With each menstrual cycle, the uterine lining (endometrium) prepares itself for fetus development. If fertilization fails to happen, the body discharges the endometrium during the cycle, which typically lasts for about three to eight days. While the severity and duration of the menstrual periods are not the same for every woman, it is abnormal when the periods are too light, too heavy, occur too often, last longer, irregular or occur after menopause.
Some causes of irregular bleeding are not consequential. A number of things can cause the abnormality. These may include hormone-based birth control, infection of the uterus lining or cervix, STI, blood clotting disorders, and other health conditions.
About Premenstrual Syndrome (PMS)
PMS is an unpleasant, but typically normal, symptom that women experience during the menstruation cycle. The symptoms may last for a few hours to several days, and the intensity and variety of the symptoms differ from woman to woman. Premenstrual Dysphoric Disorder (PMDD) is the most prevalent form of PMS. It affects approximately 5 percent of women at reproductive age.
Women may experience PMS because of fluctuation of progesterone and estrogen levels during the cycle. The genetic makeup of some women may also trigger PMS. Also, women who are susceptible to PMS tend to have lower serotonin levels.
The American College of Obstetricians and Gynecologists estimates that 85% of women experience at least one PMS symptom during their reproductive age. Even though symptoms may vary in individuals, the most common ones include the following:
- Depression, irritability and anxiety
- Fluid retention (evidence from swelling of feet and fingers)
- Acne and other skin conditions
- Muscle spasms
- Heart palpitations
- Vision problems and eye infections
- Reduced sex drive
- Lack of appetite
Most forms of PMS do not require medical treatment. Simple changes to one's lifestyle can also reduce or eliminate the intensity of the symptom. These could include:
- Getting adequate rest
- Exercising at least three times per week
- Maintaining a balanced diet which includes vegetables, fruits, and whole grains but with less caffeine, sugar or alcohol
When do periods change from normal to abnormal? Below are four of the most common types of abnormal menstrual periods.
1. Menorrhagia & Polymenorrhea (Prolonged, Heavy Bleeding)
Menorrhagia is one of the most prevalent types of menstrual bleeding. The condition is characterized by prolonged, heavy bleeding. In some instances, the bleeding may disrupt normal daily activities. There are different forms of this condition. The most common ones are polymenorrhea (too frequent), postmenopausal (menstrual periods after menopause), and metrorrhagia (bleeding between periods).
While there are many causes associated with menorrhagia, the most common causes include the following:
- Hormonal imbalance
- Uterine fibroids
- Miscarriage and other forms of abnormal pregnancy
- Pelvic inflammatory disease (PID)
- Tumors or infections in the pelvic cavity
- Platelet or bleeding disorder
- High concentration of endothelin
The main symptoms of this condition are the frequent need to change sanitary pads during the day, or when the menstrual period lasts more than seven days. Other prevalent symptoms include bleeding or spotting during pregnancy or between menstrual periods.
A medical professional will diagnose menorrhagia after ruling out other menstrual bleeding disorders, as well as the medication or medical conditions that may aggravate the condition. The doctor may also perform other diagnostic procedures such as blood test, Pap test, biopsy, magnetic resonance imaging, laparoscopic (a thin tube inserted into the abdominal wall), ultrasound and hysteroscopy.
After the diagnosis, the doctor will take into consideration other factors such as age, overall health, the severity of the condition and current symptoms to determine the treatment plan.
2. Dysmenorrhea (Excess Pain During Period)
Dysmenorrhea is a condition characterized by pain and menstrual cramps during menstruation. The conditions can be described as either primary or secondary, depending on the causes. For primary dysmenorrhea, an individual experiences abnormal uterine contractions as a result of a chemical imbalance. Secondary dysmenorrhea is usually associated with medical conditions.
Other known causes include uterine fibroids, pelvic inflammatory disease, tumors or infections in the pelvic cavity, and abnormal pregnancy.
The condition is more prevalent among women who smoke, are obese, consume excessive alcohol during periods, or started menstruating at an early age. The main symptoms of this condition are:
- Pain or cramping in the lower abdomen
- Pain in the low back and legs
3. Amenorrhea (Absent Periods)
Amenorrhea is a menstrual disorder characterized by absent or missed periods for more than three cycles. There are two types of this disorder: primary amenorrhea and secondary amenorrhea. With primary amenorrhea, the menstruation fails to start at puberty. Secondary amenorrhea is when a normal menstrual cycle becomes increasingly irregular or absent.
Women may experience this condition for various reasons, usually related to biological changes in the course of life such as breastfeeding, pregnancy or menopause. It may also occur as a result of medications or health condition such as:
- Ovulation abnormality
- Eating disorder
- Birth defect
- Thyroid disorder
- Excessive exercise
As with any menstrual disorder, early diagnosis and treatment will help to restore normal menstruation.
4. Hypomenorrhea (Extra Light Periods)
Hypomenorrhea is the opposite of menorrhagia. Hypomenorrhea is a disorder characterized by light periods. The menstruation often lasts less than two days, or it is less than 80ml. The condition can occur as a result of using hormonal contraceptives like oral contraceptives, IUDs or Depo-Provera®.
Other causes may include:
- Low body fat
- Intrauterine adhesions or Asherman’s syndrome
- Nervousness or stress
- Hormonal imbalance
- Premature ovarian failure
The condition can occur at any stage in a woman’s life, but it is more prevalent just before menopause or after puberty. Hypomenorrhea can be diagnosed through ultra-sonogram, blood tests, and other medical tests to check the thickness and the causes of scanty flow.
When to Call Your Ob/Gyn
Dr. Crystal M. Newby, MD is a physician at Kansas City ObGyn. She received her medical degree from the University of Missouri - Kansas City School of Medicine. Dr. Newby married her fellow Kansas native high school sweetheart and they have 3 daughters.