Menstrual problems are the most common gynecologic complaints. Menstrual disorders include menstrual irregularity, menorrhagia, dysmenorrhoea and other related symptoms. The prevalence is highest in the 20 to 24-year-old age group and decreases progressively thereafter. They affect not only the woman, but also family, social and national economics as well.
There is a wide spectrum of differences in how women experience menstruation. There are several ways that someone's menstrual cycle can differ from the norm, any of which should be discussed with a doctor to identify the underlying cause.

There are many different types of menstrual disorders:

Disorders of ovulation

Disorders of ovulation include oligoovulation and anovulation:

Oligoovulation is infrequent or irregular ovulation (usually defined as cycles of ≥ 36 days or < 8 cycles a year). Oligoovulation is seen in women with asymmetrical cycles, or very long cycles (more then 50 days).

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).

Disorders of cycle length:

Polymenorrhea is the medical term for cycles with intervals of 21 days or fewer.
Irregular menstruation is where there is variation in menstrual cycle length of more than approximately eight days for a woman. The term metrorrhagia is often used for irregular menstruation that occurs between the expected menstrual periods.

Irregular menstruation is where there is variation in menstrual cycle length of more than approximately eight days for a woman. The term metrorrhagia is often used for irregular menstruation that occurs between the expected menstrual periods.

Oligomenorrhea is the medical term for infrequent, often light menstrual periods (intervals exceeding 35 days).

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.

Disorders of flow:

Hypomenorrhea is abnormally light menstrual periods, substantially less than 30 ml per menstrual cycle.

Menorrhagia is an abnormally heavy and prolonged menstrual period (more than 80 ml per menstrual cycle). If there is excessive menstrual and uterine bleeding other than that caused by menstruation, menometrorrhagia 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.

Dysmenorrhea

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.

Associated diseases

Some conditions associated with heavy bleeding, such as ovulation abnormalities, fibroids, or endometriosis, are important contributors to infertility. 

Many conditions that cause absence of a menstrual period (amenorrhea), such as ovulation abnormalities and PCOS (Polycystic Ovarian Syndrome), can also cause infertility. Asymmetrical periods from any cause may make it more difficult to conceive. 

Sometimes treating the underlying condition can resume fertility. In other cases, specific fertility treatments that use ART may be helpful.

A detailed picture of your overall health is a good step for the prevention of menstrual disorders.

  • infrequent periods    
  • short or extremely light periods 
  • too-frequent periods (defined as more frequently than every 21 days)    
  • extremely heavy or long periods (one guideline is soaking a sanitary napkin or tampon every hour or so, or menstruating for longer than 7 days)    
  • extremely painful periods    
  • breakthrough bleeding (also called spotting) between periods; normal in many females
  • absent periods

Acupuncture 

Acupuncture is a kind of non-drug therapy originated from traditional Chinese medicine. It is a safe treatment with few side effects. Now it has been already widely used all over the world. Previous studies have shown that acupuncture can inhibit androgen secretion, regulate gonadotropin secretion and enhance ovulation and menstruation.  

Yoga 

The hormones liberated from the hypothalamus, pituitary and ovary are interdependent. A well-coordinated axis is formed called hypothalamo pituitary ovarian axis. The secretion of hormones is modified through feedback mechanism operating through this axis. The axis is modified by many factors like stress, hormones liberated from thyroid and adrenal glands. Breathing yoga exercises not only calms the mind but also improves the blood supply to vital and endocrine organs of the body. Yoga corrects the imbalance of autonomic nervous system and controls the over activity of sympathetic nervous system. It corrects the uterine hyperactivity and dysrrhytenmic uterine contractions which otherwise are responsible for dysmenorrheal.

Pharmacotherapy 

There are a number of different medicines prescribed for menstrual disorders:

Nonsteroidal anti-inflammatory drugs (NSAIDs)

These medications are commonly used in different fields of reproductive medicine, for pain management after operative procedures and to relieve dysmenorrhea. In addition to their analgesic effect, NSAIDs are helpful in the management of menorrhagia by decreasing menstrual blood loss. 

Progestins

Progestins are synthetic progestogens that have progestogenic effects similar to those of progesterone. The two most common uses of progestins are for hormonal contraception (either alone or with an estrogen), and to prevent endometrial hyperplasia from unopposed estrogen in hormone replacement therapy. Progestins are also used to treat secondary amenorrhea, dysfunctional uterine bleeding and endometriosis, and as palliative treatment of endometrial cancer, renal cell carcinoma, breast cancer, and prostate cancer.

Danazol

Danazol is a derivative of the synthetic steroid ethisterone that suppresses the production of gonadotropins and has some weak androgenic effects. Although effective for endometriosis, its use is limited by its masculinizing side-effects. Its role as a treatment for endometriosis has been largely replaced by the GnRH agonists.

Surgical therapy 

Endometrial ablation

Endometrial ablation is a medical procedure that is used to remove (ablate) or destroy the endometrial lining of a uterus. This technique is most often employed for people who suffer from excessive or prolonged bleeding during their menstrual cycle but cannot or do not wish to undergo a hysterectomy. The procedure is most commonly done on an outpatient basis. Placenta accretamay occur if the patient becomes pregnant after endometrial ablation, so birth control is recommended. However, heavy menstrual bleeding is most commonly due to dysfunctional uterine bleeding or adenomyosis. Approximately 80% of those who undergo this procedure will have reduced menstrual bleeding. Of those, approximately 45% will stop having periods altogether. However, a second procedure or a hysterectomy will be required in approximately 22% of cases.

Hysterectomy

Hysterectomy is the preferred strategy for the first intervention for heavy menstrual bleeding. Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries, fallopian tubes and other surrounding structures.
Usually performed by a gynecologist, hysterectomy may be total (removing the body, fundus, and cervix of the uterus; often called "complete") or partial (removal of the uterine body while leaving the cervix intact; also called "supracervical"). It is the most commonly performed gynecological surgical procedure.

Other therapies

Intrauterine device (IUD)

While copper IUDs may increase menstrual bleeding and result in more painful cramps hormonal IUDs may reduce menstrual bleeding or stop menstruation altogether. Cramping can be treated with NSAIDs. Other potential complications include expulsion (2–5%) and rarely perforation of the uterus (less than 0.7%). A previous model of the intrauterine device (the Dalkon shield) was associated with an increased risk of pelvic inflammatory disease.

IVF with own or donated gametes is a major treatment in infertility when other methods of achieving conception have failed. With egg donation, women who are past their reproductive years or menopause can still become pregnant.

Find more about related issues

Sources

Menstruation ―sourced from Wikipedia licensed under CC BY-SA 3.0
Menstrual disorder ―sourced from Wikipedia licensed under CC BY-SA 3.0
Human Physiology/Pregnancy and birth ―sourced from Wikibooks licensed under CC BY-SA 3.0
Egg donation ―sourced from Wikipedia licensed under CC BY-SA 3.0
Total_laparoscopical_hysterectomy ―by Hic et nunc licensed under CC BY-SA 3.0
Role of Non-Steroidal Anti-Inflammatory Drugs in Gynecology ―by Livshits and Seidman licensed under CC BY 3.0
Progestin ―sourced from Wikipedia licensed under CC BY-SA 3.0
Danazol ―sourced from Wikipedia licensed under CC BY-SA 3.0
Endometrial ablation ―sourced from Wikipedia licensed under CC BY-SA 3.0
Intrauterine device ―sourced from Wikipedia licensed under CC BY-SA 3.0
Effects of Yoga in Menstrual Disorders ―by Tejwani and Tejwani licensed under CC BY-NC 3.0
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