Menstrual Disorders

Dr. Wei-Wei Wee-Stekly

Senior Consultant Obstetrician & Gynaecologist

MBBS (London), MRCOG (United Kingdom), MMed (O&G) (Singapore), FAMS (Singapore), FRCOG (United Kingdom)

Menstruation is a natural and essential part of a woman’s reproductive health. For most women, monthly periods follow a relatively regular pattern, with manageable symptoms. However, for many others, periods can become a source of distress due to irregularity, excessive pain, heavy bleeding, or unexpected changes in timing and flow. These issues are collectively known as menstrual disorders.

Common Symptoms of Menstrual Disorders

Menstrual disorders can present in a variety of ways. If you experience any of the following, it may be a sign of an underlying issue that warrants medical attention:

• Periods that are excessively heavy or last longer than 7 days
• Irregular or missed periods (not due to pregnancy or menopause)
• Severe menstrual cramps that affect daily activities
• Bleeding between periods
• Absence of periods (amenorrhoea) for several months
• Spotting after intercourse
• Premenstrual symptoms that are unusually intense or prolonged
• Signs of anaemia, such as fatigue or dizziness, due to heavy bleeding

It’s important to track your cycle and note any persistent or worsening symptoms. Even seemingly “common” menstrual complaints can have serious causes.

What Are the Types of Menstrual Disorders?

Several types of menstrual disorders can affect women at different stages of life. Below are the most common:

1. Dysmenorrhoea (Painful Periods)

This condition involves cramping or pelvic pain before or during menstruation.

• Primary dysmenorrhoea is caused by uterine contractions without an underlying condition.
• Secondary dysmenorrhoea is due to other medical issues like endometriosis or fibroids.

2. Menorrhagia (Heavy or Prolonged Bleeding)

Menorrhagia is defined as excessively heavy or long-lasting periods, often requiring frequent pad or tampon changes and sometimes leading to iron-deficiency anaemia.

3. Amenorrhoea (Absence of Periods)

• Primary amenorrhoea is when menstruation has not begun by age 15.
• Secondary amenorrhoea is the absence of periods for 3 months or more in someone who previously had regular cycles.

Causes include hormonal imbalances, excessive exercise, stress, significant weight changes, or underlying medical conditions like PCOS or thyroid disorders.

4. Oligomenorrhoea (Infrequent Periods)

This refers to cycles that are longer than 35 days apart. It can be a sign of polycystic ovary syndrome (PCOS), perimenopause, or hormonal imbalances.

5. Polymenorrhoea (Frequent Periods)

This occurs when periods happen more frequently than every 21 days, which may lead to low iron levels and fatigue.

6. Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)

These involve emotional and physical symptoms before menstruation, such as mood swings, bloating, and irritability. PMDD is a more severe form of PMS, causing intense emotional distress.

What Are Common Causes of Menstrual Disorders

Understanding the root cause of a menstrual disorder is key to effective treatment. Common causes include:

• Hormonal imbalances (e.g., estrogen and progesterone)
• Polycystic Ovary Syndrome (PCOS)
• Uterine fibroids
• Endometriosis
• Thyroid dysfunction
• Eating disorders or extreme weight loss
• Chronic stress
• Use of certain medications (e.g., blood thinners or contraceptives)
• Structural abnormalities of the reproductive organs

A thorough evaluation with a gynaecologist is essential to pinpoint the cause and create a personalised treatment plan.

How Are Menstrual Disorders Diagnosed?

When you visit the clinic for menstrual concerns, Dr. Wei-Wei will start with a detailed medical history and physical examination. You may also undergo:

• Pelvic ultrasound to check for structural abnormalities
• Blood tests to assess hormone levels, thyroid function, and iron status
• Pap smear if cervical conditions are suspected
• Endometrial biopsy in selected cases, especially in women with very heavy or irregular bleeding
• Laparoscopy may be recommended if endometriosis or other internal issues are suspected

How Are Menstrual Disorders Treated?

Treatment depends on the type and cause of the menstrual disorder, as well as your symptoms, age, and fertility goals. Options include:

1. Lifestyle Modifications

• Managing stress through mindfulness or therapy
• Maintaining a healthy weight
• Regular exercise
• Balanced diet rich in iron and vitamins

2. Medications

• Hormonal treatments like birth control pills or hormone therapy
• Non-hormonal medications to reduce bleeding (e.g., tranexamic acid)
• Pain relievers (NSAIDs) for cramping
• Iron supplements for anaemia

3. Minimally Invasive Procedures

• Laparoscopy for endometriosis or fibroids
• Hysteroscopy to diagnose and treat polyps or abnormal bleeding
• Endometrial ablation to reduce heavy bleeding (not for women planning to conceive)

4. Surgery

• Myomectomy for fibroid removal while preserving the uterus
• Hysterectomy in severe cases where childbearing is no longer desired