin to menstruate. Girls who show no signs of sexual development (breast development and pubic hair) by age 14 should be evaluated. Girls who do not have their periods by two years after sexual development should also be checked. Any girl who does not have her period by age 16 should be evaluated for primary amenorrhea.
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Secondary amenorrhea occurs when periods that were previously regular become absent for at least three cycles.
Oligomenorrhea (Light or Infrequent Menstruation)
Oligomenorrhea is a condition in which menstrual cycles are infrequent. It is very common in early puberty and does not usually indicate a medical problem. When girls first menstruate they often do not have regular cycles for a couple of years. Even healthy cycles in adult women can vary by a few days from month to month. In some women, periods may occur every 3 weeks and in others, every 5 weeks. Flow also varies and can be heavy or light. Skipping a period and then having a heavy flow may occur; this is most likely due to missed ovulation rather than a miscarriage. Women should be concerned when periods come less than 21 days or more than 3 months apart, or if they last more than 10 days. Such events may indicate ovulation problems.
Premenstrual Syndrome (PMS)
Premenstrual syndrome (PMS) is a set of physical, emotional, and behavioral symptoms that occur during the last week of the luteal phase (a week before menstruation) in most cycles. The symptoms typically do not start until at least day 13 in the cycle, and resolve within 4 days after bleeding begins. Women may begin to experience premenstrual syndrome symptoms at any time during their reproductive years. Once established, the symptoms tend to remain fairly constant until menopause, although they can vary from cycle to cycle. About 100 symptoms have been identified with the premenstrual phase. [For more information, see
In-Depth Report #79
: Premenstrual syndrome.]
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Review Date: 6/11/2006
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Reviewed By: Harvey Simon, M.D., Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital
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