Menstrual cycle disorders I Disorders of cycle length Amenorrhea is the absence of a menstrual period in a woman of reproductive age Physiologic states of amenorrhoea are seen during pregnancy and lactation breastfeeding Outside of the reproductive years there is absence of menses during childhood and after menopause 8 Irregular menstruation is where there is variation in menstrual cycle length of more than approximately 8 days for a woman The term metrorrhagia is often used for irregular menstruation that occurs between the expected menstrual periods 9 10 Oligomenorrhea is the medical term for infrequent often light menstrual periods intervals exceeding 35 days 11 Polymenorrhea is the medical term for cycles with intervals of 21 days or fewer II Disorders of flow Normal menstrual flow length is 3 7 days Abnormal uterine bleeding AUB is a broad term used to describe any disruption in bleeding that involves the volume duration and or regularity of flow Bleeding may occur frequently or infrequently and can occur between periods after sexual intercourse and after menopause Bleeding during pregnancy is excluded Hypomenorrhea is abnormally light menstrual bleeding Menorrhagia meno prolonged rrhagia excessive flow discharge is an abnormally heavy and prolonged menstrual period Metrorrhagia is bleeding at irregular times especially outside the expected intervals of the menstrual cycle If there is excessive menstrual and uterine bleeding other than that caused by menstruation menometrorrhagia meno prolonged metro time rrhagia excessive flow discharge may be diagnosed Causes may be due to abnormal blood clotting disruption of normal hormonal regulation of periods or disorders of the endometrial lining of the uterus Depending upon the cause it may be associated with abnormally painful periods III Disorders of ovulation Disorders of ovulation include oligoovulation and anovulation Anovulation is absence of ovulation when it would be normally expected in a post menarchal premenopausal woman Anovulation usually manifests itself as irregularity of menstrual periods that is unpredictable variability of intervals duration or bleeding Anovulation can also cause cessation of periods secondary amenorrhea or excessive bleeding dysfunctional uterine bleeding Oligoovulation is infrequent or irregular ovulation usually defined as cycles of 35 days or 8 cycles a year IV Other menstrual disorders Dysmenorrhea or dysmenorrhoea cramps or painful menstruation involves menstrual periods that are accompanied by either sharp intermittent pain or dull aching pain usually in the pelvis or lower abdomen Signs and symptoms of menstrual disorders The signs and symptoms of menstrual disorders can cause significant stress Abnormal uterine bleeding AUB has the potential to be one of the most urgent gynecological problems during menstruation Dysmenorrhea is the most common Premenstrual Syndrome PMS Symptoms may include irritability Bloating depression food cravings aggressiveness mood swings Fluid retention and fluctuating weight gain are also reported Precipitating risk factors include stress alcohol consumption exercise smoking some medications Amenorrhea Lack of a menses by the age of 16 where secondary sexual characteristics have developed or by the age of 14 where no secondary sexual characteristics have developed primary amenorrhea or lack of a menses for more than 3 6 months after first menstruation cycle Although missing a period is the main sign other symptoms can include excess facial hair loss headache changes to vision milky discharge from the breasts or absence of breast development Abnormal Uterine Bleeding One third of women will experience abnormal uterine bleeding in their life Normal menstrual cycle has a frequency of 24 to 38 days lasts 7 to 9 days so bleeding that lasts longer could be considered abnormal Very heavy bleeding for example needing to use 1 or more tampons or sanitary pads every hour is another symptom Especially painful or persistent menstrual cramping that occurs in the absence of any underlying pelvic disease Dysmenorrhea Pain radiating to the low back or upper thighs with onset of menstruation and lasting anywhere from 12 to 72 hours Headache nausea vomiting diarrhea and fatigue may also accompany the pain Pain may begin gradually with the first several years of menses and then intensified as menstruation becomes regular Patients who also have secondary amenorrhea report symptoms beginning after age 20 and lasting 5 7 days with progressive worsening of pain over time Pelvic pain is also reported Causes of menstrual disorders uterine fibroids hormonal imbalances clotting disorders cancer sexually transmitted infections polycystic ovary syndrome genetics Uterine fibroids are benign non cancerous growths in the uterus that affect most women at some point in their lives and usually does not require treatment unless they cause intolerable symptoms Stress and lifestyle factors commonly impact menstruation which includes weight changes dieting changes in exercise travel and illness Hyperprolactinaemia can also cause menstrual disorders Amenorrhea There are different causes depending on the type of menstrual period disorder Amenorrhea or the absence of menstruation is subdivided into primary and secondary amenorrhea In primary amenorrhea in which there is a failure to menstruate by the age of 16 with normal sexual development or by 14 without normal sexual development causes can be from developmental abnormalities of the uterus ovaries or genital tract or endocrine disorders In secondary amenorrhea or the absence of menstruation for greater than 6 months can be caused by the same reasons as primary amenorrhea as well as polycystic ovary syndrome pregnancy chronic illness and certain drugs like cocaine and opioids Hypomenorrhea Causes of hypomenorrhea or irregular light periods include periods around menopause eating disorders excessive exercise thyroid dysfunction uncontrolled diabetes Cushing s syndrome hormonal birth control certain medications to treat epilepsy or mental health conditions Menorrhagia Causes of menorrhagia or heavy menstrual bleeding include polycystic ovary syndrome uterine fibroids endometrial polyps bleeding disorders miscarriage Dysmenorrhea Causes of dysmenorrhea or menstrual pain include endometriosis pelvic scarring due to chlamydia or gonorrhea intrauterine devices or IUDs Primary dysmenorrhea is when there is no underlying cause that is identified secondary