Menstrual disorders (Menstrual Problem)

Menstrual disorders are a very common problem in women in their reproductive age. Disturbances of menstruation are one of the most common reasons for women to attend their gynaecologist. A woman’s menstrual periods start with the menarche (first menstrual period) and ends with the menopause( last menstrual period). In general, a woman will experience a period every 21-35 days with 3-7 days of menstrual flow.Nowadays, women are experiencing more menstrual periods than ever before and this is because women are having less children and are not breastfeeding as much as their mothers or grandmothers before them and are also living much longer. Simply put, women can expect to experience as many as 400 menstrual periods during their reproductive life. Problems relating to the menstrual cycle affect many women and can be a cause great concern and anxiety. Most often, there is no major underlying abnormality or problem but sometimes abnormal bleeding can be a consequence of significant pelvic disease.Pre Menstrual Syndrome(PMS) is the occurrence of cyclical physical, psychological and emotional symptoms in the second half of the menstrual cycle and resolves at the end of mensturaton. Symptoms of PMS can include abdominal bloatiness, weight gain, breast tenderness, fatigue, depression and irritability just to name a few.


Heavy menses(Menorrhagia)
The average menstrual period lasts 3-7 days with a mean blood loss of 35ml. Excessive menstrual blood loss is a common problem and is very subjective in nature because the perception of the severity menstrual blood loss varies form one woman to another. A marked change from what is considered usually normal should be considered as a problem and thoroughly investigated.Excessive menses is usually due to dysfunctional uterine bleeding(DUB) where there no obvious gynaecological cause but can sometimes be due to uterine fibroids, polyps or very rarely cancers of the genital tract.


Heavy and Prolonged menses
Irregular menstrual period is mainly due to anovulatory menstrual cycles i.e when there is a lack of ovulation where the ovary does not release an egg each month, and can be both heavy and prolonged when menstruation does eventually occur. Anovulatory cycles are common during puberty and around the menopause when irregular periods are experienced more often.Irregular vaginal bleeding is also a well recognized consequence of PolyCystic Ovarian Syndrome(PCOS) in particular in women in their reproductive age.Rarely, irregular bleeding can be due to uterine cancer or precancer.  Nearly 10% of women on HRT will experience unscheduled irregular bleeding.


Sporadic menses-intermenstrual or postcoital bleeding
Intermenstrual bleeding(IMB) is bleeding between two regular periods and Postcoital bleeding(PCB) is bleeding after intercourse. The two problems coexist frequently and may be due to a common cause. Most cases are due to benign disease of the female genital tract where no major problem can be found. Bleeding that occurs in the mid-cycle is usually physiological and normal and should not be a cause for concern. More often, the use of the contraceptive pill can cause unscheduled sporadic bleeding.Chlamydiae infection, a sexually transmitted infection, may present with IMB and PCB.Polyps in the cervix (neck of womb) and endometrium (lining of womb) can cause IMB and PCB.

Rarely, cervical cancer can present in this manner.


Investigations and treatments

Tests for abnormal bleeding include hormonal profile, ultrasound scan, hysteroscopy and biopsy of the lining of the womb.

Treatment depends on the abnormality detected and the options are hormonal treatment, hysteroscopic resection/ablation and hysterectomy.