A normal menstrual cycle has an average duration of menstrual bleeding of 4.5–8 days an interval of 24–38 days between the onsets of menses with 2–20 days of cycle to cycle variation over 12 months. The most blood loss occurs during the first 2 days of menstruation. The average blood loss with menstruation for normal women is ≤30 ml and menstrual blood loss more than 80 ml is considered abnormal. The menstrual cycle variation in interval during puberty and early menarche and the peri-menopausal transition is due to a high prevalence of anovulation and is probably not abnormal.
Six out of 10 women suffer from menstrual problems, but not many seek the help of a doctor. Heavy, prolonged menses is quite common, but can lead to disastrous consequences if not intervened early. The other end of the spectrum i.e. delayed or absent periods, is equally alarming. Some of the menstrual disorders commonly seen are enlisted below:
There are many causes of abnormal periods of which the most important are:
Stress and lifestyle: Significant amount of weight gain or loss, dieting, changes in exercise routines, travel, illness, or other disruptions during a woman's daily routine can have an impression on her menstrual cycle.
Birth control pills: Most contraception pills contain a mixture of the hormones estrogen and progestin (some contain progestin alone). Going on or off contraception pills can affect menstruation. On discontinuation, the contraception pills can sometimes cause irregular or missed periods. This can be important in women who are planning conception. Women who take contraception pills that contain progestin only may have bleeding between periods.
Uterine polyps and fibroids: Uterine polyps are small benign (noncancerous) growths within the lining of the uterus. Uterine fibroids are tumors arising from the wall of the uterus. These tumors are usually benign, but they can cause heavy bleeding and pain. If the fibroids are large, they could put pressure on the bladder or rectum, causing discomfort.
Endometriosis The endometrial tissue that lines the uterus breaks down monthly and is discharged with the menses. Endometriosis occurs when the endometrial tissue starts to grow outside the uterus. Often, the endometrial tissue attaches itself to the ovaries or fallopian tubes; it sometimes grows on the intestines or other organs within the lower alimentary canal and within the area between your rectum and uterus. Endometriosis may cause abnormal bleeding, cramps or pain before and through periods, and painful intercourse.
Pelvic inflammatory disease: It refers to the infection of upper part of female genital system. Bacteria may enter the vagina via sexual contact then spread to the uterus and upper genital tract. Bacteria may additionally enter the reproductive tract via gynecologic procedures or through childbirth, miscarriage, or abortion. Symptoms of PID include an important discharge with an unpleasant odour, irregular periods, pain within the pelvic and lower abdominal areas, fever, nausea, vomiting, or diarrhoea.
Polycystic ovary syndrome: In polycystic ovary syndrome (PCOS), the ovaries make large amounts of androgens, which are male hormones. Small fluid-filled sacs (cysts) may form in the ovaries. These can often been seen on an ultrasound. The hormonal changes can prevent eggs from maturing resulting in anovulation. Sometimes a lady with polycystic ovary syndrome will have irregular periods or may stop menstruating completely. In addition, the condition is related to obesity, infertility and hirsutism (excessive hair growth and acne). This condition could also be caused by a hormonal imbalance, although the precise cause is unknown. Treatment of PCOS depends on whether a lady desires pregnancy. If pregnancy isn't a goal, then weight loss, pill pills, and therefore the medication Metformin (an insulin sensitizer utilized in diabetes) can regulate a woman’s cycles. If pregnancy is desired, ovulation-stimulating medications are often tried.
Premature ovarian insufficiency: This condition occurs in women under age 40 whose ovaries don't function normally. The menstrual cycle stops, similar to menopause. This can occur in patients who are being treated for cancer with chemotherapy and radiation, or if you've got a case history of premature ovarian insufficiency or certain chromosomal abnormalities.
The treatment of abnormal menstruation depends on the underlying cause. The doctor will investigate possible causes and offer the appropriate treatment.
Heavy menstrual bleeding (HMB) is a common gynecological problem that has a significant impact on a woman’s quality of life and the activities of daily living. HMB is one of the most common reasons for women seeking a gynecological consultation. Many times it is a sign of a more serious health problem that needs urgent treatment. Heavy menstrual bleeding (HMB) has been arbitrarily defined as a menstrual blood loss (MBL) of 80 ml or greater or menses lasting more than 7 days. When menstrual bleeding is heavy, clotting can also occur. Losing large clots can be extremely upsetting and even painful if they are large because they can cause cramping as they pass through the cervix. This huge amount of blood loss can further lead to anemia, fatigue, breathing difficulties and heart problems.
A heavy bleeding in the periods can be due to hormonal imbalance (thyroid dysfunction), dysfunction of the ovaries (PCOS), uterine fibroids, adenomyosis, inherited bleeding disorders, medications, cancers, pregnancy complications like miscarriage, etc. The type of treatment will depend on the age, cause and the heaviness of the bleeding.
HMB could be treated with both medical and surgical interventions and both methods are safe, acceptable and effective. Medical treatment is the preferred primary intervention in most circumstances. The selection of treatment for each woman depends on clinical stability, overall acuity, suspected etiology of bleeding, desire for future fertility and underlying medical problems. Simple, non surgical method of treating heavy menses is to insert a hormonal intrauterine device (LNG _ IUD). If medication does not work, a surgical procedure may be needed like Hysteroscopy, Endometrial ablation, myomectomy for fibroids,hysterectomy and other surgeries depending on cause.
If your periods have changed, it's very important to see your doctor. There are a number of diseases which can cause heavy bleeding. The doctor will investigate possible causes and offer the appropriate treatment.
Menstruation occurs when the uterus sheds its lining once a month. Some pain, cramping, and discomfort during menstrual periods, is normal. Excessive pain that causes you to miss work or school is not.
Painful menstruation is also called dysmenorrhoea. There are two types of dysmenorrhoea: primary and secondary.
Primary dysmenorrhoea occurs in people who experience pain before and during menstruation. If you’ve had normal periods that become painful later in life, it may be secondary dysmenorrhoea which is a condition affecting the uterus or other pelvic organs, such as endometriosis or uterine fibroids, pelvic inflammatory disease can cause this.
Pain during periods is felt in the lower abdomen before and during the menstruation cycle. With every individual, the severity of the pain is different. It may occur due to the endometriosis, uterine fibroids, or pelvic inflammatory disease.
Pain is common with females who are younger than 30 years, bleeds heavily during menstruation, have a family history or smoke. Dr Shweta Mishra will advise you with some pain relievers, hormonal pills, other medications, lifestyle changes or may be surgery depending on cause.
Dr. Shweta Mishra shall address all the issues related to menstrual problems. She shall provide comprehensive treatment considering the wholesome management of the condition. The treatment modalities which she would include are hormonal medications, drugs to prevent excessive blood loss, surgical methods depending on the individual case.
Menstruation usually begins around 11 years of age, but there is a wide variation in this and anytime between 9-14 years is normal. If onset of menses is delayed beyond this, examination and tests of the girl are required to confirm that there is no problem.
Initially, the periods can be very irregular and may not become regular upto 12 – 18 months of starting. This is due to immaturity of the hormone axis and is normal. Too heavy bleeding during menses needs check up and treatment as it may be a sign of a bleeding disorder or hormonal problem and can result in anemia and weakness. Gradually the menses will normalize and the girl will bleed for 3 – 5 days every 28-30 days, which is the normal cycle.
Menstrual hygiene is very important and must be taught to all young girls. Frequent baths during the periods, changing pads frequently, disposing off the pads hygienically is absolutely necessary. Even today, there are lots of myths about menstruation like not eating pickle, not entering the kitchen, taking total rest during this time etc., all of which are illogical.
The adolescent girl is going through a lot of hormonal changes in her body which reflect in her physical, mental and emotional state. Mood changes, irritability, emotional swings are related as much to hormones as to environment. The attitude of the family towards menstruation will help her deal with it for the rest of her life. If it is treated as dirty, unclean and she is isolated, she will have a negative response to menses forever. If it is treated as a wonderful process of growing up or maturing and having the amazing ability to bear children later, she will treat it positively and it has been shown that these girls get much lesser pain and discomfort during menses as well as less premenstrual syndrome (PMS)
During the teenage years many girls experience PMS. This may cause bloating, breast pain, depression and irritability prior to menses and the symptoms disappear after the periods. This is perfectly normal and restriction of salt, refined flour, caffeine and chocolates alongwith light exercise during this time helps relieve symptoms. Also addition of calcium, B-complex, primrose oil and such supplements may help reduce symptoms. Occasionally, hormone treatment is required in severe cases. Painful periods (dysmennorhoea), is another common problem in teenagers and many girls miss school and college because of it. This is usually due to excessive local production of prostaglandin’s and can be reduced by light exercise, hot showers and antiprostaglandin tablets taken at the onset of menses. In some girls regular hormonal pills have to be given if there is severe pain.
Often during the growing years, there is a variation in the size of both breasts and this causes immense worry to the girl. This variation is common, may sort itself out once full growth is achieved or once in a while the discrepancy may remain till adulthood. This has to be managed by wearing a suitability-padded bra or later by surgery and there are no creams or medicines, which can help this. There are many myths associated with menstruation and growing up and proper sex education and counseling or a meeting with a good gynaecologist should be a part of growing up.
Dr. Shweta Mishra is an experienced practitioner who gives undivided attention and best of the facilities for the Menstruation Problems treatment in Ghaziabad & Noida Extension.
Get in touch with Dr. Shweta Mishra at her Crossings Republik, Ghaziabad (Crossings Republik Clinic Location & Direction) clinic for Menstrual Problems Treatment in Ghaziabad, or either at Amrapali Icon Leisure Valley, Greater Noida West (Noida Extension Clinic Location & Direction) clinic for Menstrual Problems Treatment in Noida Extension. Also, you could make a wellness appointment at any clinic location convenient to you.
Disclaimer: The content on this website is only intended for educational purposes and to create knowledge amongst masses about women's health and obstetrics & gynaecology. Hence, no information issued on this website shall be treated as an alternative to consultation from a certified obstetrician & gynaecologist. The results can vary from women to women depending on their specific health conditions.