COMMON MENSTRUAL DISORDERS
Menstrual disorders are quite common and an everyday occurrence among many women in the reproductive age group. They vary from irregularity in the menstrual cycle length to excessive or scanty menstrual flow and to the occurrence of painful menstrual flow. This article will discuss briefly the various types of menstrual disorders and their definitions. Their causes and management will be discussed in their respective sections.
COMMON MENSTRUAL DISORDERS
1) ABNORMAL MENSTRUAL CYCLES
This refers to any cycle that doesn’t fulfill the criteria for a normal menstrual cycle i.e. it is one in which the cycle length is less than 21 days or longer than 35 days, and or the menstrual flow is less than 2 days or longer than 8 days and or the menstrual cycles are irregular.
2) ABNORMAL MENSTRUAL BLEEDING
This refers to arrays of abnormal bleeding patterns related to abnormal menstrual cycles and include;
1. Prolonged menstrual bleeding: refers to menstrual flow longer than 8 days. They are usually associated with heavy menstrual flow or may presents with flow rate characterized by a period of heavy flow alternating with that of a normal flow or vaginal spotting.
2. Heavy menstrual bleeding: refers to a significant increase in the menstrual flow of a particular individual. While the perception of a heavy menses may be subjective, as what constitutes a heavy period to some women are normal to some, objective features of heavy menstrual bleeding are increase in the numbers of menstrual pads used over time, history of passage of blood clots, history of menstrual flooding or of soaking of menstrual pad along with under wears and in severe cases, history of dizziness and fainting attack especially during or just after the menstrual period.
Causes of heavy menstrual flow are varied and may be associated with both regular and irregular cycles. Because excessive or heavy menstrual bleeding predisposes to anemia and heart failure among many other health risks, women with heavy menstrual bleeding should seek urgent attention from a gynecologist before complications set in. For many others who tend to worry perpetually about excessive menstrual flow yet are without symptoms, merely talking with a specialist may allay their fears and put them at ease once and for all.
3. Inter-menstrual bleeding: This refers to bleeding from the vagina noticed in between periods. While spotting of blood from the vagina may be noted cyclically, during the mid-cycle related to the process of ovulation, there are many other treatable causes of inter-menstrual bleeding.
4. Spotting: Simply refers to the presence of blood spots from the vagina. It may occur mid-cycle just before ovulation in some women lasting for a day or two, in which it is harmless or may follow a normal or heavy menstrual flow for many days or may simply be all that remains of a previously normal menses lasting less than a day or two. It may also be seen in both regular and irregular menstrual cycles.
5. Scanty or reduced menses: This refers to a consistent and significant reduction in the volume of menstrual loss in a regular menstrual cycle. It usually follows a surgical procedure involving the inner lining of the uterus. It ranges from a subtle reduction in the volume and duration of menstrual flow to a marked or severe reduction in both the volume and the duration of the menstrual bleeding. In severe cases, a total absence of menstruation may occur, associated with or without a recurrent cyclical pain felt at the anticipated menstrual period.
Other abnormal vaginal bleeding, seen in non pregnant women that are not due to abnormal menstrual cycles include post-coital bleeding and post menopausal bleeding.
6. Post-coital bleeding: It refers to the occurrence of bleeding from the vagina during or after intercourse. Non menstrual related causes are common following trauma to the vagina during sex. It is also common in women with cervical cancer who often present with vaginal bleeding along with watery vaginal discharge usually after attaining menopause. Other causes of post-coital bleeding that may also cause abnormal menstrual bleeding include endometrial polyps and cervical polyps.
7. Post menopausal bleeding: This refers to fresh vaginal bleeding six month after a woman attains menopause.
3) IRREGULAR MENSTRUAL CYCLE
These are cycles in which ovulation occur irregularly and occasionally. They are also described as anovulatory cycles. An irregular cycle is one in which the difference between the shortest cycle length and the longest cycle length in a six month period is more than 5 days, in other words the cycle lengths when observed for about six months, differs each month by more than 5 days, after subtracting the shortest cycle length from the longest cycle length. Because ovulation may not occur for many months, depending on the severity, menstruation may be delayed for a varying period of times. This is referred to as either oligomenorrhea or amenorrhea.
1. Oligomenorrhea: This refers to a delay in menstruation greater than 35 days but less than six months in a non pregnant woman.
2. Amenorrhea: This refers to a total absence of menstruation for at least 6 months or for a period equaling 3 consecutive menstrual cycles in a woman. Causes are highly varied ranging from pregnancy to many other causes.
3) PAINFUL MENSTRUATION
This is also referred to as dysmenorrhea. It is one of the commonest menstrual disorders among women of reproductive age group and is divided into primary and secondary dysmenorrhea.
4) PREMENSTRUAL SYNDROME
This refers to a combination of psychological and physical changes in the premenstrual or luteal phase of the menstrual cycle perceived as a sense of bloating, irritability, breast tenderness and variable degree of mood swings and emotional distress that may impair proper functionality.
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