Menstrual problems - what a mess and pain at times

February 28, 2011



Menstrual disorders are a very common problem in women in their reproductive age. Disturbances of menstruation are one of the most common reasons for women to attend their gynaecologist.

What is normal menses?
A woman’s menstrual periods starts with the menarche (first menstrual period) and ends with the menopause (last menstrual period). In general, a woman will experience a period every 21-35 days with 3-7 days of menstrual flow.

Is heavy and prolonged menstruation normal?
Excessive menstrual blood loss is a common problem and is very subjective in nature because the perception of the severity menstrual blood loss varies form one woman to another. A marked change from what is considered usually normal should be considered as a problem and thoroughly investigated.

Is irregular and unpredictable menstruation normal?
Irregular and erratic troublesome menstruation is normally due to anovulatory menstrual cycles i.e when there is a lack of ovulation where the ovary does not release an egg each month, and can result in both heavy and prolonged menstrual bleeding when menstruation does eventually occur. Irregular vaginal bleeding is also a well-recognized consequence of Poly Cystic Ovarian Syndrome (PCOS) in particular in women in their reproductive age. Rarely, irregular bleeding can be due to uterine cancer or pre-cancer. Nearly 10% of women on HRT will experience unscheduled irregular bleeding.

Inter Menstrual Bleeding (IMB) is bleeding between two regular periods and Post Coital Bleeding (PCB) is bleeding after sexual intercourse. The two problems usually coexist and may be due to a common cause. Most cases are due to benign disease of the female genital tract where no major problem can be found. Bleeding that occurs in the mid-cycle is usually physiological and normal and should not be a cause for concern. More often, the use of the contraceptive pill or female hormones containing progesterone can cause unscheduled sporadic bleeding. Chlamydiae infection or the clap, a sexually transmitted infection, may present with IMB and PCB. Polyps in the cervix (neck of womb) and endometrium (lining of womb) can cause IMB and PCB. Rarely, cervical cancer can present in this manner.

Are painful periods normal?
Painful periods are a very common complaint and typically consist of crampy lower abdominal pains which start at the onset of menstruation. They are most usually harmless but may sometimes be due to other troublesome gynaecological causes. The most common form mainly affects the younger aged woman usually in her teens and is not associated with any pelvic problem of significance. The less common type of period pains occurs at a later age and can be due to a recognizable pelvic problem, such as endometriosis or pelvic infection.

Does PMS really exist?
Pre Menstrual Syndrome (PMS) is the occurrence of cyclical physical, psychological and emotional symptoms in the second half of the menstrual cycle and resolves at the end of menstruation. Symptoms of PMS can include abdominal bloatedness, weight gain, breast tenderness, fatigue, depression and irritability just to name a few. PMS when severe can be very debilitating for some women. There are a variety of different medications that can be given to improve PMS symptoms considerably well.

Why is peri- menopausal and post-menopausal bleeding a concern?
Irregular periods are common and normal during peri-menopause. But, other conditions can cause abnormalities in menstrual bleeding during the menopause transition. Potential causes of abnormal bleeding include hormonal imbalances, hormonal contraception, pregnancy, fibroids, and rare blood clotting problems or, rarely, cancer.

Post-Menopausal Bleeding (PMB) is bleeding form the genital tract one or more years following the cessation of menses. This symptom is always abnormal and must be taken seriously. Most cases are benign in nature but it is important to exclude cancer of the genital tract in every woman who complains of PMB.


Dr. Sharad Ratna
General Obstetrician and Gynaecologist
Visiting Consultant Columbia Asia Hospitals