Menstrual Disorders

Menstrual disorders or abnormalities include a group of conditions that disrupt the normal menstrual cycle. It refers to deviations from the normal duration, length, and flow of menstrual periods, including all irregularities in the cycle.

These disorders significantly impact not only the general health, but also the work, studies, emotional state, and physical well-being of females. Menstrual disorders are the primary reason females visit gynecologists. These disorders include:

• Amenorrhea refers to the complete absence or stoppage of periods.
• Oligomenorrhea is characterized by infrequent and inconsistent periods.
• Menorrhagia refers to prolonged or heavy bleeding.
• Metrorrhagia is irregular bleeding between menstrual periods.
• Menometrorrhagia is abnormally heavy bleeding both during and between menstrual periods.
• Dysmenorrhea refers to pain and discomfort during menstrual periods.
• Premenstrual syndrome includes both physical and psychological symptoms occurring before the menstrual period.

What is the menstrual cycle?

The normal menstrual cycle begins from puberty (onset of first period is known as menarche) continues until menopause (the complete stoppage of periods). During this range of reproductive age, every month the ovaries produce an egg and the uterus is prepared for nourishing a fertilized egg. When fertilization does not occur, the uterine lining sloughs off as menstrual bleeding or periods. All of this process occurs under the influence of certain hormones.

Main characteristics of the menstrual cycle

• The normal length of the cycle is 28 days on average. However, a menstrual cycle between 21 and 35 days is considered normal
• The normal duration of a menstrual period is 3 to 7 days
• The normal amount of flow during periods is 30 to 40 milliliters or 2 to 3 tablespoons
• The start of the menstruation, also known as menarche, occurs between the ages of 9 and 15
• Menopause is the permanent cessation of menstrual periods. It occurs when the ovaries no longer produce eggs and there is no ovulation. It typically occurs between the ages of 45 and 55 years.

Hormones involved in the menstrual cycle

• Gonadotropin-releasing hormone (GnRH): It is released from the hypothalamus in the brain and acts upon the pituitary gland to stimulate the release of pituitary sex hormones: FSH and LH.
• Follicular stimulating hormone (FSH): Released from the pituitary gland in the brain, it acts upon ovarian follicles, causing maturation of the egg.
• Luteinizing hormone (LH): Released from the pituitary gland, it acts upon the ovary and causes the release of the egg from the ovary, known as ovulation.
• Estrogen: Produced in the ovaries, it plays a role in the maturation of the egg, prepares the uterus, and has other effects on different body functions as well.
• Progesterone: It is produced from the ruptured follicle (corpus luteum). Progesterone also thickens the uterine endometrium and makes it suitable for the implantation of the embryo.

Phases of the menstrual cycle

• Menstruation: The menstrual cycle begins on the first day of menstruation. This phase marks the shedding of the uterine lining that was prepared in the previous cycle for a potential pregnancy. The shedding consists of blood, endometrial tissues, and mucus which is discharged from the vagina.
• Follicular phase:  It starts after menstruation. FSH encourages the growth of several ovarian follicles, each containing an immature egg. Only one follicle fully matures, and the rest degenerate. Simultaneously, the uterus is being prepared for the implantation of a fertilized egg.
• Ovulation: It occurs in the mid of the cycle when the follicle ruptures and the egg is released into the uterine tube. It requires an LH surge to cause ovulation. The egg is viable for fertilization for about 12-24 hours. If it combines with sperm, fertilization will occur.
• Luteal phase: It starts after ovulation and continues until menstrual periods. The ruptured follicle transforms into the corpus luteum, which releases progesterone and some estrogen. These hormones maintain the thickened uterine lining, preparing it for implantation.

What are the different types of menstrual disorders?

There are many types of menstrual disorders that affect women of reproductive age:

Amenorrhea

Amenorrhea refers to the complete absence of periods. There are two types of amenorrhea:

• Primary amenorrhea: This occurs when a girl is above the age of 16 and has not yet experienced her first period. It can be due to various reasons, including genetic and hormonal factors.
• Secondary amenorrhea: This is the absence of periods for three consecutive months or more. It occurs in females who previously had their normal periods.

While amenorrhea is an abnormal condition, there are certain normal conditions where there is an absence of periods, which include pregnancy and breastfeeding.

Oligomenorrhea

Oligomenorrhea refers to infrequent periods that have a length greater than 35 days, or less than a total of nine periods in a year. In oligomenorrhea, the bleeding might also be light. It can be due to hormonal issues, thyroid disorders, or other medical conditions.

Menorrhagia

Menorrhagia refers to abnormally heavy or prolonged bleeding during menstruation. In menorrhagia despite having a regular cycle, the amount of blood loss is considerably higher. It mostly occurs in the perimenopausal phase (the time before the start of menopause) and is often accompanied by dysmenorrhea because passing large clots can cause painful cramps. Menorrhagia is a type of abnormal uterine bleeding.

Abnormal uterine bleeding refers to bleeding that does not follow the normal pattern of menstruation. It is mainly due to ovulatory dysfunction, a disorder where ovulation does not occur predictably or at all. It can manifest in various other disorders:

• Metrorrhagia: It refers to irregular bleeding in between normal menstrual periods. The blood flow can vary, the timing is irregular, and not associated with a predictable menstrual cycle.
• Menometrorrhagia: It refers to abnormally heavy bleeding both during and in between menstrual periods. It can be particularly disturbing to a woman’s routine and may suggest an underlying medical condition.

Dysmenorrhea

Dysmenorrhea refers to pain and discomfort during periods. Mild pain is normal during periods, but intense pain along with other symptoms signifies some serious underlying cause. There are two types of dysmenorrhea:

• Primary dysmenorrhea: This refers to painful periods in the absence of any underlying disease. It is a normal physiological response to the menstrual cycle and occurs due to prostaglandins that cause contraction of the uterus muscles. Contracting muscles constrict blood vessels and block blood flow to the uterus, resulting in ischemia of the endometrium which stimulates pain.
• Secondary dysmenorrhea: This type of dysmenorrhea refers to painful periods due to the presence of some underlying pelvic disease. Along with pain, symptoms such as irregular periods, heavy bleeding, and spotting between periods may be experienced.

Premenstrual syndrome (PMS)

Premenstrual syndrome includes physical and psychological symptoms occurring one or two weeks before the onset of menstrual periods. It is mainly caused by fluctuating hormonal levels that affect body systems. These hormones also have psychological impacts.

• Premenstrual dysphoric disorder (PMDD): It is a severe and more complex form of premenstrual syndrome. PMDD is characterized by extreme mood swings, depression, anxiety, and irritability that occur during the week or two before menstruation and usually improve once the menstrual period begins.

What are the symptoms of different menstrual disorders?

Symptoms vary depending on the specific condition, but generally, the common symptoms of menstrual disorders are:

• Absence of periods
• Increased or decreased length of cycle
• Heavy menstrual bleeding
• Pelvic pain
• Breast tenderness
• Irritability
• Spotting between periods
• Bleeding during pregnancy
• Extreme mood swings.

These are some common symptoms experienced during menstrual disorders, however, there are certain symptoms specific to different disorders. These include:

Amenorrhea

• Complete absence of periods
• Hair loss
• Excessive facial hair
• Headache
• Milky nipple discharge
• Vision problems.

Oligomenorrhea

• Infrequent menstrual periods, often with cycles longer than 35 days
• Difficulty in conceiving due to less frequent ovulation
• Acne
• Hair loss or excessive body hair growth.

Menorrhagia

• Prolonged or heavy bleeding (you may need to change pads or tampons every hour)
• Passing of blood clots
• Painful menstrual cramps
• Headaches
• Nausea
• Symptoms of anemia (tiredness, exhaustion, and shortness of breath).

Metrorrhagia and menometrorrhagia

• More frequent periods
• Intermenstrual bleeding 
• Heavy bleeding
• Irregular bleeding.

Dysmenorrhea

• Pain in the pelvis, lower back, and inner thighs
• Vomiting
• Nausea
• Dizziness
• Fainting
• Headache
• Diarrhea.

Premenstrual syndrome

• Bloating
• Breast tenderness
• Headache and body pains
• Fatigue
• Mood swings
• Irritability and anxiety
• Food cravings.

What are the underlying causes of menstrual disorders?

Menstrual disorders, as a whole, have multiple causes ranging from hormonal issues to structural defects. We will discuss the causes of each major disorder separately.

Amenorrhea

Causes of primary amenorrhea

• Delayed puberty: The normal age for the beginning of the menstrual period is 9 to 15 years. Delayed puberty means periods occur after 16 years of age.
• Genetic disorders:
  • Turner’s syndrome (the ovaries in such females are not completely developed. As a result, they may not produce the necessary hormones to initiate the menstrual cycle, leading to amenorrhea).
  • Kallmann syndrome (a disorder characterized by delayed or absent puberty. Hypothalamus fails to produce enough GnRH for stimulating the release of FSH and LH, resulting in failure to begin the menstrual cycle).
  • Congenital adrenal hyperplasia (a condition that leads to overproduction of male sex hormones, androgens. Increased levels of androgen inhibit the release of GnRH, causing the absence of menstruation).
• Hormonal problems: Hormonal imbalances involving the hypothalamus, pituitary gland, and ovaries can disrupt the normal onset of menstruation. It also includes thyroid disorders.
• Structural abnormalities:
  • Imperforate hymen (hymen is a membrane that partially covers the vaginal opening.  Imperforate hymen completely obstructs the vaginal canal, leading to blockage of menstrual flow).
  • Mullerian agenesis (underdevelopment of the uterus, fallopian tubes, and vagina lead to amenorrhea).
  • Cervical stenosis (it refers to the narrowing of the cervix and can cause amenorrhea by obstructing the outflow of menstrual blood from the uterus).
  • Vaginal atresia (vagina is either abnormally short or completely absent which can lead to amenorrhea).

Causes of secondary amenorrhea

• Polycystic ovary syndrome (PCOS): It is characterized by the presence of multiple cysts on ovaries, irregular periods, and excess of male hormones (androgen).
• Thyroid disorders: Over or under-functioning thyroid also results in the disruption of ovulation leading to amenorrhea.
• Hypothalamic dysfunction: This condition occurs when the function of the hypothalamus is impaired. It regulates the key functions of the body by releasing certain hormones including gonadotropin-releasing hormone (GnRH) which in return disrupts the normal menstrual cycle. Weight loss, eating disorders, and stress affect the hypothalamus, resulting in disrupted hormonal release.
• Hyperprolactinemia: Increased prolactin levels, a hormone from the pituitary gland, inhibit the release of GnRH. It causes anovulation and amenorrhea.
• Primary ovarian insufficiency: This is a condition in which ovaries stop working before the age of 40 years, causing amenorrhea and infertility.
• Medications: Certain medications cause amenorrhea, which include hormonal contraceptives, anti-psychotics, and chemotherapy drugs.
• Other illnesses: Epilepsy, diabetes, chronic kidney disease, celiac sprue, and cushing syndrome can cause amenorrhea.

Oligomenorrhea

Hormonal imbalance

Mainly, diseases associated with hormonal imbalance cause oligomenorrhea. All the reproductive hormones including gonadotropin-releasing hormone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen, and progesterone are secreted in a regulated way in the normal menstrual cycle. Any aberration in their release or action disrupts normal cyclic events and may result in oligomenorrhea. The conditions that cause hormonal imbalances are:

• Polycystic ovary syndrome: There is increased secretion of androgens that results in hormonal imbalance leading to irregular periods, weight gain, hirsutism, and acne.
• Thyroid disorders: Increase or decrease levels of thyroid hormones (T3, T4) alter levels of menstrual hormones resulting in irregular periods.
• Pituitary tumors: The pituitary gland releases several hormones that regulate the menstrual cycle. Pituitary tumors cause abnormalities in the production and release of various hormones, including prolactin and FSH.
• Androgen-secreting tumors: Androgen-secreting tumors of the ovary and adrenal glands cause excessive androgen secretion that disturbs the normal menstrual cycle.
• Cushing syndrome: It is characterized by increased levels of the cortisol hormone. Elevated cortisol suppresses the release of menstrual hormones from the pituitary and ultimately leads to oligomenorrhea.
• Prolactinoma: It is a benign tumor of the pituitary gland that causes hyperprolactinemia. Increased prolactin suppresses FSH and LH secretion, disturbing the menstrual cycle.

Other medical conditions

• Pelvic inflammatory disease: It is marked by infection and inflammation of female reproductive organs due to sexually transmitted bacteria, viruses, or fungi. It also results in oligomenorrhea.
• Premature ovarian failure: Also known as primary ovarian syndrome. Normally, the menstrual cycle ceases in the 40s or 50s, but in this condition, there is dysfunction or depletion of ovarian follicles before the age of 40. It can cause infrequent or very light menstruation.
• Asherman’s syndrome: The uterus gets obstructed by scar tissue and adhesions that ultimately ends up causing irregular menstrual cycles.
• Eating disorders: Anorexia nervosa, which causes a decrease in estrogen, and bulimia nervosa, which results in electrolyte imbalance, impacts the menstrual cycle and disrupts it.
• Diabetes mellitus: Uncontrolled type 1 and type 2 diabetes mellitus also lead to oligomenorrhea.

Particular medications

Certain medications cause oligomenorrhea, which includes hormonal contraceptives, anti-psychotics, and anti-epileptics.

Menorrhagia

Causes of menorrhagia include:

• Uterine polyps: These are overgrowths of uterine endometrial tissue. As compared to the normal smooth endometrium, polyps increase the amount of tissue to be shed, leading to heavy menstrual bleeding. The presence of polyps also interferes with normal contractions, preventing the efficient shedding of the endometrial tissue and leading to prolonged and heavy bleeding.
• Uterine fibroids: They are non-cancerous growths that develop within or on the muscular walls of the uterus. Just like polyps, fibroids also increase the surface area and ultimately, the tissue that is shed during periods. They also disrupt hormonal balance, causing prolonged and heavy bleeding.
• Adenomyosis: It is a condition in which the tissue that normally lines the inside of the uterus grows into the muscular wall of the uterus. Adenomyosis increases the size of the uterus, leading to more tissue sloughing off during periods. It also increases blood flow to the uterus, which ultimately increases the blood flow during menstruation.
• Ovulatory dysfunction: It causes menorrhagia due to hormonal imbalances, particularly unopposed estrogen. Without normal ovulation, progesterone levels decrease, leading to excessive endometrial growth. Prolonged estrogen stimulation and delayed periods contribute to heavy and prolonged bleeding. Hormonal irregularities disrupt the normal shedding of the endometrial lining, causing menorrhagia.
• Coagulopathy: This includes diseases affecting the body’s ability to control bleeding. Coagulopathy causes menorrhagia by impairing blood clotting mechanisms, leading to prolonged and heavy menstrual bleeding.
• Hormonal imbalance: Conditions such as estrogen dominance and less progesterone can also lead to menorrhagia
• Endometrial hyperplasia: This is an abnormal excessive thickening of the endometrium. Endometrial hyperplasia causes menorrhagia by creating an abnormally thickened uterine lining, which sheds over a longer time with increased period flow.
• Pelvic inflammatory disease: It causes inflammation and infection of the uterus and fallopian tubes. This results in irregular shedding of the uterine lining during menstruation and causes heavy and prolonged menstrual bleeding.
• Intrauterine device: The presence of an IUD in the uterus can lead to irritation and inflammation of the uterine lining, resulting in increased shedding during menstruation. Also, some IUDs increase uterine contractions, leading to menorrhagia.
• Uterine cancer: It can cause menorrhagia due to the abnormal growth of endometrial cells. As the cancer progresses, it disrupts the normal hormonal balance, leading to irregular and excessive growth of the uterine lining. This results in heavy and prolonged menstrual bleeding.

Dysmenorrhoea

Causes of primary dysmenorrhea

• Prostaglandins: They are mainly responsible for causing pain during periods. Prostaglandins trigger uterine muscular contractions which leads to the obstruction of blood flow to uterine tissue. This causes oxygen deprivation (ischemia) and stimulates pain receptors.
• Lifestyle factors: Stress, nutritional deficiency, smoking, alcohol, and a sedentary lifestyle increase the risk of dysmenorrhea.
• Genetics: Genes play a huge part in this; those whose siblings or mothers have painful periods are at a higher risk of having primary dysmenorrhea.
• Age: Primary dysmenorrhea occurs in adolescence and decreases with age.

Causes of secondary dysmenorrhea

• Endometriosis: A condition in which endometrial tissue grows in places other than the uterus, like ovaries or fallopian tubes. This tissue also responds to hormonal fluctuations and sheds like the normal endometrium, resulting in pain and inflammation.
• Uterine fibroids: These are noncancerous growths of uterine tissue that cause pain and heavy bleeding.
• Adenomyosis: In adenomyosis, endometrial tissue grows into the muscular wall of the uterus, causing the uterus to enlarge. This also causes painful periods.
• Ovarian cysts: They form on the ovaries and if they become large or rupture, they can cause pain. 
• Pelvic inflammatory disease: This is an infection and inflammation of the female reproductive organs.
• Intrauterine device: In some cases, an IUD can cause painful periods.
• Cervical stenosis: Narrowing of the cervix halts the menstrual bleeding, causing pain.

Premenstrual syndrome

Causes of premenstrual syndrome include:

• Increase hormonal sensitivity: Some females have increased sensitivity to fluctuating hormones during the menstrual cycle. The bodies of such females respond greatly to changing hormonal levels by altering neurotransmitter levels, affecting mood, behavior, and other physical activities.
• Decreased serotonin levels: During the menstrual cycle, there are fluctuations in estrogen and progesterone levels, which can affect serotonin levels in the brain. Serotonin regulates mood, and altered levels lead to low mood, anxiety, and irritability.
• Genetics: Certain females have genes inherited from their parents that increase the susceptibility of being affected by premenstrual syndrome. Such genes affect hormonal levels and neurotransmitter functioning.
• Nutritional deficiency: Magnesium and calcium deficiencies can cause PMS by disrupting the balance of hormones and neurotransmitters, leading to increased sensitivity to hormonal fluctuations and enhancing PMS symptoms. These minerals play essential roles in hormone regulation, muscle function, and neurotransmitter activity, and their deficiency can contribute to mood swings and other PMS-related issues.
• Stress: It triggers the release of stress hormones like cortisol, which can disrupt the normal menstrual cycle and alter hormone levels, exacerbating emotional and physical PMS symptoms.
• Environmental factors: Exposure to environmental toxins and pollutants may affect hormone regulation and contribute to PMS.

What are the risk factors for menstrual disorders?

Risk factors for developing menstrual disorders include:

• Perimenopausal phase: As women approach menopause, the menstrual cycle starts to become irregular with the development of various disorders. This happens due to fluctuations in reproductive hormones, mainly estrogen and progesterone.
• Early menarche: Girls who had their menarche before the age of 11 years are at a higher risk. Early menarche has been linked with an increased risk for premenstrual syndrome, PCOS, endometriosis, and dysmenorrhea. Also, girls who had their first period earlier usually experience irregular periods at the beginning.
• Over/under Weight: Weight plays an important role in hormonal balance. Extreme changes in weight disturb this delicate balance of hormones, causing reproductive system problems. Obesity increases the likelihood of getting PCOS, amenorrhea, and irregular periods.
• Intense exercise: Exercise is good for health but intense exercise can disturb menstrual hormones. It also decreases body energy and stimulates stress response, further exacerbating menstrual abnormalities. Severe exercise can cause amenorrhea, irregular periods, and oligomenorrhea.
• Smoking: The chemicals present in smoke have negative effects on hormonal balance and reproductive health. Women who smoke may have a longer or shorter length of cycle than normal. Smoking has been associated with an increased risk of premature ovarian failure. Smoking can decrease fertility by affecting both the quantity and quality of eggs in women.
• Stress: Stress causes the release of the stress hormone, cortisol, from the adrenal glands. These stress hormones affect the reproductive hormone release and action. Stress also exacerbates premenstrual syndrome. Chronic stress can cause the stoppage of periods, known as stress-induced amenorrhea.
• Medication: Chemotherapy may disrupt the menstrual cycle temporarily or permanently.

How menstrual disorders are diagnosed?

Diagnosing any menstrual disorder requires a proper procedure step by step.

• Medical history: The doctor will take a detailed medical history from you, including your menstrual cycle history. He/She will ask you about cycle patterns, family history, menstrual hygiene history, medications, and contraceptives. This will help in evaluating the underlying condition.
• Physical examination: The medical history is followed by a physical examination. This usually involves a thorough examination of your abdomen and pelvis to detect any abnormalities that could be contributing to your symptoms.
• Blood tests: Blood tests will be done to determine hormonal levels.
• Imaging studies: This includes an ultrasound of the pelvis and sonohysterography. These can help diagnose uterine fibroids, endometriosis, and other structural abnormalities of the reproductive organs.
• Endometrial biopsy: This involves removing a small tissue sample from the endometrium for microscopic analysis. The procedure may help in locating the underlying cause of irregular menstrual cycles, abnormal uterine bleeding, or other menstrual problems.
• Hysteroscopy: In order to observe the inside of the uterus, a thin hysteroscope is inserted through the cervix and vagina. The gynecologist may thoroughly inspect the uterine cavity with the help of the hysteroscope’s camera, which projects real-time images onto a display. Hysteroscopy can detect the presence of uterine fibroids and polyps.
• Laparoscopy: This is a minimally invasive technique that involves making small incisions in the abdominal wall through which a laparoscope and other specialized instruments are inserted to examine the pelvic organs. Laparoscopy is used to detect and treat endometriosis.
• Dilation and curettage: Dilation and curettage is a slightly invasive procedure and requires general anesthesia. It is carried out to investigate serious underlying conditions that could be causing abnormal bleeding. Dilation and curettage serve dual purposes: it allows the extraction of tissue samples for further examination and can also relieve heavy menstrual bleeding in some cases.

How to manage menstrual disorders?

Lifestyle modifications 

• Eat a healthy diet, consisting of vegetables and fruits. Have nuts and seeds. Omega fatty acids are great for menstrual health
• Food rich in iron helps in the prevention of iron deficiency anemia
• Stay away from alcohol and smoking
• Limit caffeine intake
• Exercise regularly
• Maintain proper weight
• Reduce stress with various stress-reducing techniques such as meditation and yoga
• Apply heating pads for cramps
• Take care of your menstrual hygiene.

Medications

• Oral contraceptives: They are commonly known as birth control pills and consist of synthetic hormones. They are available as progestin-only or progestin and estrogen combined pills. Oral contraceptives are used to regulate the menstrual cycle and address specific menstrual disorders. They might not be safe for everyone and imply some side effects. Side effects include nausea, headache, menstrual irregularities, and weight changes.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): They work by inhibiting the production of prostaglandins, thereby reducing inflammation and pain. NSAIDs include ibuprofen and naproxen.
• Acetaminophen: It is commonly known under the brand name Tylenol and is a widely used analgesic that helps manage pain caused by dysmenorrhea or other menstrual disorders.
• GnRH agonists: They are used for the treatment of hormone-dependent disorders. GnRH agonists work by acting on GnRH receptors in the pituitary gland, either by stimulating or suppressing the release of menstrual hormones. It is specifically used for managing endometriosis. Common side effects include hot flashes, mood swings, osteoporosis, and vaginal dryness. 
• Tranexamic acid: It works by preventing the breakdown of blood clots, helpful in heavy bleeding.

Surgical interventions

When medical treatments have failed or when specific conditions are present, certain surgical procedures may be considered. These procedures include:

• Endometrial ablation: It is a surgical procedure that removes or destroys the uterine lining (endometrium) to address excessive or irregular uterine bleeding. With this surgery, severe or prolonged bleeding can be reduced or stopped in women without the necessity for a hysterectomy (the removal of the uterus).
• Uterine artery embolization: It is a minimally invasive procedure used to treat symptomatic uterine fibroids.
• Myomectomy: This is a surgical procedure to remove uterine fibroids while conserving the uterus as a whole. It is an alternative to hysterectomy for women who want to remain fertile.
• Hysterectomy: Hysterectomy is considered a last resort when other procedures have failed. It involves the removal of the uterus, which leads to the cessation of menstrual periods. 
• Hysteroscopy: It can be performed as both a diagnostic and therapeutic procedure. In therapeutic procedures, it is used for removing uterine polyps or fibroids.

Treating the underlying condition

When a menstrual disorder is caused by an underlying disease or condition, it is necessary to treat the actual cause to completely cure the menstrual disorder. Only providing symptomatic relief without treating the underlying condition is not a permanent solution.

What are the complications that can result from menstrual disorders?

If menstrual disorders are not treated timely, various complications can arise:

• Anaemia: Menstrual disorders that lead to excessive blood loss can contribute to iron deficiency anemia, which occurs when the body does not have enough iron to produce adequate amounts of hemoglobin.
• Osteoporosis: It is a condition characterized by the weakening of bones, making them more prone to fractures and breaks. A low level of estrogen increases the risk of osteoporosis over time.
• Infertility: Certain menstrual disorders interfere with the ability of ovaries to form an egg, resulting in difficulty conceiving. The common disorders that can cause infertility include endometriosis, PCOS, and fibroids.
• Psychosocial impact: Hormonal imbalances that underlie irregular periods can have widespread effects on other body functions, resulting in symptoms such as acne, hirsutism (excessive hair growth), low mood, anxiety, and irritability.

When to seek medical advice?

You should seek medical advice if:

• Your periods are consistently very heavy or prolonged
• You are experiencing severe pain during your menstrual cycle that is not relieved by painkillers
• Your periods have been skipped for more than three months, and you are not pregnant
• You are experiencing irregular bleeding in between normal menstrual periods
• You are observing mood swings, depression, anxiety, or other emotional changes that interfere with your daily life
• You are experiencing menopause symptoms such as hot flashes, night sweats, or vaginal dryness, while you are under 40 years.

Menstrual Portal also offers free online consultation, regarding all your menstrual health concerns.

Frequently asked questions

Which infections cause menstrual disorders?

Menstrual disorders can result from various types of infections, including pelvic inflammatory disease, urinary tract infections, vaginal infections, and sexually transmitted diseases.

Which foods cause heavy periods?

There are no particular foods that directly cause heavy periods. However, some foods can worsen menstrual symptoms and contribute indirectly to heavy periods. These include processed and salty foods, alcohol, and caffeine.

Why is my period late but I am not pregnant?

There are various reasons for late periods other than pregnancy. Periods might be late due to stress, hormonal imbalance, weight changes, medications, travel, or some other underlying medical conditions.

Why is my period so painful?

Painful periods can be caused by several factors, including conditions like endometriosis, fibroids, and pelvic inflammatory disease. It can also be caused by different contraceptive devices and certain medications.

What lifestyle changes can help manage my heavy periods?

Regular physical exercise, maintaining a healthy weight, and a balanced diet can help manage heavy periods. Limiting the intake of processed foods, caffeine, alcohol, and salt might also ease the symptoms.

Can excessive caffeine intake affect my period?

Excessive caffeine intake has been linked to hormonal imbalances and may affect your menstrual cycle. It can lead to irregular periods, and in some cases, can worsen menstrual symptoms such as bloating, mood swings, and cramps.