Menstruation is a major stage of puberty in girls and refers to physiological changes happening in women at usually regular intervals of 21-35 days. A period itself is a shedding of the lining of the womb (endometrium) which will have thickened due to the production of hormones (oestrogen, progestogen) by the ovaries. Any abnormalities such as delayed or early menstrual periods, excessive pain & bleeding during the periods indicate that you might be suffering from certain gynaecological conditions and might require investigation and/or treatment.
Types of menstrual irregularities include:
- Delay in onset of Periods- Primary amenorrhoea can occur for various reasons but is often ‘constitutional’ meaning periods will start naturally later than the average.
- Absence of periods in a woman who has previously had periods (Amenorrhoea) – may occur for many different reasons such as pregnancy, menopause, stopping the pill, stress as well as other less common conditions.
- Painful periods (Dysmenorrhoea) can be caused by several conditions (endometriosis, adenomyosis, adhesions, pelvic inflammatory disease).
- Heavy periods (Menorrhagia) – Excessive bleeding which floods sanitary wear which may ar not be associated with painful periods. May be related to fibroids, endometrial polyps, endometriosis, adenomyosis or be unexplained.
- Irregular periods are periods that are unpredictable. More likely to occur towards the end of reproductive life (40s), due to suboptimal ovarian function.
- Oligomenorrhoea – Irregular infrequent periods (3-4 per year). May occur in young girls after the onset of menstruation (menarche), or may be premenopausal or related to polycystic ovarian syndrome.
- Premature ovarian failure – Normal function of the ovary stops before the age of 45.
- Woman may experience other cyclical symptoms such as burning while urinating, fever, painful bowel movements, vaginal discharge, painful cramps, and lower back pain. These may have a gynaecological origin. Menstrual irregularities should be diagnosed early to prevent complications such as infertility (inability to get pregnant), anaemia, haemorrhage and uterine cancer.
A consultation for any of these conditions should include a thorough history, an ultrasound scan of the pelvis and possibly an internal examination. Other investigations may be required such as an MRI scan, a hysteroscopy or a laparoscopy. Treatments may include regular non hormonal medication to limit bleeding and pain, hormonal medication such as the combined contraceptive pill or the Mirena Coil. Surgical treatments might include removal of polyps/fibroids, endometrial ablation and hysterectomy.
- Medication – such as prostaglandin inhibitors, hormone replacement therapy or antibiotics
- Change of contraception – it may be necessary to explore methods of contraception other than the IUD or hormones
- Surgery – Hysteroscopy / Endometrial Ablation / Hysterectomy
- Treatment of underlying disorders – such as hypothyroidism or a bleeding disorder