With each menstrual cycle, the endometrium (uterine lining) prepares itself to nourish a fetus. If fertilization doesn’t occur, the body sheds the endometrium during the monthly (on average) cycle. In some cases, an irregularity can occur in this cycle, indicating any of the following menstrual disorders:
Types of Menstrual Disorders:
1.Premenstrual Syndrome (PMS)
PMS is any unpleasant or uncomfortable symptom during your cycle that may temporarily disturb normal functioning. These symptoms may last from a few hours to many days, and the types and intensity of symptoms can vary in individuals.
Although each individual may experience symptoms differently, the most common symptoms of PMS can include any of the following:
- Psychological symptoms (depression, anxiety, irritability)
- Gastrointestinal symptoms (bloating)
- Fluid retention (swelling of fingers, ankles and feet)
- Skin problems (acne)
- Muscle spasms
- Heart palpitations
- Vision problems
- Eye infections
- Decreased coordination
- Diminished libido (sex drive)
- Changes in appetite
- Hot flashes
Simple modifications in lifestyle can help eliminate or reduce the severity of symptoms, including:
- Exercising 3 to 5 times each week
- Eating a well-balanced diet that includes whole grains, vegetables and fruit, and a decreasing salt, sugar, caffeine and alcohol intake
- Getting adequate sleep and rest
Premenstrual Dysphoric Disorder (PMDD)
Premenstrual Dysphoric Disorder (PMDD) is a much more severe form of PMS which affects approximately 3%-8% of women of reproductive age. PMDD requires treatment by a physician. According to the American College of Obstetricians and Gynaecologists, nearly 85% of women experience at least one common symptom associated with PMS during their reproductive years. An estimated 5% have symptoms so extreme they are disabled by the condition.
Premenstrual Dysphoric Disorder (PMDD) is a more severe form of Premenstrual Syndrome characterized by significant premenstrual mood disturbance, often with prominent mood reactivity and irritability. Symptoms of PMDD can emerge 1-2 weeks preceding menses and typically resolve with the onset of menses. This mood disturbance results in marked social or occupational impairment, with its most prominent effects in interpersonal functioning. In fact, a recent study found that women with untreated PMDD were likely to experience a loss of three quality-adjusted life years during their lifetime as a result of their premenstrual symptoms. This did not include menstruation-free periods, such as pregnancy, breastfeeding and menopause.3
PMDD affects 3-8% of women in their reproductive years, with symptoms usually emerging during a woman’s twenties.2 These symptoms may worsen over time; for example, it has been observed that some women may experience worsening premenstrual symptoms as they enter into menopause.4 Less commonly, PMDD may begin during adolescence, with case reports suggesting that successful treatment options in adolescents with PMDD are similar to those used for adult women.
According to the International Association For Premenstrual Disorders (IAPMD), suicide represents one of the ten leading causes of deaths worldwide among reproductive age women. Studies also show that 30% of women with PMDD will attempt suicide in their lifetime while a larger percentage experience suicidal thoughts and self harm.
The major risk factors for PMDD include personal history of a mood or anxiety disorder, family history of premenstrual mood dysregulation, stress and age in the late 20’s to mid-30’s.
- Feeling overwhelmed or out of control
- Increased depressed mood
- Mood Swings
- Sense of feeling overwhelmed
- Sensitivity to rejection
- Social withdrawal
- Sudden sadness or tearfulness
- Abdominal bloating
- Appetite disturbance (usually increased)
- Breast tenderness
- Lethargy or fatigue
- Muscle aches and/or joint pain
- Sleep disturbance (usually hypersomnia)
- Swelling of extremities
- Poor Concentration
It is important for clinicians to distinguish between PMDD and other medical and psychiatric conditions. Medical illnesses such as chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome and migraine disorder can have features that overlap with PMDD. Additionally, psychiatric illnesses such as depression or anxiety disorders can worsen during the premenstrual period and thus may mimic PMDD.
PMS and PMDD in Teens
Epidemiologic studies have shown that premenstrual disorders may begin during the teen years. It has been reported that at least 20% of adolescents experience moderate to severe premenstrual symptoms. PMDD appears to be as common in teens as in older women, with various studies estimating that about 2%-6% of girls between the ages of 14 and 16 meet criteria for PMDD. Randomized controlled trials of pharmacologic treatments have not been conducted in teens with PMS and PMDD; however, clinical experience indicates that the same treatments that are effective for adults may be used in adolescents.
Teens may want to take a look at our Guide for Teens with PMS and PMDD.
Ruling Out Other Psychiatric Illnesses
Mood disorders, such as major depression or bipolar disorder, can worsen during the premenstrual period and thus may mimic PMDD. When this occurs, the term premenstrual exacerbation or PME is used to refer to the mood worsening which occurs during the premenstrual phase. An estimated 40% of women who seek treatment for PMDD actually have a PME of an underlying mood disorder.5
PMDD can be distinguished from other mood disorders primarily by the cyclical nature of the mood disturbance. PMDD mood symptoms are only present for a specific period of time, during the luteal phase (the last two weeks) of the menstrual cycle. Conversely, other mood disorders are variable or constant over time. Therefore, the best way to distinguish PMDD from an underlying mood disorder is through daily charting of symptoms. In addition, PMDD mood symptoms are not present in the absence of a menstrual cycle. Thus, PMDD resolves during pregnancy and after menopause, whereas other mood disorders typically persist across all reproductive life events.
Sourced from PMS & PMDD
Amenorrhea is characterized by absent menstrual periods for more than three monthly menstrual cycles. There are two types of amenorrhea:
Types of Amenorrhea:
- Primary amenorrhea: Menstruation does not begin at puberty.
- Secondary amenorrhea: Normal and regular menstrual periods which become increasingly abnormal and irregular or absent. This may be due to a physical cause typically of later onset.
Amenorrhea can occur for a number of reasons as part of the normal course of life, such as pregnancy, breast-feeding or menopause. Or, it may occur as a result of medications or a medical problem including:
- Ovulation abnormality
- Birth defect, anatomical abnormality or other medical condition
- Eating disorder
- Excessive or strenuous exercise
- Thyroid disorder
If at least three consecutive menstrual periods are missed or if you’ve never had a menstrual period and are 16 years or older, it is important to see a healthcare professional. As with any condition, early diagnosis and treatment is very important.
Dysmenorrhea is characterized by severe and frequent menstrual cramps and pain associated with menstruation. The cause of dysmenorrhea is dependent on if the condition is primary or secondary. With primary dysmenorrhea, women experience abnormal uterine contractions resulting from a chemical imbalance in the body. Secondary dysmenorrhea is caused by other medical conditions, most often endometriosis. Other possible causes may include:
- pelvic inflammatory disease (PID)
- uterine fibroids
- abnormal pregnancy (i.e., miscarriage, ectopic)
- infection, tumors, or polyps in the pelvic cavity
Any woman can develop dysmenorrhea, but those who are at an increased risk include:
- Those who consume excessive alcohol during their period
- Women who are overweight
- Women who started menstruating before the age of 11
The most common symptoms may include:
- Cramping or pain in the lower abdomen
- Low back pain or pain radiating down the legs
Menorrhagia is the most common type of abnormal uterine bleeding and is characterized by heavy and prolonged menstrual bleeding. In some cases, bleeding may be so severe that daily activities are disrupted.
Other types of this condition, also called dysfunctional uterine bleeding, may include:
- Polymenorrhea: Too frequent menstruation.
- Oligomenorrhea: Infrequent or light menstrual cycles
- Metrorrhagia: Any irregular, non-menstrual bleeding as in bleeding which occurs between menstrual periods
- Postmenopausal bleeding: Any bleeding that occurs more than one year after the last normal menstrual period at menopause
There are several possible causes of menorrhagia, including:
- Hormonal imbalance
- Pelvic inflammatory disease (PID)
- Uterine fibroids
- Abnormal pregnancy; i.e., miscarriage, ectopic (tubal pregnancy)
- Infection, tumors or polyps in the pelvic cavity
- Certain birth control devices; i.e., intrauterine devices (IUDs)
- Bleeding or platelet disorders
- High levels of prostaglandins (chemical substances used to control muscle contractions of the uterus)
- High levels of endothelins (chemical substances used to dilate blood vessels)
- Liver, kidney or thyroid disease
Typical symptoms of menorrhagia are when a woman has soaked through enough sanitary napkins or tampons to require changing every hour, and/or a woman’s menstrual period lasts longer than 7 days in duration. Other common symptoms include spotting or bleeding between menstrual periods, or spotting or bleeding during pregnancy. A diagnosis can only be certain when the physician has ruled out other menstrual disorders, medical conditions or medications that may be causing or aggravating the condition.
Other diagnostic procedures may include:
- Blood tests
- Pap test
- Ultrasound: An imaging technique which uses high-frequency sound waves to create an image of the pelvic organs.
- Magnetic resonance imaging (MRI): A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of the reproductive organs.
- Laparoscopy: A minor surgical procedure in which a laparoscope, a thin tube with a lens and a light, is inserted into an incision in the abdominal wall. Using the laparoscope to see into the pelvic and abdomen area, the physician can often detect abnormal growths.
- Hysteroscopy: A visual examination of the canal of the cervix and the interior of the uterus using a hysteroscope inserted through the vagina.
- Biopsy (endometrial): Tissue samples are removed from the lining of the uterus with a needle or during surgery to determine if cancer or other abnormal cells are present.
- Dilation and curettage (D&C): A common gynecological surgery which consists of widening the cervical canal with a dilator and scraping the uterine cavity with a curette – a spoon-shaped surgical tool used to remove tissue.
Your doctor may suggest a psychiatric evaluation to rule out other possible conditions, or ask you to track your symptoms in a journal to better assess the timing, severity, onset and duration of symptoms.
A specific treatment plan will be determined by your doctor based on factors such as:
- Your age, overall health and medical history
- Extent of the condition
- Possible cause of the condition
- Current symptoms
- Your tolerance for specific medications, procedures or therapies
Treatments for menstrual disorders
Discussing your menstrual disorder symptoms with your doctor can help determine what type of treatments can best reduce or relieve your symptoms, including:
- Prostaglandin inhibitors
- Hormone supplements
- Oral contraceptives
- Vitamin or mineral supplements
- Dietary modifications
- Regular exercise