Menstruation and Menstrual problems

Menstruation, or a period, is the normal vaginal bleeding that occurs in  women, as part of a monthly cycle that prepares a woman’s body for pregnancy. If no pregnancy occurs, the uterus, or womb, sheds its lining. The menstrual blood is partly blood and partly tissue from inside the uterus. It passes out of the body through the vagina.

Periods usually start between age 11 and 14 and continue until menopause at about age 51. They usually last from three to five days. Besides bleeding from the vagina, a woman may have;

  • Abdominal or pelvic cramping
  • Lower back pain
  • Bloating and sore breasts
  • Food cravings
  • Mood swings and irritability
  • Headache and fatigue

However, there are a variety of common problems that women may experience with their menstrual cycle, and these can occur at any age. Many are completely harmless but can cause significant distress to women experiencing them. The most common problems seen are;

  1. Amenorrhoea – the absence of periods.
  3. Oligomenorrhoea – irregular periods
  5. Dysmenorrhoea – painful periods
  7. Menorrhagia – heavy periods
  9. Pre-menstrual syndrome (PMS)


Used to describe the complete absence of periods, this is classified as either primary or secondary, with up to 30% of women experiencing some form of this at some time during their reproductive years. Primary amenorrhoea occurs if an otherwise healthy female has not had any periods by the time she is 16. Secondary amenorrhoea is defined as occurring when periods stop for at least 6 consecutive months, in a woman who has previously had a regular menstrual cycle.

Most cases of amenorrhoea are due to hormonal irregularities, and stopping hormonal contraception after a long time of use is a common cause. However, stress and being severely underweight may also trigger it as can excessive exercise regimens.

Treatment depends on the underlying cause and may not be needed, especially if fertility is not an issue.


With infrequent, or irregular periods (oligomenorrhoea), menstruation can happen between once every 6 weeks and 6 months. Causes can be similar to those for amenorrhoea, along with the condition polycystic ovary syndrome (PCOS) which is an inherited disorder affecting the ovaries which causes irregular periods, weight gain and excessive body hair.


Significant period pain (dysmenorrhoea) is severe enough in 10% of women to interfere with their normal daily activities and can occur before or during menstruation. There may also be associated nausea, headaches and diarrhoea and the pain can last from a few hours up to 72 hours.  There is often no cause for it but if a cause is present this is often found to be either endometriosis or fibroids.

Endometriosis occurs when cells that normally line the womb are found in places outside the womb. These respond to the normal hormonal changes in each menstrual cycle by building up, breaking down and bleeding as does the womb lining normally – but as these cells are outside the womb, the bleeding has no way of leaving the body, so these cells build up and lead to pain and swelling.

Fibroids are harmless growths in the womb lining that affect around 1 in 5 women in their lifetime, and can be small or large. They may cause no symptoms at all, or cause significant pain and heavy periods.

In both endometriosis and fibroids, treatment may not be necessary but if it is then both hormonal treatments and surgery are options.


Defined as excessively heavy period bleeding that occurs repeatedly, menorrhagia typically causes blood loss of more than 80mls, double the expected normal period blood loss. Although conditions such as fibroids or endometriosis often cause it, there may be no obvious cause found and so treatment is unique to each individual. Options include the contraceptive pill, non-hormonal treatments such as tranexamic acid (Ponstan) and fitting an IUCD device (the ‘coil’) into the womb. Severe cases may require surgery either in the form of removing the womb lining, or a hysterectomy.

Pre-menstrual syndrome (PMS)

For many women, the normal hormonal fluctuations that occur during each menstrual cycle cause few problems but for others this can be a source of great misery and distress. There are dozens of possible symptoms caused by PMS but the most usual ones include low mood, irritability and anger, breast tenderness, bloating and fatigue. Symptoms typically occur in the week before a period starts and stop quickly once bleeding occurs, occurring most commonly in the 30-46 year age group. Treatments include natural therapies such as evening primrose oil, vitamin B6 and St John’s Wort with conventional treatments including the contraceptive pill, hormonal treatment and a group of antidepressants called selective serotonin reuptake inhibitors (SSRIs).