Menstrual Disorders

There are a number of different menstrual disorders. Problems can range from heavy, painful periods to no period at all. There are many variations in menstrual patterns, but in general women should be concerned when periods come fewer than 21 days or more than 3 months apart, or if they last more than 10 days. Such events may indicate ovulation problems.

Dysmenorrhea (Painful Cramps)

Dysmenorrhea is severe, frequent cramping during menstruation. Pain occurs in the lower abdomen but can spread to the lower back and thighs. Dysmenorrhea is usually referred to as primary or secondary.

Primary dysmenorrhea. Cramps occur from contractions in the uterus. These contractions are a normal part of the menstrual process. With primary dysmenorrhea, cramping pain is directly related to and caused by menstruation. About half of menstruating women have primary dysmenorrhea. It usually begins 2 - 3 years after a women begins to menstruate. The pain typically develops when the bleeding starts and continues for 32 - 48 hours. Cramps are generally most severe during heavy bleeding.

Secondary dysmenorrhea. Secondary dysmenorrhea is menstrual-related pain that accompanies another medical or physical condition, such as endometriosis or uterine fibroids.

Heavy Bleeding

During a normal menstrual cycle, the average woman loses about 1 ounce (30 mL) of blood. Most women change their tampons or pads around 3 - 6 times per day. Menorrhagia is the medical term for significantly heavier bleeding. Menorrhagia occurs in 9 - 14% of all women and can be caused by a number of factors. Women often overestimate the amount of blood lost during their periods. Clot formation is fairly common during heavy bleeding and is not a cause for concern. However, women should consult their doctor if any of the following occurs:

• Soaking through at least one pad or tampon every 1 - 2 hours for several hours
• Heavy periods that regularly last 10 or more days
• Bleeding between periods or during pregnancy. Spotting or light bleeding between periods is common in girls just starting menstruation and sometimes during ovulation in young adult women, but it is still a good idea to speak with a doctor.

Several terms are often used to describe the pattern of abnormal bleeding:

• Menorrhagia refers to long (greater than 7 days) or excessive (more than 80 mL) bleeding that occurs at regular intervals
• Metrorrhagia refers to bleeding which occurs at frequent but irregular intervals, and with variable amounts
• Menometrorrhagia refers to prolonged episodes of bleeding that occur at irregular intervals

Amenorrhea (Absence of Menstruation)

Amenorrhea is the absence of menstruation. There are two categories: primary amenorrhea and secondary amenorrhea. These terms refer to the time when menstruation stops: