Menstrual Irregularities

Abnormalities in the menstrual cycle of a woman is called as menstrual irregularities.

Types of Menstruation Irregularities

Various menstrual irregularities include:

  • No menstrual periods until the age of 16 years or absence of menstrual periods for 3 consecutive months and is not pregnant - Amenorrhea

  • Painful menstruation periods - Dysmenorrhea

  • Excessive bleeding which lasts for 8 to 10 days - Menorrhagia

  • Irregular menstrual periods or getting periods frequently - Oligomenorrhea

  • Premature ovarian failure – Normal function of the ovary is stopped

  • Non-cancerous tumours observed in women of childbearing potential - Uterine fibroids

  • Endometriosis

Symptoms of Menstrual Disorders

Symptoms associated with menstrual disorders are:

  • Irregular periods

  • Lower back pain

  • Sense of burning during urination

  • Infertility (difficulty getting pregnant)

  • Fever

  • Abdominal cramps

  • Unusual vaginal discharge

Causes of Menstrual Disorders

Hormones play an important role in regulating growth and other bodily functions.

At the onset of puberty, a mixture of female and male sex hormones is produced for sexual maturity. An imbalance in these hormones or increased production of male hormones can lead to hirsutism (high levels of the male sex hormone androgen) and menstrual disorders.

The recent increase in childhood and adolescent obesity is also a major factor that has led to the high incidence of hirsutism and menstrual disorders.

Other causes may include:

  • Dysmenorrhea -may occur due to endometriosis (chronic condition where the uterine lining grows over the ovaries and bladder) or fibroids (noncancerous growth on the walls of the uterus), cyst in the ovaries and the use of intrauterine contraceptive devices (IUDs).

  • Menorrhagia - may be caused due to uterine fibroids, problems in ovulation (release of fully developed ovarian cells), endometriosis, uterine polyps (small benign growth), cancer, severe infection, miscarriage or ectopic pregnancy (pregnancy outside the womb), certain medications and IUDs.

  • Oligomenorrhea - may develop due to polycystic ovary syndrome (ovarian cysts), weight loss, endometriosis, stress and medications.

Treatments for Menstruation Disorders

Dr Alexander may prescribe hormone therapy or oral contraceptive pills to treat menstrual disorders.

Surgical procedures may include the removal of fibroids, cysts or tumors. Surgery may be recommended only in cases of severe menstrual disorders.


Period pain or dysmenorrhea is a condition of painful menstrual periods. Menstrual cramps or pain is felt in the abdominal areas and can occur before the menstrual cycle begins and can continue for 2 to 3 days.

Primary dysmenorrhea is the common painful condition in women with no abnormalities in the pelvic region. Women may experience severe pain before or at the onset of menstrual periods and the pain persists for 2–3 days.

Cause of Dysmenorrhea

Primary dysmenorrhea

Primary dysmenorrhea is caused by the elevated levels of the hormone prostaglandin produced by the tissues lining the uterus (womb). Prostaglandin triggers the uterine muscles to contract and push the uterine bleeding/clots out of the body through the cervix.

Conditions that may cause primary dysmenorrhea include

  • Women who have a high level of prostaglandin will experience intense pain and contractions.

Secondary dysmenorrhea

Secondary dysmenorrhea is the painful condition that may be caused because of other gynaecological problems. This kind of pain begins early in the menstrual cycle and lasts longer than primary dysmenorrhea.

Conditions that may cause secondary dysmenorrhea include

  • endometriosis,

  • fibroids,

  • infection,

  • ovarian cysts,

  • narrow cervix,

  • abnormal pregnancy, and

  • intrauterine device for birth control.

Symptoms of Dysmenorrhea

Some of the commonly observed symptoms are

  • back pain,

  • leg pain,

  • nausea,

  • vomiting,

  • diarrhea,

  • headache,

  • irritability,

  • weakness and

  • fainting.

Diagnosis of Dysmenorrhea

Dr Alexander will perform a pelvic examination to identify if there are any other problems associated with menstrual cramps.

Blood tests and cervical cultures will confirm if there is any sign of infection. Other diagnostic tests may be required which include MRI scan and ultrasound scan.

Non Surgical Treatment for Dysmenorrhea

If the menstrual cramps are because of the underlying medical conditions, then treating the conditions will help to relieve pain.

The conservative approach includes non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain and contraceptive pills which decrease the production of prostaglandins by preventing ovulation. However, these medicines are taken before the menstruation begins.

NSAIDs are contraindicated if you have a history of kidney and stomach problems. The other home remedies such as a heating pad to the pelvic area, regular exercises, massage to the back and abdomen, low-fat diet, and intake of calcium and thiamine tablets may help to treat period pain.

Surgical Treatments for Dysmenorrhea

Surgery is very rarely conducted for patients with dysmenorrhea. It is done only if the other conservative treatments are not successful. Obviously these procedures are reserved for women who do not wish to conceive, finished their family or certain age group. Some of the procedures carried out are

  • Mirena IUD which cause hormonal thinning of the endometrium and quite possible stop periods

  • Endometrial ablation – In this procedure, the superficial tissue layer lining the uterus is destroyed.  The extra tissue is destroyed by several ablation techniques such as diathermy or heating. It is recommended in patients who have heavy uterine bleeding, painful periods might persist after this procedure

  • Hysterectomy – It is the surgical removal of the entire uterus. It is recommended if you have fibroids, uterine prolapse, cancer in the uterus, and vaginal bleeding. This procedure will stop periods. It is not recommended for women who want to have children.


Menorrhagia is a condition characterized by abnormally heavy or extended menstrual bleeding. With menorrhagia, you may have an adequate blood loss and pain that disturbs your normal activities.

Symptoms of Menorrhagia

The most common symptoms of menorrhagia are:

  • Menstrual flow that soaks one or more pads per hour for several consecutive hours

  • The need to use double sanitary protection to control the flow of blood

  • Need to change your pad frequently during the night

  • Menstrual period that lasts longer than seven days

  • Menstrual flow that includes large blood clots

  • Affect the daily routine activities due to heavy menstrual flow

  • Fatigue, weakness or shortness of breath (symptoms of anemia)

Causes of Menorrhagia

The cause of menorrhagia is not known in some cases. However, several conditions that may cause menorrhagia include

  • hormonal imbalance,

  • dysfunction of the ovaries,

  • uterine fibroids (non-cancerous (benign) tumors of the uterus),

  • uterine polyps,

  • adenomyosis (where endometrial glands are found in the muscular wall of the uterus),

  • intrauterine devices (IUDs),

  • pregnancy complications,

  • cancer,

  • inherited blood disorders,

  • certain medications (anti-inflammatory medications and anticoagulants), and

  • pelvic inflammatory disease (PID),

  • thyroid problems,

  • endometriosis, and

  • liver or kidney disease.

Diagnosis of Menorrhagia

Dr Alexander will do a pelvic examination and may recommend other tests or procedures such as

  • pelvic ultrasound scan or

  • biopsy of the lining of the womb if the woman is over 40 years of age.

  • hysteroscopy

Biopsy is a technique of removing a piece of tissue from the inner lining of the uterus and examining it under a microscope. This is done to make sure that the cells are growing normally.

Dr Alexander may also recommend an examination called hysteroscopy, which involves placing a tiny tube with a light through your cervix to obtain a direct view of the lining of the womb.

Non Surgical Treatments for Menorrhagia

Treatment options will depend on the cause of menorrhagia, the severity of menorrhagia and the overall health of the patient. Some common treatments include:

  • Iron supplements may be started if your iron levels are low.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) may help reduce menstrual blood flow as well as cramping.

  • Oral contraceptives may be given to help reduce bleeding and make menstrual cycles more regular.

  • Oral progesterone may be given to help correct hormonal imbalance and reduce menorrhagia.

  • Mirena is a type of intrauterine device which may be used to release progestin in the womb that thins the uterine lining and reduces the blood flow.

Surgical Treatments for Menorrhagia

Surgery may be needed if medication therapy is not successful. The surgical procedures include:

  • Dilation and curettage (D&C): It is a procedure in which the cervix is dilated and the lining of the uterus is scraped to reduce menstrual bleeding. You may need additional D&C procedures if menorrhagia recurs. This procedure also allow the gynaecologist to take biopsy and check for abnormal endometrial cells.

  • Hysteroscopy: This procedure involves the use of a hysteroscope, a tiny tube with a light to view your uterine cavity and to remove abnormalities such as a polyp that may be causing heavy menstrual bleeding.

  • Endometrial ablation: It is a procedure that permanently destroys the entire lining of your uterus (endometrium) resulting in little or no menstrual flow.

  • Hysterectomy: It is a surgical removal of the uterus and the cervix that leads to infertility and the cessation of menstrual periods.

Surgical procedures such as hysterectomy, endometrial ablation, and endometrial resection are for women who decide not to be pregnant or have finished their family. Therefore, discuss with Dr Alexander about the treatment options if you plan to get pregnant in the future.

Treatment includes:

  • For amenorrhea, medroxyprogesterone will be given to check for withdrawal bleed

  • For dysmenorrhea, ibuprofen and naproxen  (NSAID) are given to relieve pain

  • For menorrhagia, iron supplements and anti-prostaglandin medications are given.  In severe cases of menorrhagia, surgeries such as thermal balloon endometrial ablation, transcervical resection of the endometrium (TCRE), and hysterectomy will be done.

  • For endometriosis, hormonal preparations can be used and/or, Laparoscopic surgery to remove the endometriosis tissue from pelvic peritoneum.

  • Fibroids, depending on their location and size can either be left alone and followed up by ultrasound or  treated by medications and /or Surgery remove the fibroids.