Menstrual disorders: types, causes and symptoms

Menstrual disorders are physical or emotional symptoms around your period that disrupt everyday life. They include heavy bleeding, missed or irregular periods, painful periods and severe mood changes. Some women get through their periods with little more than a minor inconvenience. Others, however, find that their symptoms affect work, relationships and wellbeing every month.

The reassuring news is that most menstrual disorders have a straightforward explanation, and there is a range of treatments that can help. Once your symptoms are accurately diagnosed, you can choose the treatment that works best for you.

How does the menstrual cycle work?

Your period is part of the menstrual cycle, a series of changes in the ovaries, womb, vagina and breasts that happens every 28 days on average. Some normal cycles are a little longer and some a little shorter. The first day of your period is day one of the cycle, and the average period lasts about five to seven days. What is normal for you may be different from what is normal for someone else.

Types of menstrual disorders

• Abnormal uterine bleeding: very heavy or prolonged periods.
• Amenorrhoea: periods stopping altogether.
• Oligomenorrhoea: light or infrequent periods.
• Fibroids: non-cancerous growths in the womb that can cause heavy bleeding.
• Premenstrual syndrome (PMS): physical and emotional discomfort before a period.
• Premenstrual dysphoric disorder (PMDD): a severe form of PMS.

What causes menstrual disorders?

Menstrual disorders can have many causes, including fibroids, hormonal imbalances, polycystic ovary syndrome (PCOS), blood clotting disorders, sexually transmitted infections and genetic factors. Less often, they can be caused by cancer, which is why persistent changes should always be checked.

Symptoms to look out for

Symptoms of menstrual disorders may include abnormal bleeding, pain or cramping, headaches, bloating, low mood and emotional distress. Talk to your doctor if your periods come fewer than 21 days apart or more than three months apart, or if they last longer than 10 days. You should also seek advice about bleeding between periods, after sex, or after the menopause.

How are menstrual disorders diagnosed?

Diagnosis starts with a detailed history and examination, including a pelvic examination and, if due, a cervical smear. You may be asked to keep a diary of your periods, noting the dates, how heavy they are, any pain and other symptoms. Further tests may include:

• blood tests, including hormone tests
• an ultrasound scan, sometimes using sterile saline to give clearer pictures of the womb
• an MRI scan
• a hysteroscopy, using a thin, lighted telescope passed through the cervix to look inside the womb
• a laparoscopy, a keyhole look at the pelvic organs through a small cut in the tummy
• an endometrial biopsy, a small sample of the womb lining checked for abnormal cells

How are menstrual disorders treated?

Treatment depends on the cause, whether you would like to have children, and what matters most to you. Options range from lifestyle changes to medicines and surgery:

• Lifestyle changes: reducing salt, caffeine, sugar and alcohol before your period may ease cramps and other symptoms.
• Medicines: painkillers for cramps, and hormonal contraception to reduce heavy bleeding and regulate, lighten or even stop periods.
• Surgery: procedures include treating problems inside the womb by hysteroscopy, keyhole surgery, endometrial ablation to destroy the womb lining and stop periods, and a hysterectomy.

NICE sets out how heavy menstrual bleeding should be assessed and managed, and the Royal College of Obstetricians and Gynaecologists has patient information on periods and their treatment. Our menstrual disorders page has more detail. If your periods feel overwhelming, you can book a consultation with Mr Jafaru Abu at The Park Hospital, Nottingham.