Menstrual Problems: Diagnosis, Treatment, and Outlook

What Are Menstrual Problems?

Menstrual cycles often bring about a variety of uncomfortable symptoms leading up to your period. Premenstrual syndrome (PMS) encompasses the most common issues, such as mild cramping and fatigue, but the symptoms usually go away when your period begins.

However, other, more serious menstrual problems may also occur. Menstruation that is too heavy or too light, or the complete absence of a cycle, may suggest that there are other issues that are contributing to an abnormal menstrual cycle.

Remember that a “normal” menstrual cycle means something different for every woman. A cycle that’s regular for you may be abnormal for someone else. It’s important to stay in tune with your body and to talk to your doctor if you notice any significant changes to your menstrual cycle.

There are several different menstrual problems that you may experience.

Premenstrual Syndrome

PMS occurs one to two weeks before your period begins. Some women experience a range of physical and emotional symptoms. Others experience few symptoms or even none at all. PMS can cause:

• bloating
• irritability
• backaches
• headaches
• breast soreness
• acne
• food cravings
• excessive fatigue
• depression
• anxiety
• feelings of stress
• insomnia
• constipation
• diarrhea
• mild stomach cramps

You may experience different symptoms every month, and the severity of these symptoms can also vary. PMS is uncomfortable, but it’s generally not worrisome unless it interferes with your normal activities.

Heavy Periods

Another common menstrual problem is a heavy period. Also called menorrhagia, heavy periods cause you to bleed more than normal. You may also have your period for longer than the average of five to seven days.

Menorrhagia is mostly caused by imbalances in hormone levels, especially progesterone and estrogen.

Other causes of heavy or irregular menstrual bleeding include:

• puberty
• vaginal infections
• inflammation of the cervix
• underactive thyroid gland (hypothyroidism)
• noncancerous uterus tumors (fibroids)
• changes in diet or exercise

Absent Periods

In some cases, women may not get their period. This is called amenorrhea. Primary amenorrhea is when you don’t get your first period by age 16. This may be caused by an issue with the pituitary gland, a congenital defect of the female reproductive system, or a delay in puberty. Secondary amenorrhea occurs when you stop getting your regular periods for six months or more.

Common causes of primary amenorrhea and secondary amenorrhea in teens include:

• anorexia
• overactive thyroid gland (hyperthyroidism)
• ovarian cysts
• sudden weight gain or loss
• stopping birth control
• pregnancy

When adults do not menstruate, the common causes are often different. These may include:

• premature ovarian failure
• pelvic inflammatory disease (a reproductive infection)
• stopping birth control
• pregnancy
• breastfeeding
• menopause

A missed period could mean that you’re pregnant. If you suspect you may be pregnant, be sure to take a pregnancy test. Drugstore pregnancy tests are the least expensive way to determine whether or not you are pregnant. To get the most accurate results, wait until you have missed your period by at least one day before taking the test.

Painful Periods

Not only can your period be lighter or heavier than normal, but it can also be painful. Cramps are normal during PMS and they also occur when your uterus contracts as your period begins. However, some women experience excruciating pain. Also called dysmenorrhea, extremely painful menstruation is likely linked to an underlying medical problem, such as:

• fibroids
• pelvic inflammatory disease
• abnormal tissue growth outside of the uterus (endometriosis)

Diagnosing Menstrual Problems

The first step in diagnosing menstrual problems is to see your doctor. Your doctor will want to know about your symptoms and for how long you’ve been experiencing them. It may help to come prepared with notes on your menstrual cycle, how regular it is, and any symptoms you have been experiencing. Your doctor can use these notes to help figure out what is abnormal.

In addition to a physical exam, your doctor will likely do a pelvic exam. A pelvic exam allows your doctor to assess your reproductive organs and to determine if your vagina or cervix is inflamed. A Pap smear will also be performed to rule out the possibility of cancer or other underlying conditions.

Blood tests can help determine whether hormonal imbalances are causing your menstrual problems. If you suspect that you may be pregnant, your doctor or nurse practitioner will order a blood or urine pregnancy test during your visit.

Other tests your doctor may use to help diagnose the source of your menstrual problems include:

• endometrial biopsy (used to extract a sample of your uterine lining that can be sent for further analysis)
• hysteroscopy (a small camera is inserted into your uterus to help your doctor find any abnormalities)
• ultrasound (used to produce a picture of your uterus)

Treating Menstrual Problems

The type of treatment will depend on what’s causing the problems with your menstrual cycle. Birth control pills can relieve symptoms of PMS, as well as regulate heavy flows. If a heavier or lighter than normal flow is related to a thyroid or other hormonal disorder, you may experience more regularity once you start hormone replacements.

Dysmenorrhea may be hormone related, but you may also require further medical treatment to address the problem. For example, antibiotics are used to treat pelvic inflammatory disease.

Long-Term Outlook

Irregularities between periods are normal, so the occasional light or heavy flow is generally not something to worry about. However, if you experience severe pain or a heavy flow with blood clots, you should call your doctor right away. It’s is also recommended that you get medical attention if your periods occur less than 21 days apart, or if they happen more than 35 days apart.